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Journal and News Scan

Source: New England Journal of Medicine
Author(s): Felicity Lee, Paul Maggiore, Kevin Chung

Read the amazing story of the 44-year-old nurse who got acute chest pain in a remote area of Australia. He was the only clinican in the area, so he took his own ECG, diagnosed his acute MI, and cannulated and thrombolysed himself!

They make them tough in Australia.

Source: News from around the web.
Author(s): Claire Vernon

Patient Care

Some Syrian refugee children have received surgery for congenital heart defects in Jordan, however many refugees in need of complex medical care are unable to receive such care.

A hospital in Philadelphia, Pennsylvania, is working to increase the rate of patient referral for cardiac rehab after surgery.

Several Rwandan heart patients will receive surgical treatment as part of a free surgery camp at King Faisal Hospital in Kigali, Rwanda, an initiative sponsored by the Rwandan Ministry of Health, King Faisal Hospital, and the non-profit organization Team Heart.


Drugs and Devices

The US Food and Drug Administration took the first formal step toward a major policy change that would reduce the amount of nicotine allowed in cigarettes.

The UK Medicines and Healthcare Products Regulatory Agency announced plans to review anticoagulant usage after a study published in the BMJ suggested increased risk for atrial fibrillation patients with chronic kidney disease.


Research, Trials, and Funding

Japanese researchers have received approval from Osaka University to test the ability of iPS cell-derived sheets of cardiac muscle to treat ischemic cardiomyopathy. The team must now gain approval from the Japanese Health, Labor, and Welfare Ministry.

Researchers from the US and Canada find that COPD patients selected for lung transplant have better survival than one would expect based on their BODE score, potentially because the transplant qualification process reduces comorbid conditions that are unrelated to lung function in this group of patients.

Early studies on wearable devices for atrial fibrillation screening were presented at the recent meeting of the American College of Cardiology, but the findings don’t yet address whether the increased screening results in improved patient outcomes.

Source: The Annals of Thoracic Surgery
Author(s): Richard D. Mainwaring, William L. Patrick, Ali N. Ibrahimiye, Naruhito Watanabe, George K. Lui, Frank L. Hanley

Mainwaring and colleagues retrospectively reviewed the outcomes for 51 patients with transposition of the great arteries (TGA) who were enrolled in a left ventricle (LV) retraining program in preparation for an arterial switch procedure. Retraining was successful in 52% of patients with D-TGA and 92% of patients with L-TGA. Of patients who had successful retraining and underwent an arterial switch operation, the procedure was successful for 77% of patients with D-TGA and 100% with L-TGA. To quantify the LV response to training, the authors calculated an “LV retraining ratio” based on the change in the LV/RV pressure ratio in response to the first pulmonary artery banding. This ratio correlated with the presence or absence of heart failure and accurately predicted the ultimate success of retraining in 95% of patients.

Source: Interactive Cardiovascular and Thoracic Surgery
Author(s): Daniel JFM Thuijs, Graeme L Hickey, Ruben LJ Osnabrugge

The EJCTS and ICVTS are publishing a series of Statistical Primers to help clinicians perform and interpret research. Although Kaplan-Meier analyses are standard in the cardiothoracic surgical literature, there are several pitfalls that should be kept in mind. In this primer, Thuijs and coauthors describe the fundamental concepts of analyzing survival data.

Source: The Annals of Thoracic Surgery
Author(s): Rishindra M. Reddy, William B. Weir, Shari Barnett, Brendan T. Heiden, Mark B. Orringer, Jules Lin, Andrew C. Chang, Philip W. Carrott, William R. Lynch, David G. Beer, J. Christopher Fenno, Yvonne Kapila

Reddy and colleagues evaluated oral, esophageal, and gastric microbial flora in 55 patients who underwent successful esophagectomy for adenocarcinoma, squamous cell carcinoma, or benign disease. The authors did not observe significant patterns between microbiome diversity and tumor stage or histology. Patients who had anastomotic leak, however, showed a greater variance in the composition of preoperative oral flora versus intraoperative gastric flora than patients who did not (p = 0.015). The authors suggest that better understanding of the relationship between the microbiome and esophagectomy recovery could lead to new predictive or therapeutic approaches for esophageal anastomotic leak.

Source: The New England Journal of Medicine
Author(s): Mandeep R. Mehra, Daniel J. Goldstein, Nir Uriel, Joseph C. Cleveland, Melana Yuzefpolskaya, Christopher Salerno, Mary N. Walsh, Carmelo A. Milano, Chetan B. Patel, Gregory A. Ewald, Akinobu Itoh, David Dean, Arun Krishnamoorthy, William G. Cotts, Antone J. Tatooles, Ulrich P. Jorde, Brian A. Bruckner, Jerry D. Estep, Valluvan Jeevanandam, Gabriel Sayer, Douglas Horstmanshof, James W. Long, Sanjeev Gulati, Eric R. Skipper, John B. O’Connell, Gerald Heatley, Poornima Sood, and Yoshifumi Naka, for the MOMENTUM 3 Investigators

An interesting two-year report from the MOMENTUM 3 randomized controlled trial comparison of HeartMate 3 and II, the analysis performed by Abbott. Although stroke and reoperation were clearly lower with the latest technology, reflected in the lower LDH measurements, there was bafflingly no improvement in survival.


Source: News from around the web.
Author(s): Claire Vernon

Patient Care

Carter Capps, a pitcher for professional baseball team the San Diego Padres, has made himself a necklace out of the rib surgeons removed during his thoracic outlet surgery.

A Connecticut, USA, man gets some experimental and synergistic help from a bacteriophage and antibiotic to treat a persistent infection in his aortic graft.


Drugs and Devices

The US Food and Drug Administration (FDA) has approved the world’s smallest mechanical heart valve for pediatric patients, a 15 mm Masters Series Heart Valve from Abbott.

Durvalumab from AstraZeneca has been approved by the US FDA for patients with unresectable stage III non-small cell lung cancer; this follows the publication of a randomized trial showing superiority of durvalumab over placebo following chemotherapy.


Research, Trials, and Funding

Researchers from Vancouver, Canada, presented their early experience with the Sapien M3, a transcatheter mitral valve replacement device that caught the attention of attendees at the recent Cardiovascular Research Technologies meeting.

The use of lung cancer treatment modalities varies by geographic region across the UK, according to research published in Thorax, and the researchers say this could be negatively affecting patient survival in regions with lower treatment rates.

In Indiana, USA, the first patient has been enrolled in the EVAS2 IDE Confirmatory Clinical Study of the Nellix EndoVascular Aneurysm Sealing System from Endologix.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Ilhan Inci, Ilker Iskender, Jonas Ehrsam, Claudio Caviezel, Sven Hillinger, Isabelle Opitz, Didier Schneiter, Walter Weder

Inci and colleagues reviewed prospectively collected data from 117 patients with end-stage emphysema undergoing lung transplantation. The authors found that short-term and long-term survival were equivalent in patients who did and did not undergo lung volume reduction surgery prior to their transplantation (107 versus 86 months, p = 0.6).

Source: Pediatric Pulmonology
Author(s): Elisabeth Dellon, Samuel B. Goldfarb, Don Hayes Jr, Gregory S. Sawicki, Joanne Wolfe, Debra Boyer

A handy view from the pediatric standpoint on an expanding indication for sequential pulmonary transplanation.

Source: Medical Economics
Author(s): Craig M. Wax

Physicians are at high risk for burnout, physical disability, and financial deprivation after investing time and money in obtaining their training.  This article highlights how physicians can maintain their health and positive outlook to enable them to continue helping others.