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Journal and News Scan

Source: The Annals of Thoracic Surgery
Author(s): Michael P. O’Neil, Rene Alie, Linrui Ray Guo, Mary-Lee Myers, John Murkin, Chris Ellis

The authors conducted a prospective randomized study of 20 high-risk cardiac surgical patients, split into two groups:  pulsatile versus nonpulsatile flow during cardiopulmonary bypass.  Using spectral imaging and near-infrared technology, the group found that the the pulsatile perfusion group maintained better perfusion indices in the microcirculation.

Source: The Thoracic and Cardiovascular Surgeon
Author(s): Ana G. Duran, Olivia Reidell, Harald Stachelscheid, Kristin Klose, Manfred Gossen, Volkmar Falk, Wilhelm Röll, Christof Stamm

In this review article, Duran and colleagues provide an overview of pluripotent stem cell (PSC) technology and its potential for application in heart failure. The authors focus on the derivation and reprogramming of these cells for cardiac regeneration, the potential immunogenicity of cardiomyocytes reprogrammed from PSCs, and current cardiac tissue engineering research.

Source: The Annals of Thoracic Surgery
Author(s): Husain N. Alshaikh, Nevin M. Katz, Faiz Gani, Neeraja Nagarajan, Joseph K. Canner, Seema Kacker, Peter A. Najjar, Robert S. Higgins, Eric B. Schneider

The Nationwide Inpatient Sample was interrogated for all patients undergoing either CABG, valve replacement, or both from 2008 to 2011, and a total of 1,078,036 patients were included in the analysis.   The authors discovered that, overall, 9.8% of patients developed acute kidney injury (AKI) postoperatively. Other important discoveries were:

Outcome                                        non-AKI          AKI                         p  

  • Death                                     1.3%              13.9%            <0.001
  • Mean hospital cost        $38,820       $77,178        <0.001

The authors calculate that the net effect of AKI after cardiac surgery at a national level in the United States is over $1 billion annually.

Source: The Annals of Thoracic Surgery
Author(s): Louis P. Perrault, Katherine A. Kirkwood, Helena L. Chang, John C. Mullen, Brian C. Gulack, Michael Argenziano, Annetine C. Gelijns, Ravi K. Ghanta, Bryan A. Whitson, Deborah L. Williams, Nancy M. Sledz-Joyce, Brian Lima, Giampaolo Greco, Nishit Fumakia, Eric A. Rose, John D. Puskas, Eugene H. Blackstone, Richard D. Weisel, Michael E. Bowdish

The authors participated in a multi-institutional prospective study to evaluate the frequency, risk factors, and outcomes of patients who suffer mediastinal infection after cardiac surgery.  A total of 5,158 patients were enrolled, and there were 43 infections in 41 patients (0.79 cumulative incidence) occurring at a median time of 20 days after surgery.  The authors discovered the following risk factors for the development of mediastinitis: 

  • higher body mass index
  • higher creatinine
  • peripheral vascular disease
  • preoperative steroids
  • ventricular assist device or transplant surgery
  • postoperative hyperglycemia in nondiabetics

Readmission rates and mortality were five times higher in patients who developed mediastinitis.

Source: New England Journal of Medicine
Author(s): Scott J. Antonia, Augusto Villegas, Davey Daniel, David Vicente, Shuji Murakami, Rina Hui, Takashi Yokoi, Alberto Chiappori, Ki H. Lee, Maike de Wit, Byoung C. Cho, Maryam Bourhaba, Xavier Quantin, Takaaki Tokito, Tarek Mekhail, David Planchard, Young-Chul Kim, Christos S. Karapetis, Sandrine Hiret, Gyula Ostoros, Kaoru Kubota, Jhanelle E. Gray, Luis Paz-Ares, Javier de Castro Carpeño, Catherine Wadsworth, Giovanni Melillo, Haiyi Jiang, Yifan Huang, Phillip A. Dennis, and Mustafa Özgüroğlu, for the PACIFIC Investigators

This randomized trial compared chemoradiotherapy alone to chemoradiotherapy followed by consolidation therapy with the PDL-1 antibody durvalumab in patients with stage III NSCLC.  The treatment group had significantly improved progression-free survival, response rate, and overall survival, with clinically meaningful differences between the groups.  The findings suggest that such regimens may be the new standard of care in these patients.

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

Patient Care

Several charities provided free surgeries to 15 Kashmiri children with congenital heart defects at the Fortis Memorial Research Institute in Gurgaon, India.

A man in his 40s discovered that he had a rare congenital heart defect after doctors were unable to access his left coronary system via angiography.

Newborns around the US are being adorned with red hats to raise heart disease awareness during February, which is considered American Heart Month.


Drugs and Devices

The PureFlex™ line of adult arterial cannulae from LivaNova has received the CE Mark.


Research, Trials, and Funding

The first patient has been enrolled in the BELIEVE trial, a postmarket prospective study sponsored by LivaNova to evaluate leaflet motion in patients who have received a commercially approved LivaNova bioprosthetic aortic valve.

Baylor College of Medicine in Texas and the University of Kentucky recently joined the American Heart Association’s Strategically Focused Vascular Disease Research Network as part of a collaborative effort to better understand the differences in aortic disease between men and women.

Source: BMJ
Author(s): Allan Hackshaw, Joan K Morris, Sadie Boniface, Jin-Ling Tang, Dušan Milenković

This review included 55 publications covering 141 cohort studies.  The authors found that the relative risk of stroke associated with smoking just one cigarette a day was 1.25 to 1.31, and for coronary artery disease it was 1.48 to 1.57.  There is no safe level of smoking.

Source: The New England Journal of Medicine
Author(s): Mark S. Link

An editorial from an influential source discussing the recent robust results of the CASTLE-AF RCT trial. It is likely that interventions for atrial fibrillation will be boosted by these results, in terms of insurance, industry, and clinical guideline support.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Manuel J. Antunes

A brief note on the feasibility (or not) of RCT on surgery for mitral fibroelastic prolapse.

Source: European Respiratory Journal
Author(s): Herbert Decaluwé, Christophe Dooms, Xavier Benoit D'Journo, Sergi Call, David Sanchez, Benedikt Haager, Roel Beelen, Volkan Kara, Thomas Klikovits, Clemens Aigner, Kurt Tournoy, Mahmood Zahin, Johnny Moons, Geoffrey Brioude, Juan Carlos Trujillo, Walter Klepetko, Akif Turna, Bernward Passlick, Laureano Molins, Ramon Rami-Porta, Pascal Thomas, Paul De Leyn

Decaluwé and colleagues prospectively tested the capacity of preoperative staging by video-assisted mediastinoscopy (VAM) or VAM-lymphadenectomy (VAM-LA) to detect hidden mediastinal lymph node involvement in patients with non-small cell lung cancer (NSCLC). Of 105 patients with clinical N1 disease based on PET-CT imaging, one quarter eventually developed N2 disease. Patients underwent either VAM or VAM-LA, which were able to detect mediastinal node involvement with a sensitivity of 73% and accuracy of 93%. The authors suggest that VAM or VAM-LA could be a good staging approach for this group of patients.