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Journal and News Scan

Source: Interactive Cardiovascular and Thoracic Surgery
Author(s): Gyoten Takayuki, Schenk Sören, Rochor Kristin, Axel Harnath, Oliver Grimmig, Just Sören, Fritzsche Dirk

Takayuki and colleagues reviewed the outcome of mitral valve replacement after failed mitral valve repair with MitraClip in 25 patients. Perioperative mortality was 28%, and overall one-year survival was 53%. Risk factors for perioperative mortality included preoperative cardiogenic shock, septic shock, and liver failure. Mitral valve regurgitation after MitraClip implantation was usually caused by valve leaflet damage, degeneration, or infection.

Source: Journal of the American College of Cardiology
Author(s): Torsten Doenst, Axel Haverich, Patrick Serruys, Robert O. Bonow, Pieter Kappetein, Volkmar Falk, Eric Velazquez, Anno Diegeler, Holger Sigusch

An important review in a mainstream periodical read by cardiologist colleagues.

Source: JAMA Oncology
Author(s): David A. Palma, Timothy K. Nguyen, Alexander V. Louie, Richard Malthaner, Dalilah Fortin, George B. Rodrigues, Brian Yaremko, Joanna Laba, Keith Kwan, Stewart Gaede, Ting Lee, Aaron Ward, Andrew Warner, Richard Inculet

The complete pathologic response rate in this study is revealed to be low, lower than expected after stereotactic ablative radiotherapy (SABR) for early stage non-small cell lung cancer: only 60%. The authors suggest a combined approach (SABR plus surgery), adopted in this experimental phase 2 trial, as a possible management scheme. This is questionable and further research will be needed.

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

Patient Care and General Interest

One of the professional golfers who qualified for this weekend’s PGA Tour event is also a two-time heart transplant recipient.

 

Drugs and Devices

LivaNova announced that its Perceval sutureless aortic valve will be reimbursed for patients through Japan’s Ministry of Health, Labor, and Welfare.

 

Research, Trials, and Funding

A program designed specifically to address racial disparity in lung cancer treatment rates in North Carolina, USA, eliminated this disparity and increased treatment rates for all participants.

Researchers from Ontario, Canada, report a 60% pathologic complete response rate for stereotactic ablative radiotherapy in patients with resectable lung cancer, much lower than they had hypothesized.

A study using data from the UK Biobank found that adults with mild congenital heart defects had increased incidences of heart failure, atrial fibrillation, stroke, and heart attack, even after accounting for cardiovascular risk factors.

The Thoracic Surgery Foundation (TSF) has awarded 24 grants that will support research and educational endeavors in 2019. Visit their website to learn more about TSF and future funding opportunities.

Women have worse outcomes after aortic surgery than men do, report researchers from Ontario, Canada.

Source: New England Journal of Medicine
Author(s): Lisa Rosenbaum, Amy Edmondson, Thoralf Sundt, Neel Shah

Though medical care has become ever more dependent on teamwork, the profession has devoted relatively little attention to what makes for a good team. In this roundtable discussion moderated by Lisa Rosenbaum, panelists Amy Edmondson, Neel Shah, and Thoralf Sundt discuss empirical and cultural approaches to the pursuit of better collaboration.

This audio roundtable is the companion to a three-part series on teamwork, written by Lisa Rosenbaum and published in the New England Journal of Medicine. In this series, Dr Rosenbaum made important reflections on and explorations into the professional, psychological, cultural, and social approaches to fostering high-quality communication and collaboration in the medical community. These articles and links are as follows:

Teamwork — Part 1: Divided We Fall

https://www.nejm.org/doi/full/10.1056/NEJMms1813427

Teamwork — Part 2: Cursed by Knowledge — Building a Culture of Psychological Safety

https://www.nejm.org/doi/full/10.1056/NEJMms1813429

Teamwork — Part 3: The Not-My-Problem Problem

https://www.nejm.org/doi/full/10.1056/NEJMms1813431

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Markus Kofler, Sebastian J Reinstadler, Agnes Mayr, Lukas Stastny, Martin Reindl, Julia Dumfarth, Theresa M Dachs, Kristina Wachter, Christian J Rustenbach, Guy Friedrich, Gudrun Feuchtner, Gert Klug, Peter Bramlage, Bernhard Metzler, Michael Grimm, Hardy Baumbach, Nikolaos Bonaros

Kofler and colleagues evaluated prospectively-measured psoas muscle area in more than 1,000 patients who underwent transcatheter aortic valve replacement at two centers. Indexed psoas area was independently associated with 30-day and follow-up mortality. The authors suggest adding indexed psoas area to The Society of Thoracic Surgeons (STS) score to improve the STS score prognostic value.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Kareem Bedeir, Tsuyoshi Kaneko, Sary Aranki

A very useful synopsis of treatment strategies for a vexing lethal condition.

