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Journal and News Scan
This is a further report from the extensive dataset of the STICH Trial. This examines the impact of immediate postoperative events (length of time of intubation) on short- and long-term outcomes. If the time was >36 hours, there was significant correlation with increased mortality, both 30-day and one-year. Those included patients with mitral valve disease, renal dysfunction, advanced age, and redo coronary surgery.
This is a look at the costs related to surgical site infections (SSI), as defined by CDC. They show the impact on the monetary costs as well as length of stay with a variety of treatment methods. The costs of a deep SSI add significanty to the overall procedure costs, mainly due to the additional length of stay. The results are not surprising but provide a basis for investment in methods to reduce infections.
Transcatheter aortic valve replacement (TAVR) periprocedural complications rate are low; however, those patients requiring conversion to surgery are under an increased mortality risk. Arsalan and colleagues evaluated 32 patients, 2.1% of 1775 total TAVR procedures at their center, who needed immediate conversion to sternotomy during the TAVR procedure. The most common reasons for conversion were annular rupture, device embolization, and pericardial tamponade. The only predictor for conversion was the usage of a self-expandable valve (OR 0.38, 95% CI 0.16 - 0.90, p = 0.03). Survival at 30 days was 56%, emphasizing the importance of an experienced heart team and access to emergency surgical procedures for these uncommon but unpredictable situations.
Endoleak is a potential complication of total endovascular aortic repair (TEVAR). This video and article from Fukuhara and Roselli illustrate a modified reverse frozen elephant trunk to repair a type IA endoleak from a prior TEVAR for an acute type B dissection. The authors also discuss the advantages and caveats associated with the technique shown.
This story from the BBC reveals a report on a London, UK, hospital’s cardiac surgery department. The hospital commissioned the external review after a higher than expected mortality rate was brought to its attention. The report underscores the importance of positive professional relationships for successful surgical teamwork and quality patient outcomes.
Patient Care and General Interest
Renowned former Formula 1 racing champion Niki Lauda recently underwent a lung transplant.
The president of the West African College of Surgeons (WACS) urged the streamlining of cardiothoracic surgery training in Nigeria in remarks during the commissioning of the WACS permanent secretariat.
The Amrita Institute of Medical Sciences in Kochi, India, is setting up a homograft bank, the second such bank in the state.
The National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand have published updated recommendations for the diagnosis and management of atrial fibrillation to confront the growing incidence of arrhythmia.
Research, Trials, and Funding
Researchers from Canada, Spain, and Germany found that optical coherence tomography was better than angiography at identifying coronary vascular changes in pediatric heart transplant recipients.
Adding racial considerations to the lung cancer screening recommendations in the US might improve screening efficacy and help reduce disparities in lung cancer mortality, say researchers from Chicago, Illinois.
Researchers from around the US have transplanted bioengineered lungs into pigs.
Ongoing questions in the surgery for type A aortic dissection include arterial cannulation site and the type of distal anastomosis for ascending or hemiarch replacement. Shimamura and colleagues report on the outcomes of 300 patients who underwent aortic repair using transapical arterial cannulation and the adventitial inversion technique at a distal anastomosis. The in-hospital mortality rate was 8%. During a mean follow-up of 31.7 ± 25.2 months, distal reintervention was performed in 11% of patients, with 3% in-hospital mortality for elective reintervention. The authors conclude that transapical cannulation and the adventitial inversion technique for repair of acute type A aortic dissection provide good early and midterm results.
Engelhardt and colleagues reviewed cases of mediastinal sarcoma in the US National Cancer Database from 2004 to 2012. Overall survival at five years was poor, at only 14.8%, and just under half of patients underwent surgical resection. For patients receiving surgery, an R0 resection was associated with better survival (30.1% versus 18.9%), and surgery combined with radiation therapy was associated with the best survival (40.1%).
The authors debate how much information should be included in the informed consent, and they use the case of resistant Mycobacterium chimaera found in the LivaNova PLC Stockert 3T heater-cooler system as a case-in-point. The issue raised specifically by this case is whether institutions that use this specific heater-cooler system are obligated to inform the patient of the specific risks of infection with resistant M chimaera. The publication is very informative, and the scope of the debate focuses on the purpose of informed consent, the legal obligation, and how narrow or broad the consent need be. It should not be surprising to anyone that there are no straightforward answers.
Head and colleagues used a patient-data pooled analysis of 11 randomized clinical trials to compare stroke rates between surgical and percutaneous coronary revascularization. They found that in the first 30 postoperative days, the stroke rate was higher after coronary artery bypass grafting (CABG, 1.1%) than after percutaneous coronary intervention (PCI, 0.4%), and this early difference accounted for the difference in the stroke rate seen at 5 years. Between 31 days and 5 years, stroke rates were not different between CABG and PCI (2.1% versus 2.2%). Regardless of the revascularization approach, patients experiencing a stroke in the first 30 days had significantly higher 5-year mortality than those not experiencing early stroke.