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Journal and News Scan
In this article Michael Mack explains his thoughts on the events leading to the death of Neil Armstrong.
Neil Armstrong suffered a tamponade after his pacing wires were removed which led to a series of events leading to his eventual death.
Michael Mack shares his thoughts on the death and his views on the issues it raises, which also raises many important issues for our community with regard to preparedness for complications after heart surgery for which STS guidelines exist but may not yet be fully adopted in some units, and also for surgery in smaller or community hospitals, of which this was an example.
Your thoughts on these important issues will be much appreciated, so please do post your views.
Patient Care and General Interest
The American College of Surgeons introduced a new quality improvement program, the Geriatric Surgery Verification Program, which outlines standards for geriatric surgery with the goal of continuously optimizing care for older adults.
Researchers from Arizona, USA, recommend that the US Preventive Services Task Force expand the eligibility criteria for lung cancer screening to include long-term tobacco quitters and individuals 50-54 years old.
Drugs and Devices
The European Medicines Agency has recommended larotrectinib for the treatment of solid tumors with an NTRK mutation, regardless of the tissue where that tumor is found.
Research, Trials, and Funding
Patients with continuity of care following transcatheter procedures have better outcomes than those with fragmented care, say researchers from North Carolina, USA.
Researchers from Australia are studying a molecule from the venom of a spider that could potentially slow cardiac damage after a heart attack.
Exposure to phtalates, plasticizers that are used in medical devices ranging from blood storage bags and tubing circuits, can affect the electrical properties of rat hearts say researchers from Washington, DC, USA.
White and colleagues retrospectively evaluated the development of postoperative pulmonary venous obstruction for patients undergoing repair of total anomalous pulmonary venous connection (TAPVC) at their institution between 2006 and 2017. Of a total 119 patients, 25 (21%) developed postoperative obstruction. Heterotaxy syndrome, single-ventricle heart disease, concomitant procedures, mixed-type TAPVC, and preoperative obstruction were found to be associated with postoperative obstruction. The authors conclude that these data may help stratify risk for patients with TAPVC.
The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD) audits the data of 10% of its participants every year. Assessment of the completeness and accuracy of data fields related to demographics, preoperative risk factors, diagnosis, procedure, complications, and mortality is performed. Overman and colleagues summarize the results of the tenth audit of the STS CHSD in this article. The rates of completeness and agreement for general data elements were both over 97%. The rate of completeness for variables in the mortality review was 100%, with a rate of agreement of 99.3%. The authors conclude that the most recently completed STS CHSD audit shows a very high level of completeness and accuracy of data variables, highlighting that this is true for variables that are most germane to outcomes measurement.
This article addresses the controversy surrounding the optimal annular stabilization technique following valve sparing root reconstruction (VSRR) and the lack of comprehensive imaging data in the evaluation of the natural history of aortic root graft geometry, valve competency, and prognosis postreconstruction. Seventy consecutive patients were prospectively enrolled between 2008 and 2017 (mean age 56.4 ± 16.4 years, 19.7% women) for VSRR. Dacron aortic annuloplasty reconstruction was found to be stable over time, without the need for external or internal stabilization. Computed tomography imaging was found to be more reliable than echocardiographic images, although given the noted stability, the authors conclude that it was of little utility.
In this experimental study on segmental artery coil embolization, the authors examined the optimal occlusion pattern to reduce the risk of spinal cord ischemia during thoracoabdominal aortic repair. Von Aspern and colleagues found that staged regional occlusion, with coiling of lumbar arteries first, leads to better perfusion recovery, no neurological deficits, and no cord tissue damage.
In this editorial, Ikonomidis et al not only describe the challenges but also provide specific actionable steps towards improving the retention as well as clinical, academic, and personal success of cardiothoracic surgeon-scientists.
- High clinical, academic, and administrative demands
- Steep competition for extramural funding
- Lack of protected time
- Lack of institutional and departmental support
Action plan includes:
- Lead by example, formal training, mentorship and institutional support
- Institute faculty start-up/support plans including funding and laboratory space that is readily accessible and locally available
- Implement protected paid time for research that is truly protected from clinical duties
- Make research productivity financially incentivized and recognized. Incorporate research productivity into the compensation plan and promotion metrics
- Disseminate opportunities
This retrospective study by Sedeek et al aimed to compare the outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) valve-in-valve (n=90) versus surgical replacement (SAVR) (n=260) of failing stented aortic biological valves in a cohort of 350 patients . They demonstrated that despite the TAVR-in-valve cohort being older and having a higher prevalence of comorbidities and STS PROM, they had fewer perioperative complications and shorter hospital stay; however, patient-to-prosthesis mismatch was more common after TAVR-in-valve (44% vs SAVR 12%, P < .001). Overall, their results suggest that TAVR valve-in-valve and repeat SAVR have comparable operative and mid-term mortality, with SAVR being associated with a superior hemodynamic profile compared to TAVR valve-in-valve with less patient-to-prosthesis mismatch.
Patient Care and General Interest
The American Heart Association published a statement advocating for a holistic care approach for patients with Fontan circulation, noting that these patients are living longer and their unique long-term care needs are being better understood.
A judge in the USA has ordered e-cigarette companies to submit their products for review by the US Food and Drug Administration (FDA) by May 2020.
Drugs and Devices
Edwards Lifesciences as issued a warning related to the risk of a burst balloon during implantation of its Sapien 3 Ultra valve, emphasizing that the instructions for use should be closely followed to avoid this problem.
The US FDA has issued an alert that Edwards Lifesciences recalled the IntraClude intra-aortic occlusion device.
Targeted therapies for EGFR mutation–positive non–small cell lung cancer were added to the updated Essential Medicines List from the World Health Organization, but other lung cancer therapies were considered and rejected.
Research, Trials, and Funding
Investigators from Kansas City, Missouri, USA, report a relationship between institutional volume and outcomes of MitraClip placement up to 50 procedures, but continued improvement was observed beyond this number.
A group at University of Utah Health in the USA is aiming to improve outcomes of refractory cardiogenic shock with a multidisciplinary “Shock Team,” comprised of a cardiothoracic surgeon, a heart failure cardiologist, an interventional cardiologist, and an intensive care unit physician.
Henry and colleagues evaluated frailty in patients undergoing cardiac surgery using two frailty indices, the simplified Study of Osteoporotic Fractures (SOF) and the complex Cardiovascular Health Study (CHS), comparing postsurgical outcomes between frail and nonfrail patients. Agreement between the two indices was poor. Of 167 total patients, the SOF identified 15 as frail while the CHS identified 47. SOF frail patients were in poorer health, had higher risk scores, and greater proportions reported lack of energy and unintentional weight loss. Additionally, SOF frail patients were more likely to experience prolonged ventilation, pneumonia, prolonged time in the intensive care unit, and readmission within 30 days.