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Journal and News Scan

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Francesco Guerrera, Alessandro Brunelli, Pierre-Emmanuel Falcoz, Pier Luigi Filosso, Claudia Filippini, Zalan Szanto, Paolo Olivo Lausi, Paraskevas Lyberis, Giulio Luca Rosboch, Enrico Ruffini

This paper looks to explore the outcomes in obese patients with non-small cell lung cancer following VATS or open lobectomy. The authors utilized data from the European Society of Thoracic Surgeons Database to assess morbidity and postoperative length of stay in 78,018 patients across a fourteen-year period. An intention-to-treat analysis was used, with assessment performed using univariable, multivariable-adjusted, and propensity-score-matched analyses. VATS lobectomy was found to be associated with improved postoperative outcomes.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Anselmi A, Mansour A, Para M, Mongardon N, Porto A, Guihaire J et al, ECMOSARS Investigators

ECMOSARS registry data was used to describe the characteristics and outcomes of COVID-19 patients undergoing either veno-arterial (VA) or veno-arterial venous (VAV) extracorporeal membrane oxygenation (ECMO). The authors concentrated on forty-seven patients, with a median age of forty-nine years, supported with VA or VAV-ECMO for refractory cardiogenic shock. Fourteen percent had a previous heart failure diagnosis. The two most common causes of cardiogenic shock were acute pulmonary embolism (30 percent) and myocarditis (28 percent). Thirty-eight percent of the patients underwent extracorporeal cardiopulmonary resuscitation (eCPR). In-hospital survival in the whole group was 28 percent (43 percent if eCPR patients were excluded). One day after ECMO cannulation, nonsurvivors had significantly more severe acidosis and higher FiO2. Several other factors were associated with death.
The authors concluded that VA-ECMO is a viable rescue therapy in carefully selected patients and suggested that eCPR is not a reasonable indication for ECMO in this group.

Source: European Journal of Vascular and Endovascular Surgery
Author(s): Cristina Lopez Espada, Christian-Alexander Behrendt, Kevin Mani, Mario D’Oria, Thomas Lattman, Manar Khashram, Martin Altreuther, Tina U. Cohnert, Arun Pherwani, Jacob Budtz-Lilly, VASCUNExplant Collaborator Group

A number of interesting points are raised in this relatively short manuscript. The authors conclude that there is an unmet need for robust independent international registry data from the manufacturers so that stakeholders can have informed choices on the performance of stent grafts. Perhaps most importantly, the authors conclude that the failed stent grafts had indications of failure in the completion angiogram, and it is not clear if action was taken.

Source: The New England Journal of Medicine
Author(s): John V. Heymach, M.D., Ph.D., David Harpole, M.D., Tetsuya Mitsudomi, M.D., Ph.D., Janis M. Taube, M.D., Gabriella Galffy, M.D., Ph.D., Maximilian Hochmair, M.D., Thomas Winder, M.D., Ph.D., Ruslan Zukov, M.D., Ph.D., Gabriel Garbaos, M.D., Shugeng Gao, M.D., Ph.D., Hiroaki Kuroda, M.D., Ph.D., Gyula Ostoros, M.D., et al., for the AEGEAN Investigators

This paper looked at the immunotherapy agent Durvalumab used in the perioperative period for resectable NSCLC. A total of 802 patients were enrolled in the study, of which 400 received Durvalumab and the remaining 402 a placebo. The two primary endpoints measured were event-free survival and pathological complete resection. Perioperative Durvalumab plus neoadjuvant chemotherapy, as compared with neoadjuvant chemotherapy alone, was significantly associated with improved results in the two primary endpoints measured. Event-free survival was longer with Durvalumab. The stratified hazard ratio for disease progression, recurrence, or death was 0.68 (p=0.004.) At twelve months, event-free survival was observed with 73.4 percent of Durvalumab patients compared to 64.5 percent of placebo patients. The incidence of pathological complete response was significantly greater with Durvalumab then with placebo (17.2 percent and 4.3 percent respectively, p <0.001). Moreover, a benefit was seen regardless of PD-L1 expression and stage. 

Source: Journal of the American Heart Association (JAHA)
Author(s): Sá MP, Jacquemyn X, Van den Eynde J, Serna-Gallegos D, Chu D, Clavel MA, Pibarot P, Sultan I

In this meta‐analysis, the authors performed a pooled analysis of time‐to‐event data from Kaplan-Meier curves of randomized controlled trials (RCTs) and propensity‐score matched (PSM) studies comparing transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in low-risk patients. The meta-analysis aimed to assess the midterm outcomes of both treatment strategies in low-risk patients. A total of eight studies (three RCTs, five PSM studies) published by December 31, 2022 met the eligibility criteria and included 5,444 patients. 2,639 patients underwent TAVR and 2,805 patients underwent SAVR. In low‐risk patients, TAVR showed a higher risk of all‐cause mortality at eight years of follow up. SAVR was associated with improved survival beyond two years. The survival benefit of SAVR was driven by PSM studies and could not be observed in RCTs. The addition of more extended follow up data from ongoing RCTs will help confirm the possible difference in mid and long term survival between TAVR and SAVR in the low‐risk population.

