CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 6, November/December 2022 334 AFRICA Cardio News First for Africa: robotic-assisted cardiothoracic surgery comes to South Africa In a first for the continent, a cardiothoracic robotic-assisted surgery programme has been established at Netcare Christiaan Barnard Memorial Hospital to provide less-invasive alternatives for procedures involving the chest cavity, including lung cancer and cardiac surgeries, among others. Minimally invasive and hybrid cardiovascular and thoracic surgeon Dr Johan van der Merwe is leading the programme, and recently performed the first cardiothoracic procedure using the da Vinci robotic surgical system at the Netcare hospital. Visiting United Kingdom cardiothoracic surgeon and lung cancer specialist Dr Joel Dunning of James Cook University Hospital, in Middlesbrough in the north of England, oversaw the procedure to remove a rib in a thoracic outlet decompression surgery in a 33-year-old man for the relief of pain and restricted movement in his right arm. ‘We are grateful for the opportunity to establish this platform, which will enable our cardiac and thoracic surgery colleagues across the country and elsewhere in the continent to provide robotic surgery as an option to their patients. This will allow more patients to receive state-of-the-art, world-class, evidencebased treatments,’ says Dr van der Merwe, who gained significant exposure to robotic techniques during six years of training in the United Kingdom and Belgium and completed intensive training on the da Vinci system. ‘Establishing cardiothoracic robotic surgery is also a significant development for cardiology patients, as it has applications including single- or multiple-vessel coronary bypass in combination with cardiac stents as a hybrid coronary artery procedure,’ Dr van der Merwe says. ‘In coronary artery revascularisation, for example, the da Vinci robotic system can be used to harvest internal mammary artery conduits, after which the bypass operation is performed minimally invasively through a small incision. The remainder of the procedure is completed with stents.’ Dr van der Merwe adds that the cardiothoracic robotic surgery centre at Netcare Christiaan Barnard Hospital evolves through efficient teamwork and ongoing international collaboration and mentoring. He also expressed his appreciation to Dr Dunning and his colleagues at Onze Lieve Vrouw Clinic in Belgium, for their support and guidance in bringing the programme to fruition. ‘Through state-of-the-art technology, expert proctors such as Dr Dunning can participate in an operation from abroad, while having full visualisation of the theatre set-up, the robotic components and the operative field in real time. This allows us to further develop our skills and build our local programme to bring the advantages of global developments in cardiac and thoracic surgery robotics to patients from South Africa and beyond our borders,’ Dr van der Merwe concluded. … continued from page 321 It also reduced the composite of death from CV causes, myocardial infarction, or stroke by 10% in patients with HF regardless of LVEF. LVEF is a measurement of the percentage of blood leaving the heart every time it contracts and has several gradations, including HF with reduced EF (HFrEF), HF with mildly reduced EF (HFmrEF) and HF with preserved EF (HFpEF). In 2021, Farxiga was the company’s primary growth driver when chronic kidney disease (CKD) was added to the label. The drug has been approved in more than 100 countries to improve glycaemic control in adults with type 2 diabetes and for HFreF in patients with and without type 2 diabetes. It received first-in-class approval for CKD in patients with and without type 2 diabetes in the US, European Union, UK, Japan and other countries. The drug brought in $3.005bn in revenue for the year, down 23% compared with the previous year. If the drug should be approved for a broader treatment of HF based on the current results, Ruud Dobber, EVP and president of AstraZeneca’s Biopharmaceuticals Business Unit, said Farxiga’s addressable patient population would jump by 50%. However, it wouldn’t be without competition for those patients; both Eli Lilly and Boehringer Ingelheim ran clinical studies of their competitive drug Jardiance in similar patients last year. Eli Lilly reported Jardiance bought in $1.498bn in 2021, up 29% from the previous year. The study results will probably bring SGLT2 inhibitors to the head of HF therapy, said study co-author Scott Solomon, PhD, professor of medicine at Harvard Medical School, Brigham and Women’s Hospital. Physicians will probably choose Farxiga or Jardiance depending on cost and availability, which will ‘probably be more important than any potential differences between those therapies’, Solomon said. Source: MedicalBrief 2022
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