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Journal and News Scan

Source: The New England Journal of Medicine
Author(s): Matthew D. Hellmann, Tudor-Eliade Ciuleanu, Adam Pluzanski, Jong Seok Lee, Gregory A. Otterson, Clarisse Audigier-Valette, Elisa Minenza, Helena Linardou, Sjaak Burgers, Pamela Salman, Hossein Borghaei, Suresh S. Ramalingam, Julie Brahmer, Martin Reck, Kenneth J. O’Byrne, William J. Geese, George Green, Han Chang, Joseph Szustakowski, Prabhu Bhagavatheeswaran, Diane Healey, Yali Fu, Faith Nathan, Luis Paz-Ares

This randomized trial evaluating the relative efficacy of immunotherapy and chemotherapy in patients with recurrent or metastatic disease, immunotherapy was associated with significantly better progression-free survival.  Tumor mutational burden was a marker for patient selection for immunotherapy.

Source: The Annals of Thoracic Surgery
Author(s): Rong Liufu, Guocheng Shi, Fang Zhu, Yongmei Guan, Zhaohui Lu, Weimin Chen, Zhongqun Zhu, Huiwen Chen

Liufu and colleagues evaluated outcomes for repair of supracardiac total anomalous pulmonary venous connection via the superior approach in 198 pediatric patients, with a median age of 95 days at the time of surgery. Repair via the superior approach avoids dispensable incisions to the atrial septum, extra force being placed on the heart, and potential anastomotic distortion. The authors found that rates of both survival (97%) and freedom from postoperative pulmonary venous obstruction (85%) were acceptable using this approach.

Source: The New England Journal of Medicine
Author(s): Leena Gandhi, Delvys Rodríguez-Abreu, Shirish Gadgeel, Emilio Esteban, Enriqueta Felip, Flávia De Angelis, Manuel Domine, Philip Clingan, Maximilian J. Hochmair, Steven F. Powell, Susanna Y.-S. Cheng, Helge G. Bischoff, Nir Peled, Francesco Grossi, Ross R. Jennens, Martin Reck, Rina Hui, Edward B. Garon, Michael Boyer, Belén Rubio-Viqueira, Silvia Novello, Takayasu Kurata, Jhanelle E. Gray, John Vida, Ziwen Wei, Jing Yang, Harry Raftopoulos, Catherine Pietanza, Marina C. Garassino, for the KEYNOTE-189 Investigators

The addition of pembrolizumab (targeting PD-1) to standard chemotherapy substantially improved time to progression and overall survival compared to chemotherapy alone in patients with metastatic lung cancer.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Marzia Umari, Valentina Carpanese, Valeria Moro, Gaia Baldo, Stefano Addesa, Enrico Lena, Stefano Lovadina, Umberto Lucangelo

Umari and colleagues appraise approaches to optimize postoperative pain management after pulmonary resection by video-assisted thoracoscopic surgery. The authors recommend an opioid-sparing multimodal approach, and they discuss loco-regional analgesic techniques, nonopioid analgesics, and perioperative gabapentinoids.

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

Patient Care and General Interest

Coal miners in central Appalachia in the US have an increasing incidence of severe black lung disease and an associated increased need for lung transplantation.

Five people have received free cardiac surgery at Lagos State University Teaching Hospital in Ikeja, Nigeria, in collaboration with the VOOM foundation.

In news related to heart-healthy diets, adhering to a Mediterranean diet seemes to temper the negative cardiovascular effects of air pollution, and regular, moderate chocolate consumption is associated with reduced risk of atrial fibrillation.


Drugs and Devices

The US Food and Drug Administration (FDA) has issued a class I recall for the HeartMate 3 Left Ventricular Assist System from Abbott.

Vestagen Protective Technologies has received clearance for its Vestex® Active Barrier daily-wear scrubs as a class II medical device from the US FDA for the fabric’s reduced MRSA accumulation.


Research, Trials, and Funding

Researchers in Germany find no evidence that electromagnetic field strength from electric cars interferes with cardiac implantable electronic devices.

