Journal and News Scan

The Nationwide Inpatient Sample (NIS) was queried for aortic valve replacements conducted between 2003 and 2014.  The data on a total of 166,809 patients (37% female) were analyzed with respect to outcomes in men vs. women.   Hospital mortality was 40% higher in women than men (5.6% v. 4%, p<0.001).   When isolated AVRs were analyzed and propensity-matched, hospital mortality was 14% higher in women than men (3.3% v. 2.9%, p=0.001).    The differential outcomes appear to be driven by a distinct risk profile.  

The authors conducted a double-blinded prospective, randomized clinical trial in 249 patients >60 years of age who underwent cardiac surgery with cardiopulmonary bypass to assess whether interventions based on cerebral oximetry would decrease the incidence of postoperative delirium.  Two groups were compared:  The control group, in which the results of cerebral oximetry were blinded, and the intervention group, in which an algorithm was instituted for oximetry values below 75% of baseline.  

Results:  Postop delirium occurred in 24.4%  and 24.6% of the intervention and control groups, respectively (p=0.97).  Thus, interventions based on cerebral oximetry data do not appear to alter the incidence of postop delirium.  Incidentally, a higher baseline cerebral oximetry value was associated with a lower incidence of postoperative delirium.

Duerr and colleagues describe the experimental development of a mitral anuloplasty ring, which should facilitate later transcatheter valve-in-ring implantation. Two accompanying videos demonstrate valve expansion and implantation within the ring. The article illustrates the potential importance these new technologies are expected to gain in the near future.

We urgently need more answers for the patients affected by mesothelioma, a devastating diasese whose prognosis is 6-9 months from the diagnosis. We are now living the era of plateau of the epidemiology due to industrial use of amiantus of the last century. Furthermore, there are other etiology than asbestos in endemic areas, like for example the natural exposure to fluoro-edenite of certain regions of Japan and Sicily. We do need more informatinos to direct the difficult management of all these individuals and there are many ongoing studies where surgery is considered a valid option. This trial will compare the outcome of 2 groups: the first group will have a debulking surgery and hyperthermic intraoperative intrathoracic chemotherapy (HITHOC) with cisplatinum while the second group will receive talc pleurodesis alone. The primary outcomes measured will be length of hospital stay, quality of life, and long-term survival.