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Journal and News Scan

Source: Annals of Cardiothoracic Surgery
Author(s): Rodrigo Modolo, Carlos Collet, Yoshinobu Onuma, Patrick W. Serruys

Modolo and colleagues provide detailed analysis and straightforward description of the SYNTAX II and SYNTAX III trials, including the impact for surgeons in contemporary practice. The article addresses both sides of the percutaneous coronary intervention (PCI) versus CABG debate with evidence from the SYNTAX II and III trials, examining specifically the outcomes of state-of-the-art PCI and CABG and comparison of heart team findings and decision making using computed tomographic angiography (including FFRCT) or conventional angiography.

Source: The Annals of Thoracic Surgery
Author(s): Kimberly A. Holst, Joseph A. Dearani, Sameh M. Said, Ryan R. Davies, Christian Pizarro, Christopher Knott-Craig, T.K. Susheel Kumar, Vaughn A. Starnes, S. Ram Kumar, Sara K. Pasquali, Dylan P. Thibault, James M. Meza, Kevin D. Hill, Karen Chiswell, Jeffrey P. Jacobs, Marshall L. Jacobs

This STS Database review included 255 neonates and 239 infants with Ebstein anomaly (EA). For neonates, repair was performed in 40%, shunt in 20%, and tricuspid valve closure in 9%; operative mortality was 27%. For infants, superior cavopulmonary anastomosis was performed in 38% and repair in 16%. Operative mortality was 9%. Optimal approach and timing for repair remain elusive.

Source: News from around the web.
Author(s): Emily Robinson

Patient Care and General Interest

Late-breaking results from the VISION study just presented at the European Society of Cardiology’s 2018 annual Congress suggest that 75% of patient deaths after noncardiac surgery can be attributed to cardiovascular causes.

Access to the Affordable Care Act in the United States has seemingly made middle-aged stroke survivors less likely to skip prescribed medications due to cost.

A new study suggests that chemotherapy may lead to early menopause in young women with lung cancer.


Drugs and Devices

A new Astrazeneca drug called Tagrisso has been approved in Japan for patients with inoperable or recurrent epidermal growth factor receptor mutation-positive non-small-cell lung cancer.

The Duke Clinical Research Institute and Cerner have jointly developed an app that estimates patients’ cardiovascular disease risk.


Research, Trials, and Funding

A new study published in the Journal of the American Heart Association finds that a simplified cardiac magnetic resonance protocol can help developing nations diagnose heart ailments more quickly and cheaply.

A meta-analysis published in JAMA Cardiology finds that young and middle-aged adults with aortic valve disease have a higher survival rate when treated via the Ross procedure as opposed to mechanical aortic valve replacement.

New guidelines on clinical care for patients undergoing myocardial revascularization have been released by the European Society of Cardiology and European Association for Cardio-Thoracic Surgery.

Source: The Thoracic and Cardiovascular Surgeon
Author(s): Peter Philipp Grimminger, Edin Hadzijusufovic, Jelle Piet-Hein Ruurda, Hauke Lang, Richard van Hillegersberg

Grimminger and colleagues present their technique for a four-armed robotic approach to esophageal cancer surgery. The authors note the improved control and dexterity offered by the addition of the fourth arm, leading to greater surgeon independence in this complex procedure.

Source: The New England Journal of Medicine
Author(s): Clifton W. Callaway, Michael W. Donnino

A balanced editorial discussing the relevant RCT from Britain. The esteemed authors are correct to highlight the overall discouraging survival from out-of-hospital cardiac arrest WITHOUT NEUROLOGICAL DEFICIT. What does need to be done to improve a 3% acceptable outcome? The 'non-superiority' of adrenaline (epinephrine) is, under the devastating primary outcome, a finding of secondary importance for the general public.  

Source: The New England Journal of Medicine
Author(s): Michael Y. Mi, Michael A. Matthay, Alan H. Morris

Quite useful case-illustrated debate on a VERY hot topic!

Source: The Annals of Thoracic Surgery
Author(s): Philipp Kiefer, Sabine Meier, Thilo Noack, Michael Andrew Borger, Joerg Ender, Alexandro Hoyer, Friedrich Wilhelm Mohr, Joerg Seeburger

Kiefer and colleagues report the outcomes of six patients who underwent transapical mitral valve repair for severe mitral regurgitation. Treatment was offered as part of the safety and feasibility trial for the NeoChord DS1000 system at the authors’ institution. One patient underwent intraoperative conversion to an open repair, two patients underwent reoperation for recurrent mitral regurgitation, and the remaining three patients had no cardiac symptoms throughout the five-year follow-up period.

Source: Interactive Cardiovascular and Thoracic Surgery
Author(s): Graeme L Hickey, Evangelos Kontopantelis, Johanna JM Takkenberg, Friedhelm Beyersdorf

Hickey and colleagues discuss the assumptions that underlie regression models, and they detail approaches to identifying deviations from these assumptions. They illustrate several points using linear regression as the basis but also discuss logistic regression and Cox regression models. The authors present both formal statistical tests and graphical diagnostics that should be used for assessing model assumptions.

Source: The New England Journal of Medicine
Author(s): Jean-François Obadia, David Messika-Zeitoun, Guillaume Leurent, Bernard Lung, Guillaume Bonnet, Nicolas Piriou, Thierry Lefèvre, Christophe Piot, Frédéric Rouleau, Didier Carrié, Mohammed Nejjari, Patrick Ohlmann, et al., for the MITRA-FR Investigators.*

Patients with severe secondary mitral regurgitation with depressed ejection fraction were randomized to either MitraClip and medical therapy vs. medical therapy alone. There was no difference in primary outcomes (i.e. death and unplanned hospitalization) at one year.

Source: News from around the web.
Author(s): Emily Robinson

Patient Care and General Interest

A new study finds that elderly heart surgery patients who exhibit postoperative delirium are sometimes given antipsychotic medications, which are ineffective and may even be dangerous.

A 5-month-old child in St. Louis, Missouri, becomes the youngest documented heart-lung transplant patient in more than a decade.

A 3-year-old boy from Germany with a rare congenital heart disease travelled all the way to Milwaukee, Wisconsin, to undergo a complex procedure.


Drugs and Devices

The first clinical use of FRAME external support technology for aneurysm repair in high flow arteriovenous (AV) fistulas took place in Germany.


Research, Trials, and Funding

A Harvard study regarding cardiothoracic surgery operating teams suggests that variations in interpersonal and leadership communication patterns may have a strong effect on teamwork.

A novel technique tested at Ohio State University’s Wexner Medical Center allows damaged lungs to be placed on a machine that keeps them alive at normal body temperature, allowing doctors to better assess whether they are viable.