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Journal and News Scan
The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD) audits the data of 10% of its participants every year. Assessment of the completeness and accuracy of data fields related to demographics, preoperative risk factors, diagnosis, procedure, complications, and mortality is performed. Overman and colleagues summarize the results of the tenth audit of the STS CHSD in this article. The rates of completeness and agreement for general data elements were both over 97%. The rate of completeness for variables in the mortality review was 100%, with a rate of agreement of 99.3%. The authors conclude that the most recently completed STS CHSD audit shows a very high level of completeness and accuracy of data variables, highlighting that this is true for variables that are most germane to outcomes measurement.
This article addresses the controversy surrounding the optimal annular stabilization technique following valve sparing root reconstruction (VSRR) and the lack of comprehensive imaging data in the evaluation of the natural history of aortic root graft geometry, valve competency, and prognosis postreconstruction. Seventy consecutive patients were prospectively enrolled between 2008 and 2017 (mean age 56.4 ± 16.4 years, 19.7% women) for VSRR. Dacron aortic annuloplasty reconstruction was found to be stable over time, without the need for external or internal stabilization. Computed tomography imaging was found to be more reliable than echocardiographic images, although given the noted stability, the authors conclude that it was of little utility.
In this experimental study on segmental artery coil embolization, the authors examined the optimal occlusion pattern to reduce the risk of spinal cord ischemia during thoracoabdominal aortic repair. Von Aspern and colleagues found that staged regional occlusion, with coiling of lumbar arteries first, leads to better perfusion recovery, no neurological deficits, and no cord tissue damage.
In this editorial, Ikonomidis et al not only describe the challenges but also provide specific actionable steps towards improving the retention as well as clinical, academic, and personal success of cardiothoracic surgeon-scientists.
- High clinical, academic, and administrative demands
- Steep competition for extramural funding
- Lack of protected time
- Lack of institutional and departmental support
Action plan includes:
- Lead by example, formal training, mentorship and institutional support
- Institute faculty start-up/support plans including funding and laboratory space that is readily accessible and locally available
- Implement protected paid time for research that is truly protected from clinical duties
- Make research productivity financially incentivized and recognized. Incorporate research productivity into the compensation plan and promotion metrics
- Disseminate opportunities
This retrospective study by Sedeek et al aimed to compare the outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) valve-in-valve (n=90) versus surgical replacement (SAVR) (n=260) of failing stented aortic biological valves in a cohort of 350 patients . They demonstrated that despite the TAVR-in-valve cohort being older and having a higher prevalence of comorbidities and STS PROM, they had fewer perioperative complications and shorter hospital stay; however, patient-to-prosthesis mismatch was more common after TAVR-in-valve (44% vs SAVR 12%, P < .001). Overall, their results suggest that TAVR valve-in-valve and repeat SAVR have comparable operative and mid-term mortality, with SAVR being associated with a superior hemodynamic profile compared to TAVR valve-in-valve with less patient-to-prosthesis mismatch.
Patient Care and General Interest
The American Heart Association published a statement advocating for a holistic care approach for patients with Fontan circulation, noting that these patients are living longer and their unique long-term care needs are being better understood.
A judge in the USA has ordered e-cigarette companies to submit their products for review by the US Food and Drug Administration (FDA) by May 2020.
Drugs and Devices
Edwards Lifesciences as issued a warning related to the risk of a burst balloon during implantation of its Sapien 3 Ultra valve, emphasizing that the instructions for use should be closely followed to avoid this problem.
The US FDA has issued an alert that Edwards Lifesciences recalled the IntraClude intra-aortic occlusion device.
Targeted therapies for EGFR mutation–positive non–small cell lung cancer were added to the updated Essential Medicines List from the World Health Organization, but other lung cancer therapies were considered and rejected.
Research, Trials, and Funding
Investigators from Kansas City, Missouri, USA, report a relationship between institutional volume and outcomes of MitraClip placement up to 50 procedures, but continued improvement was observed beyond this number.
A group at University of Utah Health in the USA is aiming to improve outcomes of refractory cardiogenic shock with a multidisciplinary “Shock Team,” comprised of a cardiothoracic surgeon, a heart failure cardiologist, an interventional cardiologist, and an intensive care unit physician.
Henry and colleagues evaluated frailty in patients undergoing cardiac surgery using two frailty indices, the simplified Study of Osteoporotic Fractures (SOF) and the complex Cardiovascular Health Study (CHS), comparing postsurgical outcomes between frail and nonfrail patients. Agreement between the two indices was poor. Of 167 total patients, the SOF identified 15 as frail while the CHS identified 47. SOF frail patients were in poorer health, had higher risk scores, and greater proportions reported lack of energy and unintentional weight loss. Additionally, SOF frail patients were more likely to experience prolonged ventilation, pneumonia, prolonged time in the intensive care unit, and readmission within 30 days.
Google Scholar has released the 2019 version of Scholar Metrics just now. This release covers articles published in 2014–2018 and includes citations from all articles that were indexed in Google Scholar as of July 2019.
Below is the top 20 journals in the field of cardio-thoracic surgery (https://scholar.google.com/citations?view_op=top_venues&hl=en&vq=med_heartthoracicsurgery). The two metrics in the bracket are the h5-index and h5-median, which are the h-index for articles published in the last 5 complete years and the median number of citations for the articles that make up its h5-index.
- The Journal of Thoracic and Cardiovascular Surgery (63, 82)
- The Annals of Thoracic Surgery (58, 74)
- European Journal of Cardio-Thoracic Surgery (54, 76)
- Interactive CardioVascular and Thoracic Surgery (35, 49)
- Annals of Cardiothoracic Surgery (31, 50)
- Journal of Cardiothoracic Surgery (27, 35)
- The Thoracic and Cardiovascular Surgeon (22, 33)
- Thoracic Surgery Clinics (22, 33)
- Perfusion (22, 30)
- General Thoracic and Cardiovascular Surgery (21, 31)
- Journal of Cardiac Surgery (21, 28)
- Annals of thoracic and cardiovascular surgery (19, 22)
- Seminars in Thoracic and Cardiovascular Surgery (17, 24)
- Asian Cardiovascular and Thoracic Annals (17, 22)
- Annals of Cardiothoracic Surgery (16, 28)
- Revista Brasileira de Cirurgia Cardiovascular (16, 25)
- World Journal for Pediatric and Congenital Heart Surgery (16, 24)
- Seminars in Cardiothoracic and Vascular Anesthesia (16, 22)
- Innovations (16, 20)
- Scandinavian Cardiovascular Journal (16, 18)
A seperate list is provided for top journals in the field of Vascular Medicine, which is availabe at: https://scholar.google.com/citations?view_op=top_venues&hl=en&vq=med_vascularmedicine
This meta-analysis included 70 articles reporting on more than 100,000 patients who underwent surgical aortic valve replacement. The incidence of patient-prosthesis mismatch (PPM) was 53.7%. Moderate and severe PPM was associated with higher mortality, both early and late after surgery. The authors conclude that the implementation of surgical strategies to prevent PPM are important in order to reduce mortality rates.
In this editorial, Harrington and coauthors introduce the updated guidelines for statistical reporting in the New England Journal of Medicine, which can be accessed at https://www.nejm.org/author-center/new-manuscripts.
The authors went into detail about the requirement to replace P values with estimates of effects or association and 95% confidence intervals when neither the protocol nor the statistical analysis plan has specified methods used to adjust for multiplicity.