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Journal and News Scan
Three more UK surgical centers will introduce heart transplants from non-heart beating donors. In the UK, this procedure is currently only performed at three hospitals, where it benefits patients such as this sports enthusiast.
The Montreal Heart Institute in Canada has a new surgical robot dedicated to CABG and mitral valve surgery.
Drugs and Devices
Neovasc Inc. released an update on the performance of its self-expanding mitral bioprosthesis, the TiaraTM valve, which is being implanted in several European and US centers as part of three parallel investigational programs.
The European Medicines Agency and the European Center for Disease Control and Prevention will host a meeting to discuss the threat of antimicrobial resistance and how they can support efforts to combat this threat.
Research, Trials, and Funding
Researchers from France analyzed data from the US Nurses’ Health Study II, finding a correlation between exposure to disinfectants and development of COPD.
Chinese researchers have published a case study on closing aortic anastomosis leaks with a transcatheter approach.
A study of a Swedish national database matched sibling pairs to further investigate the relationship between height and likelihood of venous thromboembolism.
Minimally Invasive Lobectomy for Lung Cancer is the latest installment in the Society’s webinar series on quality initiatives. The webinar features Drs Bill R. Burfeind Jr (moderator), Thomas A. D’Amico, Todd L. Demmy, Mark W. Onaitis, and Shari L. Meyerson.
Watch 47 minutes of the world's experts talking about this technique
This study details the short- and long-term outcomes for more than 3,000 patients who underwent septal myectomy for hypertrophic cardiomyopathy at the Mayo Clinic in Rochester, United States, from 1993 to 2016. In over 90% of severely symptomatic patients, relief of left ventricular outflow tract obstruction resulted in clinical improvement by at least two functional classes and reduced or eliminated symptoms of dyspnea, angina, and/or syncope.
The authors also outline outcomes for the transapical approach for basal obstruction with systolic anterior motion in 115 patients between 1993 and 2012, with all patients demonstrating postoperative gradient relief without the complication of an apical aneurysm or ventricular septal defect. These results emphasize that excellent outcomes can result from myectomy performed in experienced centers, with early mortality for isolated septal myectomy being less than 1%.
Remote perconditioning at the hindlimb and terminal warm blood cardioplegia provide synergistic cardioprotection for cardioplegic arrest in an in vivo piglet model.
Vahidkhah and colleagues used patient-specific geometry of the aortic root, ascending aorta, and coronary arteries to model blood flow near the aortic valve leaflets. The authors use this model to better understand flow-related permissive factors that might mediate leaflet thrombosis following valve replacement. Greater blood stasis was observed in the transcatheter valve-in-valve model compared to the surgical valve model, and no differences in blood stastis were modeled between coronary and noncoronary leaflets for the transcatheter valve.
CME activity related to this article is available online through The Annals of Thoracic Surgery.
Vets have performed life-saving heart surgery on what is believed to be the smallest dog to undergo the procedure.
Yorkshire terrier Jago was born with a heart valve defect but, at 3 lb (1.4 kg), was too small for vets in Cambridgeshire to treat. They had to wait until he was 5 lb (2.4 kg) to insert a balloon catheter.
Although specialists perform this operation, Jago is the smallest patient "to our knowledge", said vets.
The keyhole surgery took 90 minutes and cost Jago's owners Jennifer Daniels and Melita Chynoweth about £3,600.
This is a summary of the literature as to the prevalence of seizures in patients who have had tranexamic acid during their cardiac surgery.
The STS Adult Cardiac Surgery database data that had been submitted to a regional quality initiative were compared to a hospital claims database to assess what effect, if any, would supplying missing data provided by the latter affect the reported STS 30-day mortality rates. The STS database currently counts as "alive" any patient that has unknown status at 30 days.
- An excessive 22% of patients had unknown 30-day mortality status.
- The missing data was able to be reduced down to 7% by incorporating the data from the hospital claims database.
- Finally, the study found that, if the external data for CABG patients were included for these hospitals, the true 30-day mortality observed/expected ratio would be increased to 1.30 from 1.27. Thus, at present, the current method for reporting STS data underestimates the true 30-day mortality.
Should centers make an effort to include missing data provided from external administrative databases in order to improve the accuracy of STS reported outcomes? Should STS mandate such an inclusion of data?
The authors have concluded from a meta-analysis of over 45,000 patients, mitral regurgitation in the presence of LV dysfunction (either ischaemic cardiomyopathy or idiopathic causes) is, not surprisingly, associated with reduced survival. Whether this is due to the underlying myopathic process or the MR per se is not clear. Likely MR is a marker of LV dysfunction. The authors refer to the lack of proof that correction of MR improves outcomes in this subset of patients.