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Journal and News Scan
Several private hospitals in Kolkata, India, have applied for licenses to perform heart and lung transplants in a region underserved for transplant of these organs.
A personal trainer from England shared a picture of herself to spread the message that you don’t have to be a smoker to get lung cancer.
Surgeons at Fortis Vasant Kunj in New Delhi, India, removed a pleural tumor weighing over 3 kg from a man’s chest.
Drugs and Devices
The US Food and Drug Administration has cleared the Haart 200 aortic annuloplasty device from BioStable Science & Engineering for bicuspid aortic valve repairs.
The Minneapolis Heart Institute Foundation in Minnesota, USA, announced that the first patient has been enrolled in a study to evaluate a clip-based repair for tricuspid regurgitation.
Research, Trials, and Funding
Researchers in the United Kingdom show that greater birth weight predicts better outcomes for infants with congenital heart disease.
A biopharmaceutical company, PolyPid Ltd, announced that it has completed enrollment in an early stage trial for an antibiotic drug reservoir product meant to prevent sternal infection after cardiac surgery.
Robotic-assisted transhiatal esophagectomy is found to be safe and effective for select patients with esophageal cancer, in a retrospective study by Allina Health researchers.
Medtronic announced a global randomized clinical trial to compare dual antiplatelet therapy outcomes with two drug-eluting stents following PCI procedures.
At the Annual Meeting of the SCTS in Belfast, Catherine Fowler gave a moving talk about how her father died of a missed aortic dissection.
Catherine’s sister, Caroline has started a petition that will call on the UK parliament to implement a policy to improve diagnosis and raise awareness of aortic dissection in the NHS. If successful, this may help other countries to implement such polices internationally. It is open for anyone worldwide to put their name to this petition if you agree that the diagnosis of aortic dissection in our Hospitals needs improving.
Click on the link above if you want to give your support to this.
Here is their story :
In 2015, our father Tim Fleming suddenly became very unwell, presenting all of the classic symptoms of Aortic Dissection; severe and sudden onset of pain in his back, chest and abdomen. Sadly, it appears to us that all of the markers and indicators were missed. The correct diagnosis of an Aortic Dissection was not made when Dad initially presented to A&E. Dad paid the ultimate price with his life.
This petition is an urgent call to parliament for the implementation of a robust policy, diagnostics and awareness for Aortic Dissection within the NHS.
"Think Aorta" is a campaign to lower the unacceptable high rate of misdiagnosed Aortic Dissections in Accident and Emergency Departments and GP Surgeries across the UK and Ireland.
Aortic dissection is the most common life-threatening disorder affecting the aorta. It occurs when a tear inside of the aorta causes blood to flow between the layers of the wall of the aorta. Early diagnosis and treatment is critical for survival.Aortic Dissection can quickly lead to a painful and frightening death as a result of reduced blood flow to the heart or rupture of the aorta.
A&E medical staff must immediately rule out Aortic Dissection. It is a known fast killer where the death rate increases 1% for each hour that diagnosis and surgical repair are delayed, therefore advanced medical care is needed immediately.
Aortic Dissection IS one of the top deadly three chest pain entities and very often mimics a heart attack. ECG and chest x-rays are routinely used to diagnose heart attack but cannot rule out Aortic Dissection, as both can appear normal in a patient with a life-threatening Aortic Dissection.
A&E health care professionals and medical staff MUST remain suspicious at all times - until aortic dissection is ruled out.
The condition, "Aortic Dissection" is well documented since the early 18th Century. But AORTIC DISSECTION continues to be misdiagnosed by our A&E medical professionals and GP’s despite well established treatment guidelines but where no medical policy exists.
The rate of misdiagnosed Aortic Dissection is unacceptably high.
TIME FOR CHANGE
This is an urgent call for the government to implement the following actions across the NHS in the UK and Ireland:
1. POLICY - The introduction of policy and guidelines for timely identification and treatment of Aortic Dissection for emergency services and A&E departments across the NHS.
