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Journal and News Scan

Source: Journal of Cardiac Surgery
Author(s): Garrett N. Coyan, Edgar Aranda‐Michel, Ibrahim Sultan, Thomas G. Gleason, Forozan Navid, Danny Chu, Michael S. Sharbaugh, Arman Kilic

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.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Martin Czerny, Jürg Schmidli, Sabine Adler, Jos C van den Berg, Luca Bertoglio, Thierry Carrel, Roberto Chiesa, Rachel E Clough, Balthasar Eberle, Christian Etz, Martin Grabenwöger, Stephan Haulon, Heinz Jakob, Fabian A Kari, Carlos A Mestres, Davide Pacini, Timothy Resch, Bartosz Rylski, Florian Schoenhoff, Malakh Shrestha, Hendrik von Tengg-Kobligk, Konstantinos Tsagakis, Thomas R Wyss, EACTS/ESVS scientific document group

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:

Source: European Journal of Cardio-Thoracic Surgery
Author(s): In Kyu Park, Kwanyong Hyun, Eung Re Kim, Samina Park, Chang Hyun Kang, Young Tae Kim

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.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Daniel JFM Thuijs, Stuart J Head, Gregg W Stone, John D Puskas, David P Taggart, Patrick W Serruys, Ovidiu Dressler, Aaron Crowley, W Morris Brown III, Ferenc Horkay, Piet W Boonstra, Gabor Bogáts, Nicolas Noiseux, Joseph F Sabik III, A Pieter Kappetein

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.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Mario Gaudino, Stephen Fremes, Philippe Kohl

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.

Source: News from around the web.
Author(s): Claire Vernon

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.

Source: Interactive Cardiovascular and Thoracic Surgery
Author(s): Ivan Netuka

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.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Yosuke Inoue, Hitoshi Matsuda, Atsushi Omura, Yoshimasa Seike, Kyokun Uehara, Hiroaki Sasaki, Junjiro Kobayashi

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.

Source: The Annals of Thoracic Surgery
Author(s): Katherine R. Hebeler, Heike Baumgarten, John J. Squiers, Jordan Wooley, Benjamin D. Pollock, Cecile Mahoney, Giovanni Filardo, Brian Lima, J. Michael DiMaio

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.

Source: US Food & Drug Administration
Author(s): US Food & Drug Administration

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.