Journal and News Scan

Selzman and colleagues provide an outstanding overview of the state of the art of bridge to recovery, describing a paradigm shift that has been occurring.  A consistent theme over the years is that recovery likelihood is enhanced in younger patients, those with non-ischemic cardiomyopathy, and those who have had HF for shorter durations.  Although the INTERMACS database reflects that only about 1% of patients are successfully bridged to recovery, several studies have demonstrated that more patients may be recovered if a proactive approach is undertaken.  Such an approach necessarily includes the early identification of potential candidates for removal, the modification of the surgical approach to facilitate later device removal, an active surveillance program, the institution of intensive adjuvant medical therapy, the adoption of standardized weaning protocols, and further exploration of less invasive techniques for removal.  The authors effectively argue that only with a wholesale expansion of such a paradigm shift will more patients be successfully weaned.  The devil--of course--lays in the details. The ongoing RESTAGE-HF trial will hopefully elucidate some of these details.

The authors of this article aimed to describe survival and clinical outcomes beyond 30 years of follow-up after surgical repair of Tetralogy of Fallot. They found a survival of 72% after 40 years. Health status was comparable to the Dutch population. Factors that were associated with late mortality included: a prior shunt operation, low temperature during surgery and early postoperative arrhythmias. They conclude that although many patients needed reoperation or developed arrhythmias, long-term survival was good, as was health status.

CMS determined that the evidence of benefit for CT screening for lung cancer is sufficient to permit this as an annual benefit for Medicare and Medicaid recipients in the US.  The availability of such coverage will be limited, however, by the need to have the screening as part of a comprehensive counseling (smoking cessation, etc) visit with qualified physicians or non-physician practitioners.  Radiologists and imaging centers must meet specific criteria, and activity must be submitted to a registry.

Differentiating a primary lung cancer from an intrapulmonary metastasis can be challenging.  The authors developed a lineage test using whole genome amplification and next-generation sequencing to identify breakpoints in known primary tumors and known metastases.  Independent primary tumors did not share any genomic rearrangements, whereas primary tumors and their known metastases all had shared rearrangements.  This type of analysis may enable pathologists to distinguish primary lung tumors from intrapulmonary mets.