This site is not optimized for Internet Explorer 8 (or older).
Journal and News Scan
There is a rediscovered interest in use of a subxiphoid incision to perform lung surgery. This work follows a review of 105 lobectomies published in March 2016 in the Journal of Thoracic Disease from the same institution, Shanghai Pulmonary Hospital.
Although technical limitations exist when compared with transthoracic VATS and despite patient selction being more restrictive than for traditional surgery, the authors demonstrate the feasibility of anatomical lung resection for benign or malignant disease through the subxyphoid port. The conversion rate is acceptable (5.2%) and no post operative mortality in 153 cases (lobectomies and segmental resections) was observed. One of the main outcomes considered is post operative pain.
A most easily read brief editorial explaining in simple terms the power of a study, bootstrapping and the CLINICAL significance of risk factors in multivariate analysis. The author explains that the number of events defines the effective desirable sample size, not the number of individuals included in studies.
The authors report on their findings an ongoing Japanese multicentre prospective registry. They evaluate outcomes in 478 patients undergoing transfemoral TAVI and treated with percutaneous puncture using an expandable sheath, Edwards Sapien XTprosthesis and a Perclose ProGlide system. The primary outcome was percutaneous closure device (PCD) failure. The secondary outcome was the relation between PCD failure and the clinical outcomes (30-day and mid-term mortality rates and the length of hospital stay). PCD failures occurred in 36 patients (8%) and were not associated with the 30-day or the mid-term mortality rates. PCD failures can be predicted by the sheath-to-femoral artery ratio (SFAR). An SFAR threshold of ≥ 1.03 is the recommended cut-off point when PCD and an eSheath are used. Thus, this cut-off value may contribute to the selection of the sheath size, vascular access site, and method of approach.
Mitral valve disruption is a rare but serious complication of MitraClip insertion. This review provides an update on surgical interventions following MitraClip failure, and discusses possible valve injuries and surgical approaches.
This study examines the outcomes of bioprosthetic tricuspid valve replacement in patients with tricuspid valve infective endocarditis. Full text available.
Physiologic changes associated with sympathectomy for palmar hyperhidrosis were assessed in this randomized trial comparing T3 ganglionectomy to division of the sympathetic chain at T2 and T3. Outcomes were assessed using Holter monitoring. Clinical outcomes were similar between the groups. Electrophysiologic changes representing vagal activity measurements were more common in the ganglionectomy group.
Sixteen patients underwent percutaneous placement of a VSD closure device for management of subarterial VSD with puncture through the chest wall and infundibulum of the RV. Fifteen were successful, and 1 patient required conversion to mini-thoracotomy for pericardial effusion and tamponade. Mean LOS was 3.5 days. No deaths, arrhythmias, valve injury, or residual shunting occurred up to 1 year follow-up.
This single institution retrospective study analyzed the effects of single vs multiple complications on acute outcomes to help identify interactions among complications that might predict outcomes. Over a 4 year period 366 pts experienced a complication and 102 of these had 2 or more complications. Multiple complications were associated with mortality in 41% compared to 5% in those with one complication and 0.7% in those without complications. The number of complications was correlated with increased LOS and discharge to other than home. Interactions were evident among all complications, with the combination of renal failure and unplanned reoperation being associated with an OR for increased deaths of 108 (13.5 to 869).
This retrospective study compared Celsior (65% of pts) to all-blood continuous myocardial protection (35%) in 631 patients undergoing elective aortic valve replacement. Troponin T release was lower in Celsior patients, as was the risk of postoperative death (OR 0.33; 0.15 - 0.76). Other outcomes were similar between the groups.
This study is the 5-year follow-up of a large randomized controlled trial of on-pump CABG vs. OPCAB performed by seasoned surgeons. A total of 4,752 patients were included in this trial. At 5 years of follow-up, there was no difference between the groups in either the composite outcome of death, stroke, MI, or renal failure or between any of the individual components.
Question: There appears to be equipoise between either technique for coronary revascularization at 5 years. Are these results determinative? Is there any further information we need? Or, does this settle the issue once and for all?