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Journal and News Scan

Source: JACC: Cardiovascular Interventions
Author(s): Guerrero M, Dvir D, Himbert D, Urena M, Eleid M, Wang DD, Greenbaum A, Mahadevan VS, Holzhey D, O'Hair D, Dumonteil N, Rodés-Cabau J, Piazza N, Palma JH, DeLago A, Ferrari E, Witkowski A, Wendler O, Kornowski R, Martinez-Clark P, Ciaburri D, Shemin R, Alnasser S, McAllister D, Bena M, Kerendi F, Pavlides G, Sobrinho JJ, Attizzani GF, George I, Nickenig G, Fassa AA, Cribier A, Bapat V, Feldman T, Rihal C, Vahanian A, Webb J, O'Neill W.
The authors describe their findings in a multicenter retrospective review of clinical outcomes in 64 patients with severe mitral annular calcification considered poor candidates for traditional surgical mitral valve replacement, undergoing transcatheter mitral valve implantation with a balloon expandable prosthesis. There were procedural complications in 13 patients (20%): LVOT obstruction in 6, embolization in 4 and perforation in 3 cases. Periprocedural death occurred in 19 patients (29.7%). Most survivors reported significant improvement of symptoms. At 30 days, 21 of the 25 patients (84%) with 30-day clinical follow-up data were in NYHA functional class I or II. The authors concluded that transcatheter mitral valve implantation with balloon-expandable valves designed for aortic position is feasible in this extremely high-risk patient population. Technical success was achieved in most patients. Although there were important complications and a high 30-day mortality, these results are encouraging considering this represents the first human experience with a transcatheter heart valve not designed for the mitral position and used in an extremely high-risk patient population.
Source: ASAIO Journal
Author(s): Dzierba, Amy L, FCCM; Roberts, Russel; Muir, Justin; Alhammad, Abdullah; Schumaker, Greg; Clark, Jacqueline; Ruthazer, Robin; Devlin, John W
The authors, using 2 groups of patients, 32 ECMO and 53 non-ECMO, both with a diagnosis of ARDS, describe the two groups' severity of illness, medication regimen and use or nonuse of ECMO therapy.  Utilizing adjusted multivariate linear regression model the authors conclude that only the APACHE II score was independently associated with the development of severe thrombocytopenia, but that ECMO use was not.  
Source: World Journal for Pediatric and Congenital Heart Surgery
Author(s): Jürgen Hörer, Jelena Kasnar-Samprec, Julie Cleuziou, Martina Strbad, Michael Wottke, Harald Kaemmerer, Christian Schreiber, and Rüdiger Lange
Currently, there are few specific risk models available to predict mortality following congenital heart surgery in adults or to stratify operations on adult patients with congenital heart disease by relative risk of mortality. The study by Hӧrer and Kasnar-Samprec  et al evaluates  the predictive power of the common pediatric scores when applied to adult patients undergoing surgery for congenital heart disease. In addition, a new ‘grown-ups with congenital heart disease’ (GUCH) score, specifically intended for adults undergoing congenital heart surgery, is described and evaluated. View the invited commentary from Stephanie Fuller and Jeffrey P. Jacobs here. 
Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): JJ Squiers , B Lima , JM DiMaio
A handy mini-textbook on ECMO
Source: Journal of Thoracic Oncology
Author(s): Michelle C. Salazar, Joshua E. Rosen, Brian N. Arnold, Daniel C. Thomas, Anthony W. Kim, Frank C. Detterbeck, Justin D. Blasberg, Daniel J. Boffa
This is a retrospective National Cancer Data Base cohort study of patients with pathologic stage T3 invasive NSCLC with separate tumor nodules in the same lobe. The goal was to determine with adjuvant chemotherapy increased survival. The study cohort was divided into 2 groups: 1) Pathologic stage T3 with an additional tumor nodule in the same lobe (adjuvant chemotherapy n=450, surgery only n=563). In this group, the 3-year overall survival for the adjuvant subset was 70% versus 59% in the surgery only subset and 2) Pathologic stage T3 with an additional tumor nodule in the same lobe, excluding pN>0, Tumor size >=4 cm, and tumor invasion (adjuvant chemotherapy n=192, surgery only n=336). In this group, the 3-year overall survival for the adjuvant subset was 86% versus 71% in the surgery only subset. 
