Noteworthy Cardiac Surgical Literature 2018: Value-Based Bundled Payments, Opioid Crisis and Cardiac Surgery, Percutaneous Suction Thrombectomy for Intracardiac/Caval Thrombus and Vegetations, and Minimally Invasive Left Ventricular Assist Device Placement

Abstract

There has been tremendous evolution in the care of cardiac surgical patients in 2018. In this article, 4 topics of considerable impact on cardiac surgical care in the current landscape are reviewed based on recent publications. The first topic reviews the recent paradigm shift to value-based payments and the potential role of bundled payments on health care and physician reimbursement. The second topic highlights the impact of the opioid crisis on cardiac surgery. The third topic demonstrates the increasing utilization and expanding role of novel percutaneous suction thrombectomy technique in the extraction of caval and right-sided intracardiac thrombi and vegetations with veno-venous bypass. The final topic reviews the current trend of minimally invasive left ventricular assist device placement. Each of these topics addresses the contemporary issues in cardiac surgery with the reasoning for evolution in our current practices in 2018.

Percutaneous Mechanical Aspiration vs Valve Surgery for Tricuspid Valve Endocarditis in People Who Inject Drugs

“…Our work highlights the burden of IDU as a serious cause of IE and the need to deliver comprehensive treatment PWID, including harm reduction services and addiction management. 5,21,22 The results of our study correspond with one other comparative study that examined the utility of PMA compared with valve surgery in TVIE within a population of mostly PWID. George and colleagues 11 performed a single-center, retrospective cohort that compared Angio-Vac PMA (n ¼ 37) with valve surgery (n ¼ 63).…”

Knowledge of the Present Is the Roadmap for the Future

“…Finally, Dr Aftab et al have taken a critical look at the cardiothoracic surgery literature and selected quite an interesting array of themes. 5 The leading topic examines value-based purchasing and the potential role for bundled payments in our health care system, and in particular, in cardiac surgery. The discussion continues to focus on the opiate crisis and the effects that we are experiencing with our patient populations in the operating rooms and intensive care units, specifically with an increase in infectious endocarditis in patients with history of intravenous drug abuse.…”