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Journal and News Scan
In this editorial, Ikonomidis et al not only describe the challenges but also provide specific actionable steps towards improving the retention as well as clinical, academic, and personal success of cardiothoracic surgeon-scientists.
- High clinical, academic, and administrative demands
- Steep competition for extramural funding
- Lack of protected time
- Lack of institutional and departmental support
Action plan includes:
- Lead by example, formal training, mentorship and institutional support
- Institute faculty start-up/support plans including funding and laboratory space that is readily accessible and locally available
- Implement protected paid time for research that is truly protected from clinical duties
- Make research productivity financially incentivized and recognized. Incorporate research productivity into the compensation plan and promotion metrics
- Disseminate opportunities
This retrospective study by Sedeek et al aimed to compare the outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) valve-in-valve (n=90) versus surgical replacement (SAVR) (n=260) of failing stented aortic biological valves in a cohort of 350 patients . They demonstrated that despite the TAVR-in-valve cohort being older and having a higher prevalence of comorbidities and STS PROM, they had fewer perioperative complications and shorter hospital stay; however, patient-to-prosthesis mismatch was more common after TAVR-in-valve (44% vs SAVR 12%, P < .001). Overall, their results suggest that TAVR valve-in-valve and repeat SAVR have comparable operative and mid-term mortality, with SAVR being associated with a superior hemodynamic profile compared to TAVR valve-in-valve with less patient-to-prosthesis mismatch.
Patient Care and General Interest
The American Heart Association published a statement advocating for a holistic care approach for patients with Fontan circulation, noting that these patients are living longer and their unique long-term care needs are being better understood.
A judge in the USA has ordered e-cigarette companies to submit their products for review by the US Food and Drug Administration (FDA) by May 2020.
Drugs and Devices
Edwards Lifesciences as issued a warning related to the risk of a burst balloon during implantation of its Sapien 3 Ultra valve, emphasizing that the instructions for use should be closely followed to avoid this problem.
The US FDA has issued an alert that Edwards Lifesciences recalled the IntraClude intra-aortic occlusion device.
Targeted therapies for EGFR mutation–positive non–small cell lung cancer were added to the updated Essential Medicines List from the World Health Organization, but other lung cancer therapies were considered and rejected.
Research, Trials, and Funding
Investigators from Kansas City, Missouri, USA, report a relationship between institutional volume and outcomes of MitraClip placement up to 50 procedures, but continued improvement was observed beyond this number.
A group at University of Utah Health in the USA is aiming to improve outcomes of refractory cardiogenic shock with a multidisciplinary “Shock Team,” comprised of a cardiothoracic surgeon, a heart failure cardiologist, an interventional cardiologist, and an intensive care unit physician.
Henry and colleagues evaluated frailty in patients undergoing cardiac surgery using two frailty indices, the simplified Study of Osteoporotic Fractures (SOF) and the complex Cardiovascular Health Study (CHS), comparing postsurgical outcomes between frail and nonfrail patients. Agreement between the two indices was poor. Of 167 total patients, the SOF identified 15 as frail while the CHS identified 47. SOF frail patients were in poorer health, had higher risk scores, and greater proportions reported lack of energy and unintentional weight loss. Additionally, SOF frail patients were more likely to experience prolonged ventilation, pneumonia, prolonged time in the intensive care unit, and readmission within 30 days.
Google Scholar has released the 2019 version of Scholar Metrics just now. This release covers articles published in 2014–2018 and includes citations from all articles that were indexed in Google Scholar as of July 2019.
Below is the top 20 journals in the field of cardio-thoracic surgery (https://scholar.google.com/citations?view_op=top_venues&hl=en&vq=med_heartthoracicsurgery). The two metrics in the bracket are the h5-index and h5-median, which are the h-index for articles published in the last 5 complete years and the median number of citations for the articles that make up its h5-index.