2. DIAGNOSTICS - The implementation across the NHS of consistent, routine emergency diagnostics for Aortic Dissection – once a heart attack is ruled-out, doctors should routinely check for Aortic Dissection.
3. EDUCATION - Training, awareness and education for our medical professionals to ensure rapid, consistent adoption of the identified best practice.
4. PROCESS - Organisation of emergency cardiac surgical services so that patients with aortic dissection are always treated by surgeons with the appropriate experience.
PLEASE SIGN THIS PETITION TO STOP THE MISDIAGNOSIS OF THIS KILLER
“Think Aorta” Timely detection and treatment of Aortic Dissection will save lives.
This petition will be delivered to:
- UK Secretary of State for Health
Rt Hon. Jeremy Hunt MP
- Irish Minister for Health
Mr Simon Harris
Jimmy Kimmel's son was born with Tetralogy of Fallot with pulmonary atresia. He had emergency surgery at the Children’s Hospital Los Angeles in the first week of his life, and this video describes the operation and he goes on to thank all the medical staff who helped in the baby's care. This video has had 11 million hits. Well done, everyone involved in this case.
Many of the adverse events that occur in hospitals are a result of human error. The authors describe a system for use in the OR that collects and collates intraoperative data feeds, including patient and OR team physiological parameters, audiovisual content, and environmental factors. The data are analyzed to assist in proactive assessment of risks, support root cause analyses, facilitate team training, assess efficiency, and help in evaluation of surgical technology. This technologica approach may reflect our work environment in the future.
In this study of low volume surgeons (defined as performing fewer than 1 index operation annually) the authors studied outcomes in New York state for open AAA repair (OAR) and carotid endarterectomy (CEA). About 50% of surgeons performing these operations were low volume surgeons. Low volume surgeons had higher rates of operative mortality for OAR (OR 2.09; 95% CI 1.41 - 3.08) and of postoperative MI (OR 1.83; 1.03 - 3.26) and stroke (OR 1.78; 1.21 - 2.62) for CEA. Health care resource utilization was higher for low volume surgeons for OAR and CEA.
This editorial outlines the changing legal landscape for device manufacturers. The authors discuss a recent legal judgment against Intuitive (da Vinci robot) that found the company failed to notify a hospital regarding a new robot user, indicating that Intuitive held responsibility for ensuring safe implementation of their systems in clinical settings.
The 5-year outcomes of a Veterans Affairs trial of off-pump vs on-pump CABG are reported. Mortality in the off-pump group was 15.2% compared to 11.9% in the on-pump group (RR 1.28; p=0.02). Composite adverse events were more common in the off-pump group (31.0% vs 27.1%; RR 1.14; p=0.046). Repeat CABG was more common for the off-pump group (1.4% vs 0.5%; p=0.02). No differences were observed in nonfatal MI, death from cardiac causes, or repeat revascularization.
The Yale group retrospectively reviewed their experience with DeBakey type I aortic dissections to evaluate whether patients with bovine aortic arches had a unique distribution of entry sites and differential outcomes. A total of 315 patients were included in the study, of which 49 (16%) had a bovine aortic arch. The authors found that those patients with bovine aortic arches were 6 times more likely to have arch tears and 2.7 times more likely to suffer a stroke as those without bovine aortic arches.
The Cleveland Clinic group performed a randomized clinical trial comparing transfusion triggers of 24% vs. 28% from 2007-2014. The study included 722 patients who underwent either CABG or valve surgery. While the lower trigger group received fewer transfusions, adverse outcomes did not differ between the groups. Because the lower trigger group had equivalent outcomes but fewer transfusions, the authors recommend using a lower trigger perioperatively.
In an era of VATS surgery this is a very interesting article documenting advanced in thoracotomy and open chest surgery.
It shows us that open surgeons are also significantly improving their techniques, and the very large postero-lateral thoracotomy with rib cutting and costo-transverse ligament division may in most cases be replaced by muscle sparing and smaller incision techniques while still allowing a full open operation.
This is a very courageous and interesting article, and we should all acknowledge that modern thoracotomy is very different from the thoracotomies of the past.
Well done Dr Navarro.