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Journal and News Scan
All about James Hello, my name is James Lewis. I am 4 years old. I have been waiting for a heart transplant for 9 months. I have a heart condition called restrictive cardiomyopathy, which means that my heart does not work properly anymore. My Mummy, Kate is going to tell my story.
In July 2013, out of the blue, we had the shocking news no parent ever wants to hear. Our youngest son James was diagnosed with restrictive cardiomyopathy and at best might live for another two years or so. The only option would be a heart transplant. I said to the consultant, how can I pray for a new heart for James when someone else has to lose a child?
We went to meet the transplant team at Great Ormond Street Children's Hospital, and soon learnt that even with a successful heart transplant, James' journey would likely be shorter than you would hope, that the average life expectancy is 15-20 years. But we decided that life is for living, and that James could have a remarkable, if shorter life.
I decided at that point that I wanted to make something positive happen out of a very scary and unpredictable situation. It became apparent that there is a massive shortage of child donors, and I want to raise awareness about this.
- In 2012, 48% of parents asked to donate their child's organs said no.
- 97% people would take an organ if they needed one, yet only around a third of people are signed up to the organ donor register.
Many parents do not realise that they can sign their children up to the organ donor register.
Children are very receptive to the idea of organ donation. They see it as recycling. For parents who bravely say yes, in a terrible, traumatic situation of losing their child, they have the knowledge that their child has not died in vain.
One person's donated organs can save the lives of 7 others, and transform the lives of another 2 people.
I have been working with a charity called Live Life Then Give Life www.lltgl.org to raise awareness about organ donation, particularly in children. The work we are doing is part of the Let Love Live On campaign. Every child is part of a family, organ donation affects everyone.
In this review, the authors describe alternative treatments for hypertrophic cardiomyopathy (HCM). The most important evidence comparing alcohol septal ablation (ASA) and surgical myectomy is discussed. The authors conclude that surgery is most consistent in achieving optimal hemodynamic results, quality of life and longevity. ASA however is a good alternative in older patients with more comorbidities.
The Heart and Lung Transplant team of St. Vincent’s hospital (Sydney, Australia) have successfully transplanted “dead” hearts into three patients. The donor hearts had stopped beating for 20 minutes, but were kept viable by being immersed in a preservation solution. The hearts were then restarted and kept beating in a specially developed circuit, called a “heart in a box.”
Retrospective study on 102 consecutive asymptomatic or mildly symptomatic patients with no left ventricular dysfunction and with degenerative mitral regurgitation (MR) who underwent mitral valve surgery in three centers. The authors looked into the usefulness of exercise stress echocardiography in this group of patients to predict postoperative cardiovascular events. The findings show that the development of exercise-induced pulmonary hypertension (PHT) is a major risk factor for cardiovascular events following mitral valve surgery, regardless of symptom onset during the preoperative course. The results of this study suggest that asymptomatic patients with exercise-induced PHT may benefit from early elective surgical intervention.
The authors of this piece summarize how surgery has changed over the past decades. They do this using the mnemonic: TWO POEMS:
Teamwork, Work hours,Outcomes, Patient-centered care, Outpatient, Expense, Minimally invasive, Simulation and education.
In this study the authors evaluate the prevalence of significant aortic stenosis (diagnosed with echocardiography and computed tomography) in the elderly, in a cohort representative of the general population of Iceland. Based on their findings, the authors conclude that the number of elderly patients with severe AS will greatly increase in the coming decades. The current study shows that the largest increase will be in the population of 70 years of age and older, both in men and in women.
This survey of publicly available information on LVAD for patients considering such therapy identified numerous flaws in the materials. All discussed benefits, few discussed surgical issues, quality of life, and complications. Some had outdated statistics, some were written above a 3rd grade level, and most did not meet international standards. The perception among patients was that the materials were strongly biased towards LVAD therapy.
In this paper, the authors aim to further understand the factors associated with vein graft failure (VGF) after CABG. They used data on 1828 participants in the PREVENT IV trial to identify patient and surgical factors associated with VGF. They found that longer surgical duration, endoscopic vein harvesting, poor target artery quality and postoperative clopidogrel use were independently associated with VGF. These findings will help identifying patients at high risk of VGF, as well as helping to develop interventions with lower rates of VGF.
In this manuscript, the authors use meta-analysis techniques to evaluate the relationship between measured coronary fractional flow reserve (FFR) and patients’ outcomes. They demonstrate that FFR provides a continuous and independent marker of subsequent MACE as modulated by treatment (medical therapy vs revascularization) in a broad range of clinical scenarios. Lesions with lower FFR values receive larger absolute benefits from PCI or CABG. When FFR values are high, we can do harm by proceeding with revascularization. The cut-point for determining revascularization strategy using this statistical analysis remains in the 0.75-0.80 range, which is in keeping with previous reports on this subject. According to the findings, the authors conclude that an FFR-guided revascularization strategy significantly reduces MACE and increases freedom from angina with less PCI or CABG than an anatomy-based strategy.
In a retrospective cohort study of patients less than 18 years old who underwent cardiopulmonary bypass, intraoperative hemodynamics and vasopressor use were compared between patients who received preoperative ACE inhibitor/ARB therapy and those who did not. Use of preoperative ACE inhibitors and ARBs in pediatric patients undergoing cardiac surgery did not increase the incidence of hypotension after induction of anesthesia and did not increase vasoconstrictor requirements upon weaning from cardiopulmonary bypass.