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Journal and News Scan
Gu and colleagues developed a surgeon-specific quality monitoring system using a structured database of information derived from electronic health records. Additionally, they used a mobile-based system to provide feedback to surgeons on risk-adjusted mortality, risk-adjusted complications, and other quality measures. The authors report on both the development of the system and the quality measures of top, middle, and bottom performing surgeons, with differences observed only for the rate of internal mammary artery use, the risk-adjusted postoperative length of stay, and risk-adjusted hospitalization cost. They conclude that the system allowed surgeons to compare their own surgical quality with that of their colleagues and identify priorities for improvement.
In light of the recent Centers for Medicare and Medicaid Services recommendation for transcatheter aortic valve replacement (TAVR) volumes, this study looked at 113,662 TAVRs from the TVT registry from 2015 to 2017 and found that 30-day mortality was higher at low-volume TAVR hospitals or low-volume operators.
Intraoperative conversion may be necessary during video-assisted thoracoscopic surgery (VATS) for lung cancer. In this study on 610 patients, Fourdrain and colleagues observed that conversion during a VATS procedure was not associated with worse outcomes than undergoing an up-front thoracotomy. The authors conclude that thoracoscopic access should be preferred to thoracotomy, since conversion is not disadvantageous.
Surgeon-scientists have been instrumental in many breakthroughs that have improved the lives of millions of patients. However, despite the many rewards that a career as a surgeon-scientist offers, the number of surgeons pursuing such a path has been steadily declining.
In this thoughtful editorial, Dr Ikonomidis and other cardiothoracic leaders explore the root causes for this decline and possible solutions for keeping a surgeon-scientist activity.
Although computed tomography is the most used imaging technique in the diagnosis of acute aortic syndrome, echocardiography offers complementary information for diagnosis and management in the emergency room, operting rooom, and catheter lab. In this review, Evangelista and associates explore the current role of echocardiography in the diagnosis and management of patients with acute aortic syndrome based on its advantages and limitations.
Researchers from the University of Nottingham studied 502,628 adults aged 40 to 69 years whose health information was logged in the UK Biobank between 2006 and 2010. Using demographic data and taking into account biometric, clinical, and lifestyle factors, the authors developed predictive mortality models using deep learning, random forest, and Cox regression.
Death occurred in 14,418 adults (2.9%) over a total follow-up time of 3,508,454 person-years, and mortality data was corroborated with national records. The age- and gender-based Cox model was the least predictive, with an area under the curve (AUC) of 0.689, followed by the multivariate Cox regression model, which improved discrimination by 6.2% for an AUC of 0.751. The application of machine-learning algorithms further improved discrimination by 3.2% using the random forest model (AUC = 0.783; 95% confidence interval (CI), 0.776 - 0.791) and 3.9% using deep learning model (AUC = 0.790; 95% CI, 0.783 - 0.797). The two machine-learning algorithms improved discrimination by 9.4% and 10.1% respectively from a simple age and gender Cox regression model.
This work suggest machine learning significantly improved accuracy of prediction of premature all-cause mortality in this middle-aged population, compared to standard methods. This study illustrates the value of machine learning for risk prediction within a traditional epidemiological study design.
A robust meta-analysis of randomized controlled trials on stem cell therapies for refractory angina, offering some encouragement.
In this state-of-the-art review review, the authors summarize current knowledge of anatomic, structural, metabolic, functional, and hemodynamic characteristics of the right ventricle (RV) in both health and disease. Highlights of this review are:
- Anatomically and functionally different from the left ventricle, the RV plays an increasingly recognized role in determining both symptoms and outcomes in multiple conditions.
- The normal RV is coupled to the low-pressure, high-compliance pulmonary circulation to ensure transfer of blood to the pulmonary arteries in an energy-efficient fashion. RV adaptation to disease is determined by the degree of pressure overload, volume overload, and alterations in intrinsic contractility. These 3 situations have distinct clinical course and therapeutic approach although they commonly coexist in various degrees.
- Advances promise to enhance our understanding of the mechanisms of RV adaptation or maladaptation to pathologic conditions. These include refinements in the evaluation of RV anatomy, myoarchitecture, ultrastructure, metabolism, perfusion, function, and degree of coupling to the pulmonary circulation. Such evaluation can be performed invasively but increasingly is accomplished through noninvasive imaging.
Professor Sharma and his team from London investigated the prevalence of an enlarged aorta in 3781 British athletes and 806 control individuals. The mean age was 19 ± 5.9 years, and 63.3% were male. The average time of training was 16.7 hours per week. The follow-up lasted for 5 ± 1.5 years.
This study found that athletes had a slightly larger aortic diameter compared to controls (28.3 ± 4.1 versus 27.8 ± 4.1 mm; p=0.01), but this difference was only 0.9 mm. The 99th percentile value for the aortic diameter in men and women was 40 mm and 38 mm, respectively, which represent an enlarged aortic diameter. The aortic diameter did not exceed 43 mm in any man or 41 mm in any woman. Five men and 6 women had an enlarged aortic diameter. These 11 athletes were followed for more than 5 years with serial echocardiograms and continued to exercise during that period. No progressive enlargement in the aortic diameter was observed in this group of athletes.
In conclusion, a small minority of athletes (0.3%) had a slightly enlarged aorta. The aortic diameter rarely exceeded 40 mm in men or 38 mm in women. Medium-term follow-up revealed no evidence of progressive enlargement of the aortic diameter in those athletes with an enlarged aorta.
Cook Medical announced that Dr Joseph Lombardi in New Jersey treated the first patient in the US using the newly approved Zenith® Dissection Endovascular System as part of the device's commercial launch. The system consists of a proximal stent-graft component and a distal bare stent component. “The value in this dissection stent is that it’s pathology-specific, designed just for this disease," said Dr Lombardi, the Global Principal Investigator of the STABLE I and STABLE II clinical trials.