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Journal and News Scan
A useful if somewhat belated account of the Papworth experience in lung donation after circulatory determined death (DCD) until 2015. There are no data on heart and lung transplants in that 6-year period. No DCD recipient required extracorporeal membrane oxygenation, and DCD single lung recipients did badly. Quite interesting to see that total ischemic time was not higher in DCD, as if its warm ischemic time was somewhat factored in the planning (eg, considering DCD donation from only short distances from Papworth Hospital).
As a specialized agency of the United Nations concerned with international public health, the World Health Organization (WHO) supports the mission to treat congenital heart disease in Libya. Yet since most of the international medical staff working in Libyan hosptials have left the country since 2011, nongovernmental organizations working with Libyan heart surgeons, nurses, perfusionists, and other medical professionals have the opportunity to share skills required to operate independently in the future.
This multimedia article features Dr William Novick of the Novick Cardiac Alliance: https://cardiac-alliance.org.
The authors reviewed their experience with 602 patients who underwent mitral repair for type II mitral regurgitation. Mitral stenosis was defined as a mean transmitral pressure gradient (MTPG) of > 5 mm Hg, and 51 patients (8.5%) had mitral stenosis by this criterion. The authors found on postoperative echocardiography that annuloplasty with a smaller-sized ring was associated with a higher MTPG, PA pressures, residual TR gradient, and incidence of new-onset atrial fibrillation.
The 5-year survival rate in patients after curative surgery for N0 nonsmall cell lung cancer (NSCLC) is reduced by recurrence and metastasis, and there is evidence that the epithelial–mesenchymal transition in cancer cells is associated with metastasis. Wang and colleagues analyzed the expression of epithelial–mesenchymal transition regulators Twist and Snail, and their target E‑cadherin, in resected tissue from 78 patients diagnosed with pathological N0 NSCLC. They found that high expression of Twist and Snail and low expression of E-cadherin were associated with worse recurrence-free survival.
A brief readable commentary on the Robiscek technique on the occasion of a meta-analysis of an expensive alternative.
The latest instalment in the gender discordance saga, this one proferred by business/management school academics. I am not convinced that the coarse gender comparison takes into account the size discrepancy in coronary arteries and other, well-known to medical practitioners, anatomico-physiological differences of human genders. I do not see any discussion of age groups in the abstract. The article is already attracting considerable attention in the electronic media and, unless further scrutiny contests its titular conclusion, may affect insurance policies. I doubt that the esteemed authors are familiar with the EuroSCORE...
Patient Care and General Interest
A New Zealand woman with cystic fibrosis who is a lung transplant recipient prepares to compete in swimming, biking, and running events in the Australian Transplant Games, held at the end of September.
China’s National Health Commission has launched a congenital heart disease screening project in 24 provincial-level regions, as part of the goal to reduce the country’s neonatal mortality rate.
A Canadian man received a new heart in the 500th heart transplant performed in British Columbia.
Research, Trials, and Funding
Researchers from the University of Maryland in the US find that the development of a subspecialized coronary surgery program resulted in improved mortality rates at their center.
If recent trends continue, researchers from Spain report that global lung cancer mortality among women could increase by over 40% by 2030.
Mitral valve procedures in the US increased by more than double the rate of cardiac procedures as a whole between 2011 and 2016, say researchers.
Researchers in Seattle, Washington, US, find that many smokers have misconceptions about lung cancer and lung cancer screening.
O’Connor and colleagues hypothesized that higher risk of posttransplant mortality in children receiving heart transplants could be predicted using patient-specific factors not currently accounted for in commonly used risk models. The authors retrospectively reviewed outcomes for 74 patients who underwent heart transplant over a six-year period in their center. They identified six risk factors: single-ventricle congenital heart disease, biventricular assist device, a history of four or more sternotomies, panel reactive antibody exceeding 10%, any previous operation at another institution, and pulmonary vein disease. After assigning a single point to each of these risk factors, a score of 4 points or more predicted posttransplant mortality with 57% sensitivity and 90% specificity.
This study shows the use of inhaled nitric oxide (NO) via noninvasive means (nasal prongs or high flow nasal cannulae) is an effective method for reduction of PV resistance. With right ventricular dysfunction becoming an increasingly recognised event after cardiac surgery, this allows for application of NO without the need for intubation.
This is a further report from the extensive dataset of the STICH Trial. This examines the impact of immediate postoperative events (length of time of intubation) on short- and long-term outcomes. If the time was >36 hours, there was significant correlation with increased mortality, both 30-day and one-year. Those included patients with mitral valve disease, renal dysfunction, advanced age, and redo coronary surgery.