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Journal and News Scan

Source: The Journal of Visualized Surgery
Author(s): Omar I. Ramadan, Robert J. Cerfolio, Benjamin Wei

I particularly enjoyed Table 1 of this succinct mini manual on ' robotic' assisted oncologic pulmonary resections (‘robotic’ is a catchy cross-speciality misnomer particularly adored by popular media; probably too late to ostracise the term, yet it leaves the computer-assisted surgeons open to malpractice claims!).

I admit I would be uncomfortable NOT to re-insufflate the ipsilateral lung after clamping and before dividing a submain bronchus, although I have come across colleagues who eschew this step.

Source: Journal of the American College of Cardiology
Author(s): J. Matthew Brennan, Laine Thomas, David J. Cohen, David Shahian, Alice Wang, Michael J. Mack, David R. Holmes, Fred H. Edwards, Naftali Z. Frankel, Suzanne J. Baron, John Carroll, Vinod Thourani, E. Murat Tuzcu, Suzanne V. Arnold, Roberta Cohn, Todd Maser, Brenda Schawe, Susan Strong, Allen Stickfort, Elizabeth Patrick-Lake, Felicia L. Graham, Dadi Dai, Fan Li, Roland A. Matsouaka, Sean O’Brien, Fan Li, Michael J. Pencina, Eric D. Peterson

In this large propensity-matched study, outcomes after Transcatheter versus Surgical Aortic Valve Replacement (TAVR vs. SAVR) were assessed in a real world intermediate- and high-risk cohort of 9500 patients in the United States.  There was no difference in 1-year mortality (17.3% vs. 17.9%; HR 0.93, 95% confidence interval [CI] 0.83-1.04) and stroke (4.2% vs.3.3% HR 1.18; 95% CI 0.95-1.47). Results were consistent among subgroups of patients. Importantly, there were no differences in effect across the male/female subgroups. This shows that not gender in itself, but rather gender-related comorbidities play a role in a better outcome of TAVR in female patients.  This important study shows data from daily practice and further confirms the results of randomized controlled trials. 

Source: New England Journal of Medicine
Author(s): Charles V. Pollack, Jr., Paul A. Reilly, Joanne van Ryn, John W. Eikelboom, Stephan Glund, Richard A. Bernstein, Robert Dubiel, Menno V. Huisman, Elaine M. Hylek, Chak-Wah Kam, Pieter W. Kamphuisen, Jörg Kreuzer, Jerrold H. Levy, Gordon Royle, Frank W. Sellke, Joachim Stangier, Thorsten Steiner, Peter Verhamme, Bushi Wang, Laura Young, and Jeffrey I. Weitz

In this study, the Dabigatran reversal-drug Idarucizumab was tested.  503 patients were enrolled, of whom 202 had to undergo an urgent procedure.  Of the patients requiring an urgent procedure, the median time of initiation of the procedure was 1.6 hours, and at that time periprocedural hemostasis was assessed as normal in 93.4% of the patients. At 90 days, thrombotic events had occurred in 7.4% of the patients requiring an urgent procedure and the mortality rate was 18.9%.  The results of this study show that Idarucizumab is a rapid and effective reversal drug for the effects of Dabigatran in case of the need for urgent surgery.  As Dabigatran is increasingly being used in patients with atrial fibrillation, the availability of Idarucizumab is important. 

Source: European Heart Journal
Author(s): Richard P. Whitlock Graham R. McClure John W. Eikelboom

In this editorial, the authors review the current risks associated with aortic valve replacement in younger patients, with an emphasis on anticoagulation options and future perspectives.

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

Patient Care

A father administered CPR to his infant son in the car ride to the hospital in Mumbai, India, for complications related to a tumor in the child’s heart. He had learned CPR several months earlier in a training course at work.

Kaiser Health News discusses the practice of a surgeon “running two rooms,” focusing on patient thoughts and questioning whether such multitasking is efficient.

