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Journal and News Scan

Source: New England Journal of Medicine
Author(s): Denise R. Aberle and others

This study reports results from the first 2 of 3 incidence screening rounds of the NLST in patients who had no evidence of cancer on the initial screening CT/CXR.  Abnormal results were identified in 28% and 17% on the 1st and 2nd screening CTs compared to 6% and 5% in the CXR screens.  Among detected lung cancers, 47.5% were stage IA in the CT group and 23.5% were stage IA in the CXR group. 

Source: New England Journal of Medicine
Author(s): Annette McWilliams and others

This study investigated the probability that nodules detected on initial low dose CT screening are malignant by using the PanCan study as a development dataset and results from chemoprevention trials as a validation dataset.  In the two datasets, a total of 12,029 nodules were detected among 2961 pts.  144 nodules were malignant.  Among pts with nodules, 5.5% and 3.7% had cancer in the development and derivation sets.  Predictors of malignancy included older age, female sex, family history of lung cancer, emphysema, larger nodule size, upper lobe location, part solid morphology, lower nodule count, and spiculation.  Predictive ability of the model exceeded 90%.

Source: Annals of Thoracic Surgery
Author(s): Peter B. Licht, Ole Dan Jørgensen, Lars Ladegaard, Erik Jakobsen

The Danish Lung Cancer Registry was queried to assess rates of nodal upstaging in patients resected for clinical stage I lung cancer undergoing open vs VATS resection.  VATS and open resections were equally distributed among over 1,500 pts.  Nodal upstaging was significantly more common after open compared to VATS lobectomy.  Survival rates did not differ.  Differences in nodal upstaging rates were likely related to factors that were not assessed in this study. 

Source: Annals of Thoracic Surgery
Author(s): Hironori Matsuhisa, Naoki Yoshimura, Tomonori Higuma, Takuro Misaki, Yoshiko Onuma, Fukiko Ichida, Yoshihiro Oshima, Yutaka Okita

The author studied 16 children who underwent closer of multiple VSDs using a variety of techniques.  Global and septal function were assessed postoperatively with echo and speckle tracking imaging.  EF was correlated with the total patch area.  Septal function was significantly worse than in control pts.  Areas that were closed with synthetic material had impaired function compared to areas that were closed primarily. 

Source: Annals of Thoracic Surgery
Author(s): Niv Ad, Linda Henry, Sharon Hunt, Sari D. Holmes

Currently fewer than 40% of pts with chronic afib undergo ablation.  This study evaluated nearly 1000 pts with afib who were undergoing cardiac surgery for other indications.  Ablation frequency was positively influenced by mitral valve surgery, lower creatinine, and increasing surgeon experience.  There was an increase in ablation frequency during the period of study. 

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Moritz Seiffert, Lenard Conradi, Stephan Baldus, Johannes Schirmer, Stefan Blankenberg, Hermann Reichenspurner, Patrick Diemert and Hendrik Treede

A retrospective study characterizing "severe intraprocedural complications" during TAVR "requiring immediate surgical or interventional bailout manoeuvres."  Analysis of 458 consecutive TAVR patients through transfemoral and transapical approaches. Complications requiring intraoperative bailout manoeuvres were analysed according to the Valve Academic Research Consortium (VARC) criteria.   40 major intraprocedural complications occurred in 35 patients  (7.6%), including conversion to surgery for valve embolization/migration (17%), severe aortic regurgitation (12%) and root rupture (5%); need for surgical haemostasis secondary to left ventricular wire perforation and subsequent cardiac tamponade; and percutaneous coronary intervention in 6 patients.  All-cause mortality at 30 days was 31.4% in patients with intraprocedural complications and 38.5% in patients requiring surgical conversion.   The authors conclude that an interdisciplinary heart-term approach creates "a surgical and interventional safety net" that facilitated bailout strategies in the setting of severe intraprocedural complications. 

Source: Annals of Thoroacic Surgery
Author(s): Massimiano PS, Yanagawa B, Henry L, Holmes SD, Pritchard G, Ad N

Single center experience with minimally invasive (right minithoracotomy) fibrillating approach to mitral valve surgery (MVS) and/or atrial fibrillation ablation. Experience (01/2007 - 08/2012) included 292 consecutive patients who underwent MVS (n = 177), surgical ablation (n = 81), or both (n= 34). MV repair rate was 93.4% with 1 operative mortality (0.3%) and no conversions to sternotomy.  Other complications included 1 stroke, 1 transient ischemic attack, and 4 reoperations.  Survival at 1 and 2-years was 98.5% and 97.8%, respectively. The authors reported results at mean follow-up of 27.3 months compared favorably with data reported by Society of Thoracic Surgeons (STS) in 2011.

Source: New England Journal of Medicine
Author(s): Massimo Imazio, Antonio Brucato, Roberto Cemin, Stefania Ferrua, Stefano Maggiolini, Federico Beqaraj, Daniela Demarie, Davide Forno, Silvia Ferro, Silvia Maestroni, Riccardo Belli, Rita Trinchero, David H. Spodick, and Yehuda Adler for the ICAP Investigators

240 patients with acute pericarditis randomized to either colchine or placebo in addition to standard NSAIDs.  The colchine group had reduced rate of incessant or recurrent pericarditis.  

Source: Journal of Clinical Oncology
Author(s): Margreet Lüchtenborg, Sharma P. Riaz, Victoria H. Coupland, Eric Lim, Erik Jakobsen, Mark Krasnik, Richard Page, Michael J. Lind, Michael D. Peake, and Henrik Møller

Outcomes for over 12,800 pts operated for lung cancer in England 2004-2008 were analyzed. High volume hospitals operated on patients with more risk factors (advanced age, lower socioeconomic status, more comorbidities), yet achieved better survival, especially in the early postoperative period.

Source: New England Journal of Medicine
Author(s): John W. Eikelboom, Stuart J. Connolly, Martina Brueckmann, Christopher B. Granger, Arie P. Kappetein, Michael J. Mack, Jon Blatchford, Kevin Devenny, Jeffrey Friedman, Kelly Guiver, Ruth Harper, Yasser Khder, Maximilian T. Lobmeyer, Hugo Maas, Jens-Uwe Voigt, Maarten L. Simoons, and Frans Van de Werf, for the RE-ALIGN Investigators

This randomized trial of dabigatran vs warfarin for anticoagulation in patients immediately after or more than 3 mos after MVR or AVR with a mechanical valve was stopped early after enrollment of 252 pts. There were both excess bleeding events and excess thromboembolic events in the dabigatran group, indicating no benefit and increased risk of dabigatran compared to warfarin.

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