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Journal and News Scan
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.
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.
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.
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.
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?
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.
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.
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.
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.
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.