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Journal and News Scan
The author describes the growing role of SBRT in lung cancer therapy and the growing role of radiation oncologists in decision-making regarding lung cancer. The cautionary note is that surgeons need to remain actively involved in staging, patient assessment, and treatment recommendations. Commentary: http://www.jtcvsonline.org/article/S0022-5223%2816%2930466-4/abstract
The authors compare single-institution retrospective data on outcomes of coronary bypass grafting or PCI for isolated CAD in over 12,000 pts. Overall survival was better for PCI patients (46% vs 34% at 15 yrs). However, survival for patients undergoing CABG with multiple arterial grafts was superior to most other interventions at 15 years and was similar to PCI with drug-eluting stents. Commentary: http://www.jtcvsonline.org/article/S0022-5223%2816%2930072-1/fulltext
The authors summarize currently available catheter-based treatments for mitral regurgitation. The options are numerous and are evolving rapidly. Commentary: http://www.jtcvsonline.org/article/S0022-5223%2816%2930318-X/fulltext
June 11, 2016
Submitted by: J. Rafael Sadaba
This manuscript reports on the 3-year follow up results of the CoreValve US Pivotal Trial in which patients with aortic stenosis at high risk for surgery were randomly assigned to self-expanding TAVR or SAVR in a 1:1 manner. At 3 years, the results of this analysis demonstrate a sustained 3-year clinical benefit of TAVR with a self-expanding prosthesis over SAVR. There was a reduction in all-cause mortality and stroke. TAVR was also shown to have lower 3-year mean aortic valve gradients and larger effective orifice areas compared with SAVR. Moderate or severe AR was higher with TAVR compared with SAVR. There were no differences in the occurrence of structural valve deterioration over time in the 2 groups.
June 8, 2016
Submitted by: Tom C. Nguyen
In medicine we often use words not understandable to patients. For example, instead of saying, "does it hurt when you pee,” we say, “dysuria”… Roughly 80% of patients don’t understand their medical condition (Am J Emerg Med. 2000; PMID 11103725). This cartoon animation provides a clear explanation to help patients understand aortic stenosis.
June 5, 2016
Submitted by: Joel Dunning
The surgeon who gave his name to the simple but dramatic procedure used to rescue people from choking saved someone’s life with the Heimlich Manoeuvre for the first time this week aged 96. Dr Henry Heimlich’s technique for dislodging food or objects caught in people’s throats has been credited with saving untold thousands of lives around the world since he invented it in 1974 – but he had never once had cause to use it in an emergency situation himself.
The authors analyzed long-term outcomes after cardiac surgery in nearly 10,000 patients to evaluate the mortality risk of blood transfusion. Sex-mismatched transfusion increased mortality, and use of non-leukocyte-depleted blood was associated with increased mortality. The age of the blood productes was not related to mortality. Commentary: http://www.jtcvsonline.org/article/S0022-5223(16)30028-9/fulltext
Outcomes are reported for initial use of a 4-branched graft with an incorporated distal stent graft for management of disease of the aortic arch combined with the proximal descending aorta. Operations were equally distributed among acute dissections, chronic dissections, and aneurysms. Surgical mortality was 7%, 3-year survival was 81%, and 22% needed additional intervention, much of which was performed endovascularly. Commentary: http://www.jtcvsonline.org/article/S0022-5223(16)30069-1/fulltext http://www.jtcvsonline.org/article/S0022-5223(16)30060-5/abstract
Neurologic outcomes were evaluated in a randomized trial of TAVR or surgical aortic valve replacement (SAVR) for severe AS (750 pts). Stroke occurred about 50% more often in SAVR than TAVR pts at all follow-up time periods, but the differences were not statisticalyl significant. Cognitive changes after stroke were similar between the two groups. Commentaries: http://www.jtcvsonline.org/article/S0022-5223(16)30014-9/fulltext http://www.jtcvsonline.org/article/S0022-5223(16)00404-9/fulltext
In order to develop an algorithm for identifying acute deterioration (urgent intubation or cardiopulmonary resuscitation) in infants with parallel systemic and pulmonary circulation, continuous physiologic monitoring data of 25 patients were retrospecitively reviewed and analyzed. 20 events were identified in 13 infants. The algorithm was effective in identifying impending events 1-2 hours prior to the event (ROC area 0.91). Commentary: http://www.jtcvsonline.org/article/S0022-5223(16)30106-4/fulltext