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Journal and News Scan
A boy’s growth had fallen well behind that of his twin brother, leading doctors in Abu Dhabi, UAE, to discover and surgically treat a congenital heart condition.
A woman in the UK fell ill with a tear in her aorta late during her pregnancy, requiring a diverse team of health professionals to deliver a healthy baby and a replacement aorta.
A nurse practitioner discusses the benefits of perioperative multimodal analgesia over opioid monotherapy following her own experience as a surgical patient.
A US News & World Report analysis of publicly reported outcomes data from the STS highlights the safety of congenital heart surgery at high-volume centers.
Drugs and Devices
The US Food and Drug Administration approved the INSPIRIS RESILIA aortic valve from Edwards Lifesciences Corp., supported by data from the COMMENCE trial and the European RESILIA feasibility study.
Implanted cardiac devices might help determine time and cause of death when autopsy results are unclear.
The CardioMEMS HF System for monitoring cardiovascular status in heart failure was implanted for the first time in Canada at the Peter Munk Cardiac Centre in Toronto, Canada.
Research, Trials, and Funding
Researchers in Toronto, Canada, find that new opioid use among older COPD patients is associated with an increased risk of cardiac-related death.
Researchers at the University of Virginia School of Medicine received funding to study ex vivo lung perfusion among other approaches for improving lung transplantation and evaluating donor lungs.
An observational study of the SWEDEHEART database shows an increased incidence of myocardial infarction on Mondays and during the winter holidays, and lower incidence during the July summer holiday.
In a prospective study, the authors analyzed blood samples from 102 patients with stage I–IIIA non-small-cell lung cancers for the presence of circulating tumour cells (CTCs). Samples were taken prior to and one month after radical resection of the primary tumour, and CTCs were detected using immunomagnetic techniques. Presence of postoperative CTCs correlated to the 18F-fluorodeoxyglucose uptake of the primary tumour measured on preoperative PET scans and was associated with shorter recurrence-free survival, independent of disease staging.
The authors conducted a meta-analysis of 35 RCTs analyzing the use of IV Mg for the prevention or treatment of arrhythmias following cardiac surgery. The studies included had significant methodological heterogeneity.
Findings: Mg use was associated with a reduction in Afib as well as ventricular arrhythmias postop, with a RR of 0.69 (p=0.002) and 0.46 (p=.004), respectively.
In this excellent review article, the authors review the practice and evidence for fractional flow reserve (FFR) in patients undergoing CABG.
Talwar and colleagues randomized 100 pediatric patients receiving bidirectional superior cavopulmonary anastomosis to on-cardiopulmonary bypass (CPB) and off-CPB groups. Significantly lower anastomosis time, postoperative inotropic support, and ICU and hospital stay duration were observed in the off-CPB group. Although the study only addressed early outcomes, no short-term difference in neurocognitive measures was observed between groups.
Thornblade and colleagues report an increase in off-label esophageal stent usage to treat benign esophageal perforation between 2007 and 2014, with a concomitant decrease in surgical repair and no difference in surgical drainage. Despite increased use of stents, no significant changes in short-term outcomes were observed.
Ad and colleagues compared outcomes in patients receiving a Cox Maze (CM) procedure with cryothermal energy only or with cryothermal and bipolar radiofrequency, with 298 patients in each group. CM performed with either energy source proved safe and effective, with the authors evaluating perioperative outcomes, rhythm status, survival, and clinical events. Cryothermal ablation alone was associated with reduced perioperative stroke incidence and higher rates of sinus rhythm out to 60 months follow-up, findings that the authors highlight as important for future study.
The authors report on 38 patients who underwent bilateral lung transplantation for severe pulmonary hypertension with routine application of prophylactic postoperative veno-arterial extracorporeal membrane oxygenation (ECMO). These patients’ survival up to 5 years was not different from patients who received lung transplants for other causes, and cardiac parameters were improved 12 months after transplantation. In consequence, the authors recommend regular postoperative use of ECMO in this patient population.
Mehaffey and colleagues evaluated major adverse events in 118 cardiopulmonary bypass (CPB) patients who had received methylene blue (MB) within 72 hours of CPB. Although these patients had high incidence of comorbidities and postoperative complications, MB administration in the operating room was associated with reduced operative mortality rate and incidence of adverse events compared to MB administration in the intensive care unit.
Balsam and colleagues present two cases of Mycobacterium chimaera infection following implantation of left ventricular assist devices, likely linked to bioaerosols from heater-cooler units used during surgery. Both cases were milder than has been reported following valvular and aortic graft surgery, but long-term sterilization of the internal hardware is unlikely. The authors also discuss their local practice changes that aim to prevent future cases.