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Journal and News Scan
We urgently need more answers for the patients affected by mesothelioma, a devastating diasese whose prognosis is 6-9 months from the diagnosis. We are now living the era of plateau of the epidemiology due to industrial use of amiantus of the last century. Furthermore, there are other etiology than asbestos in endemic areas, like for example the natural exposure to fluoro-edenite of certain regions of Japan and Sicily. We do need more informatinos to direct the difficult management of all these individuals and there are many ongoing studies where surgery is considered a valid option. This trial will compare the outcome of 2 groups: the first group will have a debulking surgery and hyperthermic intraoperative intrathoracic chemotherapy (HITHOC) with cisplatinum while the second group will receive talc pleurodesis alone. The primary outcomes measured will be length of hospital stay, quality of life, and long-term survival.
This single institution observational study compares clinical outcomes and resource utilization associated with two surgical approaches for single-stage repair of coarctation of the aorta and ventricular septal defect. Authors found that single-stage two-incision repair of both defects in appropriately selected patients may be associated with higher value of care compared to single-stage one incision repair.
The authors queried the UNOS heart transplantation database to determine if LVAD device-related complications (DRCs) were associated with worse postoperative graft survival. The 5 categories of DRCs were as follows: device thrombosis, infection, device malfunction, life-threatening arrhythmias, and others.
Results: None of the 5 categories of DRCs was associated with worse graft survival on multivariate analysis.
In this study the authors randomized 142 patients within two separate treatment arms: (1) Patients undergoing on-pump CABG were randomized to either a single- vs. double-clamp technique for proximals; (2) patients undergiong OPCAB were randomized to either a Heartstring device or single clamp for proximals. For all 4 treatment groups, the number of embolic HITS was assessed with transcranial doppler of the middle cerebral artery.
(1) On-pump CABG: The mean number of HITS in the single-clamp group was 10.0, while that for the double-clamp group was 16.0 (p=.10). (Although the difference was not significant, the treatment groups were rather small.)
(2) OPCAB: The mean number of HITS in the Heartstring group was 30.0, whereas that for the partial clamp group was 7.0 (p<.0001). Thus, the Heartstring group had more than 4 times the embolic load by TCD.
Notably, neurocognitive outcomes were not different among the groups.
Three more UK surgical centers will introduce heart transplants from non-heart beating donors. In the UK, this procedure is currently only performed at three hospitals, where it benefits patients such as this sports enthusiast.
The Montreal Heart Institute in Canada has a new surgical robot dedicated to CABG and mitral valve surgery.
Drugs and Devices
Neovasc Inc. released an update on the performance of its self-expanding mitral bioprosthesis, the TiaraTM valve, which is being implanted in several European and US centers as part of three parallel investigational programs.
The European Medicines Agency and the European Center for Disease Control and Prevention will host a meeting to discuss the threat of antimicrobial resistance and how they can support efforts to combat this threat.
Research, Trials, and Funding
Researchers from France analyzed data from the US Nurses’ Health Study II, finding a correlation between exposure to disinfectants and development of COPD.
Chinese researchers have published a case study on closing aortic anastomosis leaks with a transcatheter approach.
A study of a Swedish national database matched sibling pairs to further investigate the relationship between height and likelihood of venous thromboembolism.
Minimally Invasive Lobectomy for Lung Cancer is the latest installment in the Society’s webinar series on quality initiatives. The webinar features Drs Bill R. Burfeind Jr (moderator), Thomas A. D’Amico, Todd L. Demmy, Mark W. Onaitis, and Shari L. Meyerson.
Watch 47 minutes of the world's experts talking about this technique
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%.
Remote perconditioning at the hindlimb and terminal warm blood cardioplegia provide synergistic cardioprotection for cardioplegic arrest in an in vivo piglet model.
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.