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Journal and News Scan
October 23, 2013
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This randomized controlled trial evaluated routine mural thrombus aspiration followed by PCI to PCI alone in 7,244 pts with STEMI undergoing PCI. Thrombus aspiration did not significantly decrease mortality, recurrent MI, or stent thrombosis. Stroke and neurologic complication rates were similar between the groups.
October 23, 2013
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This study evaluated the effects of COPD on outcomes after TAVI in 319 pts, 30% of whom had COPD. COPD pts had a lower survival rate at 1 yr (71% vs 85%) and experienced less improvement in functional status. Cumulative mortality was predicted by the 6 min walk test, and periprocedural pulmonary complications were predicted by FEV1. TAVI was deemed futile in 40% of COPD pts.
October 23, 2013
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In this randomized trial involving 100 pts requiring PCI for STEMI and occluded LAD, half received lower extremity preconditioning for 3 cycles of 5min/5min ischemia/reperfusion. Preconditioning reduced enzymatic infarct size, reduced myocardial edema, and provided greater improvement in ST segment resolution.
October 22, 2013
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This single institution restrospective review examined outcomes of treatment for loco-regional recurrence after definitive trimodality therapy (chemotherapy, radiation therapy, resection) for esophageal adenocarcinoma. Isolated local recurrence developed in 27 patients (5%), most within 3 years. Median overall survival of those with loco-regional recurrence was 17 mos, with a poor response to additional therapy. These data suggest that intense post-treatment surveillance programs aimed at early detection of loco-regional recurrence may not provide much benefit.
October 20, 2013
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This study found that tricyclic antidepressants like Imipramine, used to treat major depression and Promethazine used as an antiemetic and antihistaminic, induce apoptosis in both chemonaïve and chemoresistant SCLC cells in culture,v and in mouse and human SCLC tumors transplanted into immunocompromised mice. The relevance of this work is based on the power of bioinformatics to find new drugs to treat SCLC. The authors used gene expression microarrays to know how expression levels change in SCLC compared to normal lung cells. They found a gene expression signature for SCLC by using publically available gene expression data from FDA-approved drugs. Tricyclic antidepressants had a similar signature to previous chemotherapy agents, which suggested their ability to antagonize SCLC growth.
October 18, 2013
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This interesting retrospective study compared the long-term results of surgical valvuloplasty and balloon valvuloplasty for congenital aortic stenosis in neonates and infants. During the study period, 86 patients underwent surgical valvuloplasty and 37 patients had a balloon valvuloplasty as first intervention. The two most important factors adversely related to long-term outcomes (including re-stenosis, re-intervention, and regurgitation) on multivariate analysis were having a balloon valvuloplasty as first procedure and undergoing initial treatment as a neonate. Freedom from reintervention at 10 years with surgery was 55% for neonates and 78% for infants. On the contrary, freedom from reintervention at 8 years with balloon valvuloplasty was 15% for neonates and 40% for infants. The authors concluded that despite the retrospective nature of this analysis (and the possibility of bias), surgical valvuloplasty is associated with better long-term outcomes than balloon valvuloplasty.
October 17, 2013
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In this manuscript, the authors review 44 cases of coronary artery obstruction following TAVI from a registry of 6688 patients. This complication is rare but life threatening. A number of variables such as older age, female gender, previous CABG, the use of balloon expandable prosthesis, previous surgical bioprosthesis, left coronary ostia height, and sinus of Valsalva diameter appear to be related to this complication.
October 17, 2013
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This paper is an expert consensus on the new definition of relevant myocardial infarction following both PCI and CABG. In patients with normal baseline CK-MB, post-procedural MI is defined as a peak CK-MB rise, measured within 48 hours of the procedure, equal or greater than 10-times the local laboratory upper limit of normal (ULN) or equal or greater than 5-times the local laboratory ULN with new pathologic Q-waves in more than 2 contiguous leads or new persistent LBBB, OR in the absence of CK-MB measurements and a normal baseline cTn, a cTn (I or T) level rise, measured within 48 hours of the procedure, greater than 70-times the local laboratory ULN, or greater than 35-times the ULN with new pathologic Q-waves in more than 2 contiguous leads or new persistent LBBB.
October 15, 2013
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The pulmonary autograft aortic valve replacement (Ross AVR) has clear advantages in growing children below the teenage years. Some recent reports have questioned the durability of the Ross AVR in older children and young adults, particularly those who present with predominant aortic regurgitation and a dilated aortic root. Brown and associates review their experience with the Ross operation in 79 children and young adults between the age of 10 and 20, mean of 16.0 ± 2.7 years. Analysis of outcomes including mortality, early and late complications and the need for reoperation is presented, with comparison to non-Ross AVR patients of the same age group during the same time period. The impact of technical modifications to the Ross operation is also assessed.
October 11, 2013
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This is a very interesting retropsective cohort study that looks at patients that either did or did not have an FFR preoperatively.
FFR for intermediate stenoses reduced the number of grafts required and increased the number of patients suitable for OFF pump surgery with no difference in clinical outcome measures.