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Journal and News Scan
In this manuscript, the authors describe their experience with the treatment of 8 high risk patients with pure, severe aortic valve regurgitation, using the self-expandable Acurate TA prosthesis through a transapical approach. All procedures were carried out successfully with no 30-day mortality or stroke. None of the patients had more that grade I residual aortic regurgitation and none of them required permanent pacemaker implantation.
Bakaeen and colleagues have retrospectively reviewed the use of off-pump surgery among 2137841 primary isolated CABG operations in the Society of Thoracic Surgeons Database. They showed that off-pump procedures peaked in 2002 with 23% of CABG operations, after which it declined to 17% in 2012. In 2012, 34% of surgeons performed no off-pump operations and 86% of surgeons performed <20 off-pump operations per year. These data are important to establish the most appropriate infrastructure and resources related to off-pump CABG operations.
In a two-part review, Bax and many other authorities on transcatheter aortic valve implantation (TAVI) provide an extensive overview of the open issues related to patient selection, treatment strategy, and procedural aspects that will help further improve outcomes after TAVI.
In this multi-institution randomized trial, patients with heart failure underwent daily telemonitoring and standard care or just standard care. At 1 year, fewer patients in the telemonitoring group had worsened composite score (19% vs 27%) and experienced fewer deaths (10 vs 27 pts).
This retrospective study involving 7 institutions evaluated the utility of PET for mediastinal staging in patients who had undergone resection of pulmlonary carcinoid tumors and nodal dissection. 88% of pts had typical carcinoid tumors. The sensitivity of PET was only 33%, whereas the specificity was 94%.
This double-blind placebo-controlled trial involved 153 pts undergoing elective endovascular aortic aneurysm repair, of whom half received methylprednisolone preoperatively. The intervention reduced the systemic inflammatory response from 92% to 27%, plasma IL-6 was decreased by 90%, and CRP, body temperature, IL-8, and TNF were also reduced. MMP-9, D-dimer, and myeloperoxidase were unchanged. Medical and surgical morbidity were similar between the groups. The intervention reduced time to meet discharge criteria from 3 to 2 days.
This retrospective review reports on single-institution results for management of aneurysms involving the entire aorta using a 2-stage elephant trunk technique. 288 pts had only a first stage operation, and 157 pts underwent a complete 2 stage repair. Mortality was 9.1% and stroke rate after stage 1 was 3.4%. Mortality prior to 2nd stage repair was 18%.
The authors of this study investigated the effect of myectomy on pulmonary hypertension in patients with hypertrophic cardiomyopathy (HCM). In a retrospective study of 306 HCM patients, they found that myectomy was associated with an evident reduction in right ventricular systolic pressure (RVSP), both in patients with moderate/severe PH and in all patients with PH (RVSP>35mmHg). Their findings can help to guide therapeutic expectations and provide insight into pulmonary haemodynamics following obstruction relief.
Data from 6 cohort studies were evaluated to assess the ongoing risk of mesothelioma more than 40 years after initial environmental exposure to asbestos. Among over 22,000 of those exposed, 707 cases of pleural mesothelioma were diagnosed. The rate and risk increased until 45 years after exposure, then the rate of increase tapered off somewhat.
In an effort to identify clinical findings associated with deterioration and mortality after PE, the authors prospectively monitored 298 pts admitted through the ED with documented PE. 34% of pts experienced clinical deterioration, which was associated with hypotension, hypoxia, residual DVT, CAD, and right heart strain on echocardiogram. In contrast, 30-day mortality was associated with malignancy and CHF.