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Journal and News Scan
Allen and colleagues reviewed the Food and Drug Administration Medical Device Reporting database for reports of nontuberculous mycobacterium (NTM) infections following extracorporeal circulation usage during surgery. This review of a US database found that reported infections were attributable to several device manufacturers, perhaps indicating that design features of these devices make them susceptible to NTM contamination. Infections associated with aerosolized NTM during surgery represent an epidemiologic departure from the usual transmission route of inhalation, and such infections are aggressive despite being slow to develop. The authors conclude that NTM infection secondary to cardiothoracic surgery, despite being uncommon, is an emerging public health concern that merits attention and awareness.
Right anterior thoracotomy is a technique for aortic valve replacement. Minimal extracorporeal circulation (MECC) is known to reduce the deleterious effects of cardiopulmonary bypass. The authors present a sutureless aortic valve replacement via right anterior thoracotomy by using MECC in an 84-year-old patient with severe aortic stenosis.
Preoperative tomographic angiography showed a right sided aorta. A 4 cm transverse incision was made through the right second intercostal space. Rib resection was not used. A femoral arterial and venous cannulation was used. The main advantage of MECC is less inflammatory response and less hemodilution. By using standard surgical instruments a transverse aortotomy was made from the fat pad. Calcified leaflets are resected and small size. Perceval sutureless valve is inserted. Aortotomy was then closed.Postoperative TEE showed no leak and excellent hemodynamics. Patient recovery was uneventfull.
Sutureless aortic valve replacement with mini cardiopulmonary bypass through the right anterior thoracotomy is a safe and feasible technique and provides an excellent result.
Tapias and colleagues find that the surgical management of epiphrenic diverticula can provide good results, with symptoms being resolved in 21 of 31 patients. The authors’ retrospective review confirmed the rarity of this condition, with fewer than one case per year over 40 years. Acute presentation with either ruptured diverticula or hematemesis was associated with poorer outcomes. The authors conclude that a diverticulectomy and myotomy should always be performed but that an antireflux procedure might not influence patient outcomes.
A team at the American University of Beirut Medical Center in Lebanon performs the first transcaval percutaneous aortic valve replacement in the region.
A woman who received a transplanted heart in 2013 will run the Chicago Marathon on Sunday with her donor’s father.
Drugs and Devices
BioStable Science & Engineering, Inc. announced the first commercial use of its HAART 200 Aortic Annuloplasty Device, which has been cleared by the US FDA to facilitate bicuspid aortic valve repair.
Research, Trials, and Funding
Researchers in Ohio, US, find that balloon aortic valvuloplasty is a successful intervention for 70% of patients with noncritical congenital aortic stenosis. Is a 70% success rate good enough?
The second report from the Prospective Urban Rural Epidemiology (PURE) study, an observational study of over 130,000 people from many different countries, finds a positive association between activity level and lowered risk of cardiovascular disease. The conclusions from the first PURE report questioned the current views of carbohydrates and fats in a healthful diet.
Researchers at Gentofte Hospital in Denmark find that infective endocarditis developed in 2.5% of patients with end-stage renal disease.
A study from researchers at the University of Texas at Arlington in the US finds that zinc interferes with overactive calcium signaling to specifically impede cancerous esophageal cell growth in culture.
A stimulating editorial triggered by tri-species autopsy work on angiodysplasia potentially attributable to continuous-flow LVAD. Dr Birks discusses the findings and appears open to the suggestion that LVAD per se is a cause of gastrointestinal angiodysplasia and thence bleeding, as opposed to the anticoagulation for LVAD.
Researchers used a nanomaterial sensor array and pattern recognition statistical techniques to evaluate exhaled breath samples from patients with suspicious lesions on imaging. A total of 119 patients were included, of whom 30 had benign lesions. In cancer patients, the accuracy of discriminating EGFR mutations from wild-type EGFR was 83%. The accuracy of differentiating early stage cancer from benign disease was 87%.
The authors demonstrated substantial concordance between sequencing of 39 genes in a liquid assay and routine diagnostic testing in tissue in 82 patients. Agreement was 98%, and the primary reason for failure was low levels of circulating DNA in the plasma. Sensitivity was 70%, and specificity was 100%. The system offers accurate identification of driver mutations in plasma of patients with NSCLC.
In this Masters of Cardiothoracic Surgery, Meier and colleagues outline their approach to transmitral myectomy and surgical management of systolic anterior motion in a case vignette of a 45-year-old male with hypertrophic cardiomyopathy. The technique combines a transmitral left ventricular myectomy and a resuspension of the anterior mitral leaflet with a partial, flexible annuloplasty. The perils and pitfalls of this technique are presented in this article, which is accompanied by a narrated video with operative footage.
A Brazilian woman ran a road race in Rio de Janiero, powered by the transplanted heart of a German Olympian that she had received only a year earlier.
A suspicious shadow showed up on the x-ray of a UK man’s lung, but surprisingly and luckily turned out to be a toy traffic cone he had swallowed as a child.
The September issue of The Surgeons’ Lounge delves into myths and facts about blood transfusion.
Drugs and Devices
The European Medicines Agency gave a positive opinion to a once-a-day triple-drug inhaler for COPD made by GlaxoSmithKline.
Research, Trials, and Funding
Oral intubation might be a better choice than nasal intubation for anesthesia in children over 6 months old undergoing cardiac surgery.
Researchers at Boston Children’s Hospital in Massachusetts are developing a device to better monitor tissue oxygen levels as a way to predict impending cardiac failure.
Paci and colleagues investigated the effect that multimodal enhanced recovery pathways (ERP) have on the costs of lung resection. The authors’ analysis evaluated the socioeconomic impact of ERPs including postdischarge health care system utilization and caregiver burden, in addition to institutional costs.