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Journal and News Scan
Patient Care and General Interest
An accident during a sword swallowing trick was bad news for the performer’s esophagus.
An imaging case study from Medscape walks through the echocardiography of a patient with rheumatic disease involving all four valves.
Disagreement between four different hospital ranking systems regarding cardiac surgery quality in the USA could cause confusion for patients trying to understand this publicly available data.
Research, Trials, and Funding
Researchers in the UK find unexpectedly high levels of cancer-associated mutations in normal esophageal tissue.
Researchers from Washington, DC, in the USA presented the prototype of their miniature pacemaker at the recent American Heart Association’s Annual Meeting, a device that they hope allows for less invasive placement of pacemaker leads on infants’ hearts.
An interesting randomized controlled trial asserting robustly that endoscopic harvesting of saphenous vein is: (1) better for leg dehiscence and (2) at least noninferior for MACE compared to the conventional open "full touch" method. Somewhat puzzling are the high mortalities and revascularization rates in both arms, across a median follow up less than three years. The requisite hour or more to harvest the vein(s) openly also seems a bit long for experienced operators, even if we include closure of the incision.
In this randomized controlled trial, Padmanabhan and colleagues focused on the ability of iron given intravenously to increase hemoglobin levels before elective cardiac surgery, comparing this with iron given orally. The study included 50 anemic patients who were scheduled for cardiac surgery. Ferritin levels increased significantly in patients with intravenous iron administration. Iron administration did not influence hemoglobin level, regardless of the method of administration.
Thornblade and colleagues endeavored to develop and validate a model that would predict the 2-year risk of recurrence in patients with completely resected node-negative non-small cell lung cancer (NSCLC). Improved recurrence prediction could direct selective use of adjuvant therapy and surveillance imaging in these patients. The authors’ models performed similar to chance, despite using clinical risk factors for recurrence and biomarkers associated with poor survival. They discuss potential reasons for the difficulty in predicting recurrence in this patient group.
In this paper, Dr Svensson covers his technique of leaflet repair during aortic root reimplantation. The core technical points are described as well as the long-term clinical outcomes. The author's experience has shown that for patients having leaflet repair, bracing the root with a reimplantation operation appears to reduce the risk of late regurgitation and reoperation.
A multidisciplinary team led by Bob Kiaii at the London Health Sciences Centre in Ontario, Canada, has reportedly completed the world's first robotic performance of a specific aortic valve replacement procedure in a patient with aortic stenosis.
The charity Tiny Tickers is launching a campaign with the goal of ensuring that all maternity wards across the United Kingdom have access to machines for detecting heart defects in newborns.
A woman with cystic fibrosis living in Holbrook, Massachusetts, USA, recently completed her first 5K race after receiving a double-lung transplant.
After reports of several patient injuries, the U.S. Food and Drug Administration has announced a Class I recall for a batch of warfarin test strips used with point-of-care or in-home devices to adjust warfarin dosing.
Research published in The Journal of Nuclear Medicine suggests that a new nuclear medicine tracer could improve the diagnosis and treatment of non-small cell lung cancer.
Interesting small randomized controlled trial that will definitely be widely discussed.
This is a randomized controlled trial evaluating the impact of adjunct atrial fibrillation surgical treatment in patients undergoing cardiac surgery. Included are 352 patients. Sinus rhythm was restored two times more frequently in those who underwent atrial fibrillation surgery. There was no difference in survival and quality of life up to two years.
Watanabe and associates studied the association between false lumen remodeling late after type A dissection repair and the shape of the true lumen in the early postoperative period. They found that the true lumen shape in the early postoperative period predicts false lumen remodeling late after surgery. The methodology of computed tomography angiography measurements used in this work serves as a good example of quantitative image analysis for patients with aortic disease.
Why this study – the rationale/objective
This study compared the volumes of transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) since the approval of TAVR in the United States. The Medicare Provider Analysis and Review (MEDPAR) database was used to extract volumes for 2011-2014. The volume of SAVR decreased in hospitals with the largest number of TAVR procedures. At the same time, 30-day and 1-year mortality after SAVR declined in the hospitals with the largest TAVR volumes. Patients who underwent SAVR showed a decrease in comorbidities over time. The study provides some interesting insights. First, the large number of excluded centers highlight the large amount of centers in the US that perform very few aortic valve procedures. Second, the lower mortality after SAVR and low risk profile of SAVR patients was likely the result of high risk patients getting TAVR. Third, the current study does not include data from recent years. It will be very interesting to learn whether the increasing TAVR volume leads to a decrease in SAVR volume, especially since results of TAVR vs. SAVR in low risk patients are expected shortly.