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Journal and News Scan

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Gonçalo F. Coutinho, Filipe Leite, Manuel J. Antunes

With the impressive average of 150 mitral repairs annually for the last 16 years (possibly a world record, even more impressive given the population of Portugal), the Coimbra team led by Antunes reflects on six cases of circumflex artery injury, mostly in non-right dominant anatomy as expected.

Source: The Annals of Thoracic Surgery
Author(s): Carlos M. Mery, Luis E. De León, J. Rubén Rodriguez, R. Michael Nieto, Wei Zhang, Iki Adachi, Jeffrey S. Heinle, Lauren C. Kane, E. Dean McKenzie, Charles D. Fraser Jr

Mery and colleagues retrospectively reviewed outcomes of 383 neonates and infants undergoing repair of congenital heart defects to determine if the presence of congenital gastrointestinal (GI) malformations affected cardiac surgery outcomes. Although long-term survival after discharge was similar between groups, patients with thoracic GI malformations had worse perioperative outcomes than controls. The authors conclude that GI malformations do not contraindicate cardiac repair, however they suggest that families receive appropriate counseling on the risk.

Source: JAMA Cardiology
Author(s): Ankur Gupta, Larry A. Allen, Deepak L. Bhatt, Margueritte Cox, Adam D. DeVore, Paul A. Heidenreich, Adrian F. Hernandez, Eric D. Peterson, Roland A. Matsouaka, Clyde W. Yancy, Gregg C. Fonarow

The Hospital Readmissions Reduction Program (HRRP) was established as part of the Affordable Care Act in the US with the goal of adding an incentive for quality care that reduced hospital readmission rates. HRRP reduces Medicare reimbursement for hospitals with excess readmissions.

Gupta and colleagues sought to understand how this program affected outcomes for heart failure patients. The authors evaluated readmission for Medicare beneficiaries with heart failure from 2006 to 2014 using the American Heart Association’s Get With The Guidelines-Heart Failure registry and associated Medicare claims files. The authors found that the one-year risk-adjusted readmission rate decreased (HR 0.92) and the one-year risk-adjusted mortality rate increased (HR 1.10) following HRRP implementation. Secondary analysis that excluded patients who were discharged to hospice care found similar though attenuated changes.

The authors conclude that public health policies should be studied, as are drugs and devices, to ensure they confer the intended benefits.

The Wall Street Journal published an article highlighting this paper.

Source: New England Journal of Medicine
Author(s): C. David Mazer, Richard P. Whitlock, Dean A. Fergusson, Judith Hall, Emilie Belley-Cote, Katherine Connolly, Boris Khanykin, Alexander J. Gregory, Étienne de Médicis, Shay McGuinness, Alistair Royse, François M. Carrier, Paul J. Young, Juan C. Villar, Hilary P. Grocott, Manfred D. Seeberger, Stephen Fremes, François Lellouche, Summer Syed, Kelly Byrne, Sean M. Bagshaw, Nian C. Hwang, Chirag Mehta, Thomas W. Painter, Colin Royse, Subodh Verma, Gregory M.T. Hare, Ashley Cohen, Kevin E. Thorpe, Peter Jüni, and Nadine Shehata, for the TRICS Investigators and Perioperative Anesthesia Clinical Trials Group

This randomized trial evaluated restricted (threshold of Hgb <7.5  at induction of anesthesia ) versus liberal (Hgb <9.5 at induction of anesthesia or <8.5 on arrival in ICU) for patients undergoing cardiac surgery who had a EuroSCORE of 6 or more.  The composite outcome was death, MI, stroke, or new onset renal failure.  Transfusion occurred in 52% of the restricted group and 73% of the liberal group.  Outcomes were similar between these moderate-to-high risk groups.

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

Patient Care

To commemorate its 15th anniversary, the Asian Heart Institute in Mumbai, India, has pledged to subsidize the costs of 15 heart transplants for patients who cannot afford them.

Doctors at the Cleveland Clinic Abu Dhabi in UAE have noted a relatively high number of patients treated for achalasia with peroral endoscopic myotomy.


Drugs and Devices

Abbott’s MitraClip is the first transcatheter treatment for mitral regurgitation to be approved by Japan’s Ministry of Health, Labor, and Welfare.

An app developed by a startup in Haifa, Israel, can monitor a COPD patient’s phone calls and alert them to changes in their voice that might be associated with worsening lung function.


Research, Trials, and Funding

Neovasc has received US Food and Drug Administration approval to begin a North America clinical trial of its Reducer, a catheter-based technology for refractory angina that is already approved in Europe.

An editorial from Nature discusses the road of translational research that lead to the genetically-modified skin transplant that now allows a young boy to play outside without blistered skin. 

Source: VUMEDI
Author(s): Ahmed Ouda, Utz Kappert

This video shows you how to take down a skeletonised LIMA. 

Very nice 

Source: JAMA Cardiology
Author(s): Rohan Khera, Ambarish Pandey, Thomas Koshy, Colby Ayers, Brahmajee K. Nallamothu, Sandeep R. Das, Mark H. Drazner, Michael E. Jessen, Ajay J. Kirtane, Timothy J. Gardner, James A. de Lemos, Deepak L. Bhatt, Dharam J. Kumbhani

Using a data set from 682 US hospitals during a 10-year period, the relationship of hospital procedure volume for AVR and MVR to adjusted mortality rate was evaluated.  Using terciles of volume to classify hospitals according to quality resulted in misclassification of 305 hospitals.  Hospital volume has only a modest association with quality as judged by adjusted mortality rates. 

Source: New England Journal of Medicine
Author(s): Andrew B. Goldstone, Peter Chiu, Michael Baiocchi, Bharathi Lingala, William L. Patrick, Michael P. Fischbein,and Y. Joseph Woo

Trends in the use of bioprosthetic versus mechanical valves for AVR and MVR were assessed using a California-based surgical population from 1996-2013.  During this period the use of bioprosthetic devices increased from 12% to 52% for AVR and from 17% to 54% for MVR.  Bioprostheses were associated with substantially increased 15-year mortality in younger patients and had a higher rate of reoperation.  Mechanical valves were associated with higher rates of bleeding and stroke.

Source: JAMA Surgery
Author(s): Amelia W. Maiga, Stephen A. Deppen, Sarah Fletcher Mercaldo, Jeffrey D. Blume, Chandler Montgomery, Laszlo T. Vaszar, Christina Williamson, James M. Isbell, Otis B. Rickman, Rhonda Pinkerman, Eric S. Lambright, Jonathan C. Nesbitt, Eric L. Grogan

This multicenter retrospective study sought to assess the utility of PET in the diagnosis of pulmonary nodules.  It emphasized the inclusion of patient cohorts from different geographic regions and who underwent PET for different indications such as lung cancer screening or surgical evaluation.  Among 1188 patients the positive predicted value was 86% and the negative predictive value was 49%.  The authors conclude that aggressive tissue acquisition needs to be emphasized in a population of patients with a high rate of false-positive scans and unreliable utility from negative scans.

Source: Journal of Visualized Surgery
Author(s): Edited by Marcello Migliore, Alan Sihoe, and Diego Gonzalez-Rivas

Uniportal VATS and uniportal lobectomy have been developed over the last few years as valuable tools in modern thoracic surgery. This special issue of JOVS, with the aid of multimedia materials,  gives insights regarding the procedures performed with a uniportal technique.  The articles are also useful in order to understand the history, the difinitions, and the future possible applications of this revolutionary step for general thoracic surgery.