Source: University of Maryland School of Medicine
Author(s): Deborah Kotz

An official press release from the University of Maryland School of Medicine announced the passing of Mr. Lawrence Faucette, the patient with terminal heart failure who received the world’s second genetically modified pig heart transplant. Mr. Faucette lived for nearly six weeks following the surgery and ultimately succumbed on October 30 due to acute organ rejection despite the initial early success and significant progress after surgery. The medical and scientist team in charge of the xenotransplantation program will conduct an extensive analysis to identify factors that can help to improve the outcome in future xenotransplantation.

Source: Circulation Research
Author(s): Antoine Rauch, Annabelle Dupont, Mickael Rosa, Maximilien Desvages, Christina Le Tanno, Johan Abdoul, Mélusine Didelot, Alexandre Ung, Richard Ruez, Emmanuelle Jeanpierre, Mélanie Daniel, Delphine Corseaux, Hugues Spillemaeker, Julien Labreuche, Bénédicte Pradines, Natacha Rousse, Peter J. Lenting, Mouhamed D. Moussa, André Vincentelli, Jean-Claude Bordet, Bart Staels, Flavien Vincent, Cécile V. Denis, Eric Van Belle, Caterina Casari and Sophie Susen

The clinical problem addressed in this study is bleeding in patients who undergo ECMO. The authors endeavor to address the issue through a quantitative cohort study by reflecting on how to target the behavior of platelets.

Source: Society for Cardiothoracic Surgery in Great Britain and Ireland
Author(s): SCTS Contributors

SCTS reported that Dr. Marian Ionescu, a pioneer in cardiac surgery, has passed away. In addition to inventing several artificial heart valves, Dr. Ionescu was a medical educator and established numerous fellowships for cardiothoracic surgeons and allied health professionals.

Source: Interdisciplinary Cardiovascular and Thoracic Surgery
Author(s): Miura K, Eguchi T, Ide S, Mishima S, Matsuoka S, Takeda T et al

Segmentectomy is on the rise, but understanding of the segmental bronchial branching pattern is limited. Computed tomography scans of 303 patients were used to determine and categorize the branching of the right upper lobe bronchi. Four major types and eleven subtypes were identified. Volumetry was done to determine the predominant segment in each case. The order of frequency of branching types was trifurcated nondefective (64.4 percent), then bifurcated nondefective (22.1 percent), bifurcated defective (8.6 percent), and trifurcated half-defective (4.0 percent). In 71 percent of cases, one segment was volumetrically predominant, and in 52 percent of all cases this was segment three. There was a higher risk of complex branching in the volumetrically nonpredominant segment and care should be taken during segmentectomy of these segments.

Source: STS and EACTS
Author(s): Society of Thoracic Surgeons (STS) and European Association of Cardio-Thoracic Surgery (EACTS)

The Society of Thoracic Surgeons (STS) and the European Association of Cardio-Thoracic Surgery (EACTS) published a joint press release regarding aortic valve replacement in low-risk patients. Both associations highlight the value of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) as outstanding therapeutic options for patients with aortic stenosis and acknowledge the important role of TAVI in high-risk or advanced-age patients. 

Furthermore, STS and EACTS welcome randomized controlled trials (RCTs) studying low- and intermediate-risk populations to help inform clinical decision making. Despite the interesting insights of the recently presented and simultaneously published five-year PARTNER 3 and four-year Evolut low-risk trials results, and given the highly selected cohorts and the industry sponsored nature of these trials, both societies consider some equipoise statements as inappropriately weighted. Therefore, STS and EACTS suggest caution in adopting a TAVI-first strategy in low-risk patients, particularly in those patients who differ from the specific cohorts studied in these low-risk trials. Before encouraging a TAVI-first strategy in low-risk patients, more follow-up time from the existing low-risk trials is required. 

Finally, STS and EACTS encourage the investigators from both low-risk trials to publish their results for the isolated SAVR and isolated TAVI arms to allow valve therapy specialists to compare low-risk TAVI all-cause mortality outcomes with the real world analysis of patients undergoing low-risk isolated SAVR in the STS Adult Cardiac Surgery Database (Thourani VH, et al., The Annals of Thoracic Surgery, October 2023). Until this data is available, any statements or conclusions from the PARTNER 3 and Evolut Low Risk trials are still hypothesis-generating and speculative.