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Journal and News Scan
August 17, 2017
Submitted by: Joel Dunning
Jimmy Kimmel's son was born with Tetralogy of Fallot with pulmonary atresia. He had emergency surgery at the Children’s Hospital Los Angeles in the first week of his life, and this video describes the operation and he goes on to thank all the medical staff who helped in the baby's care. This video has had 11 million hits. Well done, everyone involved in this case.
August 17, 2017
Submitted by: Mark Ferguson
Many of the adverse events that occur in hospitals are a result of human error. The authors describe a system for use in the OR that collects and collates intraoperative data feeds, including patient and OR team physiological parameters, audiovisual content, and environmental factors. The data are analyzed to assist in proactive assessment of risks, support root cause analyses, facilitate team training, assess efficiency, and help in evaluation of surgical technology. This technologica approach may reflect our work environment in the future.
August 17, 2017
Submitted by: Mark Ferguson
In this study of low volume surgeons (defined as performing fewer than 1 index operation annually) the authors studied outcomes in New York state for open AAA repair (OAR) and carotid endarterectomy (CEA). About 50% of surgeons performing these operations were low volume surgeons. Low volume surgeons had higher rates of operative mortality for OAR (OR 2.09; 95% CI 1.41 - 3.08) and of postoperative MI (OR 1.83; 1.03 - 3.26) and stroke (OR 1.78; 1.21 - 2.62) for CEA. Health care resource utilization was higher for low volume surgeons for OAR and CEA.
August 17, 2017
Submitted by: Mark Ferguson
This editorial outlines the changing legal landscape for device manufacturers. The authors discuss a recent legal judgment against Intuitive (da Vinci robot) that found the company failed to notify a hospital regarding a new robot user, indicating that Intuitive held responsibility for ensuring safe implementation of their systems in clinical settings.
August 17, 2017
Submitted by: Mark Ferguson
The 5-year outcomes of a Veterans Affairs trial of off-pump vs on-pump CABG are reported. Mortality in the off-pump group was 15.2% compared to 11.9% in the on-pump group (RR 1.28; p=0.02). Composite adverse events were more common in the off-pump group (31.0% vs 27.1%; RR 1.14; p=0.046). Repeat CABG was more common for the off-pump group (1.4% vs 0.5%; p=0.02). No differences were observed in nonfatal MI, death from cardiac causes, or repeat revascularization.
August 17, 2017
Submitted by: Arie Blitz
The Yale group retrospectively reviewed their experience with DeBakey type I aortic dissections to evaluate whether patients with bovine aortic arches had a unique distribution of entry sites and differential outcomes. A total of 315 patients were included in the study, of which 49 (16%) had a bovine aortic arch. The authors found that those patients with bovine aortic arches were 6 times more likely to have arch tears and 2.7 times more likely to suffer a stroke as those without bovine aortic arches.
August 17, 2017
Submitted by: Arie Blitz
The Cleveland Clinic group performed a randomized clinical trial comparing transfusion triggers of 24% vs. 28% from 2007-2014. The study included 722 patients who underwent either CABG or valve surgery. While the lower trigger group received fewer transfusions, adverse outcomes did not differ between the groups. Because the lower trigger group had equivalent outcomes but fewer transfusions, the authors recommend using a lower trigger perioperatively.
August 15, 2017
Submitted by: Joel Dunning
In an era of VATS surgery this is a very interesting article documenting advanced in thoracotomy and open chest surgery.
It shows us that open surgeons are also significantly improving their techniques, and the very large postero-lateral thoracotomy with rib cutting and costo-transverse ligament division may in most cases be replaced by muscle sparing and smaller incision techniques while still allowing a full open operation.
This is a very courageous and interesting article, and we should all acknowledge that modern thoracotomy is very different from the thoracotomies of the past.
Well done Dr Navarro.
August 11, 2017
Submitted by: Claire Vernon
Patient Care
A heart team at Kingston Health Sciences Centre in Ontario performs the first hybrid cardiac ablation for atrial fibrillation in Canada.
A five-year-old boy from Newcastle, South Africa, is among the youngest and smallest people to receive a heart ventricular assist device.
Surgical teams in Armenia already use minimally invasive procedures in the abdominal cavity, and they will soon add them to their arsenal of tools for treating lung cancer.
A cardiac surgery resident in Edmonton, Canada, has designed paper toys that help teach pediatric patients about their hearts and hospital stays.
News outlets highlight athletic successes of transplant patients including a cyclist from Fairlie, United Kingdom, and a swimmer from Michigan, USA, who medaled in the World Transplant Games in Málaga, Spain.
Two paramedics in New York, USA, responded immediately when a nurse suffered a cardiac arrest in their home during a postsurgical follow-up visit.
Drugs and Devices
Surgeons have implanted the first Biostage Cellspan esophageal implant, in which a patient’s stem cells are seeded onto an esophageal scaffold.
Research, Trials, and Funding
Physicians from the Cleveland Clinic in Ohio wrote a letter to the New England Journal of Medicine where they report a decrease in nitroprusside and isoproterenol usage at 47 US hospitals following price hikes in the cost of each drug.
A highly-detailed, 3D representation of the cardiac conduction system in the intact human heart is published in Scientific Reports.
The University of Maryland School of Medicine has received a grant to establish the first cardiac xenotransplantation research center in the USA.
August 11, 2017
Submitted by: Mark Ferguson
This prospective study evaluated whether intraoperative molecular imaging (IMI) with a folate receptor targeted contrast agent visible in the near-infrared spectrum improved the detection of peripheral malignant lung nodules. Fifty patients undergoing surgery for peripheral nodules had a preoperative PET scan and were imaged intraoperatively. IMI identified 95% of nodules and 9 additional lesions not seen preoperatively. IMI sensitivity was greater than that of PET (96% vs 74%) and had a greater positive predictive value (94% vs 89%). IMI improved management in 30% of patients.