This site is not optimized for Internet Explorer 8 (or older).

Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.

Journal and News Scan

Source: Annals of Surgery
Author(s): Pasquer, Arnaud; Renaud, Florence; Hec, Flora; Gandon, Anne; Vanderbeken, Marguerite; Drubay, Vincent; Caranhac, Gilbert; Piessen, Guillaume; Mariette, Christophe; On behalf of the FREGAT Working GroupFRENCH

All patients undergoing surgical therapy for esophageal or gastric cancer in France 2010-2012 were evaluated for postoperative mortality stratified by comorbidity score and assessed by medical center volume (low, medium, high, very high).  Most operations were performed in low volume centers.  Mortality decreased linearly with increasing center volume.  The linear decrease was present regardless of comorbidity score.  Comparing low to very high volume centers, a 70% reduction in relative risk was present. 

Source: Annals of Surgery
Author(s): Anderegg, Maarten C. J.; Lagarde, Sjoerd M.; Jagadesham, Vamshi P.; Gisbertz, Suzanne S.; Immanuel, Arul; Meijer, Sybren L.; Hulshof, Maarten C. C. M.; Bergman, Jacques J. G. H. M.; van Laarhoven, Hanneke W. M.; Griffin, S. Michael; van Berge Henegouwen, Mark I.

The authors explored the relationship of nodal region and survival from adenocarcinoma of the esophagus/GEJ in patients undergoing induction therapy and transthoracic resection.  Survival diminished related to nodal status/region:  highest for no nodes, followed in order by: local/regional, truncal, upper thoracic, and combined truncal and upper thoracic.  They suggest that nodal location should be considered in future staging systems.

Source: Annals of Surgery
Author(s): Gandon, Anne; Gronnier, Caroline; Renaud, Florence; Borde, Paul; Vanderbeken, Marguerite; Hec, Flora; Piessen, Guillaume; Adenis, Antoine; Mirabel, Xavier; Mariette, Christophe

In this retrospective review, the authors queried whether a hiatal hernia (HH; >5cm) was associated with adverse outcomes after esophagectomy for cancer.  After adjustment, they found that HH patients had a lower rate of complete resection and  lower median survival.  They also found that in patients with HH who received induction therapy the rate of perioperative mortality was higher than those without HH who underwent induction therapy, largely due to increased cardiopulmonary complications.

Source: Journal of the American College of Cardiology
Author(s): Urena M, Himbert D, Ohlmann P, Capretti G, Goublaire C, Kindo M, Morel O, Ghodbane W, Iung B, Vahanian A.

This is the first report of the use of a balloon expandable transcatheter heart valve (Edwards Sapiens 3) for TAVI in chronic aortic regurgitation (AR) involving non-calcified native valves. The authors implanted Edwards Sapiens 3 prostheses in three patients with severe AR deemed inoperable by the heart team. After the procedure, there was no more than trivial AR in any of the patients (one required post-procedure dilation). At one month all three patients were alive and in New York Heart Association functional class I or II. Transthoracic echocardiograms failed to show any valve displacement or paravalvular AR. The authors advise positioning the valve more ventricular than what is recommended for aortic stenosis and use of a balloon “slow inflation” technique.

Source: Annals of Thoracic Surgery
Author(s): Shinya Unai, MD, My-Le Nguyen, MD, Daizo Tanaka, MD, Nataliya Gorbachuk, BA, Gregary D. Marhefka, MD, Hitoshi Hirose, MD, Nicholas C. Cavarocchi, MD

This single-center study explored the relationship between spontaneous echo contrast (SEC) and the incidence of thromboembolism and CVA in 98 patients undergoing peripheral VA ECMO.  Twenty-two percent of patients had SEC while they were on ECMO.  Those exhibiting SEC had significantly higher rates of intracardiac thrombus (46% v. 13%, p = 0.002) and CVA (36% v. 7.9%, p = 0.002).  The patients who showed SEC had a lower EF and less frequent aortic valve opening.

Comment:  Should we be venting the LV more frequently in VA ECMO?  If so, how should we vent the LV?  Alternatively, should we maintain a baseline level of inotropic support on these patients to discourage stasis in the LV?

Source: Annals of Thoracic Surgery
Author(s): Ismail Bouhout, MD, MS, Amine Mazine, MD, MS∗, Lena Rivard, MD, Aly Ghoneim, MD, Ismail El-Hamamsy, MD, PhD, Yoan Lamarche, MD, MS, Michel Carrier, MD, Philippe Demers, MD, MS, Denis Bouchard, MD, PhD

This single center retrospective study analyzed the incidence of permanent pacemaker requirement in 108 consecutive patients undergoing sutureless aortic valve replacement with the Perceval S bioprosthesis.  In-hospital postoperative pacemakers were required in 23% of patients, 3 times the rate reported in earlier studies and approximately 6 times the historical rate following a standard surgical AVR.

Source: Eur Heart J
Author(s): Usman Baber, Michael E. Farkouh, Yaron Arbel, Paul Muntner, George Dangas, Michael J. Mack, Taye H. Hamza, Roxana Mehran, Valentin Fuster

In the FREEDOM trial, 1900 diabetic patients were randomized between coronary bypass surgery and percutaneous coronary intervention (PCI). Of these, 451 patients had chronic kidney disease (CKD) with a GFR 30-60 mL/min/1.73m2, and the remaining patients were categorized as having no CKD. In both groups, bypass surgery performed better over 5-year follow-up than PCI in patients with CKD (26.0% versus 35.6%; HR=0.73, 95% CI 0.50-1.05) and no CKD (16.2% verus 23.6%; HR=0.76, 95% CI 0.58-1.00). Therefore, independent of chronic kidney disease, diabetic patients with multivessel disease should undergo CABG.

Source: Annals of Thoracic Surgery
Author(s): Timothy S Lancaster, Matthew R Schill, Jason W Greenberg, Marc R Moon, Richard B Schuessler, Ralph J Damiano, and Spencer J Melby

In this single institution retrospective study of postoperative cardiac surgery patients, serum potassium and magnesium levels at times when postoperative atrial fibrillation (POAF) occured were compared with levels in patients who did not experience POAF.  The incidence of POAF was 37%, and was associated with increasing magnesium levels.  Prophylactic potassium administration had no effect on POAF, whereas prophylactic magnesium administration was associated with an increase in POAF risk.

Source: Annals of Thoracic Surgery
Author(s): Byung Kwon Chong, Jae Suk Baek, Yu-Mi Im Im, Chun Soo Park, Jeong-Jun Park, and Tae-Jin Yun

This retrospective study evaluated whether a systemic-PA shunt in infants with TOF facilitated enlargement of the pulmonary valve annulus (PVA).  Placement of a shunt was the only factor associated with PVA growth.  This knowledge may affect how repair is staged with an eye towards avoiding a transannular patch.

Source: Annals of Thoracic Surgery
Author(s): Valerie W Rusch, Ritu R Gill, Alan Mitchell, David Naidich, David C Rice, Harvy I Pass, Hedy L Kindler, Marc De Perrot, and Joseph Friedberg

Semiautomated CT volumetric measurements of tumor volume in patients with malignant pleural mesothelioma were compared to stage and overall survival.  CT volumes correlated well with stage and survival.