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Journal and News Scan

Source: The Annals of Thoracic Surgery
Author(s): Jeremiah R. Brown, Heather Thiessen-Philbrook, Christine A. Goodrich, Andrew R. Bohm, Shama S. Alam, Steven G. Coca, Eric McArthur, Amit X. Garg, Chirag R. Parikh
Given that acute kidney injury (AKI) after cardiac surgery is a risk factor for readmission, Brown and colleagues sought to determine whether urinary biomarkers were better at predicting readmission within 30 days that duration of AKI during the index admission. Using data from patients enrolled in the Translational Research Investigating Biomarker Endpoints-AKI trial, preoperative and postoperative levels of interleukin-18, neutrophil gelatinase–associated lipocalin, kidney injury molecule-1, liver-fatty-acid-binding protein, cystatin C, microalbumin, creatinine, and albumin-to-creatinine ratio were compared with the total number of days that AKI was present during the initial hospitalization. AKI duration of 3 to 6 days was associated with 30-day readmission or death (adjusted odds ratio, 1.82%; 95% confidence interval, 1.08 - 3.05), while urinary biomarkers had no association with readmission and death.
Source: Heart, Lung and Circulation
Author(s): Edward Litton, Frances Bass, Cheryl Dickson, Graham Hillis, Deborah Inskip, Theresa Jacques, David McGiffin, Shay McGuiness, Jennene Miller, Rachael Parke, Hugh Playford, Chris Reid, Julian Smith, Noah Solman, Lavinia Tran, Elizabeth Yarad, Anthony Delaney, on behalf of the ANZICS Clinical Trials Group

An intresting pilot that was stopped due to underrecruitment. Commendable mortality in high-risk coronary artery bypass grafting.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Arnar Geirsson, Arnar Geirsson, Kayoko Shioda, Christian Olsson, Anders Ahlsson, Jarmo Gunn, Emma C. Hansson, Vibeke Hjortdal, Anders Jeppsson, Ari Mennander, Anders Wickbom, Igor Zindovic, Tomas Gudbjartsson

Food for thought from a retrospective non-randomized study on the Scandinavian experience with acute aortic dissection. The reader may find outcomes that will surpise them.

Source: JACC
Author(s): Katelyn M. Atkins, Bhupendra Rawal, Tafadzwa L. Chaunzwa, Nayan Lamba, Danielle S. Bitterman, Christopher L. Williams, David E. Kozono, Elizabeth H. Baldini, Aileen B. Chen, Paul L. Nguyen, Anthony V. D’Amico, Anju Nohria, Udo Hoffmann, Hugo J.W.L. Aerts, Raymond H. Mak

In this retrospective review of the effects of radiation dose to the heart on long-term outcomes, 748 patients with regionally advanced non–small cell lung cancer were studied.  An increasing cardiac radiotherapy dose was associated with an increased risk of MACE and all-cause mortality. This was observed primarily in patients without preexisting heart disease.

Source: The Washington Post
Author(s): Emily Langer

Leonard L. Bailey, a pediatric surgeon who attracted international attention in 1984 when he transplanted a baboon’s heart into a newborn human — “Baby Fae” — a medical moon shot that sparked breathless controversy but was credited with demonstrating the lifesaving potential of organ transplants for the tiniest patients, died May 12 at his home in Redlands, California. He was 76.

Source: News from around the web.
Author(s): Claire Vernon

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.

Source: European Heart Journal
Author(s): Karsten Keller, Lukas Hobohm, Matthias Ebner, Karl-Patrik Kresoja, Thomas Münzel, Stavros V. Konstantinides, Mareike Lankeit

The treatment approaches and in-hospital outcomes were analyzed for 885,806 patients with acute pulmonary embolism (PE) in Germany between 2005 and 2015. The incidence of acute PE increased from 85 per 100,000 in 2005 to 109 per 100,000 in 2015 [β 0.32 (0.26–0.38), P < 0.001]. During the same period, in-hospital case fatality rates decreased from 20.4% to 13.9% [β −0.51 (−0.52 to −0.49), P < 0.001]. The overall proportion of patients treated with systemic thrombolysis increased from 3.1% in 2005 to 4.4% in 2015 [β 0.28 (0.25–0.31), P < 0.001]. Thrombolysis was associated with lower in-hospital mortality rates in patients with hemodynamic instability, both in those with shock not necessitating cardiopulmonary resuscitation (CPR) or mechanical ventilation [odds ratio (OR) 0.42 (0.37–0.48), P < 0.001], and in patients who underwent CPR [OR 0.92 (0.87–0.97), P = 0.002]. This association was independent of age, sex, and comorbidities. However, systemic thrombolysis was administered to only 23.1% of hemodynamically unstable patients.

Source: Web MD
Author(s): Steven Reinberg

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.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Agustin Sibona, Kiran K. Khush, Udo E. Oyoyo, Timothy P. Martens, Nahidh W. Hasaniya, Anees J. Razzouk, Leonard L. Bailey, David G. Rabkin

Left ventricular ejection fraction was not a predictor of outcomes after heart transplant, and was normal in all recipients at 1 year posttransplant. The reliance on generic transthoracic echocardiography for donor assessment may well be the Achilles heel of this retrospective case study.

Source: The New England Journal of Medicine
Author(s): Frank A. Lederle, Tassos C. Kyriakides, Kevin T. Stroupe, Julie A. Freischlag, Frank T. Padberg Jr, Jon S. Matsumura, Zhiping Huo, Gary R. Johnson, for the OVER Veterans Affairs Cooperative Study Group

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.