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Journal and News Scan
The American Association for Thoracic Surgery (AATS), American College of Cardiology (ACC), American Society of Echocardiography (ASE), Society for Cardiovascular Angiography and Interventions (SCAI), and Society of Thoracic Surgeons (STS) published a joint expert consensus and evidence-based recommendations for systems of care related to valvular heart disease with respect to patient outcomes, cost, and cost-effectiveness.
At the Charing Cross Symposium, held April 15 to 18 in London, UK, Professor Fabio Verzini presented the 30-day data from Medtronic's Valiant Navion investigational device exemption study of 100 patients with thoracic aortic aneurysm and penetrating atherosclerotic ulcer. This study showed low rates of perioperative mortality at 2.0% and secondary procedures at 2.0%. The rate of type Ia endoleaks was 1.1% at imaging follow-up after one month.
In this study, researchers from Spain have found that the longitudinal strain of the proximal aorta, as detected by cardiac magnetic resonance, is a risk factor for aortic root dilation rate and aortic events (hazard ratio 1.290, 95% confidence interval 1.123 - 1.481, P<0.001) in patients with Marfan syndrome.
Transcatheter aortic valve is usually implanted via transfemoral or transapical access. Reents and colleagues sought to compare the safety of these two access routes, using a retrospective analysis of their experience. Among more than 1,000 patients, the risk-adjusted short- and long-term mortality and major morbidity rates were similar for both approaches. The authors found that mortality was associated with the risk profile and the institutional experience but not with the access mode itself.
Fukui and colleagues retrospectively compared outcomes for patients who were either smokers (410 patients) or never smokers (256 patients) and who underwent resection for primary lung cancer (stage I to III). The authors evaluated 90-day mortality and respiratory complications, both of which were higher for smokers than for never smokers. Smoking cessation mitigated the increased likelihood of pulmonary complications for smokers, and the odds ratios for complications compared to never smoking patients were lowest for those patients with the longest interval of preoperative smoking cessation (more than 12 months). The authors conclude that smoking cessation is always valuable for lung cancer surgery, but that longer periods of time are more efficacious for reducing pulmonary complications.
Cardiothoracic surgeons in the US were the most underpaid specialty, calculated according to undervalued work based on RVUs in comparison to data from the American College of Surgeons National Surgical Quality Improvement Program.
Buitrago and Restrepo report the largest series to date from Latin America of patients undergoing robot-assisted thoracic surgery. A total of 69 patients underwent robot-assisted procedures with 47 undergoing pulmonary resections, 18 undergoing mediastinal procedures, and 4 undergoing another type of operation. The authors report the outcomes for these procedures, which included no in-hospital mortality. They also report on the association between total operative time and the year that the surgery was performed, finding an approximately 10 minute reduction in total operative time each year.
Assmann and colleagues conducted a survey of extracorporeal life support (ECLS, extracorporeal membrane oxygenation) usage in cardiac surgery departments across Germany, given that German scientific guidelines call for the use of ECLS for cardiac and circulatory failure. With 78 of 84 departments responding, the authors found variability between respondents in ECLS therapy, from program structure to the management and monitoring of the therapy. Satisfaction was higher in programs that had clearly defined responsibilities. They conclude that there is a need for a multidisciplinary guideline concerning ECLS therapy in Germany.
The UK Aortic Group report their experience with the frozen elephant trunk (FET) repair for 66 acute type A aortic dissection (ATAAD) patients using the Thoraflex Hybrid graft at eight UK high-volume aortic centers. The in-hospital mortality was 12% (8/66). Postoperative temporary or permanent neurological events and temporary renal replacement therapy occurred in 17% and 20%, respectively. No spinal cord injury events were documented. These data were similar to those reported in literature in the two largest experiences with the use of FET in patients with ATAAD (in-hospital/30-day mortality: 11-12%). This initial experience demonstrated that FET can potentially be adopted as standard approach in life-threatening aortic diseases, with acceptable complication and mortality rates.