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Journal and News Scan
A useful editorial debating current issues on the classification of mesothelioma.
Barili and colleagues discuss the importance of identifying heterogeneity in meta-analyses and the use of a random-effects or fixed-effects model to account for differences between or within studies. The authors review the assumptions and components of these models, discussing appropriate applications for each of them. Finally, they use an example analysis of surgical and transcatheter valve replacement outcomes to demonstrate the differences between random-effects and fixed-effects models.
Interesting to read that percutaneous coronary intervention did not confer any survival benefit (nor protection from myocardial infarction) in an international randomized controlled trial of 888 patients when compared to medical therapy!
This video and article from Desai and colleagues demonstrates double transposition and single branched endovascular repair for total arch replacement in a 59-year-old man who presented with a 7 cm chronically dissected arch and distal aorta. The patient had previously undergone a DeBakey I dissection repair.
Ma and colleagues evaluated left ventricular diastolic function in 183 patients who had undergone isolated aortic valve replacement for severe aortic regurgitation. Echocardiographic data was used to evaluate the relationship between preoperative diastolic function and postoperative mortality and cardiac function. Serial echocardiographic data from a subgroup of 104 patients was used to further evaluate postoperative changes in diastolic function. The authors found that 43% of patients had an improved New York Heart Association functional class at long-term follow-up. Preoperative left ventricular end-diastolic volume index was the only predictor of reduced long-term diastolic functional recovery, emphasizing the importance of appropriately-timed surgical intervention.
Patient Care and General Interest
Cardiac surgical and cardiology societies weigh in as an advisory committee revisits the US Centers for Medicare and Medicaid Services procedure volume requirements for transcatheter aortic valve replacement programs.
As the Houston Methodist Hospital in Texas, USA, moves to new facility, it is closing historic operating rooms where renowned heart surgeon Dr Michael DeBakey developed the Dacron graft.
The LUNGevity Foundation has published recommendations to expand eligibility for lung cancer trial participation to more patients.
Drugs and Devices
Polares Medical has received venture capital funding to continue developing a transcatheter hemireplacement device that would replace only the posterior leaflet of the mitral valve.
Research, Trials, and Funding
Researchers from Johns Hopkins University in Baltimore, Maryland, explored surgeon decision-making and the factors that influence a surgeon’s decision to operate or not in a scenario where a patient has a likely nonsurvivable medical problem.
Palliative care support offered to families of infants with single-ventricle heart disease by health care teams at the University of Michigan may help them cope with and navigate their child’s medical care.
Researchers in Canada studied factors that influence hemodynamic valve deterioration after surgical aortic valve replacement.
The authors report on their experience with three-demensional (3D) printed heart models in congenital cardiac surgery, having printed 20 3D models for preoperative simulation within the last three years. All operations were performed by a young consultant surgeon. The authors concluded that 3D printing helped them to understand the pathology and simulate the surgical approach.
Barbetta and colleagues retrospectively reviewed outcomes for 80 patients with T2N0 esophageal adenocarcinoma, staged by endoscopic ultrasound (EUS) and treated by surgery alone. EUS staging was inaccurate in the majority of patients, and final pathologic staging found nodal disease in 35% of patients. Vascular invasion was identified as an independent predictor of nodal involvement, and the authors suggest that its utility as a marker to select patients for induction therapy should be further explored.
Inoue and Suematsu report their experience using a minimally invasive approach to left atrial appendage resection. The procedure was performed in 87 patients using an endoscopic linear cutter device, without cardiopulmonary bypass or cardiac arrest. The authors found no change in cardiac function and no thrombus formation during patient follow-up three months after the operation.
Buratto and colleagues retrospectively analyzed the outcomes of 68 patients with atrioventricular septal defects (AVSD) who underwent pulmonary artery banding between 1983 and 2016. Of these, 40 patients had balanced AVSD and 28 patients had unbalanced AVSD. Pulmonary arterial banding was not associated with a short-term increase in atrioventricular valve regurgitation for either group. Patients with unbalanced AVSD did not have a higher rate of atrioventricular valve reoperation than in previous series of patients without pulmonary artery banding. Patients with balanced AVSD did have a higher rate of valve reoperation than reported in previous series, though the authors speculate that the higher rate of reoperation might have been due to an increased severity of disease. The authors conclude that pulmonary artery banding can be used in patients with AVSD without affecting early survival or compromising atrioventricular valve function.