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Journal and News Scan
Shroyer and colleagues evaluated observed-to-expected outcome ratios for 30-day operative mortality and major morbidity across over 540,000 nonemergent first-time coronary artery bypass graft (CABG) procedures in The Society for Thoracic Surgeons Adult Cardiac Surgery Database. Given the increasing number of US health care system mergers and the decreasing proportion of cardiothoracic surgeons in private practice, the authors sought to determine whether risk-adjusted CABG outcomes varied based on the number of centers at which a surgeon operates. They found that observed-to-expected mortality ratios were better for single-center than for multicenter surgeons (0.97, 95% CI 0.94-1.00, versus 1.06, 95% CI 1.01-1.12), and that ratios for multicenter surgeons were better at their primary hospital (1.01, 95% CI 0.96-1.07) than at their satellite facilities (1.17, 95% CI 1.09-1.27).
This systematic review by Udelsman and colleagues assesses the clinical successes and setbacks of the current methods of airway replacement. Twenty-one studies, focusing primarily on the clinical translation of circumferential or near circumferential tracheal substitutes, were included in the final assessment. A total of 41 patients were identified as having received allotransplantation, autologous tissue reconstruction, bioprosthetic reconstruction, or tissue engineered reconstruction between January 2000 and October 2017. The authors conclude that each modality has its unique advantages and disadvantages; however, no clear ideal prosthetic or graft material stands out at present. Further laboratory work is required before tracheal substitutes, particularly tissue engineered conduits, are more widely utilized.
Patient Care and General Interest
An article in the New York Times looks at the ethical dilemma of performing surgery for endocarditis in illicit drug users whose addictions go untreated.
ERAS® Cardiac Surgery presented an expert consensus statement on best practices to speed recovery at the Enhanced Recovery After Cardiac Surgery session at the recent AATS Annual Meeting in San Diego, California.
Drugs and Devices
The Australian Research Council Research Hub for Advanced Manufacturing of Medical Devices has been launched at the University of Queensland as part of an initiative to drive innovation by supporting collaborative research between academic and industry groups.
The Cardioband transcatheter tricuspid valve reconstruction system from Edwards Lifesciences has received CE Mark approval.
Research, Trials, and Funding
Terumo Aortic has launched an early feasibility study to evaluate the safety and efficacy of its RelayBranch thoracic stent-graft system.
Research presented at the recent AATS Annual Meeting suggests that the likelihood of upstaging increases with each week between staging and surgery for non-small cell lung cancer, which supports sooner surgery to avoid cancer progression and improve the likelihood of curative resection.
A detailed well-referenced update on cardiovascular biomarkers, included in a compendium issue of the periodical.
The concept of ventricular mural antagonism has been introduced recently, where the main constrictive forces in the ventricular myocardium are complemented by a dilatory force component. Lunkenheimer and colleagues provide evidence for the radial force underlying this dilatory component, and they highlight its role in healthy and diseased myocardium.
A stimulating discussion of the Vienna paper that advances elective ECMO support for bilateral pulmonary transplantation.
The latest on portable venovenous ECMO in a cohort in which half of the subjects died after a resource-intensive treatment. The results of the relevant EOLIA trial are keenly awaited.
A somewhat delayed publication of a 2016 paper that discusses important trends in cardiac transplanation in the light of increasing use of ECMO.
Using the Premier healthcare database, the authors analyzed the data of over 100,000 adult patients admitted to an ICU in the U.S. with a primary diagnosis of heart failure from 2010-2014. Hierarchical logistic regression models revealed that the likelihood of care by a cardiologist was 42% higher for white as opposed to black patients with heart failure. Cox regression showed that care by a cardiologist was associated with a 20% higher likelihood of survival.
Question: Is this healthcare disparity a true disparity based on race, or are other confounding and unaccounted for variables responsible?
The authors performed a patient-level meta-analysis of six randomized trials comparing left internal mammary artery (LIMA) + saphenous vein graft (SVG) versus LIMA + radial artery graft. In a total of more than 1000 patients and at a follow-up of 60 months, the incidence of adverse cardiac events (death, myocardial infarction, or repeat revascularization) was significantly lower in patients with a radial artery graft as compared with those in the SVG group (hazard ratio, 0.67; 95% confidence interval, 0.49 - 0.90; p = 0.01). Moreover, the patency rate at 50 months of angiographic follow-up was higher in the LIMA + radial artery group. These results emphasize the importance of using more arterial grafts.