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Journal and News Scan
In this extensive review, the authors focus on extracorproreal membrane oxygenation (ECMO), both for cardiac and respiratory failure. They describe the explosive increase in ECMO use, the expanding indications, and the need for more evidence-based use. Moreover, they review the cannulation strategies, current indications and potential future applications.
Traditionally, patients undergoing TAVI are treated with dual antiplatelet therapy (DAPT). This strategy in not based on strong evidence. In this paper, the authors describe their findings in a randomized trial comparing outcomes (morbidity and mortality) in two groups of patients undergoing TAVI, one treated with aspirin only (ASA group) and another treated with aspirin and clopidogrel or ticlopidine (DAPT group). There were no significant differences in “all cause” and “cardiovascular” mortality at six months or in the VARC (Valve Academic Research Consortium) combined safety endpoints at 30 days. Nevertheless, at 30 days, vascular complications were significantly more frequent in the in the DAPT group. Based on their data, the authors suggest that, in patients undergoing TAVI, vascular complications may be reduced by the adoption of an antiplatelet therapy based only on aspirin.
Pts undergoing salvage esophagectomy after definitive chemoradiotherapy were evaluated for perdictors of survival. 5-year survival was 30%, which was related to tumor recurrence rather than residual tumor, complete resection, N status, M status, and dissection of more than 15 nodes. Additional neck dissection was not found to provide additional benefit.
This study evaluated over 200 RTCs of systemic therapy for NSCLC. There has been a steady increase in the number of trials reporting outcomes for progression-free survival. Over 50% of trials now report a positive outcome without meeting the primary endpoint of the trial. Although the sample size of the trials is increasing, the magnitude of reported survival gain is decreasing (now 2.5 mos).
The PORTICO trial has opened to evaluate the Portico Transcatheter Aortic Valve System. This prospective multicenter trial involving up to 40 sites will randomize pts to Portico vs another TAVR valve in the US.
The influence of continuous flow LVAD devices on heart transplant was examined using UNOS data, comparing outcomes of cfLVAD to pulsatile flow LVAD (pfLVAD) and no LVAD pts. cfLVAD pts spent longer time on the waitlist and were status IA for longer than either of the other groups. Waitlist survival was better for the cfLVAD pts. Post-transplant survival was similar among the 3 groups.
The authors present results of surgery in 12 pts for hypertrophic cardiomyopathy extending to the papillary muscles. Repair was performed through a detached anterior mitral leaflet, which was subsequently repaired. The intraventricular end-diastolic gradient was decreased by 80% postop, and mitral regurgitation that was present preop was eliminated. One patient died, the others were in NYHA class I or II postop.
This expert review identifies knowledge gaps with regards to valvulopathy and aortopathy associated with bicuspid valves and proposes strategies for improving knowledge.
The researchers performed a systematic review to look at outcomes and complications associated with transcatheter closure of ventricular septal defects (VSD). This analysis suggests that transcatheter device closure of VSD is safe and yields good results. The limitations of this study are difficulties in analyzing different devices individually, and segregating the different VSD types, Further stratification by type of VSD, age of patients, and prevention of complications is needed before this can be recommended for routine treatment.
- A PubMed search for series in English on device closure of VSD from 2003 to June 2012 was performed.
- They excluded small series that were included in multicenter studies and patients who had acquired VSD following myocardial infarction.
- The random effects model was used to obtain pooled estimates of success and complications.
- A total of 37 publications comprising 4,406 patients with VSD (perimembranous=3,758, muscular=419, intracristal=47, doubly committed subarterial=36, multiple=16, postsurgical=123, unclassified=7) were included in this analysis.
- The age of patients ranged from 3 days to 84 years.
- The pooled estimate of successful device implantation was 96.6% (95% CI: 95.7-97.5).
- The most common complication is residual shunt (pooled estimated 25.5%; 95% CI: 18.9-32.1).
- Others included valvular defects (pooled estimate 4.9%; 95% CI: 3.4–6.4) and arrhythmias (pooled estimate 10.6%; 95% CI: 8.4-12.7).
We are all dissapointed to see that a study that looked at 783 patients from the chianti region over 10 years that looked at resveratrol metabolites showed no health benefits for high intake of this mtabolite of chocolate and wine