Journal and News Scan

White and colleagues retrospectively evaluated the development of postoperative pulmonary venous obstruction for patients undergoing repair of total anomalous pulmonary venous connection (TAPVC) at their institution between 2006 and 2017. Of a total 119 patients, 25 (21%) developed postoperative obstruction. Heterotaxy syndrome, single-ventricle heart disease, concomitant procedures, mixed-type TAPVC, and preoperative obstruction were found to be associated with postoperative obstruction. The authors conclude that these data may help stratify risk for patients with TAPVC.

This article addresses the controversy surrounding the optimal annular stabilization technique following valve sparing root reconstruction (VSRR) and the lack of comprehensive imaging data in the evaluation of the natural history of aortic root graft geometry, valve competency, and prognosis postreconstruction. Seventy consecutive patients were prospectively enrolled between 2008 and 2017 (mean age 56.4 ± 16.4 years, 19.7% women) for VSRR. Dacron aortic annuloplasty reconstruction was found to be stable over time, without the need for external or internal stabilization. Computed tomography imaging was found to be more reliable than echocardiographic images, although given the noted stability, the authors conclude that it was of little utility.

In this editorial, Ikonomidis et al not only describe the challenges but also provide specific actionable steps towards improving the retention as well as clinical, academic, and personal success of cardiothoracic surgeon-scientists.

Challenges include:

1. High clinical, academic, and administrative demands
2. Steep competition for extramural funding
3. Lack of protected time
4. Lack of institutional and departmental support

Action plan includes:

1. Lead by example, formal training, mentorship and institutional support
2. Institute faculty start-up/support plans including funding and laboratory space that is readily accessible and locally available 
3. Implement protected paid time for research that is truly protected from clinical duties
4. Make research productivity financially incentivized and recognized. Incorporate research productivity into the compensation plan and promotion metrics
5. Disseminate opportunities

Patient Care and General Interest

The American Heart Association published a statement advocating for a holistic care approach for patients with Fontan circulation, noting that these patients are living longer and their unique long-term care needs are being better understood.

A judge in the USA has ordered e-cigarette companies to submit their products for review by the US Food and Drug Administration (FDA) by May 2020.

Drugs and Devices

Edwards Lifesciences as issued a warning related to the risk of a burst balloon during implantation of its Sapien 3 Ultra valve, emphasizing that the instructions for use should be closely followed to avoid this problem.

The US FDA has issued an alert that Edwards Lifesciences recalled the IntraClude intra-aortic occlusion device.

Targeted therapies for EGFR mutation–positive non–small cell lung cancer were added to the updated Essential Medicines List from the World Health Organization, but other lung cancer therapies were considered and rejected.

Research, Trials, and Funding

Investigators from Kansas City, Missouri, USA, report a relationship between institutional volume and outcomes of MitraClip placement up to 50 procedures, but continued improvement was observed beyond this number.

A group at University of Utah Health in the USA is aiming to improve outcomes of refractory cardiogenic shock with a multidisciplinary “Shock Team,” comprised of a cardiothoracic surgeon, a heart failure cardiologist, an interventional cardiologist, and an intensive care unit physician.