Search form

Search Surgeons

CTSNet is sponsored in part by an educational grant from

Journal and News Scan

Source: JAMA surgery
Submitted by: Joel Dunning
July 15, 2014
Author(s): Harskamp RE, et al.
   – The aim of this study was to evaluate the effect of vein graft preservation solutions on vein graft failure (VGF) and clinical outcomes in patients undergoing coronary artery bypass graft (CABG) surgery. These researchers concluded that patients undergoing CABG whose vein grafts were preserved in a buffered saline solution had lower VGF rates and showed trends toward better long–term clinical outcomes compared with patients whose grafts were preserved in saline– or blood–based solutions. Methods Researchers used data from the Project of Ex–Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) study, a phase 3, multicenter, randomized, double–blind, placebo–controlled trial that enrolled 3014 patients at 107 US sites from August 1, 2002, through October 22, 2003. Eligibility criteria for the trial included CABG surgery for coronary artery disease with at least 2 planned vein grafts. Interventions included preservation of vein grafts in saline, blood, or buffered saline solutions. Main outcomes measures included 1–year angiographic VGF and 5–year rates of death, myocardial infarction, and subsequent revascularization.   Results Most patients had grafts preserved in saline (1339 [44.4%]), followed by blood (971 [32.2%]) and buffered saline (507 [16.8%]). Baseline characteristics were similar among groups. Researchers found that 1–year VGF rates were much lower in the buffered saline group than in the saline group (patient–level odds ratio [OR], 0.59 [95% CI, 0.45–0.78; P<0.001]; graft–level OR, 0.63 [95% CI, 0.49–0.79; P<0.001]) or the blood group (patient–level OR, 0.62 [95% CI, 0.46–0.83; P=0.001]; graft–level OR, 0.63 [95% CI, 0.48–0.81; P<0.001]). Use of buffered saline solution also tended to be associated with a lower 5–year risk for death, myocardial infarction, or subsequent revascularization compared with saline (hazard ratio, 0.81 [95% CI, 0.64–1.02; P=0.08]) and blood (0.81 [0.63–1.03; P=0.09]) solutions.  
Source: Heart
Submitted by: J. Rafael Sadaba
July 14, 2014
Author(s): Capoulade R, Magne J, Dulgheru R, Hachicha Z, Dumesnil JG, O'Connor K, Arsenault M, Bergeron S, Pierard LA, Lancellotti P, Pibarot P.
The timing of surgery in patients with asymptomatic severe aortic stenosis (AS) remains a matter of debate. In this study, the authors evaluate the prognostic value of plasma levels of B-type natriuretic peptide (BNP) during exercise in 211 patients with asymptomatic AS.  In multivariate analysis, second and third tertiles of peak-exercise BNP were strong predictors of death or aortic valve replacement motivated by development of symptoms or LV dysfunction, compared with the first tertile. Patients with asymptomatic severe AS and a high peak BNP values may require closer follow up and may benefit from earlier surgery.
Source: JAMA
Submitted by: J. Rafael Sadaba
July 13, 2014
Author(s): Dvir D, Webb JG, Bleiziffer S, Pasic M, Waksman R, Kodali S, Barbanti M, Latib A, Schaefer U, Rodés-Cabau J, Treede H, Piazza N, Hildick-Smith D, Himbert D, Walther T, Hengstenberg C, Nissen H, Bekeredjian R, Presbitero P, Ferrari E, Segev A, de Weger A, Windecker S, Moat NE, Napodano M, Wilbring M, Cerillo AG, Brecker S, Tchetche D, Lefèvre T, De Marco F, Fiorina C, Petronio AS, Teles RC, Testa L, Laborde JC, Leon MB, Kornowski R; Valve-in-Valve International Data Registry Investigators.
In this paper, the authors evaluate 30-day and one-year  survival in patients undergoing valve-in-valve TAVI for failing surgical bioprostheses with data obtained from the Valve-in-Valve International Data (VIVID) Registry. 30-day mortality was 7.6%, and it was higher in patients with stenotic surgical valves (10.5%) than in those with regurgitant ones (4.3%). Overall 1-year survival was 83.2%. Of the surviving patients ,92.6% had good functional status (NYHA class I-II). 1-year mortality was higher in patients with small bioprostheses and in those with predominant surgical valve stenosis.
Source: Annals of Surgery
Submitted by: Mark Ferguson
July 12, 2014
Author(s): Reames, Bradley N.; Ghaferi, Amir A.; Birkmeyer, John D.; Dimick, Justin B.
Volume-outcomes relationships for operative mortality were first identified more than a decade ago.  This study updated the data using Medicare claims for more than 3 million patients.  The inverse relationship between volume and outcomes was confirmed for all 8 procedures studied.  The inverse ratio actually increased for 5 of 8 procedures despite overall improvements in outcomes.  For esophagectomy mortality the OR for very low compared to very high volumes was 2.25 in 2000-2001 and 3.68 in 2008-2009. 
Source: Annals of Surgery
Submitted by: Mark Ferguson
July 12, 2014
Author(s): Talsma, A. Koen; Lingsma, Hester F.; Steyerberg, Ewout W.; Wijnhoven, Bas P. L.; Van Lanschot, J. Jan B.
