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Journal and News Scan
The authors review cybersecurity issues related to newer generations of pacemakers. Telemetric capabilities providing patient data to health care workers can be co-opted, enabling malicious software to endanger patients. Risks include intentional battery depletion and malicious reprogramming.
This study evaluates 1028 octogenarians who underwent isolated aortic valve replacement (AVR, 306 TAVR and 722 SAVR) between 2002 and 2015 at Brigham and Women’s Hospital in the US. The mean age of patients was 84.4 ± 3.4 years old, with overall STS-PROM score of 5.96 ± 3.87. After adjusting for confounders, both of these elderly cohorts had similar operative mortality and short-term outcomes. No difference in mid-term survival was seen when comparing transfemoral TAVR, transsubclavian or transaortic TAVR, minimally invasive AVR, and sternotomy AVR. The authors suggest that these results indicate a continued role for SAVR in treating aortic stenosis in this patient population.
The authors report the non-intuitive finding that blood from female donors who had ever been pregnant was associated with increased mortality among male recipients (HR 1.13). If validated by other studies, might this substantially complicate matching donated blood with appropriate recipients? Clearly the underlying mechanism will be interesting to sort out.
The author decries what he sees as the corporatization of airline pilots, with their accompanying loss of autonomy and prestige. He speculates on whether a similar future is ahead for physicians, but does not provide specific suggestions on how to avoid this from occurring.
In this JAMA Forum article, Harvard's Ashish Jha discusses the pros and cons of public reporting of individual surgeon's outcomes. He uses the New York state cardiac surgery registry as an example and argues why, despite its problems, it is still the way forward. What are your thoughts!?
Hobbes and colleagues retrospectively evaluated systemic-to-pulmonary shunt procedures for 173 patients over a 10-year period at a single institution. Despite their importance for many patients with single ventricle or complex biventricular lesions, shunt procedures carry a high risk of morbidity and mortality. The authors found the main predictors of morbid events in their cohort were patient characteristics such as extracardiac or genetic anomalies and needing preoperative ventilation, but not age, weight, or shunt size to weight ratio. Additionally, oxygen saturation on ICU admission and amount of platelets transfused each predicted early shunt thrombosis.
Very nice paper that, once again, demonstrates established experience with awake thoracic surgery. Is this the future? Does a minimally invasive surgeon need a minimally invasive anesthesiologist beside?
Read a summary of presentations on percutaneous mitral valve techniques from the 2017 PCR London Valves meeting in the UK.
Drugs and Devices
In an interview with Nature, the executive director of the European Medicines Agency talks about the effect that the agency’s impending move from London could have on its operations.
The US Food and Drug Administration (FDA) will temporarily allow imports of intravenous saline to avoid shortages as Puerto Rico, which manufactures about 10% of medical products consumed in the US, continues recovering from the devastation caused by Hurricane Maria.
The US FDA approved a magnet-tipped catheter device for correcting pediatric esophageal atresia without open surgery.
Research, Trials, and Funding
Researchers from Uganda, the US, and France find that prophylactic penicillin might be helpful for children with mild latent rheumatic heart disease.
Two studies published in JAMA Cardiology and the European Heart Journal suggest that low mitochondrial DNA copy number might indicate increased risk of cardiac events.
A new protocol from a multidisciplinary team at Johns Hopkins University in Baltimore, US, aims to reduce the incidence of acute kidney injury after cardiac surgery.
Researchers at Harvard University in Boston, US, used “lung-on-a-chip” tissue models to study NSCLC adenocarcinoma cells. Mechanical forces, applied to these model lungs to mimic breathing, reduced cancer cell growth and invasion and influenced anti-cancer drug efficacy.
This study examined risk estimates for complex major surgery by trainees in internal medicine and in general surgery using seven clinical scenarios. Surgery residents expressed more confidence in their estimates, but were less likely to use published risk models. Most trainees in both specialties significantly overestimated every type of risk, averaging a quarter to a third higher than risk model predictions.
The authors report on the design and use of a growth-accommodating device that may have a variety of pediatric applications, including valve annuloplasty. The device consists of a biodegradable core and a tubular braided sleeve (woven much like a 'finger trap' toy). After implantation, the core—which constrains the length of the device—degrades so as to allow the annuloplasty to enlarge gradually over time. Thus, the device 'grows' with the child. The authors further present validation of the device in a swine model.
The free full text is available.