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Journal and News Scan
September 14, 2017
Submitted by: Claire Vernon
This study details the short- and long-term outcomes for more than 3,000 patients who underwent septal myectomy for hypertrophic cardiomyopathy at the Mayo Clinic in Rochester, United States, from 1993 to 2016. In over 90% of severely symptomatic patients, relief of left ventricular outflow tract obstruction resulted in clinical improvement by at least two functional classes and reduced or eliminated symptoms of dyspnea, angina, and/or syncope.
The authors also outline outcomes for the transapical approach for basal obstruction with systolic anterior motion in 115 patients between 1993 and 2012, with all patients demonstrating postoperative gradient relief without the complication of an apical aneurysm or ventricular septal defect. These results emphasize that excellent outcomes can result from myectomy performed in experienced centers, with early mortality for isolated septal myectomy being less than 1%.
September 13, 2017
Submitted by: Claire Vernon
Remote perconditioning at the hindlimb and terminal warm blood cardioplegia provide synergistic cardioprotection for cardioplegic arrest in an in vivo piglet model.
September 12, 2017
Submitted by: Claire Vernon
Vahidkhah and colleagues used patient-specific geometry of the aortic root, ascending aorta, and coronary arteries to model blood flow near the aortic valve leaflets. The authors use this model to better understand flow-related permissive factors that might mediate leaflet thrombosis following valve replacement. Greater blood stasis was observed in the transcatheter valve-in-valve model compared to the surgical valve model, and no differences in blood stastis were modeled between coronary and noncoronary leaflets for the transcatheter valve.
CME activity related to this article is available online through The Annals of Thoracic Surgery.
September 12, 2017
Submitted by: Joel Dunning
Vets have performed life-saving heart surgery on what is believed to be the smallest dog to undergo the procedure.
Yorkshire terrier Jago was born with a heart valve defect but, at 3 lb (1.4 kg), was too small for vets in Cambridgeshire to treat. They had to wait until he was 5 lb (2.4 kg) to insert a balloon catheter.
Although specialists perform this operation, Jago is the smallest patient "to our knowledge", said vets.
The keyhole surgery took 90 minutes and cost Jago's owners Jennifer Daniels and Melita Chynoweth about £3,600.
September 12, 2017
Submitted by: Joel Dunning
This is a summary of the literature as to the prevalence of seizures in patients who have had tranexamic acid during their cardiac surgery.
September 9, 2017
Submitted by: Arie Blitz
The STS Adult Cardiac Surgery database data that had been submitted to a regional quality initiative were compared to a hospital claims database to assess what effect, if any, would supplying missing data provided by the latter affect the reported STS 30-day mortality rates. The STS database currently counts as "alive" any patient that has unknown status at 30 days.
Findings:
- An excessive 22% of patients had unknown 30-day mortality status.
- The missing data was able to be reduced down to 7% by incorporating the data from the hospital claims database.
- Finally, the study found that, if the external data for CABG patients were included for these hospitals, the true 30-day mortality observed/expected ratio would be increased to 1.30 from 1.27. Thus, at present, the current method for reporting STS data underestimates the true 30-day mortality.
Should centers make an effort to include missing data provided from external administrative databases in order to improve the accuracy of STS reported outcomes? Should STS mandate such an inclusion of data?
September 9, 2017
Submitted by: Benjamin Bidstrup
The authors have concluded from a meta-analysis of over 45,000 patients, mitral regurgitation in the presence of LV dysfunction (either ischaemic cardiomyopathy or idiopathic causes) is, not surprisingly, associated with reduced survival. Whether this is due to the underlying myopathic process or the MR per se is not clear. Likely MR is a marker of LV dysfunction. The authors refer to the lack of proof that correction of MR improves outcomes in this subset of patients.
September 8, 2017
Submitted by: Claire Vernon
Patient Care
Natural disasters, such as hurricanes and earthquakes, disrupt many aspects of daily life. How do medical teams respond to the disruption of cardiac care?
Pediatric surgeons at Jehangir Hospital in Pune, India, removed a pleuropulmonary blastoma type-II tumor from a toddler.
Drugs and Devices
The US Food and Drug Administration approved a new, lower dose of the endothelin receptor antagonist bosentan for congenital pulmonary arterial hypertension in pediatric patients.
NaviGate reported the investigational implantation of its size-52 mm Gate tricuspid atrioventricular valved stent into a patient’s transplanted heart at the University of Padua, Italy.
Research, Trials, and Funding
Researchers in Texas, USA, have developed a handheld mass spectrometry “pen” for rapid, nondestructive, intraoperative diagnosis of cancer tissues.
Protembis reported the first in-human use, as part of a European trial, of its next generation cerebral-focused embolic protection device, the ProtEmboTM System, at Galway University Hospital in Ireland.
September 8, 2017
Submitted by: Claire Vernon
The authors describe a new technique for localization of very small, non-visible, and non-palpable pulmonary lesions for video-assisted thoracoscopic sublobular resection.
September 7, 2017
Submitted by: Claire Vernon
Murashita and colleagues reviewed the surgical outcomes of patients with intraoperatively-confirmed constrictive pericarditis. The authors divided patients into a historical group (1936- 1990) and a contemporary group (1990-2013) to compare patient presentation and analyze risk factors for negative outcomes. The etiology of pericarditis was known in nearly half of contemporary cases, as opposed to fewer than 20% of historical cases. Long-term outcomes were similar between the groups when patient characteristics were controlled for.
CME activity related to this article is available online.