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Journal and News Scan
Grimminger and colleagues present their technique for a four-armed robotic approach to esophageal cancer surgery. The authors note the improved control and dexterity offered by the addition of the fourth arm, leading to greater surgeon independence in this complex procedure.
A balanced editorial discussing the relevant RCT from Britain. The esteemed authors are correct to highlight the overall discouraging survival from out-of-hospital cardiac arrest WITHOUT NEUROLOGICAL DEFICIT. What does need to be done to improve a 3% acceptable outcome? The 'non-superiority' of adrenaline (epinephrine) is, under the devastating primary outcome, a finding of secondary importance for the general public.
Quite useful case-illustrated debate on a VERY hot topic!
Kiefer and colleagues report the outcomes of six patients who underwent transapical mitral valve repair for severe mitral regurgitation. Treatment was offered as part of the safety and feasibility trial for the NeoChord DS1000 system at the authors’ institution. One patient underwent intraoperative conversion to an open repair, two patients underwent reoperation for recurrent mitral regurgitation, and the remaining three patients had no cardiac symptoms throughout the five-year follow-up period.
Hickey and colleagues discuss the assumptions that underlie regression models, and they detail approaches to identifying deviations from these assumptions. They illustrate several points using linear regression as the basis but also discuss logistic regression and Cox regression models. The authors present both formal statistical tests and graphical diagnostics that should be used for assessing model assumptions.
Patients with severe secondary mitral regurgitation with depressed ejection fraction were randomized to either MitraClip and medical therapy vs. medical therapy alone. There was no difference in primary outcomes (i.e. death and unplanned hospitalization) at one year.
Patient Care and General Interest
A new study finds that elderly heart surgery patients who exhibit postoperative delirium are sometimes given antipsychotic medications, which are ineffective and may even be dangerous.
A 5-month-old child in St. Louis, Missouri, becomes the youngest documented heart-lung transplant patient in more than a decade.
A 3-year-old boy from Germany with a rare congenital heart disease travelled all the way to Milwaukee, Wisconsin, to undergo a complex procedure.
Drugs and Devices
The first clinical use of FRAME external support technology for aneurysm repair in high flow arteriovenous (AV) fistulas took place in Germany.
Research, Trials, and Funding
A Harvard study regarding cardiothoracic surgery operating teams suggests that variations in interpersonal and leadership communication patterns may have a strong effect on teamwork.
A novel technique tested at Ohio State University’s Wexner Medical Center allows damaged lungs to be placed on a machine that keeps them alive at normal body temperature, allowing doctors to better assess whether they are viable.
Nguyen and colleagues evaluated whether left atrium (LA) enlargement in hypertrophic cardiomyopathy was reversed after septal myectomy. The authors retrospectively reviewed transthoracic echocardiographic measurements of LA volume index from 656 patients who underwent myectomy over eight years at their center. Only patients with both preoperative and postoperative measurements were included. The authors noted both early reduction in LA volume index prior to hospital discharge, and late reduction at two-year follow-up, which they suggest is indicative of continued reverse remodeling. The severity of preoperative mitral regurgitation and the risk of postoperative atrial fibrillation were associated with preoperative LA volume index, but the risks of postoperative stroke and survival were not.
A brief, useful editorial advancing the position of watchful waiting in selected aneurysmopathic patients, on the occasion of new AATS guideline on bicuspid aortic valve (BAV) aortopathy.
This video and article detail the author’s technique for the classic hybrid arch debranching procedure. It is performed for patients who have had a prior type A dissection repair with aortic arch and descending thoracic aortic dilation but who are not felt to be candidates for more extensive hybrid repairs that require total arch replacement. Hughes emphasizes the importance of appropriate patient selection for the success of this type I hybrid arch repair and discusses his center’s selection criteria.