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Journal and News Scan
Rodríguez-Caulo and colleagues report a retrospective multicenter study on almost 1,500 patients aged 50-65 who underwent aortic valve replacement with mechanical or biological prosthesis. The mean length of follow-up was 8 years. There was no significant difference in survival between the valve types. There was a higher rate of major bleeding in patients with mechanical prosthesis; however, reoperation was more frequent among those with a biological prosthesis. The authors conclude that a bioprosthesis in patients of age 55 years and older is a reasonable choice.
Patient Care and General Interest
San Francisco, California, passed an ordinance to ban the sale of e-cigarettes in the city, the first such ordinance in the USA.
The US Centers for Medicare & Medicaid Services (CMS) has released the anticipated update to the national coverage decision for transcatheter aortic valve replacement. The full decision memo is available on the CMS website.
Patient-specific 3D modeling is used to aid planning of a complex chest wall reconstruction.
A brief interview with the chief of cardiothoracic surgery at Phoenix Children’s Hospital in Arizona, USA, focuses on the importance of transparency and a true team attitude to achieve the best possible patient outcomes.
Research, Trials, and Funding
Researchers from Vanderbilt University in Tennessee, USA, report that among adults diagnosed with lung cancer, a smaller proportion of black Americans than white Americans would have qualified for screening.
In this systematic review, Arnaoutakis and colleagues evaluated the repair durability and survival of patients who underwent repair for a bicuspid aortic valve (BAV). Twenty-six studies were evaluated after full exclusion criteria were applied. BAV repair was demonstrated to have low operative mortality and excellent 5-year survival. Variations in surgical technique (eg, in reimplantation or remodeling), were not associated with protection from reintervention. Systematic assessment of cusp height and annular stabilization favored long-term durability, and increased leaflet calcification was noted to have higher rates of reintervention.
Social media offers enormous potential benefits for both care providers and patients, because the platform allows for the dissemination and gathering of information and has the innate ability to network globally. The Cardiothoracic (CT) Ethics Forum functions as the ethics educational arm for the CT surgical community, producing ethics-related programs at major CT surgery meetings and subsequently publishing articles on those proceedings as well as ethical topics in CT surgical and other medical specialty journals. The Forum has constructed a very important and useful set of recommendations for CT surgeons as they engage with social media.
An interesting small British-led randomized controlled trial on modern imaging of coronary atheroma.
This is a cohort study from the Pediatric Cardiac Care Consortium based on data from 616 patients with pulmonary atresia with intact ventricular septum (PA/IVS) treated between 1982 and 2003. Median follow-up was 16.7 years (IQR 12.6-22.7).
Initial interventions included aortopulmonary shunt in 247, right ventricular decompression in 96, and both in 273. Risk factors for death at initial intervention included earlier birth era (1982-1992), chromosomal abnormality, and atresia of one or both coronary ostia. Among 494 survivors of neonatal hospitalization, there were 99 deaths (4 posttransplant) and 10 transplants (median age of death or transplant 0.7 years, IQR, 0.3-1.8). Definite repair or last-stage palliation was achieved in the form of completed 2-ventricle repair (n=201), one-and-a-half ventricle (n=39), or Fontan (n=96). Overall 20-year survival was 66%, but for patients discharged alive after definitive repair, it reached 97.6% for single-ventricle patients, 90.9% for those with one-and-a-half ventricle, and 98.0% for those with complete 2-ventricle repair (log-rank p=0.052).
The authors conclude that transplant-free survival in PA/IVS is poor due to significant infantile and interstage mortality. Survival into early adulthood is excellent for patients reaching completion of their intended treatment path, independent of type of repair.
Colleagues from five heart centers performed a study on the incidence and factors associated with acute stroke following type A repair using the Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD).
Among 7353 Acute type A repair performed at 772 centers between 2014 to 2017, operative mortality was 17% and incidence of postoperative stroke was 13%. Multivariate analysis showed that patients with axillary cannulation versus femoral (OR=0.60, P<0.001) and retrograde cerebral perfusion versus no cerebral perfusion (OR=0.75, P=0.008) or antegrade cerebral perfusion (OR=0.75, P=0.007) were less likely to develop acute stroke, while total arch replacement versus hemi-arch technique (OR=1.30, P=0.013) was predictive of higher risk for stroke. Longer times of circulatory arrest, cerebral perfusion and cardiopulmonary bypass were all related to higher risk of postoperative stroke. The degree of hypothermia and center volume were not related to stroke incidence.
Oliveira and colleagues retrospectively analyzed outcomes for 1,628 patients who underwent on-pump coronary artery bypass grafting at a single center in Brazil over a six-year period. They divided patients into quartiles based on their preoperative creatinine levels, finding a higher mortality rate in the highest creatinine quartile than in the lowest two quartiles. Additionally, variance of more than 0.4 mg/dL between the creatinine level measured at admission and the highest level measured in the intensive care unit was associated with a greater risk of death for patients in all quartiles.
Verdial and colleagues prospectively characterized the performance of a guideline-recommended invasive mediastinal staging (IMS) strategy in detecting nodal disease among 123 patients with non–small cell lung cancer (NSCLC). While the guideline-recommended approach identified all patients with true nodal disease, it also selected 65% of patients without nodal disease to undergo IMS. Toward the goal of reducing the usage of invasive procedures in patients with node-negative NSCLC, the authors developed a prediction model composed of five radiographic factors. They found that their prediction model maintained the sensitivity of the guideline-recommended IMS strategy (within a margin of error) while selecting fewer patients without nodal disease to undergo invasive staging. The authors note the need for the model to be independently validated in other cohorts.