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Journal and News Scan

Source: The Annals of Thoracic Surgery
Author(s): Richard L. Prager, Alejandro Murillo Berlioz, Gregory D. Trachiotis, Joseph B. Zwischenberger, Robert M. Sade

The authors debate how much information should be included in the informed consent, and they use the case of resistant Mycobacterium chimaera found in the LivaNova PLC Stockert 3T heater-cooler system as a case-in-point. The issue raised specifically by this case is whether institutions that use this specific heater-cooler system are obligated to inform the patient of the specific risks of infection with resistant M chimaera. The publication is very informative, and the scope of the debate focuses on the purpose of informed consent, the legal obligation, and how narrow or broad the consent need be. It should not be surprising to anyone that there are no straightforward answers.

Source: Journal of the American College of Cardiology
Author(s): Stuart J. Head, Milan Milojevic, Joost Daemen, Jung-Min Ahn, Eric Boersma, Evald H. Christiansen, Michael J. Domanski, Michael E. Farkouh, Marcus Flather, Valentin Fuster, Mark A. Hlatky, Niels R. Holm, Whady A. Hueb, Masoor Kamalesh, Young-Hak Kim, Timo Mäkikallio, Friedrich W. Mohr, Grigorios Papageorgiou, Seung-Jung Park, Alfredo E. Rodriguez, Joseph F. Sabik III, Rodney H. Stables, Gregg W. Stone, Patrick W. Serruys, A. Pieter Kappetein

Head and colleagues used a patient-data pooled analysis of 11 randomized clinical trials to compare stroke rates between surgical and percutaneous coronary revascularization. They found that in the first 30 postoperative days, the stroke rate was higher after coronary artery bypass grafting (CABG, 1.1%) than after percutaneous coronary intervention (PCI, 0.4%), and this early difference accounted for the difference in the stroke rate seen at 5 years. Between 31 days and 5 years, stroke rates were not different between CABG and PCI (2.1% versus 2.2%). Regardless of the revascularization approach, patients experiencing a stroke in the first 30 days had significantly higher 5-year mortality than those not experiencing early stroke.

Source: Centers for Medicare and Medicaid Services
Author(s): Peter Pelikan, Carl Tommaso, Joseph Bavaria, Martin Leon, Aaron Horne, Ted Feldman, John Carroll, David Shahian, Thoralf Sundt, Susan Strong, Donnette Smith, Marilyn Serafini, Steven Goldberg, Larry Wood, Megan Coylewright

The US Centers for Medicare and medicaid Services (CMS) convened a panel on 07/25/2018 to discuss recommendations for hospitals to maintain and begin TAVR programs.  The focus of the discussion was the procedural volume requirements for TAVR, SAVR, and PCI (  The dialogue was balanced.  Further recommendations from CMS will be forthcoming.

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

Patient Care and General Interest

A woman developed a combination planner, record-keeping notebook, and journal to help her husband through his treatment for esophageal cancer, and other patients now use it to manage their own journeys through complex illness.

August 1 is World Lung Cancer Day.

A surgeon’s experience with related procedures may correlate with reduced hospital mortality for patients undergoing complicated procedures such as esophagectomies.


Drugs and Devices

HeartStitch® presented an initial series of percutaneous suture-based tricuspid repairs with its Heart-Rose™ technology at the recent CSI Frankfurt Conference in Germany.

Australian company Ademus will sell its bioscaffold product CardioCel® through Medical Instruments in Italy and Cardiva in Spain and Portugal.


Research, Trials, and Funding

Research from the Multicenter Italian Lung Detection trial suggests that subsolid lung nodules are an indication of increased cancer risk but that they can be safely managed with surveillance.

Source: Journal of Thoracic Oncology
Author(s): Anne S. Tsao, Gregory W. Gladish, Ritu R. Gill

A useful editorial debating current issues on the classification of mesothelioma.

Source: Interactive Cardiovascular and Thoracic Surgery
Author(s): Fabio Barili, Alessandro Parolari, Pieter A Kappetein, Nick Freemantle

Barili and colleagues discuss the importance of identifying heterogeneity in meta-analyses and the use of a random-effects or fixed-effects model to account for differences between or within studies. The authors review the assumptions and components of these models, discussing appropriate applications for each of them. Finally, they use an example analysis of surgical and transcatheter valve replacement outcomes to demonstrate the differences between random-effects and fixed-effects models.

Source: The New England Journal of Medicine
Author(s): Panagiotis Xaplanteris, Stephane Fournier, Nico H.J. Pijls, William F. Fearon, Emanuele Barbato, Pim A.L. Tonino, Thomas Engstrøm, Stefan Kääb, Jan-Henk Dambrink, Gilles Rioufol, Gabor G. Toth, Zsolt Piroth, Nils Witt, Ole Fröbert, Petr Kala, Axel Linke, Nicola Jagic, Martin Mates, Kreton Mavromatis, Habib Samady, Anand Irimpen, Keith Oldroyd, Gianluca Campo, Martina Rothenbühler, Peter Jüni, Bernard De Bruyne, for the FAME 2 Investigators

Interesting to read that percutaneous coronary intervention did not confer any survival benefit (nor protection from myocardial infarction) in an international randomized controlled trial of 888 patients when compared to medical therapy!

Source: Annals of Cardiothoracic Surgery
Author(s): Nimesh D. Desai, Grace Wang, Ashley Hoedt, Wilson Szeto, Joseph E. Bavaria

This video and article from Desai and colleagues demonstrates double transposition and single branched endovascular repair for total arch replacement in a 59-year-old man who presented with a 7 cm chronically dissected arch and distal aorta. The patient had previously undergone a DeBakey I dissection repair.

Source: The Annals of Thoracic Surgery
Author(s): Wenrui Ma, Wei Zhang, Wei Shi, Ye Kong, Xinyu Ma

Ma and colleagues evaluated left ventricular diastolic function in 183 patients who had undergone isolated aortic valve replacement for severe aortic regurgitation. Echocardiographic data was used to evaluate the relationship between preoperative diastolic function and postoperative mortality and cardiac function. Serial echocardiographic data from a subgroup of 104 patients was used to further evaluate postoperative changes in diastolic function. The authors found that 43% of patients had an improved New York Heart Association functional class at long-term follow-up. Preoperative left ventricular end-diastolic volume index was the only predictor of reduced long-term diastolic functional recovery, emphasizing the importance of appropriately-timed surgical intervention.

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

Patient Care and General Interest

Cardiac surgical and cardiology societies weigh in as an advisory committee revisits the US Centers for Medicare and Medicaid Services procedure volume requirements for transcatheter aortic valve replacement programs.

As the Houston Methodist Hospital in Texas, USA, moves to new facility, it is closing historic operating rooms where renowned heart surgeon Dr Michael DeBakey developed the Dacron graft.

The LUNGevity Foundation has published recommendations to expand eligibility for lung cancer trial participation to more patients.


Drugs and Devices

Polares Medical has received venture capital funding to continue developing a transcatheter hemireplacement device that would replace only the posterior leaflet of the mitral valve.


Research, Trials, and Funding

Researchers from Johns Hopkins University in Baltimore, Maryland, explored surgeon decision-making and the factors that influence a surgeon’s decision to operate or not in a scenario where a patient has a likely nonsurvivable medical problem.

Palliative care support offered to families of infants with single-ventricle heart disease by health care teams at the University of Michigan may help them cope with and navigate their child’s medical care.

Researchers in Canada studied factors that influence hemodynamic valve deterioration after surgical aortic valve replacement.