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Journal and News Scan
Hobbes and colleagues retrospectively evaluated systemic-to-pulmonary shunt procedures for 173 patients over a 10-year period at a single institution. Despite their importance for many patients with single ventricle or complex biventricular lesions, shunt procedures carry a high risk of morbidity and mortality. The authors found the main predictors of morbid events in their cohort were patient characteristics such as extracardiac or genetic anomalies and needing preoperative ventilation, but not age, weight, or shunt size to weight ratio. Additionally, oxygen saturation on ICU admission and amount of platelets transfused each predicted early shunt thrombosis.
Very nice paper that, once again, demonstrates established experience with awake thoracic surgery. Is this the future? Does a minimally invasive surgeon need a minimally invasive anesthesiologist beside?
Read a summary of presentations on percutaneous mitral valve techniques from the 2017 PCR London Valves meeting in the UK.
Drugs and Devices
In an interview with Nature, the executive director of the European Medicines Agency talks about the effect that the agency’s impending move from London could have on its operations.
The US Food and Drug Administration (FDA) will temporarily allow imports of intravenous saline to avoid shortages as Puerto Rico, which manufactures about 10% of medical products consumed in the US, continues recovering from the devastation caused by Hurricane Maria.
The US FDA approved a magnet-tipped catheter device for correcting pediatric esophageal atresia without open surgery.
Research, Trials, and Funding
Researchers from Uganda, the US, and France find that prophylactic penicillin might be helpful for children with mild latent rheumatic heart disease.
Two studies published in JAMA Cardiology and the European Heart Journal suggest that low mitochondrial DNA copy number might indicate increased risk of cardiac events.
A new protocol from a multidisciplinary team at Johns Hopkins University in Baltimore, US, aims to reduce the incidence of acute kidney injury after cardiac surgery.
Researchers at Harvard University in Boston, US, used “lung-on-a-chip” tissue models to study NSCLC adenocarcinoma cells. Mechanical forces, applied to these model lungs to mimic breathing, reduced cancer cell growth and invasion and influenced anti-cancer drug efficacy.
This study examined risk estimates for complex major surgery by trainees in internal medicine and in general surgery using seven clinical scenarios. Surgery residents expressed more confidence in their estimates, but were less likely to use published risk models. Most trainees in both specialties significantly overestimated every type of risk, averaging a quarter to a third higher than risk model predictions.
The authors report on the design and use of a growth-accommodating device that may have a variety of pediatric applications, including valve annuloplasty. The device consists of a biodegradable core and a tubular braided sleeve (woven much like a 'finger trap' toy). After implantation, the core—which constrains the length of the device—degrades so as to allow the annuloplasty to enlarge gradually over time. Thus, the device 'grows' with the child. The authors further present validation of the device in a swine model.
The free full text is available.
What is already known on this topic:
Female and male physicians differ in their practice of medicine in ways that might substantially affect patient outcomes. Outcomes after surgery depend on the technical and cognitive skills of treating physicians, so findings from medical specialties might not apply to surgical specialties.
What this study adds:
This large, population-based, matched cohort analysis found small differences in surgical outcomes between patients treated by female and male surgeons, with the former having a small but statistically significant decreased risk of short-term postoperative death.
In this retrospective study, the long-term survival benefits of multiple arterial coronary grafting were evaluated among over 20,000 patients in British Columbia by comparing outcomes to those of L IMA + SVG. Multiple arterial grafting was associated with decreased mortality (HR 0.79) and decreased revascularization rates (HR 0.74). The incidences of MI and heart failure were also reduced (HR 0.63 and 0.79, respectively).
The Impella RP device was approved by the FDA for use as a temporary percutaneous assist for the right ventricle, as announced by Abiomed. Use is approved for up to 14 days for a variety of indications including post MI, heart transplant, open heart surgery, or right heart failure after LVAD implant.
The authors, using a decision analysis model, compared the cost-effectiveness (over one year) of three different strategies for preventing Staphylococcus aureus infections in patients undergoing CABG in the U.S. The three strategies were as follows:
- Universal decolonization with mupirocin, chlorhexidine, and vancomycin in all patients undergoing CABG
- Targeted decolonization with mupirocin, chlorhexidine, and vancomycin only in patients who are S aureus carriers
- No decolonization in any patients
Findings: Universal decolonization is the most cost-effective strategy in >91% of simulations in this model. Annually in the US, universal decolonization is predicted to lead to $102 million in cost savings, while targeted decolonization is predicted to lead to $45 million in cost savings.
Beckmann and colleagues present data from over 100,000 heart surgery procedures performed at 78 German centers in 2016. Registry data, divided by procedure type and compared over the last decade, show increases in the proportion of elderly patients, the usage of transcatheter procedures, and the implantation of left ventricular assist devices. The analysis also indicates consistently excellent patient survival rates and nationwide provision of cardiac surgical care.