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Journal and News Scan
A New York Times journalist travels with Team Heart, a nonprofit organization providing humanitarian heart surgery for rheumatic disease in Rwanda. In addition to highlighting the overwhelming need, her perspective illuminates some harsh realities of these efforts in resource-poor countries. Examples include the cultural repercussions of mechanical valves in females of childbearing age and the challenging surgical judgment required when operating on patients who are sick enough to warrant surgery, yet not too sick to survive in the context of limited perioperative support. Dr. Ralph Bolman III, Dr. Thoralf Sundt, and Dr. Bruce Leavitt are among the physicians participating in the effort and featured story.
This study compares the early outcomes and hospital charges associated with early primary repair vs systemic-to-pulmonary artery shunt for neonates and young infants. The Pediatric Health Information System database was queried for patients <90 days of age with primary diagnosis of tetralogy of Fallot who underwent nonelective surgical repair or palliation between January 2008 and December 2014. The initial cohort of 821 patients (group 1 early primary repair, N = 554; group 2 systemic-to-pulmonary artery shunt, N = 267) was propensity score matched (248 patients in each group) to account for baseline imbalances in age and prostaglandin use. The analysis suggests that the two approaches are comparable with regard to morbidity, mortality and hospital resource utilization. The article is accompanied by separate Invited Commentaries, by Emile Bacha, MD and by Yves D’Udekem, MD, PhD.
Results of a clinical trial using transcatheter aortic valve replacement provided a "strong signal" that it is safe for patients with low surgical risk, potentially helping to open the way for broader use of the minimally invasive procedure, also known as TAVR.
The Low-Risk TAVR trial results, presented this week at the European Society of Cardiology Congress 2018 showed no deaths or disabling strokes within 30 days of undergoing the procedure for 200 patients with low surgical risk who participated in the study, led by MedStar Heart & Vascular Institute at MedStar Washington Hospital Center.
The results of the trial, the first of its kind, approved by the Food and Drug Administration, were published online in the Journal of the American College of Cardiology.
The highly respected Cochrane Collaboration is in crisis today at its 25th annual meeting in Edinburgh as one board member is expelled and six more resign. There are more links below but it seems to have been over a dispute regarding the independence of authors and members with regards to links to industry and pharmaceutical companies. Here is a statement from the rump governing board, released yesterday:
Peter Gøtzsche's statement: "I regret to inform you that I have been expelled from membership in the Cochrane Collaboration by the favourable vote of six of the 13 members of the governing board."
Four other members of the board have resigned: Gerald Gartlehner, David Hammerstein, Joerg Meerpohl, and Nancy Santesso.
Two other members of the governing bord (Rae Lamb and Catherine Marshall) resigned because of governance issues.
This dispute has been going on for some time but the trigger may have been the critique of the Cochrane reivew of HPV vaccines (not of the vaccines themselves, but of the methods used):
Here is the Cochrane editor in chief's response to the critique:
Responses to this will be published in BMJ-EBM. Earlier coverage is published in BMJ and The Lancet. There is a lot more but these are all the public facts up to now.
Cochrane HPV vaccine review: BMJ journal defends "inconvenient criticisms."
Details provided by professor Tom Jefferson, senior associate tutor.
Patient Care and General Interest
3D personalized simulations of patient hearts reportedly allow physicians to better locate and treat arrhythmias.
A six-year-old girl became the first patient to receive congenital open heart surgery in Mali.
Star LA Dodgers closer Kenley Jansen will need to undergo a second ablation procedure at the end of the baseball season to correct an irregular heartbeat.
A study published in CHEST suggests the prevalence of racial disparities in the United States regarding the surgical treatment of lung cancer, even in relation to participants in the National Lung Screening Trial.
Jonathan Chen has joined the Children’s Hospital of Philadelphia as its new Chief of the Division of Cardiothoracic Surgery.
Research, Trials, and Funding
A new meta-analysis indicates that TAVR patients who are discharged early do not fare worse than patients with longer hospital stays.
Data from the IMPULSE registry suggests that many patients in European countries with aortic stenosis who have no related symptoms are being sent for aortic valve replacement, despite the absence of guideline-recommended indications.
A study from the Tianjin Medical University Cancer Institute in China suggests that patients with primary left lung cancer who undergo 4L lymph node dissection have more favorable outcomes than those who do not receive 4L dissection.
This illustrated, instructional article details a reproducible, total-arterial surgical revascularization technique which does not require cardiopulmonary bypass or any manipulation of the ascending aorta. This guide aims to improve outcomes for surgeons new to off-pump coronary artery bypass grafting (OPCABG) and goes some way to addressing concerns raised by critics of OPCABG.
Exciting debate on the EOLIA trial!
In this Men's Journal feature, Dr. William Novick describes his beginnings in international congenital heart surgery and how the personal credo: "Screw politics, screw religion; I'm here to help" has landed him inside the operating rooms of some of the world's most hostile regions. His experiences in Iraq are guaranteed to make everyday stressors of surgery amidst suboptimal turnover time or administrative oversight seem trivial in comparison to surgery amidst mounting insurgency or ISIS.
In this review article, the authors focus on epigenetic regulation of gene expression, including the role of histone methylation and acetylation, deoxyribonucleic acid methylation, and noncoding ribonucleic acids in the pathogenesis of thoracic aortic aneurysms (TAA) and ascending aortic dissection (AAD). They provide a translational perspective, presenting recent data that motivate the evaluation of the potential of epigenetics to diagnose TAA and prevent ascending aortic dissection AAD.
The Editorial Group is grateful to Dr Manos Kapetanakis for bringing to our attention their small case series on a ' lifestyle' late complication of pneumonectomy for malignancy. It will be challenging to guide the swimmer with curable central pulmonary cancer in making an informed decision on the strength of the sporadic Keeling Syndrome. The biomechanic discussion holds translational value.