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Journal and News Scan
In this trial involving over 400 patients, accupuncture was compared to two sham groups and an observation group. The intervention group experienced a nearly two-thirds reduction in the frequency of angina attacks during the 20-week treatment period, significantly better than the sham and observation groups.
In this article, Umana-Pizana et al performed a phases-of-care mortality analysis amongst 5141 cardiac surgery cases with a 4.6% crude mortality in a population with a median STS risk score of 5.8%. They demonstrate that triggers for mortality occured primarily preoperatively (49.3%), followed by in the intensive care unit (23.9%), intraoperatively (13.4%), discharge phase (10.4%), and postoperative floor (3.0%). Importantly, their findings demonstrate that the mortality distribution is bimodal, occuring in those at lowest and highest risk, and they provide targets for areas of improvement and elimination of triggers for mortality in the cardiac surgical patient.
Corsini et al examined the results of a single-institution's 5-year experience of cardiothoracic surgery mock oral examinations. They demonstrate that this time- and labor-intensive exercise where trainees verbalize and practice their certification examination in a safe, controlled environment with their faculty can lead to improvement in preparation for the high-stakes real examination, with an impressive 5-year 100% pass rate for trainees involved in this experience.
These results are encouraging for surgical educators and trainees alike in our quest to better prepare tomorrow's cardiothoracic surgeons for their transition to practice.
U.S. News has just released the 2019-2020 best hospitals in the United States based on data from nearly 5,000 medical centers.
In the category for Cardiology & Heart Surgery, Cleveland Clinic in Cleveland, Ohio, Mayo Clinic in Rochester, Minnesota, Cedars-Sinai Medical Center in Los Angeles, California, New York-Presbyterian Hospital-Columbia and Cornell in New York, and Massachusetts General Hospital in Boston make up the top five.
Also published is a roster of the best U.S. hospitals for congestive heart failure, heart bypass surgery, and aortic valve replacement.
Beckers and colleagues evaluated toxicity and outcomes of regional chemotherapeutic treatment with isolated lung perfusion of melphalan combined with metastasectomy for patients with resectable pulmonary metastases. The prospective study included 107 patients with metastases of colorectal carcinoma, osteosarcoma, or soft-tissue sarcoma. The authors report low morbidity and no long-term pulmonary toxicity. The disease-free and progression-free rates at 5 years were 26% and 44% for patients with colorectal carcinoma and 29% and 63% for patients with sarcoma. The authors conclude that isolated lung perfusion with melphalan combined with metastasectomy is both feasible and safe, and that further evaluation of this approach is warranted.
This narrated video highlights an aortic valve repair performed for a 47-year-old man who presented with severe, symptomatic aortic regurgitation on a quadricuspid valve. The repair was performed through a median sternotomy using conventional cannulation for cardiopulmonary bypass, and Mastrobuoni and colleagues extensively outline their technique for “tricuspidization.” Additionally, the authors discuss their experience with 10 quadricuspid valve repairs. No increased perioperative risk is noted by the authors, with excellent long-term results in terms of regurgitation and reoperation on the valve.
Delvin and associates reported the long-term outcomes and quality of life in patients with d-TGA after repair using data from 24 centers of the Congenital Heart Surgeons’ Society (CHSS).
Among 830 neonates operated on between 1985 and 1990, 516 underwent arterial switch, 110 had Mustard operations, 175 Senning procedures, and 29 Rastelli operations. The median duration of follow-up was 24 years, extending to just over 32 years. Survival at 30 years was over 70% for all operations: 86±8% for Rastelli, 81±5% for Mustard, 80±2% for arterial switch, and 70±4% for Senning. The risk of late death was lowest in patients with arterial switch operation. Chest pain and fainting, pacemaker implantation, and unemployment were associated with reduced self-reported health status. Arterial switch patients reported higher functional health status in all domains than did atrial switch patients.
In this article Michael Mack explains his thoughts on the events leading to the death of Neil Armstrong.
Neil Armstrong suffered a tamponade after his pacing wires were removed which led to a series of events leading to his eventual death.
Michael Mack shares his thoughts on the death and his views on the issues it raises, which also raises many important issues for our community with regard to preparedness for complications after heart surgery for which STS guidelines exist but may not yet be fully adopted in some units, and also for surgery in smaller or community hospitals, of which this was an example.
Your thoughts on these important issues will be much appreciated, so please do post your views.
Patient Care and General Interest
The American College of Surgeons introduced a new quality improvement program, the Geriatric Surgery Verification Program, which outlines standards for geriatric surgery with the goal of continuously optimizing care for older adults.
Researchers from Arizona, USA, recommend that the US Preventive Services Task Force expand the eligibility criteria for lung cancer screening to include long-term tobacco quitters and individuals 50-54 years old.
Drugs and Devices
The European Medicines Agency has recommended larotrectinib for the treatment of solid tumors with an NTRK mutation, regardless of the tissue where that tumor is found.
Research, Trials, and Funding
Patients with continuity of care following transcatheter procedures have better outcomes than those with fragmented care, say researchers from North Carolina, USA.
Researchers from Australia are studying a molecule from the venom of a spider that could potentially slow cardiac damage after a heart attack.
Exposure to phtalates, plasticizers that are used in medical devices ranging from blood storage bags and tubing circuits, can affect the electrical properties of rat hearts say researchers from Washington, DC, USA.
White and colleagues retrospectively evaluated the development of postoperative pulmonary venous obstruction for patients undergoing repair of total anomalous pulmonary venous connection (TAPVC) at their institution between 2006 and 2017. Of a total 119 patients, 25 (21%) developed postoperative obstruction. Heterotaxy syndrome, single-ventricle heart disease, concomitant procedures, mixed-type TAPVC, and preoperative obstruction were found to be associated with postoperative obstruction. The authors conclude that these data may help stratify risk for patients with TAPVC.