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Journal and News Scan

Source: The Annals of Thoracic Surgery
Author(s): Aly Ghoneim, Ismail Bouhout, Louis P. Perrault, Denis Bouchard, Michel Pellerin, Yoan Lamarche, Philippe Demers, Michel Carrier, Raymond Cartier, Ismail El-Hamamsy

Ghoneim and colleagues retrospectively evaluated surgical risk caused by prior mediastinal radiation therapy (MRT) in patients undergoing aortic valve replacement (AVR). The authors found that operative mortality was higher than predicted when AVR was performed with concomitant procedures, and they speculate this is in part related to the longer cardiopulmonary bypass time required. Despite good short-term outcomes in the isolated AVR group, MRT patients undergoing both isolated and concomitant AVR had reduced midterm survival. The authors suggest this should be considered when weighing the choice of device, the invasiveness of the AVR procedure, and the inclusion of concomitant procedures for this population of patients.

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

Patient Care

An Iraqi boy from Mosul went from Jordan to Australia for surgery to correct the blood flow through his heart and repair a hole between his ventricles.

Transcatheter approaches continue growing as transcatheter aortic valve implantation (TAVI) is performed for the first time in Kenya at the Aga Khan University Hospital and in Bangladesh at the United Hospital Ltd.

The Palestinian Authority chief negotiator will need a lung transplant as medical treatment for his pulmonary fibrosis is no longer sufficient.

A professional basketball player in the USA talks about undergoing and recovering from open heart surgery.


Drugs and Devices

Mayo Clinic in Rochester, Minnesota, is partnering with AliveCor to improve early detection of long QT syndrome with AliveCor’s Kardia Mobile device.

The European Medicines Agency must relocate from its current London offices ahead of Brexit (the UK leaving the European Union), and 19 different cities are vying to be the agency’s new home.

The Avalus pericardial aortic surgical valve from Medtronic, an MRI-safe stented valve, is now CE (Conformité Européenne) marked and has received US Food and Drug Administration approval. Medtronic also announced CE mark and the European launch of the CoreValveTM EvolutTM PRO valve.


Research, Trials, and Funding

Researchers at Ohio State University in Columbus, Ohio, find that the human heart has multiple pacing mechanisms with redundancies in the sinoatrial node.

Researchers at the CSIR Institute of Genomics and Integrative Biology in New Delhi, India, will soon start a longitudinal study of the factors affecting lung function in children.

Source: The Annals of Thoracic Surgery
Author(s): Emma J.M. Grigor, Jelena Ivanovic, Caitlin Anstee, Zach Zhang, Sebastian Gilbert, Donna E. Maziak, Farid M. Shamji, Sudhir Sundaresan, Patrick J. Villeneuve, Tim Ramsay, Andrew J.E. Seely

Grigor and colleagues investigated the relationship between self-reported patient experience and the incidence of adverse events or prolonged length of hospitalization after surgery. Patients with a prolonged length of stay rated their experience lower on more measures than patients with adverse events did. Notably, extended length of stay was associated with a lower rating of the comprehensiveness of information provided by surgeons.

Source: Journal of Thoracic Oncology
Author(s): Boris Sepesi, Kathryn A. Gold, Arlene M. Correa, John V. Heymach, Ara A. Vaporciyan, Jason Roszik, Ethan Dmitrovsky, Xi Liu

This retrospective study of the association of BMI to long-term survival after resection of NSCLC identified BMI > 30kg/m2 as an independent predictor of survival.  In a propensity score matched set, patients with BMI >30 had better survival than those with a BMI of 25 (p=0.003).   The reason for this relationship remains to be elucidated.

Source: Journal of Thoracic Oncology
Author(s): Ross A. Soo, Emily C.A. Stone, K. Michael Cummings, James R. Jett, John K. Field, Harry J.M. Groen, James L. Mulshine, Yasushi Yatabe, Lukas Bubendorf, Sanja Dacic, Ramon Rami-Porta, Frank C. Detterbeck, Eric Lim, Hisao Asamura, Jessica Donington, Heather A. Wakelee, Yi-Long Wu, Kristin Higgins, Suresh Senan, Benjamin Solomon, Dong-Wan Kim, Melissa Johnson, James C.H. Yang, Lecia V. Sequist, Alice T. Shaw, Myung-Ju Ahn, Daniel B. Costa, Jyoti D. Patel, Leora Horn, Scott Gettinger, Solange Peters, Murry W. Wynes, Corinne Faivre-Finn, Charles M. Rudin, Anne Tsao, Paul Baas, Ronan J. Kelly, Natasha B. Leighl, Giorgio V. Scagliotti, David R. Gandara, Fred R. Hirsch, David R. Spigel

This is an excellent summary of progress during the past year in all aspects of lung cancer, from prevention/detection through molecular therapies and future perspectives.  Each section is written by a handful of international experts. 