Source: JAMA Internal Medicine
Author(s): Kooistra HA, Calf AH, Piersma-Wichers M, Kluin-Nelemans HC, Izaks GJ, Veeger NJ, Meijer K.
In this matched cohort study the authors evaluate the age-associated risk of bleeding and thrombosis in 3313 patients ≥70 years attending a single thrombosis service and treated with vitamin K antagonist (VKA). Patients were matched 1:1:1 by decade (70-79, 80-89, 90-99 years) and duration of treatment. The primary end point was a composite of clinically relevant non-major and major bleeding. The main finding of this study was that the frequency of bleeding events was not significantly increased in patients aged 80 to 89 years and only mildly increased in patients 90 years or older compared with patients in their 70s. The subgroup analyses showed that the risk of bleeding increased more with age in men than in women.
Source: Circulation: Cardiovascular Interventions
Author(s): Stefano Rosato, Francesco Santini, Marco Barbanti, Fausto Biancari, Paola D’Errigo, Francesco Onorati, Corrado Tamburino, Marco Ranucci, Remo Daniel Covello, Gennaro Santoro, Claudio Grossi, Martina Ventura, Danilo Fusco, Fulvia Seccareccia, on behalf of the OBSERVANT Research Group
This article explores the controversial topic of TAVR versus surgical AVR in low-risk patients.  The primary outcome was 3-year survival.  The authors report 3-year survival for TAVR and surgical AVR as 72% and 83.4%, respective (p=0.0015).  Although TAVR is an exciting technology, there should be caution in adopting it in lower risk patients.  
Source: J Anesth. 2016 Jun 22. [Epub ahead of print]
Author(s): Ying-Hsuan Tai, Kuang-Yi Chang, Shu-Wei Liao, Kwei-Chun Chung, Chun-Che Shih, Shung-Tai Ho, Chih-Cherng Lu, Mei-Yung Tsou
This retrospective study evaluated the effects of high-dose nitroglycerine (NTG) on glucose metabolism, tissue oxygenation and postoperative recovery in cardiac surgical patients. Two groups were classified: NTG group (iv loading of NTG starting at rewarming of cardiopulmonary bypass; n=101), NON-NTG group (n=151). Authors found that the the plasma glucose was significantly lower in the NTG group during and after CPB, the total consumption of regular insulin was significantly lower in the NTG group, there was a significantly lower incidence of hyperlactatemia in the NTG group during CPB, and the mixed venous oxygen saturation in the intensive care unit was higher in the NTG group.
Source: Annals of Thoracic Surgery
Author(s): Elisabeth Mahla, MD, Florian Prueller, MD, Sylvia Farzi, MD, Gudrun Pregartner, MSc, Reinhard B. Raggam, MD, Elisabeth Beran, MD, Wolfgang Toller, MD, Andrea Berghold, PhD, Udaya S. Tantry, PhD, Paul A. Gurbel, MD
The authors enrolled 149 patients on DAPT undergoing urgent cardiac surgery in a prospective study analyzing the association between platelet reactivity and postoperative bleeding.  They found that decreasing platelet reactivity correlated with an increase in calculated red blood cell loss after surgery.  Their findings support the use of objective measures of platelet function prior to proceeding with cardiac surgery.
Source: Critical Care
Author(s): Ayan Sen, Joel S. Larson, Kianoush B. Kashani, Stacy L. Libricz, Bhavesh M. Patel, Pramod K. Guru, Cory M. Alwardt, Octavio Pajaro and J. Christopher Farmer
With the rapid expansion of mechanical circulatory support (MCS) in various contexts (CVICU, in-hospital cardiac arrest (E-CPR) and the ED), the authors have provided a very nice overview of the general principles of MCS options and management to assist the broader healthcare team involved with these complex patients.