- The Journal of Thoracic and Cardiovascular Surgery (63, 82)
- The Annals of Thoracic Surgery (58, 74)
- European Journal of Cardio-Thoracic Surgery (54, 76)
- Interactive CardioVascular and Thoracic Surgery (35, 49)
- Annals of Cardiothoracic Surgery (31, 50)
- Journal of Cardiothoracic Surgery (27, 35)
- The Thoracic and Cardiovascular Surgeon (22, 33)
- Thoracic Surgery Clinics (22, 33)
- Perfusion (22, 30)
- General Thoracic and Cardiovascular Surgery (21, 31)
- Journal of Cardiac Surgery (21, 28)
- Annals of thoracic and cardiovascular surgery (19, 22)
- Seminars in Thoracic and Cardiovascular Surgery (17, 24)
- Asian Cardiovascular and Thoracic Annals (17, 22)
- Annals of Cardiothoracic Surgery (16, 28)
- Revista Brasileira de Cirurgia Cardiovascular (16, 25)
- World Journal for Pediatric and Congenital Heart Surgery (16, 24)
- Seminars in Cardiothoracic and Vascular Anesthesia (16, 22)
- Innovations (16, 20)
- Scandinavian Cardiovascular Journal (16, 18)
A seperate list is provided for top journals in the field of Vascular Medicine, which is availabe at: https://scholar.google.com/citations?view_op=top_venues&hl=en&vq=med_vascularmedicine
This meta-analysis included 70 articles reporting on more than 100,000 patients who underwent surgical aortic valve replacement. The incidence of patient-prosthesis mismatch (PPM) was 53.7%. Moderate and severe PPM was associated with higher mortality, both early and late after surgery. The authors conclude that the implementation of surgical strategies to prevent PPM are important in order to reduce mortality rates.
In this editorial, Harrington and coauthors introduce the updated guidelines for statistical reporting in the New England Journal of Medicine, which can be accessed at https://www.nejm.org/author-center/new-manuscripts.
The authors went into detail about the requirement to replace P values with estimates of effects or association and 95% confidence intervals when neither the protocol nor the statistical analysis plan has specified methods used to adjust for multiplicity.
Abbott announced that its fourth-generation MitraClip device, MitraClip G4, was approved by the US Food and Drug Administration on July 15, 2019, to treat mitral regurgitation (MR) in a wider population of patients. The MitraClip G4 include new clip sizes and an enhanced leaflet grasping feature
- More flexibility with four unique clip sizes, including clips with a wider grasping area to provide additional treatment options
- Independently controlled grippers that better help with the grasp of one or both mitral leaflets during transcatheter mitral valve interventions
- Upgraded MitraClip catheter can be integrated with a commercially available pressure monitor to continuously track and confirm MR reduction during the implant procedure
Aortic valve repair is complex, and techniques must be tailored to the pathology. With this in mind, the author summarizes his core philosophy on aortic valve repair in 10 points:
- Be prepared!
- Know the geometry of the aortic valve
- Understand the echocardiographic analysis of the aortic valve
- Do not trust looks!
- Identify suitable substrates
- Keep the repair simple and reproducible
- Assess the repair result systematically
- Carefully consider the alternatives
- Follow your patients/Learn from your failures
- Share your results
Each point is discussed in more depth in this editorial.
Investigators reported the distribution of thoracic aortic growth in smokers based on longitudinal data of current and ex-smokers aged 50-70 years from the Danish Lung Cancer Screening Trial. Mean and 95th percentile of annual aortic growth of the ascending aortic and descending aortic diameters were calculated with the first and last noncontrast computed tomography scans during follow-up.
A total of 1,987 participants (56% male, mean age 57.4 ± 4.8 years) were included and followed for a median of 48 months. The ascending and descending aortic growth was approximately 0.1 mm/year and consistent with growth in the general population. The 95th percentile ranged from 0.42 to 0.47 mm/year, depending on sex and location. Larger aortic growth was associated with lower age, increased height, absence of medication for hypertension or hypercholesterolemia, and lower Agatston scores.