Source: Journal of the American College of Cardiology
Author(s): Jonathan Afilalo, Sandra Lauck, Dae H. Kim, Thierry Lefèvre, Nicolo Piazza, Kevin Lachapelle, Giuseppe Martucci, Andre Lamy, Marino Labinaz, Mark D. Peterson, Rakesh C. Arora, Nicolas Noiseux, Andrew Rassi, Igor F. Palacios, Philippe Généreux, Brian R. Lindman, Anita W. Asgar, Caroline A. Kim, Amanda Trnkus, José A. Morais, Yves Langlois, Lawrence G. Rudski, Jean-Francois Morin, Jeffrey J. Popma, John G. Webb, Louis P. Perrault

Frailty is an important factor in patients undergoing either Transcatheter or Surgical Aortic Valve Replacement. However, it is hard to assess. Multiple scoring systems have been proposed which are either underperforming or are cumbersome to calculate.

In the current study, the authors introduced and tested the Essential Frailty Toolset (EFT), consisting of four items: lower-extremity weakness, cognitive impairment, anemia, and hypoalbumenia. The EFT outperformed other frailty assesment tools in approximatly 1000 elderly patients undergoing either TAVR or SAVR.

Dr. Mack notes in the accompanying editorial that several conclusions can be drawn:

1. Frailty can be assessd using an easy tool

2. Frailty is predictive of 1-year mortality after either TAVR or SAVR

3. EFT improves the power of the STS-PROM to predict 1 year mortality

4. EFT is also predictive for 30-day mortality and 1-year mortality and disability

This important study shows that frailty can classified easily. This facilitates comparitive studies, heart team discussions and clinical decision-making in patients undertoing an invasive treatment for aortic stenosis.

Source: European Journal of Cardiothoracic Surgery
Author(s): Malakh Shrestha, Andreas Martens, Tim Kaufeld, Erik Beckmann, Sebastian Bertele, Heike Krueger, Julia Neuser, Felix Fleissner, Fabio Ius, Firas Abd Alhadi, Jasmin Hanke, Jan D. Schmitto, Serghei Cebotari, Matthias Karck, Axel Haverich, Ajay Chavan

The authors present an extensive experience with the Frozen Elephant Trunk procedure for aortic pathology of varying types. They provide useful tips for each type. The results justify the techniques. The authors also provide some insight into when results may not be so good.

Source: The Annals of Thoracic Surgery
Author(s): Vinay Badhwar, J. Scott Rankin, Niv Ad, Maria Grau-Sepulveda, Ralph J. Damiano, A. Marc Gillinov, Patrick M. McCarthy, Vinod H. Thourani, Rakesh M. Suri, Jeffrey P. Jacobs, James L. Cox

Badhwar and colleagues analyzed the usage and outcomes of surgical ablation (SA) for atrial fibrillation reported in The Society of Thoracic Surgeons database. They found an incrementally increasing volume of SA procedures concomitant with cardiac operations like coronary artery bypass and valve repair/replacement over the 3-year period analyzed. Concomitant SA was associated with reduced risk of mortality and stroke but increased risk of renal failure and subsequent pacemaker implantation.

This research was presented at the 2016 Annual Meeting of the Southern Thoracic Surgical Association, and a brief discussion from that meeting follows the article.

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

Patient Care

The first total aortic replacement in Malaysia was performed for a patient with a thoracoabdominal aneurysm at the National Heart Institute (IJN) in Kuala Lumpur.

A balloon dilation of his narrowing airway helps a premature baby breathe easier in Cape Town, South Africa.

Engineering principles and 3D printing help a surgical team reshape and stabilize the ribcage of a man with scoliosis in North Carolina, USA.

A man suffered a cardiac arrest at a water park in Israel, but quick action and an onsite automatic defibrillator saved his life.


Drugs and Devices

Randomization in the TANGO-2 trial of meropenem-vaborbactam for carbapenem-resistant Enterobacteriaceae infections was halted early due to superior outcomes from the investigational treatment.

The European Medicines Agency recommended multiple anticancer agents for approval, including atezolizumab, an anti-PD-L1 immunotherapy for non–small cell lung cancer.

AstraZeneca’s MYSTIC trial has found that a combination of biologics did not improve progression-free survival with PD-L1-positive lung cancer over chemotherapy, though overall survival results are still pending.

AdvaMed sent a letter to the US FDA to protest changes to its definition of “intended use.”

Health Canada has licensed Medtronic Canada’s MR-conditional cardiac resynchronization therapy defibrillators.


Research, Trials, and Funding

Applications are now being accepted for the 2017 Carolyn E. Reed Traveling Fellowship Award, awarded each year to a woman thoracic or cardiac surgeon for travel with the purpose of learning a new technology.

Researchers from Melbourne, Australia, published a study in the NEJM that questions whether new interventions to help premature infants breathe are better for their long-term lung function.

Source: The Thoracic and Cardiovascular Surgeon
Author(s): Valerie Lacroix, Zahra Mosala Nezhad, David Kahn, Arnaud Steyaert, Alain Poncelet, Thierry Pieters, Philippe Noirhomme

Lacroix and colleagues evaluated pulmonary function, pain, and quality of life in patients who underwent robotic thoracic surgery, predominantly for non-small cell lung cancer. The authors observed no difference between preoperative and 7-month postoperative pulmonary function. Although the majority of patients reported some level of pain at the surgical site, pain was not neuropathic-like and only weakly interfered with daily activities.