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Journal and News Scan
This is a cohort study from the Pediatric Cardiac Care Consortium based on data from 616 patients with pulmonary atresia with intact ventricular septum (PA/IVS) treated between 1982 and 2003. Median follow-up was 16.7 years (IQR 12.6-22.7).
Initial interventions included aortopulmonary shunt in 247, right ventricular decompression in 96, and both in 273. Risk factors for death at initial intervention included earlier birth era (1982-1992), chromosomal abnormality, and atresia of one or both coronary ostia. Among 494 survivors of neonatal hospitalization, there were 99 deaths (4 posttransplant) and 10 transplants (median age of death or transplant 0.7 years, IQR, 0.3-1.8). Definite repair or last-stage palliation was achieved in the form of completed 2-ventricle repair (n=201), one-and-a-half ventricle (n=39), or Fontan (n=96). Overall 20-year survival was 66%, but for patients discharged alive after definitive repair, it reached 97.6% for single-ventricle patients, 90.9% for those with one-and-a-half ventricle, and 98.0% for those with complete 2-ventricle repair (log-rank p=0.052).
The authors conclude that transplant-free survival in PA/IVS is poor due to significant infantile and interstage mortality. Survival into early adulthood is excellent for patients reaching completion of their intended treatment path, independent of type of repair.
Colleagues from five heart centers performed a study on the incidence and factors associated with acute stroke following type A repair using the Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD).
Among 7353 Acute type A repair performed at 772 centers between 2014 to 2017, operative mortality was 17% and incidence of postoperative stroke was 13%. Multivariate analysis showed that patients with axillary cannulation versus femoral (OR=0.60, P<0.001) and retrograde cerebral perfusion versus no cerebral perfusion (OR=0.75, P=0.008) or antegrade cerebral perfusion (OR=0.75, P=0.007) were less likely to develop acute stroke, while total arch replacement versus hemi-arch technique (OR=1.30, P=0.013) was predictive of higher risk for stroke. Longer times of circulatory arrest, cerebral perfusion and cardiopulmonary bypass were all related to higher risk of postoperative stroke. The degree of hypothermia and center volume were not related to stroke incidence.
Oliveira and colleagues retrospectively analyzed outcomes for 1,628 patients who underwent on-pump coronary artery bypass grafting at a single center in Brazil over a six-year period. They divided patients into quartiles based on their preoperative creatinine levels, finding a higher mortality rate in the highest creatinine quartile than in the lowest two quartiles. Additionally, variance of more than 0.4 mg/dL between the creatinine level measured at admission and the highest level measured in the intensive care unit was associated with a greater risk of death for patients in all quartiles.
Verdial and colleagues prospectively characterized the performance of a guideline-recommended invasive mediastinal staging (IMS) strategy in detecting nodal disease among 123 patients with non–small cell lung cancer (NSCLC). While the guideline-recommended approach identified all patients with true nodal disease, it also selected 65% of patients without nodal disease to undergo IMS. Toward the goal of reducing the usage of invasive procedures in patients with node-negative NSCLC, the authors developed a prediction model composed of five radiographic factors. They found that their prediction model maintained the sensitivity of the guideline-recommended IMS strategy (within a margin of error) while selecting fewer patients without nodal disease to undergo invasive staging. The authors note the need for the model to be independently validated in other cohorts.
Patient Care and General Interest
A father got a sternotomy scar tattoo in support of his son after the boy underwent surgery for supravalvular aortic stenosis.
In a Viewpoint paper in JAMA Surgery, the authors highlight the importance of training on Geneva conventions and humanitarian law for surgeons embarking on medical missions to conflict zones.
Drugs and Devices
The US Food and Drug Administration has cleared Mimics Enlight from Materialise, software that is intended to assist in planning complex transcatheter mitral valve replacement procedures.
Research, Trials, and Funding
Researchers from Vancouver, Canada, used gut bacteria to convert type A blood cells into type O.
Researchers from France find that spin in health news, defined as overstating the efficacy or safety of a treatment, positively influences people’s views of those treatments.
A restrictive approach to blood cell transfusions did not increase the risk of acute kidney injury in patients undergoing cardiac surgery on cardiopulmonary bypass, report researchers from London, Canada.
US News & World Report published a list of 613 hospitals in Cardiology & Heart Surgery that see many challenging patients, including those needing heart transplants, those with cardiovascular disease, and other complex heart conditions. In order to be eligible for ranking, listed hospitals had to treat at least 1,391 such Medicare inpatients in 2014, 2015, and 2016. The 50 top-scoring hospitals are ranked, followed by high performing hospitals.
This position paper written by the EACTS, STS, and AATS Valve Labeling Task Force focuses on problems around sizing and labeling of various prosthetic valves. The authors provide information on European and international regulations and use of standards in prosthetic heart valve labeling, characteristics of surgical prosthetic heart valve design, and their hemodynamic performance and thrombogenicity. This first paper from the task force reviews current practices and identifies where improvements are necessary.
This large review of over 100,000 patients undergoing transcatheter aortic valve replacement demonstrated a stroke rate of 2.3% within 30 days of the procedure, and no decrease in the rate between 2011 and 2015.
Thoracoabdominal aortic aneurysm (TAAA) repair began in Houston, Texas, with pioneer surgeons such as Drs Michael E. DeBakey, Denton A. Cooley, and E. Stanley Crawford. Their early attempts to repair TAAA were complicated by risk of renal and spinal cord ischemia and difficulty in reattaching the branching vessels of the thoracoabdominal aorta. This article delves into this history and the work being done at the current forefront of TAAA repair.