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Journal and News Scan
November 25, 2018
Submitted by: Mark Ferguson
This single institution retrospective study examined the utility of using nonpledgeted sutures for aortic valve replacement. In short-term follow-up, 3.6% of patients had insignificant perivalvular leak and 0.9% had significant perivalvular leak requiring reoperation. This technique has the potential benefits of reduced cross-clamp time, reduced risk of decreasing the effective orifice area, reduced cost, and reduced indwelling foreign body.
November 23, 2018
Submitted by: Claire Vernon
Brown and colleagues evaluated levels of six biomarkers to determine if they improved the prediction of readmission after cardiac surgery: ST2, galectin-3, N-terminal pro-brain natriuretic peptide, cystatin C, interleukin-6, and interleukin-10. The addition of these biomarkers to a model based on only clinical risk factors improved the predictive ability of the model in the derivation cohort (area under the receiver-operating characteristics curve (AUROC) of 0.74 versus 0.66), but it did not improve prediction in an external validation cohort (AUROC of 0.52 versus 0.48).
November 20, 2018
Submitted by: Claire Vernon
Primary focal hyperhidrosis (PFH) may lead to psychosocial deficits. One of the minimally invasive treatment methods is endoscopic thoracic sympathectomy, an effective therapeutic option that the authors hypothesized might lead to decreased psychotropic medications usage. Li and colleagues looked at psychiatric symptomatology and medication usage in 106 patients with PFH, comparing this with 213 patients without PFH. Additionally, they evaluated medication usage, anxiety, and depression before and after surgical intervention in PFH patients, finding improvements following endoscopic thoracic sympathectomy.
November 20, 2018
Submitted by: Claire Vernon
Soquet and colleagues reviewed records from 289 pediatric patients who underwent 376 cavopulmonary connection (CPC) procedures to determine the incidence and associated complications of chylothorax following these procedures. The authors found that the incidence of postoperative chylothorax was high in these patients (19.7%), and they confirmed that chylothorax was indicative of a worse postoperative course. The presence of a systemic right ventricle was a risk factor for chylothorax (odds ratio 2.49).
November 19, 2018
Submitted by: Claire Vernon
Conzelmann and colleagues aimed to gain information about outcomes of transcatheter aortic valve replacement (TAVR) procedures in patients with coronary heights less than 7 mm. These procedures are not common, as one of the contraindications for TAVR is a low coronary height. Among more than 3,000 TAVR patients from the Karlsruhe registry, 86 had an average coronary height of 6.4 mm. Within 30 days, there were four cardiac deaths, three noncardiac deaths, and three coronary obstructions in this patient group. The authors concluded that coronary-related complications in TAVR with coronary heights less than 7 mm occurred infrequently, however they were serious when they occurred.
November 16, 2018
Submitted by: Claire Vernon
Patient Care and General Interest
An accident during a sword swallowing trick was bad news for the performer’s esophagus.
An imaging case study from Medscape walks through the echocardiography of a patient with rheumatic disease involving all four valves.
Disagreement between four different hospital ranking systems regarding cardiac surgery quality in the USA could cause confusion for patients trying to understand this publicly available data.
Research, Trials, and Funding
The US Food and Drug Administration is releasing the open source code for their MyStudies app in order to allow researchers to better adapt the tool to the specific needs of their clinical trials.
Researchers in the UK find unexpectedly high levels of cancer-associated mutations in normal esophageal tissue.
Researchers from Washington, DC, in the USA presented the prototype of their miniature pacemaker at the recent American Heart Association’s Annual Meeting, a device that they hope allows for less invasive placement of pacemaker leads on infants’ hearts.
November 15, 2018
Submitted by: Aristotle Protopapas
An interesting randomized controlled trial asserting robustly that endoscopic harvesting of saphenous vein is: (1) better for leg dehiscence and (2) at least noninferior for MACE compared to the conventional open "full touch" method. Somewhat puzzling are the high mortalities and revascularization rates in both arms, across a median follow up less than three years. The requisite hour or more to harvest the vein(s) openly also seems a bit long for experienced operators, even if we include closure of the incision.
November 14, 2018
Submitted by: Claire Vernon
In this randomized controlled trial, Padmanabhan and colleagues focused on the ability of iron given intravenously to increase hemoglobin levels before elective cardiac surgery, comparing this with iron given orally. The study included 50 anemic patients who were scheduled for cardiac surgery. Ferritin levels increased significantly in patients with intravenous iron administration. Iron administration did not influence hemoglobin level, regardless of the method of administration.
November 14, 2018
Submitted by: Claire Vernon
Thornblade and colleagues endeavored to develop and validate a model that would predict the 2-year risk of recurrence in patients with completely resected node-negative non-small cell lung cancer (NSCLC). Improved recurrence prediction could direct selective use of adjuvant therapy and surveillance imaging in these patients. The authors’ models performed similar to chance, despite using clinical risk factors for recurrence and biomarkers associated with poor survival. They discuss potential reasons for the difficulty in predicting recurrence in this patient group.
November 13, 2018
Submitted by: Wei-Guo Ma
In this paper, Dr Svensson covers his technique of leaflet repair during aortic root reimplantation. The core technical points are described as well as the long-term clinical outcomes. The author's experience has shown that for patients having leaflet repair, bracing the root with a reimplantation operation appears to reduce the risk of late regurgitation and reoperation.