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Journal and News Scan
De Beaufort and colleagues assessed the outcomes of acute aortic dissections in 258 consecutive patients with Marfan syndrome in the International Registry of Acute Aortic Dissection (IRAD) database, comparing these with the dissection outcomes in the general population. Patients with Marfan syndrome were younger and had fewer comorbidities. In-hospital mortality rates were lower for patients with Marfan syndrome than for the general population (10.9% versus 16.9%, p = 0.01). There was lower mortality after open surgical repair of type B aortic dissection when compared to the general population (0% versus 17.6%, p = 0.011). As expected, the freedom from reintervention in the cohort of patients with Marfan syndrome was significantly less than in the general population (44.7% versus 81.5%, p<0.001).
Folliguet and colleagues report on 145 patients from three French centers who underwent transcarotid aortic valve implantation. The procedures were successful in all. Eight patients suffered a stroke, and one patient had a localized carotid dissection. There were no intraoperative conversions and no postoperative respiratory complications were observed.
The authors compared low risk patients undergoing office spirometry only (FEV1 of >60%) to those undergoing laboratory spirometry followed by lung resection. Outcomes for propensity score matched patients were similar for complications, length of stay, and readmission. Use of office-based spirometry was estimated to save their insitution $38,000 annually.
Among patients aged 65 and older undergoing lung resection for NSCLC, long-term survival was related to cancer stage and patient age. Lobectomy patients fared better than those undergoing parenchymal-sparing resections or pneumonectomy. VATS approaches provided better long-term survival.
The authors review their clinical experience with management of postoperative chylothorax among 97 patients. They favor duct ligation over embolization, and recommend intervention in patients with outputs greater than 1,100/day.
The authors demonstrate that use of an ultrasonic sealing device is safe for pulmonary artery branches 7 mm or less in diameter. This information could substantially reduce costs for lobectomy related to stapler use.
The authors explored the optimal extent of LN resection for T1aN0 carcinoid tumors undergoing lung resection using the National Cancer Data Base. Twenty-five percent of patients had no nodes evaluated. Four percent of patients were upstaged based on node status. Survival was similar comparing lobectomy to sublobar resection.
A good follow up for repair of mitral insufficiency due to excessive leaflet mobility, confirming good results for what appears again to be a not very lethal condition. (Be aware of the somewhat confusing abbreviation "MI" for mitral insufficiency.)
Rahmanian and colleagues retrospectively compared surgical outcomes and hemodynamics between rapid deployment aortic valve replacement (RDAVR) and standard AVR. The authors conclude that RDAVR required shorter aortic cross-clamp times and allowed for larger prostheses, achieving better hemodynamics than standard AVR. The two procedures had similar rates of postoperative complications.
A very brief editorial on frailty as a risk factor. In the time of weighing transcatheter interventions versus variable access surgical options, quantifying this physiological concept is of major importance for the cardiac teams and, importantly, the autonomy of the patient.