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Journal and News Scan
Farhood Saremi and colleagues from the University of Southern California contributed a comprehensive review of the computed tomography angiographic (CTA) findings that improve the accuracy of diagnosis of thoracic aortic dissection and predict the outcomes of different management strategies for this highly lethal disease. The authors present the concept of aortic remodeling and the spectrum of CTA findings with regard to favorable or failing remodeling. This review also summarizes important image findings that are predictive of positive or negative remodeling before and after thoracic endovascular aortic repair. Knowledge of these imaging findings and their inclusion in a concise radiology report are important for optimum patient care.
Kim and colleagues sought to determine if a supra-annular aortic valve prosthesis implantation is superior to an intra-annular implantation. The authors retrospectively reviewed outcomes and echocardiographic data for 587 patients who received either supra-annular or intra-annular aortic valve prostheses from St Jude Medical. The implantation technique did not significantly affect the risk of overall mortality or major adverse events, however there were superior hemodynamics with lower peak velocity, lower mean pressure gradient, and improved ventricular mass index in patients with supra-annular implantation.
In a single institution review comparing acute outcomes for men and women after surgery for non-small cell lung cancer, men were found to have an increased risk of postoperative cardiac complications, whereas women were found to have an increased incidence of 30-day readmission, the latter despite similar frequency of postoperative emergency department visits and presenting symptoms. Reasons for the higher readmission rate for women are ascribed to a variety of possible causes, but gender bias perhaps also should be considered as a possible explanation.
Forty-nine patients with limited metastatic non-small cell lung cancer (three or fewer metastatic sites) who did not progress on initial systemic therapy were randomized to surgery or RT vs standard maintenance therapy. Overall survival for the intervention group was 41.2 mos vs 17.0 mos in those getting maintenance therapy (p=0.017).
Patient Care and General Interest
The Boston Marathon race director, who has run the marathon 46 straight times, underwent triple bypass surgery last Friday at Boston’s Massachusetts General Hospital.
A 12-year-old patient at Lucile Packard Children’s Hospital Stanford in Palo Alto, California, USA, recently became the youngest and smallest person in the country to receive a HeartMate 3 ventricular assist device.
A study published in Cancer Prevention Research suggests that due to the success of tobacco controls in California, USA, annual lung cancer mortality in the state during 2013 was 28 percent lower than in the rest of the country.
A woman with stage IV lung cancer completed the IRONMAN World Championship race in Kailua Kona, Hawaii, USA, this past Saturday.
Research, Trials, and Funding
A study just published in the Journal of the American Heart Association suggests that a history of percutaneous coronary intervention has a minimal effect on CABG outcomes.
A study conducted by the Cleveland Clinic, Cleveland, Ohio, USA, indicates that biopsies of hand tissue in carpal tunnel patients could detect early signs of cardiac amyloidosis.
The European Association for Cardio-Thoracic Surgery and the European Society for Vascular Surgery released a joint expert consensus on the treatment of thoracic aortic pathologies involving the aortic arch, the first guidelines on the diagnosis and treatment of aortic arch disease. This expert consensus includes 11 parts and aims to help medical professionals in understanding the natural history of aortic arch pathologies and choosing the best, latest treatment options for specific subgroups of patients at the most appropriate time, with the best attainable quality.
In this single institution study including over 1900 patients with severe degenerative mitral regurgitation (MR) undergoing mitral valve repair, early intervention was associated with a reduced risk of recurrent MR.
Click on the link below and register for free to gain access to two operations that were performed live in Bologna, Italy, on October 1st, 2018.
The first video is a right upper lobe microthymectomy with energy division of the posterior ascending artery and tumour retrieval from a subxiphoid port with lymphadenectomy, followed by a presentation about microlobectomy.
Next, there is a case that was set up as for a microthymectomy. The authors used the flexdex needle holder and the L-hook ligasure device, which is a ligasure and a hook cautery in one. In fact, while the case was set up as a thymectomy and the approach was that used for a thymectomy, the mass turned out to be a solitary fibrous tumour of the pleura. It was 6cm in size, so this was again removed through a subxiphoid port and the patient made an excellent recovery.
I hope you enjoy these videos. You can see more at www.microlobectomy.com.
Pulmonary hypertension is considered a contraindication for lung volume reduction surgery. Caviezel and colleagues evaluated outcomes of lung volume reduction performed in 30 patients with emphysema, 10 of whom had mild-to-moderate pulmonary hypertension. At the authors’ center, pulmonary hypertension was a contraindication for patients with homogeneous, but not heterogeneous, emphysema. There was no 90-day mortality, and the postoperative course did not differ between patients with and without pulmonary hypertension. The authors conclude that mild-to-moderate pulmonary hypertension might not be a contraindication for lung volume reduction surgery and encourage further confirmation in other studies.
Despite the benefit for most patients, some patients have poor outcome after transcatheter aortic valve implantation (TAVI). Currently it is hard to predict which patient is predisposed to poor outcome at one year. This paper investigates the performance of a previously developed prediction model of poor outcome after TAVI.
Arnold and colleagues previously built a prediction model of poor outcome using data from high-risk TAVI trials. The model included the preoperative Kansas City Cardiomyopathy Questionnaire (KCCQ), mean aortic valve gradient, usage of home oxygen, creatinine level, atrium fibrillation, and atrial fibrillation. Poor outcome was defined as death, poor quality of life (KCCQ-OS <60), or moderate worsening in quality of life (decrease of >10 points in KCCQ-OS) at one year. In the current paper they set out to validate the model in lower-risk real-world dataset of >13000 TAVI patients from the TVT registry. The model was validated based on discrimination and calibration, and was recalibrated for this real-world population.
Poor outcome decreased from 42.0% in 2012 to 37.8% in 2015. Initially, the model performed poorly with moderate discrimination but poor calibration. After recalibration, the model performed well with a C index of 0.65, but excellent calibration.
The recalibrated model can be used to identify patients who are less likely to benefit from TAVI and to help patients prepare for the recovery phase after the procedure.
Unfortunately, risk models are inherently imperfect, as was shown by the only moderate discrimination. This means it cannot be used to accurately predict who will or will not have a poor outcome. Rather, it helps to estimate the chances of good recovery. This information will be useful for patients in order to prepare for the recovery and have realistic expectations.