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Journal and News Scan
Frailty is an important factor in patients undergoing either Transcatheter or Surgical Aortic Valve Replacement. However, it is hard to assess. Multiple scoring systems have been proposed which are either underperforming or are cumbersome to calculate.
In the current study, the authors introduced and tested the Essential Frailty Toolset (EFT), consisting of four items: lower-extremity weakness, cognitive impairment, anemia, and hypoalbumenia. The EFT outperformed other frailty assesment tools in approximatly 1000 elderly patients undergoing either TAVR or SAVR.
Dr. Mack notes in the accompanying editorial that several conclusions can be drawn:
1. Frailty can be assessd using an easy tool
2. Frailty is predictive of 1-year mortality after either TAVR or SAVR
3. EFT improves the power of the STS-PROM to predict 1 year mortality
4. EFT is also predictive for 30-day mortality and 1-year mortality and disability
This important study shows that frailty can classified easily. This facilitates comparitive studies, heart team discussions and clinical decision-making in patients undertoing an invasive treatment for aortic stenosis.
The authors present an extensive experience with the Frozen Elephant Trunk procedure for aortic pathology of varying types. They provide useful tips for each type. The results justify the techniques. The authors also provide some insight into when results may not be so good.
Badhwar and colleagues analyzed the usage and outcomes of surgical ablation (SA) for atrial fibrillation reported in The Society of Thoracic Surgeons database. They found an incrementally increasing volume of SA procedures concomitant with cardiac operations like coronary artery bypass and valve repair/replacement over the 3-year period analyzed. Concomitant SA was associated with reduced risk of mortality and stroke but increased risk of renal failure and subsequent pacemaker implantation.
This research was presented at the 2016 Annual Meeting of the Southern Thoracic Surgical Association, and a brief discussion from that meeting follows the article.
The first total aortic replacement in Malaysia was performed for a patient with a thoracoabdominal aneurysm at the National Heart Institute (IJN) in Kuala Lumpur.
A balloon dilation of his narrowing airway helps a premature baby breathe easier in Cape Town, South Africa.
Engineering principles and 3D printing help a surgical team reshape and stabilize the ribcage of a man with scoliosis in North Carolina, USA.
A man suffered a cardiac arrest at a water park in Israel, but quick action and an onsite automatic defibrillator saved his life.
Drugs and Devices
Randomization in the TANGO-2 trial of meropenem-vaborbactam for carbapenem-resistant Enterobacteriaceae infections was halted early due to superior outcomes from the investigational treatment.
The European Medicines Agency recommended multiple anticancer agents for approval, including atezolizumab, an anti-PD-L1 immunotherapy for non–small cell lung cancer.
AstraZeneca’s MYSTIC trial has found that a combination of biologics did not improve progression-free survival with PD-L1-positive lung cancer over chemotherapy, though overall survival results are still pending.
AdvaMed sent a letter to the US FDA to protest changes to its definition of “intended use.”
Health Canada has licensed Medtronic Canada’s MR-conditional cardiac resynchronization therapy defibrillators.
Research, Trials, and Funding
Applications are now being accepted for the 2017 Carolyn E. Reed Traveling Fellowship Award, awarded each year to a woman thoracic or cardiac surgeon for travel with the purpose of learning a new technology.
Researchers from Melbourne, Australia, published a study in the NEJM that questions whether new interventions to help premature infants breathe are better for their long-term lung function.
Lacroix and colleagues evaluated pulmonary function, pain, and quality of life in patients who underwent robotic thoracic surgery, predominantly for non-small cell lung cancer. The authors observed no difference between preoperative and 7-month postoperative pulmonary function. Although the majority of patients reported some level of pain at the surgical site, pain was not neuropathic-like and only weakly interfered with daily activities.
This collaborative position paper recommendations are provided on the management of peri-operative myocardial infarction in patients undergoing CABG.
These recommendations are based on thorough literature review and are illustrated in a practical flowchart.
This review paper, written by the ESC working group on valvular heart disease, defines what consitutes a good Heart Valve Centre. All relevant topics including multidisciplenary heart teams, data collection and review, training and future directions are discussed from an organizational point of view.
A Letter to the Editor of Lung Cancer that was kindly brought to our attention while still 'in press.' Our readership may find in it 'food for thought' on all matters of healthcare policies and economics, especially on maintaining morale ('reshaping prevailing nihilistic attitudes') and efficient resupply and recycling of semi-disposable surgical devices in time of austerity. Economizing always sets a desirable paradigm for cardiothoracic surgeons and their managers worldwide!
Public outcomes reporting on individual cardiac surgeons in California, USA, sparks debate on what such statistics mean and how they might influence the willingness of a surgeon to help the sickest patients.
Can around-the-clock care from an experienced intensivist reduce complication risk in the cardiac ICU?
Visualizing the surgery with 3D technology helps surgeons separate conjoined sisters who shared a heart.
An ophthalmology surgeon talks about responding to intraoperative complications on the JAMA Network Blog.
A US woman with Marfan syndrome suffered an aortic dissection late in her pregnancy, and four medical teams worked together to deliver a healthy mom and baby.
An external minister of affairs in India helps a Pakistani infant receive heart surgery at Jaypee Hospital in Noida, India.
Drugs and Devices
Philips Electronics is expanding its profile in cardiac ultrasound by acquiring TomTec Imaging Systems, which is headquartered in Germany.
The availability of ClearFlow’s “shorter effective drainage length” PleuraFlow for pediatric patients will expand to all cardiac surgery centers, after a limited release in Germany, Switzerland, the UK, and the US was successful.
Research Trials and Funding
Researchers at Mount Sinai in New York have been studying gene therapy for pulmonary hypertension, and Mount Sinai is partnering with Theragene Pharmaceuticals to work toward clinical trials.
Failing Fontan circulation poses risk factors for cardiac transplantation that are distinct from patients needing transplantation for other congenital heart diseases. In this review, Kirklin and colleagues discuss the circulatory, lymphatic, and hepatic vulnerabilities associated with Fontan circulation that make early referral for heart transplant important for these patients. The authors also review the surgical challenges of transplantation after a Fontan operation, and they present approaches that are key to improved patient outcomes.