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Journal and News Scan
June 28, 2016
Submitted by: Aamir Shah
This article investigates the effects of varying degrees of aortic regurgitation (AR) on survival after transcatheter aortic valve replacement (TAVR). They retrospectively evaluated a cohort of 237 patients undergoing TAVR from 2006 to 2012 with echocardiogram performed within 30 days of the procedure. Using a Cox proportional multivariable regression model, they found each 1+ increase in AR (on a scale of none to 4+) was associated with a unit hazard ratio of 2.26. After TAVR, patients with no paravalvular aortic regurgitation (15% of patients) had 0% mortality at 1 year, trivial to 1+ AR (29.5% of patiens) had 7.1% mortality at 1 year, and 1+ AR (32.5% of patients) had 16.9% mortality at 1 year. The authors conclude that even a mild degree of AR is associated with significant prognostic value after TAVR and that more discriminating grading scales of AR will be important in evaluating TAVR as it is applied to intermediate and low risk patient populations.
June 27, 2016
The paper provides a comprehensive overview of current and developing applications of nanotechnologies for diagnostics, surveillance and therapy of thoracic cancer.
June 27, 2016
The paper reports on the first experience in 14 consecutive patients who underwent elective one-stage frozen elephant trunk procedures via minimally invasive approach. There was no 30-day mortality and no permanent neurologic complication.
June 25, 2016
Submitted by: Aristotle Protopapas
A large retrospective study of the UNOS database advances that elevated troponin I in selected cardiac donors is NOT associated with various adverse events. The conclusion is likely to stimulate heated discussions. A number of limitations of the study are discussed, and the POST-OPERATIVE values of this important biomarker are not included in the study.
June 24, 2016
The authors compared the results of annuloplasty with flexible and rigid rings in patients with tricuspid valve regurgitation. This is a propensity score-matched analysis with 98 pairs. They concluded that both rings are equally effective, however the rigid one causes a more complete right heart reverse remodelling.
June 24, 2016
The RESCUE study recruited 178 patients with heart failure and systolic dyssynchrony. Patients were randomized to CABG alone or to CABG with concomitant epicardial CRT implantation. Results for long-term survival (55 ± 10.7 months) were in favor of the CABG+RCT group.
June 22, 2016
In his new book The Naked Surgeon: The Power and Peril of Transparency in Medicine, Samer Nashef of Papworth Hospital, Cambridge, UK reports that of the 115 specialists surveyed, 30% said that they had recommended non-surgical treatment to high risk patients to avoid a poor mortality rating.
The authors summarize findings in a single institution retrospective review of patients undergoing pre-discharge VTE screening after pneumonectomy for NSCLC and compare outcomes to an historic series of patients who did not have screening. Rates of VTE in the screened group were 8.9% at discharge, an additional 3.4% within 30 days postop, and 5.4% >30 days postop. These rates were significantly higher than in the non-screened cohort. VTE was associated with decreased survival at 1 year. Commentary: http://www.jtcvsonline.org/article/S0022-5223%2816%2930070-8/fulltext
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