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Journal and News Scan

Source: Annals of Cardiothoracic Surgery
Author(s): Mohamed Rahouma, Ahmed Abouarab, Antonino Di Franco, Jeremy R. Leonard, Christopher Lau, Mohamed Kamel, Lucas B. Ohmes, Leonard N. Girardi, Mario Gaudino

Meta-analysis of composite death/myocardial infarction/stroke/repeat revascularization outcome in 4700 patients across six randomized controlled trials is presented. Percutaneous coronary intervention was associated with a higher risk of the composite outcome in all SYNTAX score tertiles as well as increased risk of repeat revascularization. Additionally, no difference was shown between bare metal stent and drug eluting stents on a sub-group analysis.

Source: The New England Journal of Medicine
Author(s): Gregg W. Stone, JoAnn Lindenfeld, William T. Abraham, Saibal Kar, D. Scott Lim, Jacob M. Mishell, Brian Whisenant, Paul A. Grayburn, Michael Rinaldi, Samir R. Kapadia, Vivek Rajagopal, Ian J. Sarembock, Andreas Brieke, Steven O. Marx, David J. Cohen, Neil J. Weissman, and Michael J. Mack for the COAPT Investigators

This multicenter study evaluated the efficacy of medical therapy plus transcatheter valve repair (MitraClip) to medical therapy alone for heart failure accompanied by secondary moderate to severe mitral regurgitation. The device group experienced significantly fewer hospitalizations and lower mortality at 24 months follow-up. 

Source: The New England Journal of Medicine
Author(s): Scott J. Antonia, Augusto Villegas, Davey Daniel, David Vicente, Shuji Murakami, Rina Hui, Takayasu Kurata, 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, Corinne Faivre-Finn, Martin Reck, Johan Vansteenkiste, David R. Spigel, Catherine Wadsworth, Giovanni Melillo, Maria Taboada, Phillip A. Dennis, Mustafa Özgüroğlu for the PACIFIC Investigators

This comprises the eagerly anticipated summary of the second primary endpoint of the PACIFIC trial of Durvalumab vs placebo in patients who completed CT/RT without progression for unresectable stage III NSCLC. Durvalumab significantly improved overall survival, progression free survival, and time to distant metastasis or death. No new safety concerns were raised.

Source: News from around the web.
Author(s): Emily Robinson

Patient Care and General Interest

A man who received quintuple bypass surgery in Little Rock, Arkansas, USA, plans to cycle a 50-mile race only two months later.

A woman in Denver, Colorado, USA, was told she had 6-9 months to live after being diagnosed with Stage 3 lung cancer; however, after participating in clinical trials for lung cancer treatment, she is doing well 10 years later.


Drugs and Devices

A hospital in New Jersey, USA, is testing an artificial intelligence device designed to detect bleeding during endovascular procedures.

The US Food and Drug Administration has approved the PK Papyrus covered coronary stent system for the treatment of acute coronary artery perforations during PCI, the first device to be approved for this indication in 17 years.

A study by the New York University School of Medicine in New York City suggests that an artificial intelligence tool can diagnose non-small cell lung cancer types with 97 percent accuracy.


Research, Trials, and Funding

A paper published in the Irish Journal of Medical Science indicates that undetected cases of high cholesterol are adding to the incidence of cardiovascular disease, which is the greatest cause of death in Ireland.

A Journal of the American College of Cardiology study of off-pump versus on-pump CABG suggests that the on-pump approach provides superior long-term survival.  

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Chin L Poh, Edward Buratto, Marco Larobina, Rochelle Wynne, Michael O’Keefe, John Goldblatt, James Tatoulis, Peter D Skillington

Poh and colleagues analyzed the results of the Ross procedure in 129 patients with bicuspid aortic valve and pure aortic regurgitation. The mean age at surgery was 34.7 ± 10.6 years and mean length of follow-up was 9.6 ± 6.8 years. Late survival at 10 and 20 years after surgery were 99% and 95%, respectively, and aortic valve redo surgery was necessary in 11 patients. Longer aortic cross-clamp and cardiopulmonary bypass times and larger preoperative sinotubular junction diameter were predictors of having redo aortic valve surgery.