Researchers at the University of Zurich in Switzerland are using computer simulations to predict the structural changes that will occur in bioengineered heart valves after they are implanted in sheep, with the goal of using those predictions to design customized regenerative heart valves with greater durability.

Source: The New England Journal of Medicine
Author(s): Alain Combes, David Hajage, Gilles Capellier, Alexandre Demoule, Sylvain Lavoué, Christophe Guervilly, Daniel Da Silva, Lara Zafrani, Patrice Tirot, Benoit Veber, Eric Maury, Bruno Levy, Yves Cohen, Christian Richard, Pierre Kalfon, Lila Bouadma, Hossein Mehdaoui, Gaëtan Beduneau, Guillaume Lebreton, Laurent Brochard, Niall D. Ferguson, Eddy Fan, Arthur S. Slutsky, Daniel Brodie, Alain Mercat, for the EOLIA Trial Group, REVA, and ECMONet

A severe blow to the concept of venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome in the form of a well-executed randomized controlled trial.

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

Over 1200 patients with stable coronary artery disease and at least one angiographically-significant stenosis were randomized to percutaneous coronary intervention (PCI) plus medical therapy or medical therapy alone for lesions with fractional flow reserve (FFR) <0.8.  FFR-guided PCI was associated with a significantly reduced composite outcome (death, myocardial infarction, or urgent revascularization).  Patients without hemodynamically significant lesions had good outcomes on medical therapy alone.

Source: The New England Journal of Medicine
Author(s): Ahmedin Jemal, Kimberly D. Miller, Jiemin Ma, Rebecca L. Siegel, Stacey A. Fedewa, Farhad Islami, Susan S. Devesa, Michael J. Thun

The age-specific incidence of non-small cell lung cancer has reversed in individuals born since the 1960s, with women now having a higher incidence than men.  This trend is not explained by differences in smoking habits.

Source: The New England Journal of Medicine
Author(s): Patrick M. Forde, Jamie E. Chaft, Kellie N. Smith, Valsamo Anagnostou, Tricia R. Cottrell,Matthew D. Hellmann, Marianna Zahurak, Stephen C. Yang, David R. Jones, Stephen Broderick, Richard J. Battafarano, Moises J. Velez, Natasha Rekhtman, Zachary Olah, Jarushka Naidoo, Kristen A. Marrone, Franco Verde, Haidan Guo, Jiajia Zhang, Justina X. Caushi, Hok Yee Chan, John-William Sidhom, Robert B. Scharpf, James White, Edward Gabrielson, Hao Wang,Gary L. Rosner, Valerie Rusch, Jedd D. Wolchok, Taha Merghoub, Janis M. Taube, Victor E. Velculescu, Suzanne L. Topalian, Julie R. Brahmer, Drew M. Pardoll

This is among the first and largest summaries of the use of neoadjuvant PD-1 inhibitor (nivolumab) in patients with resectable lung cancer.  The safety profile was adequate, 20 of 21 patients underwent complete resection, and the pathologic major response rate was 45%.   The response was similar regardless of PD-L1 status, and response was related to tumor mutational burden.  

Source: The Annals of Thoracic Surgery
Author(s): Satoshi Kawatsu, Konosuke Sasaki, Ko Sakatsume, Shingo Takahara, Katsuhiro Hosoyama, Naoki Masaki, Yusuke Suzuki, Yukihiro Hayatsu, Ichiro Yoshioka, Kei Sakuma, Osamu Adachi, Masatoshi Akiyama, Kiichiro Kumagai, Naotaka Motoyoshi, Shunsuke Kawamoto, Yoshikatsu Saiki

Kawatsu and colleagues performed a retrospective analysis of preoperative characteristics and laboratory data for patients who did and did not exhibit heparin resistance (n = 25 and n = 464, respectively) prior to establishment of cardiopulmonary bypass for a cardiovascular operation. They identified chronic thoracic aortic dissection, smoking, chronic obstructive pulmonary disease, and elevated fibrinogen as independent predictors for heparin resistance. The authors conclude that patients with these predictive factors could potentially be given antithrombin-III if an initial dose of heparin does not achieve the desired activated clotting time, rather than being given an additional heparin dose that may be ineffective.