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Journal and News Scan
February 5, 2016
A useful reference tool for all colleagues interested in research and biomedical publishing
February 2, 2016
This randomized trial (NEAT-HFpEF) of 110 subjects (59 placebos) disproves, by clinical and biological markers, the utility of nitrates for exercise tolerance. This is a subset of cardiac failure patients we are likely to encounter in general cardiothoracic surgical practice.
February 1, 2016
A retrospective analysis of patients suffering blunt cardiac injury was performed to identify factors associated with mortality. Death was not associated with abnormal ECG or the site or number of bone fractures. Mortality was related to hypotension, elevated lactate, and elevated troponins.
January 31, 2016
Whether open and VATS lobectomy for lung cancer result in similar nodal assessment is unclear. The authors compared rates of nodal upstaging for nearly 17,000 patients in the National Cancer Database who underwent resection for T2N0M0 or lower stage NSCLC. Upstaging was more common in patients undergoing open resection (12.8% vs 10.3%). This finding persisted when evaluating propensity score matched pairs. The difference in nodal upstaging was not significant among patients operated on in academic centers.
The authors determined the need for transannular patch enlargement (TAPE) in management of ToF by measuring the ratio between pulmonary annulus size to aortic valve annulus size (GA ratio). A retrospective analysis of 122 pts who had undergone ToF repair with or without TAPE was performed. GA ratios were smaller in patients undergoing TAPE. The GA ratio was a better predictor of TAPE (accuracy 90%) than a traditional method (z-score).
3D echo was used to preoperatively assess the likelihood of recurrent MR after ring annuloplasty for ischemic MR. Recurrence was asssociated with P3 tethering angle greater than 29.9 degrees (accuracy 92%). The authors suggest that valve replacement rather than ring annuloplasty should be considered in such patients.
Outcomes of CABG for patients in cardiogenic shock after acute MI were evaluated using data from the STS Database. The study group of nearly 5,500 patients comprised 1.5% of all CABG patients during the study period. Operative mortality was 18.7%. Mechanical circulatory support use was most common in patients with more risk factors or high clinical acuity, and was associated with an operative mortality of 37.2% (preop and intraop use) and 58.4% (postoperative use only). CABG as salvage had an operative mortality of 53.3%.
Readmission after lung resection is associated with increased costs and is used as a benchmark for quality. Outcomes of more than 22,000 lobectomies were evaluated for factors associated with readmission. 30- and 90-day readmission rates were 11.5% and 19.8%. Causes for readmission were pulmonary (24%), cardiovascular (16%), and surgical/procedural-related complications (15%). Preop characteristics associated with readmission were male gender and Medicaid payer status. Surgical approach and specific postoperative complications were not associated with readmission.
January 29, 2016
A robust manuscript from a small randomized trial: the authors indicate mid-term non-superiority of mitral annuloplasty over replacement in an important subset of patients with severe regurgitation!
January 28, 2016
Submitted by: Ruben Osnabrugge
In this Cardiothoracic Surgical Trials Network (CTSN) trial 251 patients with ischemic mitral regurgitation were randomized to mitral-valve repair or mitral-valve replacement. The current publication reports the 2-year outcomes of the trial. This trial shows that there was no significant difference in two-year survival between repair and replacement (19.0% vs 23.2%, HR 0.79, 0.46-1.35), although the trial was not powered to study survival. There was no difference in left ventricular end-systolic volume index between the two treatments. Recurring moderate or severe mitral regurgitation was seen more frequently in the repair group (58.8% versus 3.8%, p<0.001), as well as more cardiovascular admissons and heart-failure related adverse events.