Journal and News Scan

Patient Care and General Interest

A new study looking a dietary protein sources and LDL cholesterol levels calls into question the idea that white meat is more heart healthy than red meat.

An expert consensus document on cardiogenic shock provides a standardized vocabulary for diagnosis and outlines best practices for treating patients.

Drugs and Devices

A US Food and Drug Administration panel recommended reclassifying surgical staplers to class II medical devices as the agency acknowledged a greater number of device malfunction reports than had been publicly disclosed.

Research, Trials, and Funding

The European Respiratory Society says that the strategy of tobacco harm reduction using e-cigarettes should not be used as a population-based approach for tobacco control, citing a lack of evidence that they reduce nicotine dependence and the potential for health risks that are not yet known.

In related news, researchers from the UK report that e-cigarettes improved rates of tobacco cessation, while researchers from the US find that e-cigarette flavorings have negative effects on endothelial cell function.

Researchers at Imperial College London in the UK have developed a small patch of stem cells that can be sewn to the heart, and in rabbits the patches integrated and improved heart function after experimental myocardial infarction.

Interim results from a trial on immune checkpoint inhibitors given before surgery to patients with resectable lung cancer suggest the treatment was well-tolerated and may provide benefit to these patients.

As the procedure began, doctors found that one lung was stuck to the chest bone forming bullae, which are like blisters and often occur with COPD. The surgeons punctured one of the blisters, causing an air leak. So that the patient wouldn't have trouble breathing, the anesthesiologist increased the amount of oxygen.

Fed by leaking oxygen, a spark from an electrocautery device set a dry surgical pack on fire. Doctors immediately put the fire out and continued with the procedure, successfully repairing the torn artery. The findings were presented at the 2019 European Society of Anesthesiology meeting in Vienna, Austria.

The NEJM published the long-term results of the OVER study of open repair (OR) versus endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) on May 30.

The OVER study demonstrated similar long-term overall survival between patients undergoing EVAR and OR. These results were not consistent with the findings of worse performance of EVAR with respect to long-term survival that were seen in two studies conducted in Europe.

In OVER, patients with asymptomatic AAA were randomly assigned to either EVAR or OR for aneurysm treatment and were followed for up to 14 years. This study enrolled 881 patients who were candidates for either procedure, with 444 assigned to EVAR and 437 to OR. The primary outcome was all-cause mortality. Although elective EVAR of AAA has shown lower perioperative mortality than OR, this survival advantage was not seen after 4 years.

Imporant trends include, although none were signficant:

• 302 patients (68%) in the EVAR group and 306 patients (70%) in the OR group died (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.82–1.13).
• In the first 4 years of follow-up, overall survival appeared to be higher with EVAR versus OR.
• In year 4 through year 8, overall survival was higher in the OR group.
• After 8 years, overall survival was higher in the EVAR group (HR for death, 0.94; 95% CI, 0.74–1.18).

Additional findings:

• There were 12 aneurysm-related deaths (2.7%) in the EVAR group and 16 (3.7%) in the OR group (between-group difference, -1.0 percentage point; 95% CI, -3.3–1.4) with most deaths occurring in the perioperative period.
• Aneurysm rupture occurred in seven patients (1.6%) with EVAR, and rupture of a thoracic aneurysm occurred in one patient (0.2%) with OR (between-group difference, 1.3 percentage points; 95% CI, 0.1–2.6).
• Death from chronic obstructive lung disease was approximately 50% more common in OR patients than EVAR patients (8.2% vs 5.4%) with a between-group difference of -2.8 percentage points (95% CI, -6.2–0.5).
• More patients in the EVAR group underwent secondary procedures.

Butt and colleagues examined the incidence and reasons for hospitalizations following coronary artery bypass grafting  (CABG). This study was performed using a Danish nationwide registry including more than 30,000 patients. Within 1 year after CABG, 40% of patients were readmitted at least once, most of them due to a cardiovascular cause. Risk factors for readmission included lower socioeconomic status, preoperative comorbidities, postoperative complications during the index admission, and a longer length of stay in the hospital.