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Journal and News Scan
Excellent review of recent advances that will shape therapy in the next 5 years.
Discussion and critique editorials accompany this report on extensive emergency surgical treatment of aortic dissection, fueling an important debate.
Vaughn A. Starnes, MD, became the 100th President of the American Association for Thoracic Surgery (AATS). He officially succeeded David H. Adams, MD, in a ceremony at the AATS 99th Annual Meeting in Toronto. Joining him in new positions on the Executive Committee are Marc R. Moon, MD, who is now President-Elect after serving as Vice President for the past year and Secretary for five years, Shaf Keshavjee, MD, who was elected as the new AATS Vice President and who served as Treasurer for five years, and Emile A. Bacha, MD, who became Treasurer following three years as Director. David R. Jones, MD, was reappointed to serve as Secretary.
In this surgical video, Durand presents a four-arm robotic sleeve right upper lobectomy and node harvest. The patient was a 60-year old man who had been diagnosed with a proximal right upper lobe squamous cell carcinoma after exploration for hemoptysis. Additionally, the author highlights the differences between the technique shown in this video and other recently published techniques.
Patient Care and General Interest
The British Heart Foundation reports that the number of premature deaths related to cardiovascular disease has risen in the UK for the first time in 50 years.
A federal judge in the US ruled against the Food and Drug Administration’s (FDA) 2017 decision to allow e-cigarettes to remain on the commercial market prior to obtaining FDA approval, a move that was applauded by the associations that brought the suit.
Drugs and Devices
The US FDA has expanded the approved duration of support for 2 Impella heart pumps from 6 to 14 days.
Xvivo Perfusion, Inc, was granted premarket approval by the US FDA for its ex vivo lung perfusion system, a move that expands the device’s previous humanitarian device exemption authorization.
The US FDA has approved dalteparin sodium for treating venous thromboembolism in children as young as 1 month old.
Research, Trials, and Funding
The antiplatelet agent ticagrelor showed antibacterial activity against Staphylococcus and Enterococcus strains that was not seen with other antiplatelet agents, say researchers from Liege, Belgium.
Researchers in China compared the levels of circulating tumor cells after either a vein-first or artery-first approach to lobectomy for lung cancer.
An iron boost on the day before cardiac surgery reduced the need for blood transfusion in patients with anemia or iron deficiency, say researchers from Zurich, Switzerland.
Researchers in Durham, North Carolina, USA, grew human acellular vessels that were implanted in dialysis patients, and they speculate about potential future applications for these vessels, such as use during heart surgery.
Zhang and colleagues retrospectively compared outcomes for 27 patients who underwent lung transplantation either with or without ex vivo lung perfusion at their center. The ex vivo lung perfusion group consisted of recipients who received initially-discarded donor lungs that were reconditioned using ex vivo perfusion. Similar outcomes were observed between the two groups, including primary graft dysfunction, pulmonary function, chronic lung allograft dysfunction, and survival.
I believe that this is the world's first randomized controlled trial of mini aortic valve replacement (AVR) versus full sternotomy AVR.
It is a very well-conducted study where the surgeon was randomly assigned to perform an AVR by sterntomy or by manubrium-only. The same consultant surgeon performed either operation after randomization. No trainee performed any operations as operating surgeon. The protocol was very tightly adhered to.
The primary outcome was red cell transfusion at 7 days, and there were many secondary outcomes including length of stay, complications, etc, as might be expected.
The mean age was 69 and the mean EuroSCORE was 5.2 and the groups were perfectly matched.
The bypass time was 82 minutes in the ministernotomy group and 59 minutes in the sternotomy group.
The major outcome results might surprise you! Click on the link to find out!
An interesting metanalysis, especially:
- The ad hoc results of off-pump surgery.
- The mean number of silent brain infarcts per patient was significantly higher in the transcatheter aortic valve implantation group (4.58 ± 2.09) compared with the aortic valve replacement group (2.16 ± 1.62, P=0.03).
The manuscript summarizes evidenced-based perioperative guidelines for enhanced recovery after surgery (ERAS).
Ticagrelor (Brilinta), an oral P2Y12 inhibitor, is an agent used in combination with aspirin for dual antiplatelet therapy after coronary interventions. It's antiplatelet function cannot be reversed by platelet transfusion. The authors evaluated the efficacy of IV PB2452, a monoclonal antibody, in reversing ticagrelor's antiplatelet effect in a randomized, double-blind, placebo-controlled, phase 1 trial in healthy volunteers. The administration of PB2452 resulted in reversal of ticagrelor's antiplatelet effect within 5 minutes of infusion of the former, and this effect was sustained. There were minimal adverse events associated with this reversal agent.