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Journal and News Scan

Source: Circulation Research
Author(s): Mariann Gyöngyösi, Paul M. Haller, Derek J. Blake, Enca Martin Rendon

A detailed and somewhat disheartening analysis of stem cell therapy for cardiac failure.

Source: World Journal for Pediatric and Congenital Heart Surgery
Author(s): Joseph A. Dearani

Joseph Dearani, Chair of the Department of Cardiovascular Surgery at the Mayo Clinic in Rochester, Minnesota, graciously shares a copy of the letter with which he welcomes cardiothoracic surgery residents as they embark on their rotation on his service. Dr Dearani’s letter describes the importance of professionalism, preparedness, responsibility, introspection, and honesty to both self and others. It would be equally appropriate as an essay defining the key elements of a successful and productive relationship between a trainee and mentor in any surgical subspecialty.

Source: The Annals of Thoracic Surgery
Author(s): John M. Fallon, Joseph P. DeSimone, J. Matthew Brennan, Sean O’Brien, Dylan P. Thibault, Anthony W. DiScipio, Philippe Pibarot, Jeffrey P. Jacobs, David J. Malenka

Fallon and colleagues evaluated patient-prosthesis mismatch (PPM) following isolated aortic valve replacement reported in the STS Adult Cardiac Surgery Database. They found that both moderate and severe PPM were associated with worse outcomes compared to no PPM over the 10-year study period. Readmission for congestive heart failure and aortic valve rereplacement were both more likely in patients with moderate or severe PPM, and overall survival was lower. The incidences of moderate and severe PPM were reduced over the study period, from 60.1% to 46.8% and from 13.8% to 6.2%, respectively. Because of the worse outcomes with even moderate PPM, the authors emphasize that continued efforts to avoid implantation of too small a prosthesis remain necessary.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Kunihiro Yoshioka, Ryoichi Tanaka, Hidenobu Takagi, Yuta Ueyama, Tsuyoshi Sugawara, Takuya Chiba, Kazumasa Arakita, Joanne D Schuijf

Yoshioka and colleagues evaluated the artery of Adamkiewicz using multidetector row computed tomography in 64 patients. These patients had descending thoracic or thoracoabdominal aortic aneurysms that were associated with the occlusion of the segmental artery from which the artery of Adamkiewicz originated. Seventy-five collateral pathways were identified in 53 patients, and these were more frequently located around the spinal column than in the thoracic wall.

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

Patient Care and General Interest

A guideline for the number of opioid pills that should be prescribed after different surgeries, from cochlear implantation to coronary artery bypass grafting, is self-published by an expert group of health professionals as part of the effort to reduce overprescribing these drugs in the US.

A webcam in the operating room allows cardiothoracic surgeons in Pennsylvania, US, to update a patient’s family on a successful procedure earlier than usual.

After a baby’s heart transplant, her parents—a pediatrician and a school district trustee—are writing a children’s book for the kids and families who face this type of procedure.

The first double-lung transplant in the UAE is performed at the Cleveland Clinic Abu Dhabi using a minimally invasive approach.


Drugs and Devices

The Incraft Stent Graft System for endovascular abdominal aortic aneurysm repair, from Cardinal Health/Cordis, has received a vote of approval from a US Food and Drug Administration advisory panel.


Research, Trials, and Funding

A trial has begun to evaluate the first biological heart valve made in India. If shown to be a good therapeutic option, it is hoped that this locally-manufactured bioprosthesis will help bring down the cost of valve implantation for patients.

A VATS approach to early-stage lung cancer resection leads to survival outcomes similar to thoracotomy, say researchers from Yale University in Connecticut, US.

Source: The Annals of Thoracic Surgery
Author(s): Joshua L. Chan, Justin G. Miller, Mandy Murphy, Ann Greenberg, Margaret Iraola, Keith A. Horvath

Chan and colleagues describe a stepwise approach to reducing the time to extubation after cardiac surgery, driven primarily by bedside providers as opposed to a conventional physician-directed approach. The authors demonstrate that this fast-track extubation protocol increased the rate of early extubation and decreased the median time to extubation without altering reintubation or early mortality rates.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Michele Di Mauro, Roberto Lorusso

A brief, readable, sensibly balanced, and well-referenced editorial on the occasion of the retrospective Austrian paper on venoarterial extracorporeal membrane oxygenation (ECMO). Taken in the context of the recent New England Journal of Medicine paper on venovenous ECMO for acute respiratory distress syndrome and the relevant ATS presentations on the EOLIA trial, the editorial raises questions on the utility of the expensive innovation of ECMO.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Graeme L Hickey, Stuart W Grant, Joel Dunning, Matthias Siepe

Sample size calculations are a necessary prerequisite in the design of clinical studies. Most often, they are encountered in randomized controlled trials. Hickey and colleagues describe the reasoning behind determinations of sample size and illustrate some basic calculations. The authors also discuss estimation and sample size for nonrandomized studies.

Source: Annals of Cardiothoracic Surgery
Author(s): Asishana Osho, Uma Sachdeva, Cameron Wright, Ashok Muniappan

This written and video case review from Osho and colleagues centers on a 54-year-old woman who suffered smoke inhalation injury as a result of a house fire. Following prolonged intubation, mechanical ventilation, open tracheostomy tube placement, and recurrent pneumonia, the patient was diagnosed with a tracheoesophageal fistula (TEF). The authors prefer to manage TEF via an anterior cervical approach with division of the trachea, though a right thoracotomy may be used in the setting of highly distal TEFs. They emphasize that careful operative technique and the interposition of a robust muscle flap are the most important safeguards in surgical management of TEF.

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

Patient Care and General Interest

Screening infants for critical congenital heart disease at birth is becoming mandatory in the US state of Idaho and the Indian state of Kerala.

Tufts Medical Center in Boston, Massachusetts, USA, has completed its 500th heart transplant.


Drugs and Devices

The Venus P-Valve self-expanding pulmonary valve from Venus Medtech has been launched in Canada. The valve was developed for percutaneous implantation in native right ventricular outflow tracts.

The US Food and Drug Administration has issued a Class I recall for the HeartWare Ventricular Assist Device from Medtronic due to the possibility of an interrupted connection between the power source and the device controller.


Research, Trials, and Funding

A cardiac surgery team in Japan has approval to test induced pluripotent stem cell grafts in patients with damaged heart tissue to determine the safety of this regenerative medicine approach.

Interim data from a phase II trial from Leading BioSciences suggests that the company’s serine protease inhibitor, which targets postoperative ileus, reduces the length of intensive care and hospital stay for patients undergoing cardiac procedures on cardiopulmonary bypass.

An analysis from a European registry determined that mortality prediction models for heart failure patients have relatively poor reliability and are not used often in clinical practice.