Families at St Louis Children’s Hospital in Missouri, USA, can receive Snapchat-like updates from the teams performing their child’s surgery.

According to the UK’s National Health Service, more than 50,000 people in the UK are alive today because of an organ transplant.

Mount St John’s Medical Centre in Antigua & Barbuda performs its first pacemaker implantation.

 

Drugs and Devices

Data from the SURTAVI trial has lead the US Food and Drug Administration to approve a Medtronic TAVR/TAVI platform for use in intermediate-risk patients.

 

Research, Trials, and Funding

Researchers at Loyola Medicine in Chicago, USA, are enrolling patients in a major study of Hermansky-Pudlak syndrome, a rare, hereditary lung disease that affects a disproportionately large number of Puerto Ricans.

Accra, Ghana, hosted the 20thAfrica Union Conference on Lung Health this week, which focused on tuberculosis, tobacco use, and non-communicable diseases.

Running might be good for your heart, but perhaps running a marathon isn’t ideal.

Source: Journal of Cardiopulmonary Rehabilitation & Prevention
Author(s): Turky, Khalid PhD; Afify, Amera M. Abdelaziz PhD

Preoperative Inspiratory Muscle Training (IMT) with the Powerbreathe device was assessed with regard to whether A-a gradients and inspiratory muscle power would be improved after CABG.  A group of 40 male patients were randomized to receiving (20) or not receiving (20) preop IMT.  Postoperatively, the group receiving IMT had significantly better lung function (inspiratory muscle power, A-a gradient, oxygen saturation) .

Source: Video Assisted Thoracic Surgery Journal
Author(s): Izanee Mohamed Mydin et al

Video assisted thoracoscopic surgery (VATS) lobectomies have been instrumental in the evolution of thoracic surgical oncology since its introduction in the early 90s. Although there is no robust data to confirm or refute its superiority over open conventional lobectomy, there have been a number of meta-analyses which have shown that VATS is safe and feasible for those undergoing radical resection for cancer. Over the years, VATS lobectomy has continued to evolve with newer techniques, less ports and better instruments. There is now an interest in performing uniportal VATS lobectomy and this is now moving to one without a need for incision in the intercostal space. Microlobectomy, originally envisaged by a group of surgeons from 6 different centres and involves using subcentimeter incisions alongside a subxiphoid utility port. Some of the technical disadvantages of VATS are that the images are 2-dimensional (2D), there is limited depth perception; and manoeuvring rigid instruments within the limited confines of the chest can make dissection difficult. The advent of robotic lobectomy has addressed some of these problems. The 3D vision is unparalleled, the endowrist seamLessly mimic human hand movements and the instrument movement within the chest is fluid. However, the high capital costs may deter smaller centres from introducing this service, especially when working within a limited budget in the public hospital. This can be circumvented by ensuring that the robot is used in a multi-specialty setting and concentrated in a few high volume tertiary centres.

Source: The 2017 Mitral Valve Conclave
Author(s): Richard Mark Kirkner

Minimally invasive mitral valve surgery provides outcomes that match those of conventional sternotomy without increasing use of resources, and lower costs after surgery offset potentially higher operation costs, according to a single-center, propensity-matched analysis of almost 500 patients presented at the meeting sponsored by the American Association for Thoracic Surgery.

Source: israel21c
Author(s): Abigail Klein Leichman

In a risky and delicate procedure performed for the first time in Israel this week, an interdisciplinary team of Hadassah Medical Center physicians fixed a severe heart defect in a 28-week-old fetus in the womb.

 

Source: the telegraph
Author(s): David Millward

 

A mother has published the hospital bill for her child's heart operation on Twitter to make a highly personal plea to the US Senate not to scrap one of the key provisions of  Obamacare.

With the fate of the replacement for Obamacare hanging in the balance, Ali Ranger, used social media to illustrate what would happen if the new measure allowed insurers to impose a lifetime cap on benefits.

 

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