Source: The Annals of Thoracic Surgery
Author(s): David L.S. Morales, Joseph W. Rossano, Christina Vander Pluym, Angela Lorts, Ryan Cantor, James St. Louis, Devin Koeh, David L. Sutcliffe, Iki Adachi, James K. Kirklin, David N. Rosenthal, Elizabeth D. Blume, for the Pedimacs investigators

Today, The Society of Thoracic Surgeons published the third annual Pediatric Interagency Registry for Mechanical Circulatory Support (PEDIMACS) report. Between Sep 19, 2012 and Dec 31, 2017, 423 patients (less than 19 years of age) in 30 hospitals were supported with 508 devices. The etiology was cardiomyopathy in 261 patients (62%), myocarditis in 48 (11%), congenital heart disease (CHD) in 86 (20%, with 52 of these having single ventricle physiology), and other in 28 (7%). The two most common support strategies included left ventricular assist device in 342 patients (81%) and biventricular assist device (BiVAD) in 64 (15%).

At 6 months, 80% of patients were alive on a device or bridged to transplantation/recovery. Patient characteristics and survival were different among three groups of patients supported with three types of pumps:

  1. 197 implantable continuous flow pumps: implant age 13.4 ± 3.8 years, 19% INTERMACS profile 1, 21% intubated at implant, 12% with CHD; 92% alive at 6 months
  2. 79 paracorporeal continuous flow (PC) pumps: implant age 3.9 ± 5.2 years, 49% INTERMACS profile 1, 86% intubated at implant, 38% with CHD; 66% alive at 6 months
  3. 121 paracorporeal pulsatile pumps: implant age 3.3 ± 3.9 years, 41% INTERMACS profile 1, 77% intubated at implant, 21% with CHD; 77% alive at 6 months

Risk factors for early death were INTERMACS profile 1 (hazard ratio, HR 12.6), BiVAD (HR 3.6), percutaneous devices (HR 13.5), PC pumps (HR 4.1), small volume center (HR 3.3), low age (HR 1.01 for age squared), and low weight (HR 0.9). Intubation (functional capacity, HR 4.3) and liver dysfunction (bilirubin in mg/dL, HR 1.1) at the time of implant were constant hazards.

The investigators conclude that implantable continuous flow pumps are the most common type in children, with greater than 90% survival at 6 months, which may represent the maturation in both patient selection and timing of implantation. Currently paracorporeal continuous flow or pulsatile pumps are limited to supporting most challenging patients, those weighing less than 20 kg, and those with congenital heart defects.

Source: Interactive Cardiovascular and Thoracic Surgery
Author(s): Kathrin Schubert, Tim Schaller, Elisabeth Stojenthin, Christian Stephan, Hans-Hinrich Sievers, Michael Scharfschwerdt

Schubert and colleagues developed a novel trileaflet mechanical heart valve prosthesis. They compared this device with a conventional mechanical bileaflet heart valve in vitro, evaluating hemodynamic parameters and thrombogenicity. The trileaflet valve had a larger effective orifice area and smaller pressure gradient than the bileaflet one. There were fewer clotting deposits on the trileaflet valve, and the authors pointed to the off-wall systolic position of the hinges in the new valve as a major advantage.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Stuart W. Grant, Graeme L. Hickey, Stuart J. Head

In this statistical primer, Grant and colleagues focus on the use of multivariable regression analyses. The authors review the three most common types of multivariable regression models encountered in the cardiothoracic surgical literature, and they highlight less common models, underscoring the importance of using the correct model for a particular study. They also discuss appropriate approaches for selecting variables and the need to report the model completely so others can reproduce it.

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