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Journal and News Scan

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Michele Di Mauro, Roberto Lorusso

A brief, readable, sensibly balanced, and well-referenced editorial on the occasion of the retrospective Austrian paper on venoarterial extracorporeal membrane oxygenation (ECMO). Taken in the context of the recent New England Journal of Medicine paper on venovenous ECMO for acute respiratory distress syndrome and the relevant ATS presentations on the EOLIA trial, the editorial raises questions on the utility of the expensive innovation of ECMO.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Graeme L Hickey, Stuart W Grant, Joel Dunning, Matthias Siepe

Sample size calculations are a necessary prerequisite in the design of clinical studies. Most often, they are encountered in randomized controlled trials. Hickey and colleagues describe the reasoning behind determinations of sample size and illustrate some basic calculations. The authors also discuss estimation and sample size for nonrandomized studies.

Source: Annals of Cardiothoracic Surgery
Author(s): Asishana Osho, Uma Sachdeva, Cameron Wright, Ashok Muniappan

This written and video case review from Osho and colleagues centers on a 54-year-old woman who suffered smoke inhalation injury as a result of a house fire. Following prolonged intubation, mechanical ventilation, open tracheostomy tube placement, and recurrent pneumonia, the patient was diagnosed with a tracheoesophageal fistula (TEF). The authors prefer to manage TEF via an anterior cervical approach with division of the trachea, though a right thoracotomy may be used in the setting of highly distal TEFs. They emphasize that careful operative technique and the interposition of a robust muscle flap are the most important safeguards in surgical management of TEF.

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

Patient Care and General Interest

Screening infants for critical congenital heart disease at birth is becoming mandatory in the US state of Idaho and the Indian state of Kerala.

Tufts Medical Center in Boston, Massachusetts, USA, has completed its 500th heart transplant.


Drugs and Devices

The Venus P-Valve self-expanding pulmonary valve from Venus Medtech has been launched in Canada. The valve was developed for percutaneous implantation in native right ventricular outflow tracts.

The US Food and Drug Administration has issued a Class I recall for the HeartWare Ventricular Assist Device from Medtronic due to the possibility of an interrupted connection between the power source and the device controller.


Research, Trials, and Funding

A cardiac surgery team in Japan has approval to test induced pluripotent stem cell grafts in patients with damaged heart tissue to determine the safety of this regenerative medicine approach.

Interim data from a phase II trial from Leading BioSciences suggests that the company’s serine protease inhibitor, which targets postoperative ileus, reduces the length of intensive care and hospital stay for patients undergoing cardiac procedures on cardiopulmonary bypass.

An analysis from a European registry determined that mortality prediction models for heart failure patients have relatively poor reliability and are not used often in clinical practice.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Sung Jun Park, Joon Bum Kim

Park and Kim describe the construction and use of semimanufactured eight-branched aortic graft for open repair of thoracoabdominal aortic aneurysm. The authors review the results of open repair using this graft in 12 patients, eight of whom had Marfan syndrome.

Source: The Annals of Thoracic Surgery
Author(s): Qiang Chen, Zhi-Nuan Hong, Gui-Can Zhang, Liang-Wan Chen, Qi-Liang Zhang, Ze-Wei Lin, Hua Cao

Chen and colleagues present their experience closing ventricular septal defects with a device using a minimally invasive surgical approach that does not require cardiopulmonary bypass. This approach relies on transthoracic echocardiography for device guidance and was substantially cheaper than transcatheter approaches. The authors conclude that intraoperative device closure of ventricular septal defects is a reasonable alternative to transcatheter approaches, particularly in developing countries.

Source: Journal of the American College of Cardiology
Author(s): John D. Puskas, Marc Gerdisch, Dennis Nichols, Lilibeth Fermin, Birger Rhenman, Divya Kapoor, Jack Copeland, Reed Quinn, G. Chad Hughes, Hormoz Azar, Michael McGrath, Michael Wait, Bobby Kong, Tomas Martin, E. Charles Douville, Steven Meyer, Jian Ye, W.R. Eric Jamieson, Lance Landvater, Robert Hagberg, Timothy Trotter, John Armitage, Jeffrey Askew, Kevin Accola, Paul Levy, David Duncan, Bobby Yanagawa, John Ely, Allen Graeve, for the PROACT Investigators

Controversial and revisited topic of dual-antiplatelet therapy (DAPT) (aspirin and clopidogrel) versus low dose warfarin after On-X mechanical aortic valve replacement.  There were two arms to the study: low and high risk for thromboembolism.  The low-risk arm was terminated secondary to higher thromboembolic events in the DAPT group.  For the high-risk groups, patients receiving low dose warfarin with an international normalized ratio goal of 1.5 to 2.0 experienced no difference in mortality or thromboembolic complications compared to the standard dose warfarin group.

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

Patient Care and General Interest

Cardiac arrest survivors gathered at Basildon Hospital in the UK to share their stories and raise awareness, while attempting to set a world record for most cardiac arrest survivors at one gathering.

The University of Washington in the US joins a growing list of institutions that offer hearts from hepatitis C-positive donors to patients on the transplant waiting list, as evidence accumulates that the virus can be safely treated in organ recipients.


Drugs and Devices

Japan’s Ministry of Health, Labor, and Welfare has approved the Perceval sutureless valve from LivaNova for treating aortic valve disease.


Research, Trials, and Funding

Researchers from the University of California Los Angeles in the US and from Edwards Lifesciences trained a machine-learning algorithm to predict intraoperative hypotension using physiological data that is routinely collected during surgery.

Swedish researchers have found an association between invasive procedures such as coronary artery bypass grafting and infective endocarditis, and the accompanying editorial postulated that improving sterile technique and procedures for infection control when possible may prove more beneficial than administering prophylactic antibiotics.

Research presented at the recent American Thoracic Society meeting in San Diego, California, evaluated patient refusal of lung cancer treatment, finding that US patients with early stage disease were more likely to refuse surgical treatment if they did not have insurance or if they were covered by Medicaid.

Source: The Annals of Thoracic Surgery
Author(s): Tara R. Semenkovich, Margaret A. Olsen, Varun Puri, Bryan F. Meyers, Benjamin D. Kozower

Semenkovich and colleagues examined the current treatment practices for empyema in New York state using information from the Healthcare Cost and Utilization Project New York State Inpatient Database. The largest proportion of patients were initially treated with chest tube placement (38.2%) rather than a VATS or open surgical approach, and only 53% of patients were treated with a single procedure, highlighting that definitive treatment was often not the first treatment given. When patients were stratified by definitive treatment, the reintervention rate was higher for patients who treated with a chest tube than for patients treated by either surgical approach (6.1% versus 1.9% and 2.1%).

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Christiaan FJ Antonides, David J Cohen, Ruben LJ Osnabrugge

Antonides and colleagues present fundamental concepts of cost–effectiveness analysis (CEA) and they discuss the interpretation of these analyses. CEAs of new treatment strategies are being increasingly reported in the literature and national reports, and governments and healthcare payers frequently require a CEA to aid in the decision of whether to fund a new treatment or not. The authors consider a real-world example CEA, comparing transcatheter to surgical aortic valve replacement for intermediate-risk patients.