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Journal and News Scan
This objective, well-researched, and well presented article summarizes the importance of gender inclusion in cardiothoracic surgery as a means for improving institutional culture, patient safety, patient outcomes, and gender equality.
A seismic shift occurred today when the NELSON screening trial results were presented at the IASLC 19th World Conference on Lung Cancer (#WCLC2018). Hear from the CEO, Dr. Fred R. Hirsch, as he comments on these results. Men have a 24% survival advantage in the screening programme. This is a very large shift to earlier stage cancer detection. There can be no doubt that lung cancer screening is a lifesaving intervention in lung cancer.
Meta-analysis of composite death/myocardial infarction/stroke/repeat revascularization outcome in 4700 patients across six randomized controlled trials is presented. Percutaneous coronary intervention was associated with a higher risk of the composite outcome in all SYNTAX score tertiles as well as increased risk of repeat revascularization. Additionally, no difference was shown between bare metal stent and drug eluting stents on a sub-group analysis.
This multicenter study evaluated the efficacy of medical therapy plus transcatheter valve repair (MitraClip) to medical therapy alone for heart failure accompanied by secondary moderate to severe mitral regurgitation. The device group experienced significantly fewer hospitalizations and lower mortality at 24 months follow-up.
This comprises the eagerly anticipated summary of the second primary endpoint of the PACIFIC trial of Durvalumab vs placebo in patients who completed CT/RT without progression for unresectable stage III NSCLC. Durvalumab significantly improved overall survival, progression free survival, and time to distant metastasis or death. No new safety concerns were raised.
Patient Care and General Interest
A man who received quintuple bypass surgery in Little Rock, Arkansas, USA, plans to cycle a 50-mile race only two months later.
A woman in Denver, Colorado, USA, was told she had 6-9 months to live after being diagnosed with Stage 3 lung cancer; however, after participating in clinical trials for lung cancer treatment, she is doing well 10 years later.
Drugs and Devices
A hospital in New Jersey, USA, is testing an artificial intelligence device designed to detect bleeding during endovascular procedures.
The US Food and Drug Administration has approved the PK Papyrus covered coronary stent system for the treatment of acute coronary artery perforations during PCI, the first device to be approved for this indication in 17 years.
A study by the New York University School of Medicine in New York City suggests that an artificial intelligence tool can diagnose non-small cell lung cancer types with 97 percent accuracy.
Research, Trials, and Funding
A paper published in the Irish Journal of Medical Science indicates that undetected cases of high cholesterol are adding to the incidence of cardiovascular disease, which is the greatest cause of death in Ireland.
A Journal of the American College of Cardiology study of off-pump versus on-pump CABG suggests that the on-pump approach provides superior long-term survival.
Poh and colleagues analyzed the results of the Ross procedure in 129 patients with bicuspid aortic valve and pure aortic regurgitation. The mean age at surgery was 34.7 ± 10.6 years and mean length of follow-up was 9.6 ± 6.8 years. Late survival at 10 and 20 years after surgery were 99% and 95%, respectively, and aortic valve redo surgery was necessary in 11 patients. Longer aortic cross-clamp and cardiopulmonary bypass times and larger preoperative sinotubular junction diameter were predictors of having redo aortic valve surgery.
This comphrensive review by Spadaccio and Benedetto try to address the unanswered question: to stent or not to stent?
The conclusions underline that the higher cerebrovascular risks associated with surgery are still overcome by long term outcome.
Management of tricuspid endocarditis in this single institution study of 63 patients included repair, replacement, and excision. Repair patients were older and sicker. Acute outcomes were similar among the groups. Valvectomy patients had a lower rate of readmission during the first postoperative year, highlighting this approach as a useful strategy for identifying eventual candidates for valve replacement.
A New York Times journalist travels with Team Heart, a nonprofit organization providing humanitarian heart surgery for rheumatic disease in Rwanda. In addition to highlighting the overwhelming need, her perspective illuminates some harsh realities of these efforts in resource-poor countries. Examples include the cultural repercussions of mechanical valves in females of childbearing age and the challenging surgical judgment required when operating on patients who are sick enough to warrant surgery, yet not too sick to survive in the context of limited perioperative support. Dr. Ralph Bolman III, Dr. Thoralf Sundt, and Dr. Bruce Leavitt are among the physicians participating in the effort and featured story.