Source: Annals of Cardiothoracic Surgery
Author(s): Cristiano Spadaccio, Umberto Benedetto

This comphrensive review by Spadaccio and Benedetto try to address the unanswered question: to stent or not to stent?

The conclusions underline that the higher cerebrovascular risks associated with surgery are still overcome by long term outcome.

Source: The Annals of Thoracic Surgery
Author(s): Adam N. Protos, Jaimin R. Trivedi, William M. Whited, Michael P. Rogers, Ugochukwu Owolabi, Kendra J. Grubb, Kristen Sell-Dottin, Mark S. Slaughter

Management of tricuspid endocarditis in this single institution study of 63 patients included repair, replacement, and excision. Repair patients were older and sicker. Acute outcomes were similar among the groups. Valvectomy patients had a lower rate of readmission during the first postoperative year, highlighting this approach as a useful strategy for identifying eventual candidates for valve replacement.

Source: The New York Times
Author(s): Denise Grady

A New York Times journalist travels with Team Heart, a nonprofit organization providing humanitarian heart surgery for rheumatic disease in Rwanda. In addition to highlighting the overwhelming need, her perspective illuminates some harsh realities of these efforts in resource-poor countries. Examples include the cultural repercussions of mechanical valves in females of childbearing age and the challenging surgical judgment required when operating on patients who are sick enough to warrant surgery, yet not too sick to survive in the context of limited perioperative support. Dr. Ralph Bolman III, Dr. Thoralf Sundt, and Dr. Bruce Leavitt are among the physicians participating in the effort and featured story.

Source: World Journal for Pediatric and Congenital Heart Surgery
Author(s): Karthik V. Ramakrishnan, David Zurakowski, William Pastor, Richard A. Jonas, Pranava Sinha

This study compares the early outcomes and hospital charges associated with early primary repair vs systemic-to-pulmonary artery shunt for neonates and young infants. The Pediatric Health Information System database was queried for patients <90 days of age with primary diagnosis of tetralogy of Fallot who underwent nonelective surgical repair or palliation between January 2008 and December 2014. The initial cohort of 821 patients (group 1 early primary repair, N = 554; group 2 systemic-to-pulmonary artery shunt, N = 267) was propensity score matched (248 patients in each group) to account for baseline imbalances in age and prostaglandin use. The analysis suggests that the two approaches are comparable with regard to morbidity, mortality and hospital resource utilization. The article is accompanied by separate Invited Commentaries, by Emile Bacha, MD and by Yves D’Udekem, MD, PhD.

Source: Journal of the American College of Cardiology
Author(s): Ron Waksman, Toby Rogers, Rebecca Torguson, Paul Gordon, Afshin Ehsan, Sean R. Wilson, John Goncalves, Robert Levitt, Chiwon Hahn, Puja Parikh, Thomas Bilfinger, David Butzel, Scott Buchanan, Nicholas Hanna, Robert Garrett, Federico Asch, Gaby Weissman, Itsik Ben-Dor, Christian Shults, Roshni Bastian, Paige E. Craig, Hector M. Garcia-Garcia, Paul Kolm, Quan Zou, Lowell F. Satler, Paul J. Corso

Results of a clinical trial using transcatheter aortic valve replacement provided a "strong signal" that it is safe for patients with low surgical risk, potentially helping to open the way for broader use of the minimally invasive procedure, also known as TAVR.

The Low-Risk TAVR trial results, presented this week at the European Society of Cardiology Congress 2018 showed no deaths or disabling strokes within 30 days of undergoing the procedure for 200 patients with low surgical risk who participated in the study, led by MedStar Heart & Vascular Institute at MedStar Washington Hospital Center.

The results of the trial, the first of its kind, approved by the Food and Drug Administration, were published online in the Journal of the American College of Cardiology.