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Journal and News Scan
The authors conducted a meta-analysis of propensity-scored matched patients in published studies to assess outcomes of right internal mammary artery (RIMA) and radial artery (RA) as second conduits for CABG. Eight studies included nearly 3000 matched pairs. RITA was associated with better long-term survival and freedom from reoperation, but also was associated with an increased risk of sternal wound infection when pedicled harvest was conducted. See also: http://www.jtcvsonline.org/article/S0022-5223(16)30538-4/fulltext
This single institution retrospective review assessed outcomes of AVR in patients with concomitant aortic root disease using a composite graft. Early mortality was 5.3% and was related to advanced age, poor NYHA status, urgent operation, and associated MVR or CABG. Late death was related to CRI, COPD, aortic dissection, CABG, and use of the Cabrol technique. 10-year survival was 66%. See also: http://www.jtcvsonline.org/article/S0022-5223(16)30703-6/fulltext
The success of training techniques including dividing robotic lobectomy into graduated steps, reviewing video peformances of trainees, and coaching through challenging technical maneuvers were tracked during a 5-year experience. Performance of individual steps among general surgery and cardiothoracic surgery trainees increased over time, while metrics of outcomes remained the same or improved. See also: http://www.jtcvsonline.org/article/S0022-5223(16)30833-9/pdf
MRI assessment of cerebral blood flow and calculated cerebral oxygen delivery were compared between neonates with congenital heart disease and normal controls. Although cerebral blood flow was similar between the groups, oxygen delivery was over 30% lower in neonates with congenital heart disease, primarily because of arterial desaturation. These findings may influence the timing of repair of congenital heart disease. Also see: http://www.jtcvsonline.org/article/S0022-5223(16)30659-6/fulltext
The authors assessed the relationship between second hand smoke exposure in non-smokers and mortality related to lung cancer using serum cotinine levels. Cotinine levels were associated with survival, death from lung cancer, and death from all cancers after adjustment. Such levels identify second hand smoke effects.
The Duke group analyzed their group of patients undergoing proximal aortic operations during a 9-year period (n=869) to determine the incidence and etiology of reintervention on the aorta during follow-up. In all, 4.32% of patients required reintervention—roughly evenly divided between the proximal ascending aort and the distal aorta—and most occured within 3 years. The type of intervention needed in the second setting varied based upon the indications for, and type of, initial operation.
The authors performed a subgroup analysis of the Papillary Muscle Approximation (PMA) trial, a randomized trial that, while showing superiority of PMA + restrictive annuloplasty (RA) over RA alone in terms of LV remodeling and MR recurrence, failed to show a survival advantage and was plagued by a relatively high incidence of reoperation. In this study, the authors found that the best outcomes were seen in patients with preop symmetric tethering, asymmetric tethering, or inferior wall dyskinesia. Patients with primarily anterolateral wall dysfunction did not benefit from the addition of the PMA.
This erudite publication by Dr. Engelman explores the alphabet soup of the new payment models already upon us and sure to be central to our future. If you are not well-versed in acronyms such as MACRA, MIPS, BPCI and so forth, this is a must-read. Dr. Engelman does a superb job of covering all the central topics in a form that is easily digestible and extremely important for the future of our specialty.
September 23, 2016
The Johns Hopkins group reviewed their experience with mediastinal exploration for bleeding after cardiac surgery during the period from 2011 through June 2014, and retrospectively reviewed the outcomes of two categories of patients: (1) Planned Reexploration, defined as patients left open at the initial operation with a plan for a second-look procedure (n=62), and (2) Unplanned Reexploration, defined as those patients who initially underwent sternal closure but required reexploration for bleeding (n=48). Propensity matching generated 30 well-matched pairs for comparison. The primary outcome, operative mortality, was no different between the planned and unplanned reexploration groups, whether propensity-matched (37% v. 37%, p=.47) or not (29% v. 23%, p=.47). The authors conclude that delayed sternal closure with planned reexploration is a safe alternative to initial sternal closure in patients at increased risk for ongoing bleeding. Comment: After reading this study, would you have a lower threshold for leaving a chest open for bleeding upon completion of a cardiac operation? Why or why not?
September 15, 2016
Submitted by: CTSNet Staff
Balloon aortic valve dilatation has been assumed by some to provide the same outcomes as surgical aortic valvuloplasty. However, the development of precise modern surgical valvuloplasty techniques may result in better long-term durability of the aortic valve repair. This review of the recent literature suggests that current surgical aortic valvuloplasty techniques provide a safe and durable repair. Furthermore, primary surgical valvuloplasty appears to have greater freedom from re-intervention and aortic valve replacement as compared to balloon aortic valve dilatation.