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Journal and News Scan
Bicuspid AV repair was performed in 146 pts over a period of 34 years; the primary indication was stenosis. Survival at 20 yrs was 88%. Freedom from reintervention at 18 yrs was 43%. 30 additional pts without reintervention had moderate to severe stenosis or moderate regurgitation at last follow-up.
The patency and clinical outcomes of the right internal thoracic artery (RITA) and right gastroepiploic artery (RGEA) as Y-grafts to the LIMA in situ were evaluated in 443 pts using propensity score matching. Graft patency, overall survival, and freedom from reintervention rates were similar for the two groups.
Osteopontin (OPN) influences metastatic behavior of tumors through binding to CD44v6 and integrin. The authors in this study assessed OPN and CD44v6 expression in 159 NSCLC pts and evaluated survival. The combination of markers stratified overall and disease-free survival, especially in stage I pts. Overall survival for [OPN- AND CD44v6-] pts was 64.4%, for [OPN+ OR CD44v6+] was 49.1%, and for [OPN+ AND CD44v6+] was 16.4%.
Guidelines for evaluation of patients with suspected lung cancer and evidence for mediastinal adenopathy in the absence of distant metastatic disease recommend mediastinal nodal sampling as the initial diagnostic/staging technique. In this study the authors evaluated compliance with that guideline in 137 pts. Guideline-compliant pts underwent 1.3 tests compared to 2.3 tests for guideline-noncompliant pts and experienced fewer complications (0% vs 17%). Most complications were related to unnecessary CT-FNA. Initial EBUS-TBNA was sufficient in 64%. Guideline compliance was only 22%.
The New York Times revisits the spiraling increase in health care costs in the United States.
The authors performed off-pump left ventricular reconstruction for ischemic cardiomyopathy in ovine model applying epicardial catheter-based ventricular reconstruction. Six weeks after ventricular reconstruction end-systolic volume was decreased by 38% and ejection fraction increased by 13%. Histopathology showed appreciable reduction of the chronic infarct in the left ventricle.
The authors analyzed cardiac CT scans of 70 patients for the smallest distance between each point on the annulus and each of the left circumflex and right coronary arteries. The global minimum for the left circumflex was <5 mm for about 30% of patients. Knowledge of the exact anatomic relationships could help to reduce iatrogenic complications of mitral annuloplasty.
The authors present a case series of 11 patients with N3 non-small-cell lung cancer who received multimodality treatment including surgery. They conclude that such regimen is worth to be considered in selected patients.
Intermittent lower body perfusion during repair of acute DeBakey type I aortic dissection in moderate hypothermic circulatory arrest (MHCA) seems to be protective against renal failure and increase of liver enzymes compared to MHCA only in a study on 107 patients.
Effect of statin drugs on thoracic aortic aneurysms The American Journal of Cardiology, 10/09/2013 Clinical Article Stein LH et al. - Pharmacologic interventions for thoracic aneurysms remain poorly characterized. The results of a pilot study by the group suggested improved outcomes among patients with thoracic aortic aneurysm who were taking statins. These findings provide a medicinal option for the arsenal of treatment options for patients with aneurysms of the thoracic aorta. Methods The authors undertook a comprehensive analysis of a larger cohort of patients from the Database of the Aortic Institute at Yale-New Haven Hospital. A total of 1,560 patients met the inclusion criteria. The adverse events (i.e., death, dissection, or rupture) and surgery rates for patients with (n = 369, 24%) and without (n = 1,191, 76%) statin therapy were compared. They evaluated 3 anatomic components of the aorta: root, ascending and arch, and descending and thoracoabdominal aortic aneurysms. Results A smaller proportion of the statin group had adverse events: overall, 7% versus 15%; ascending and arch, 6% versus 15%; and descending and thoracoabdominal aortic aneurysms, 8% versus 20%. Also, a smaller proportion of statin patients required surgery: overall, 48% versus 60%; ascending and arch, 51% versus 62%; and descending and thoracoabdominal aortic aneurysms, 36% versus 59% (p <0.001 to 0.01). The protective effect of statins was seen in all segments, except the aortic root. Log-rank evaluation of the interval to an adverse event or surgery was longer among statin-treated patients (p <0.001). The protective effect of statins was seen in all segments, except the aortic root. Log-rank evaluation of the interval to an adverse event or surgery was longer among statin-treated patients (p <0.001). Logistic regression analysis found statin use, angiotensin receptor blocker use, and chronic obstructive pulmonary disease were associated with decreased adverse events, and statin use, angiotensin receptor blocker use, (beta)-blocker therapy, and age were associated with a decreased odds of requiring surgery. Multiple logistic regression analysis found only statins were associated with a decreased odds of an adverse event and that statins, coronary artery disease, and chronic obstructive pulmonary disease were associated with a decreased odds of undergoing surgery.