This site is not optimized for Internet Explorer 8 (or older).
Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.
Journal and News Scan
Coyan and colleagues report outcomes following double valve surgery in a cohort of patients who underwent operation between 2011 and 2017. Mitral repair was associated with better perioperative outcomes than mitral replacement when performed concomitantly with aortic valve replacement, though the authors note that differences in underlying comorbidities between the groups could have contributed to this result. Longer term outcomes were comparable between mitral repair and replacement.
Essential reading, paying particular attention to the table in Section 7: the European experts recommend, again, that in Marfan and other systematic connective tissue diseases conventional techniques are still advantageous because the landing zones will eventually degenerate.
Jointly published in the European Journal of Vascular and Endovascular Surgery at: https://doi.org/10.1016/j.ejvs.2018.09.016
Park and colleagues genotyped cancer tissue for epidermal growth factor receptor (EGFR) mutations in patients with complete resection for lung adenocarcinoma who had a recurrence. Lung adenocarcinoma with EGFR gene mutations was associated with a longer disease-free interval than was the wild-type EGFR gene. Additionally, EGFR gene mutation was a prognostic factor for disease-free interval.
The EXCEL is one of several prospective studies that examine the use of single versus bilateral internal thoracic artery (ITA) grafts for myocardial revascularization (in this case, compared with percutaneous coronary intervention) for left main disease. This did not show differences in the surgical population (905 patients) between one and two ITA grafts with regard to mortality and DSWI. There are significant limitations in the patient allocation process that make the value of these outcomes less than helpful.
Once again, analyses of studies that are ostensibly well-designed randomized controlled trials have limitations that do not answer the question at hand: are two-arterial CABGs better than one? This editorial comments on a publication regarding the EXCEL Study, which showed no differences at 3 years.
Patient Care and General Interest
Surgeons at the Cleveland Clinic Abu Dhabi in the UAE used a metal stent for an emergency repair of a patient’s windpipe, which had been completely severed in a traffic accident.
A report from the UK Lung Cancer Coalition says that geographic variation persists despite improvements in 5-year survival rates for lung cancer in the UK.
Drugs and Devices
Medtronic has received the CE Mark for its Valiant Navion™ thoracic stent graft system, a low-profile thoracic stent for patients with small iliac arteries and other anatomic variations.
Research, Trials, and Funding
Physicians in Ontario, Canada, evaluate in-hospital counseling and surgery for injection drug users with endocarditis, finding that both reduce mortality in these patients.
Researchers at Stanford University in California are matching donor and pediatric recipient heart volumes using CT scans, rather than relying on height and weight to determine if a child could accept a particular donor heart.
At the recent meeting of the American Heart Association, researchers from Germany reported similar rates of major adverse cardiovascular events and major bleeding for patients taking either ticagrelor or aspirin after coronary artery bypass.
Netuka provides several important technical nuances to consider when implanting the HeartMate 3 left heart assist device. He focuses on apical cuff attachment, optimal positioning of the pump in the pericardial cavity, and positioning of the outflow graft. Furthermore, he describes alternative surgical implantation strategies for minimizing invasiveness.
Patent descending aortic false lumen in type A dissection is associated with limited long-term outcomes. Inoue and colleagues aimed to evaluate the efficacy of their group’s strategy for these patients. Among 290 patients with type A aortic dissection and patent false lumen at the descending aorta, 124 underwent ascending aortic replacement and 166 additional total aortic arch replacement. Total aortic arch replacement was associated with better freedom from descending aortic aneurysm. There was no difference in in-hospital mortality between the groups.
Hebeler and colleagues hypothesized that the inclusion of measures of frailty might improve the prediction of mortality one-year after transcatheter aortic valve replacement (TAVR). In 470 patients undergoing TAVR, sarcopenia was measured and frailty was assessed preoperatively by gait speed, hand grip strength, serum albumin, and Katz activities of daily living. The addition of both sarcopenia and frailty measures to the STS Predicted Risk of Mortality improved the predictive capacity of the model (area under the curve of 0.61 versus 0.52), and albumin was the only marker that was significantly associated with an increased one-year mortality risk.
On November 26, 2018, FDA Commissioner Scott Gottlieb, MD, and Director of the Center for Devices and Radiological Health Jeff Shuren, MD, announced proposed changes intended to modernize the 510(k) clearance pathway to keep pace with the increasing complexity of rapidly evolving technology. The FDA is planning to rename this new approach the “Safety and Performance Based Pathway” to reflect its focus on advancing improved safety and performance of new low-risk to moderate-risk products. It is an alternative pathway to substantial equivalence that will provide more direct evidence of the safety and performance of a device and better information for patients and providers to make well-informed health care decisions. This new approach may also drive greater market competition to develop safer devices.