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Journal and News Scan
February 28, 2014
Submitted by: Stuart Head
Yates and coauthors evaluated the implementation of Heart Team discussions for patients with complex coronary artery disease, and determined whether the 2010 ESC/EACTS guideline recommendations changed clinical practice in this regards. Unfortunately, Heart Team discussions were infrequent pre- and post-guideline publication (9% vs 17%).
February 28, 2014
Submitted by: Ruben Osnabrugge
In this meta-analysis, the authors set out to investigate whether MV repair or replacement was better for patients with ischemic mitral regurgitation. Combining 12 eligible studies, they found that MV repair is associated with lower operative mortality, but higher recurrence of regurgitation. There were no differences in survival, functional measures and NYHA class.
A group of 1365 pts from 6 institutions was retrospectively reviewed for outcomes after palliative treatment, chemotherapy alone, pleurectomy/decortication (P/D), or extrapleural pneumonectomy (EPP). Multivariable analysis identified age <70, epithelial histology, and chemotherapy as independent predictors of improved survival. In patients with all 3 favorable characteristics, median survival with or without P/D or EPP was similar.
Using SEER data the authors compared open to VATS segmental resection in a population of pts >65 years old. Propensity score matching was used to adjust for baseline differences between the groups. VATS pts had lower complication rates, fewer ICU admissions, and shorter length of hospital stay. Outcomes did not appear to be surgeon-specific. Survival was similar between the groups.
This study evaluated safety and efficacy of EBUS-TBNA in a population of pts 70 or older and compared their results to those of younger patients. Tolerance was better in the older group, and complication rates were similar. Overall accuracy was higher in the older group, possibly related to differences in the underlying diagnoses.
The authors hypothesized that major lung surgery may predispose patients to post-traumatic stress disorder (PTSD). 47 pts were evaluated prospectively. 50% were identified as having an elevated PTSD risk score 3 months posteroperatively. Predictors included excess preoperative anxiety and increased acute postoperative pain.
Aorto-oesophageal fistulation following thoracic endovascular aortic repair occurred in 36 of 2387 patients with a mean interval of 90 days according to the European Registry of Endovascular Aortic Repair Complications. Key symptoms included fever, haematemesis and shock. Aggressive therapy with radical oesophagectomy and aortic replacement achieved the best 1-year survival.
There is growing interest in reparative techniques that durably improve the mitral orifice while preserving the subvalvular apparatus. Many of these techniques are technically challenging and require complex resections with intricate chordal adjustments, which may have limited their global acceptance. In this report, a three-step technique is outlined that does not require significant resection or involve the use of neochords. This offers a potentially simplified approach to the repair of rheumatic mitral stenosis.
Systolic and diastolic myocardial motion was determined using magnetic resonance tissue phase mapping (n=27). Cold ischemic time of the transplanted heart >155 min is associated with decreased myocardial velocities whereas longer postoperative time has a positive influence. The future aim is to develop a non-invasive method to diagnose transplant rejection.
Computational models based on data from computed tomography show that maximal wall shear stress is associated with the maximal diameter in large aortic aneurysms whereas eccentricity of the bulge is more important in small aneurysms.