Journal and News Scan

In this phase three national, multicenter, UK randomized controlled trial, the authors seek to compare outcomes after extended pleurectomy decortication plus chemotherapy versus chemotherapy alone. The trial recruited patients between 2015 and 2021 from 26 UK hospitals, recruiting and randomly assigning patients with a 1:1 allocation ratio. In total 335 patients were randomized, 87 percent of which were male. The authors concluded that extended pleurectomy decortication was associated with a worse survival up to two years.

This study assessed the incidence rates of permanent pacemaker implantation (PPM) and the associated long-term clinical consequences of PPM implantation after isolated mitral valve (MV) repair compared to concomitant MV repair and tricuspid annuloplasty. Data from public hospital discharge databases from New York and California were queried for patients undergoing MV repair (isolated or with concomitant tricuspid annuloplasty) between 2004 and 2019. Patients were stratified by whether they received a PPM within 90 days of index surgery. After propensity score matching, survival, heart failure hospitalizations, endocarditis, stroke, and reoperation were compared between patients with or without PPM. A total of 32,736 patients underwent isolated MV repair (n = 28,003) or MV repair with tricuspid annuloplasty (n = 4,733). The incidence of PPM implantation less than 90 days after surgery was 7.7 percent for MV repair and 14.0 percent for MV repair with tricuspid annuloplasty. PPM was associated with reduced long-term survival among MV repair patients (HR: 1.96; 95 percent CI: 1.75-2.19; P < 0.001) and MV repair with tricuspid annuloplasty patients (HR: 1.65; 95 percent CI: 1.28-2.14; P < 0.001). In both surgical groups, PPM was also associated with an increased risk of heart failure hospitalizations (HR: 1.56; 95 percent CI: 1.27-1.90; P < 0.001) and endocarditis (HR: 1.95; 95 percent CI: 1.52-2.51; P < 0.001), but not with stroke or reoperation.

The COMICS trial is the largest randomized trial of minimally invasive extracorporeal circulation (MiECC) compared to conventional ECC (CECC). MiECC reduced the frequency of SAEs prespecified to qualify for the primary outcome. This finding was of borderline significance due to stopping recruitment early, but is consistent with the results of large-scale, published meta-analyses. MiECC improved a visual analogue quality-of-life measure. MiECC was safe with respect to other SAEs and adverse events that were reported. It did not reduce mortality, any SAE not included in the primary outcome, time to ICU or hospital discharge or transfusion of any red cells or any other blood product. However, all treatment effect estimates for these outcomes, except for hospital stay, favored MiECC; and the magnitude of the reductions in mortality and risk of any SAE not included in the primary outcome were consistent with the reduction in risk observed for the primary outcome.

In this trial of 337 patients undergoing open or thoracoscopic lung resection randomized to postoperative chest drain removal based on a standard threshold of 200 mL/24 hours or 5 mL/kg/24 hours, there were no differences in pleural effusion, dyspnea, or time to chest drain removal; however, the weight-adjusted threshold was associated with earlier hospital discharge.