This single institution study evaluated differences in 30-day and 90-day mortality after esophagectomy in nearly 1300 patients.  30-day mortality was 2.9%, hospital mortalit was 5.1%, and 90-day mortality was 7%.  Late deaths were related to surgery (particularly the occurrence of anastomotic leakage), sudden death, and recurrent cancer.  The sensitivity of 30-day mortality in detecting surgery-related deaths was only 33%.   
Source: Annals of Surgery
Submitted by: Mark Ferguson
July 12, 2014
Author(s): Takeuchi, Hiroya; Miyata, Hiroaki; Gotoh, Mitsukazu; Kitagawa, Yuko MD; Baba, Hideo; Kimura, Wataru; Tomita, Naohiro; Nakagoe, Tohru; Shimada, Mitsuo; Sugihara, Kenichi; Mori, Masaki
A risk model of mortality associated with esophagectomy in Japan was developed using variables identified in the ACS NSQIP program.  30-day and overall surgical mortality rates were 1.2% and 3.4%, and the morbidity rate was 42%.  Morbidity was higher after minimally invasive esophagectomy.  Mortality was related to difficulty with ADLs, recent smoking, greater preoperative weight loss, male sex, and COPD.
Source: Annals of Surgery
Submitted by: Mark Ferguson
July 12, 2014
Author(s): van Diepen, Sean; Brennan, J. Matthew; Hafley, Gail E.; Reyes, Eric M.; Allen, Keith B.; Ferguson, T. Bruce; Peterson, Eric D.; Williams, Judson B.; Gibson, C. Michael; Mack, Michael J.; Kouchoukos, Nicholas T.; Alexander, John H.; Lopes, Renato D.
This prospective multiinstitutional study evaluated outcomes of different devices used for endoscopic vein harvesting classified as open or closed tunnel devices.  There was no difference in the incidence of early graft failure or late clinical outcomes.   The poorer graft outcomes related to endoscopic vein harvesting are not attributable to device type.    
Source: Annals of Oncology
Submitted by: Mark Ferguson
July 12, 2014
Author(s): V. Valentini, P-A. Abrahamsson, S.K. Aranda, A. Astier, R. A. Audisio, M. Boniol, L. Bonomo, A. Brunelli, B. Bultz, A. Chiti, F. De Lorenzo, J.G. Eriksen, V. Goh, M. K. Gospodarowicz, L. Grassi, J. Kelly, R. D. Kortmann, T. Kutluk, A. Plate, G. Poston, T. Saarto, R. Soffietti, A. Torresin, W. H. van Harten, J.F. Verzijlbergen, C. von Kalle, and P. Poortmans
This editorial, authored by a number of presidents/leaders of prominent medical societies, laments a recent position paper of the ESMO espousing medical oncologists as the natural team leaders of multidisciplinary oncologic care.  It cautions other cancer specialists not to abandon their roles as advocates for their cancer patients.
Source: Heart
Submitted by: Stuart Grant
July 9, 2014
Author(s): Price J, Toeg H, Lam B-K, Lapierre H, Mesana TG, Ruel M
The objective of this study was to investigate whether the consequences of patient prosthesis mismatch (PPM) following aortic valve replacement (AVR) differ according to patient age. The authors hypothesised that in older patients (aged 70 and above) the implications of PPM may be less important due to lower baseline physical function and competing mortality risks. This single centre study included 707 patients who underwent first-time AVR with follow-up out to 17.5 years. The incidence of PPM was 68% in patients aged 70 or older compared to 26% in patients aged less than 70. The authors found that in patients aged less than 70 with left ventricular dysfunction PPM was associated with reduced survival and increased congestive heart failure. Post-operative left ventricular mass regression was impaired in older patients in general and in those with PPM aged 70 or over with left ventricular dysfunction.     
Source: Journal of the American Medical Association
Submitted by: Ruben Osnabrugge
July 8, 2014
Author(s): Danny Dvir; John G. Webb; Sabine Bleiziffer; Miralem Pasic; Ron Waksman; Susheel Kodali; Marco Barbanti; Azeem Latib; Ulrich Schaefer; Josep Rodés-Cabau; Hendrik Treede; Nicolo Piazza; David Hildick-Smith; Dominique Himbert; Thomas Walther; Christian Hengstenberg; Henrik Nissen; Raffi Bekeredjian; Patrizia Presbitero;Enrico Ferrari; Amit Segev; Arend de Weger; Stephan Windecker; Neil E. Moat; Massimo Napodano; Manuel Wilbring;Alfredo G. Cerillo; Stephen Brecker; Didier Tchetche; Thierry Lefèvre; Federico De Marco, MD; Claudia Fiorina, MD;Anna Sonia Petronio; Rui C. Teles; Luca Testa; Jean-Claude Laborde; Martin B. Leon; Ran Kornowski
The consortium of authors of this paper determined the survival after Transcatheter valve in valve implantation inside a failed surgical bioprosthesis. The authors report a 1 month mortality rate of 7.6% and a major stroke rate of 1.7%. One-year survival was 83.2%, and 313 (92.6%) of survivors had a good functional status (NYHA I/II). Patients who had an aortic stenosis (n=181) had worse 1-year survival (76.6%) than patients with aortic regurgitation (91.2%) or combined stenosis/regurgigation (83.9%; p=0.01). Moreover, a small surgical bioprosthesis was associated with higher mortality. 

Pages