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Journal and News Scan
The authors report on 38 patients who underwent bilateral lung transplantation for severe pulmonary hypertension with routine application of prophylactic postoperative veno-arterial extracorporeal membrane oxygenation (ECMO). These patients’ survival up to 5 years was not different from patients who received lung transplants for other causes, and cardiac parameters were improved 12 months after transplantation. In consequence, the authors recommend regular postoperative use of ECMO in this patient population.
Mehaffey and colleagues evaluated major adverse events in 118 cardiopulmonary bypass (CPB) patients who had received methylene blue (MB) within 72 hours of CPB. Although these patients had high incidence of comorbidities and postoperative complications, MB administration in the operating room was associated with reduced operative mortality rate and incidence of adverse events compared to MB administration in the intensive care unit.
Balsam and colleagues present two cases of Mycobacterium chimaera infection following implantation of left ventricular assist devices, likely linked to bioaerosols from heater-cooler units used during surgery. Both cases were milder than has been reported following valvular and aortic graft surgery, but long-term sterilization of the internal hardware is unlikely. The authors also discuss their local practice changes that aim to prevent future cases.
A cardiac surgeon in Mumbai, India, is raising money to fund bypass surgeries, angioplasties, and angiographies for people who cannot afford them.
A boy in Hong Kong receives heart transplant after 282 days on a mechanical pump.
TAVI is now an option for patients in Saskatchewan, Canada, and the first transcatheter pulmonary valve replacement in West Virginia, USA, is performed at WVU.
Doctors in Al Ain, UAE, call for more facilities to offer cardiac surgery.
Drugs and Devices
The US FDA used data from the STS/ACC Transcatheter Valve Therapy Registry to expand the approved use of a Edwards Lifesciences’ Sapien 3 TAVR to valve-in-valve procedures. The US FDA also cleared FlowGlide Technology, the latest generation of technology for chest drainage after CT surgery from company ClearFlow, Inc.
MedReleaf Corp. in Canada is now the first ICH-GMP certified medical cannabis producer.
Stryker Corporation is expanding into surgical imaging technologies with its purchase of Novadaq Technologies.
Research Trials and Funding
Tilray will support a Phase II trial on the efficacy of vaporized cannabis in COPD at McGill University in Montreal, Canada.
The authors analyzed long-term recurrent aortic regurgitation (AR) in 249 patients with aortic insufficiency and reimplantation procedure. Of the cusp repair techniques evaluated in the analysis, only free margin reinforcement and patch repair influenced valve durability, the former positively and the latter negatively. Proportional hazard analysis also identified preoperative cusp prolapse as a significant risk factor for recurrent AR.
Please make sure that you are aware of this recall for testing of System CS100, CS100i and CS300 Intra-aortic Balloon Pumps for electrical testing.
Overall Action for User
Patients receiving IABP therapy are in critical condition and sudden interruption of therapy could result in unsafe, hemodynamic instability. Maquet/Getinge indicates that the risk-benefit of using an affected CS100i, CS100 or CS300 IABP should be assessed by the medical team for each patient when no alternative IABP or alternative therapy is available. Please adhere to the following instructions when using affected devices as mentioned in the link provided
Hiraoka and colleagues compared outcomes of 337 patients receiving conventional total aortic arch repair to 58 patients receiving hybrid aortic arch repair at a single cardiovascular institution. The authors observed no differences in operative or 30-day death. Five-year survival rate was similar between the groups despite stroke occurring more frequently in the hybrid repair group.
Accompanying commentaries from Atkins and Szeto, and De Santo discuss the comparison of a standard technique to a one performed on a higher-risk population of patients:
Hybrid aortic arch surgery: Have we reached clinical equipoise? Marvin D. Atkins, Wilson Y. Szeto.
Hybrid aortic arch repair: Facts and hints beyond the statistical truth. Luca Salvatore De Santo.
The Amsterdam Investigator-initiated Absorb Strategy All-comers Trial report safety concerns identified in early results for the bioresorbable scaffold drug eluting stent. The scaffold group experienced significantly higher rates of device thrombosis than the stent group (3.5% vs 0.9%; p<0.001). It seems that no stent, no matter how sophisticated and costly it may be, will ever match arterial coronary bypass in long term outcomes.
David and colleagues investigate tricuspid regurgitation (TR) before and after mitral valve (MV) repair in a retrospective analysis of over 1000 patients. TR was present prior to surgery in 11.8% of cases and new postoperative TR was not common. The authors suggest that their findings support repairing the MV before TR develops.
Commentary from Gillinov and collegues, Dreyfus, and Chikwe and Adams adds to the discussion on tricuspid annuloplasty during degenerative mitral repair:
The tricuspid valve: If it's not broken, don't fix it. Marc Gillinov, Stephanie Mick, Kenneth McCurry, Jose Navia.
Functional tricuspid pathology: To treat or not to treat? That is the question. Gilles D. Dreyfus.
The donkey's shadow. Joanna Chikwe, David H. Adams.