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Journal and News Scan

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Abby J. Isaacs, Jeffrey Shuhaiber, Arash Salemi, O. Wayne Isom, Art Sedrakyan

The authors analyzed all patients greater than age 18 in the National Inpatient Sample from 1998-2011 to evaluate trends and outcomes of tissue vs. mechanical aortic valve replacements. Implantation of tissue valves increased overall from 38% to 64% when comparing the earlier era to the later one.  The patients undergoing tissue AVR had a greater presence of comorbidites and concomitant operations.  Whereas the complication rate was higher in the tissue valve population, the mortality rate was lower.  Interestingly, lower volume facilities tended to favor mechanical AVR and higher volume facilities tended to favor tissue AVR.

Source: Clinical Cardiology
Author(s): Grant W. Reed, Amit Kumar, Jianping Guo, Sary Aranki, Prem Shekar, Arvind Agnihotri, Andrew O. Maree, Dalton S. McLean, Kenneth Rosenfield and Christopher P. Cannon

Dr. Reed et al from the Cleveland Clinic conducted this prospective study to assess whether VerifyNow point-of-care platelet testing could predict bleeding in 39 patients receiving Plavix and undergoing CABG.  Patients in higher PRU quartiles experienced smaller decreases in hematocrit and less bleeding.  By ROC analysis, a PRU threshold of ≤207 was the optimal threshold for discrimination of major bleeding during surgery, with 85% sensitivity and an 89% NPV.

Question:  Should VerifyNow platelet testing be used as a discriminator for timing of CABG rather than waiting the guideline-recommended 5 days for patients who have received Plavix?

Source: MedPage Today
Author(s): John Gever

The Centers for Medicare and Medicaid Services (CMS) announced on February 5, 2015, that CT lung cancer screening will be a covered service.  This long awaited decision followed the preliminary announcement in November 2014.  After a period of comment, the coverage ages were expanded to include patients 55-77 years old.  The process mandates maintenance of a registry, smoking cessation counseling, and physician orders for each of the elements rather than patient self-referral.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Hiroo Takayama, Elissa Landes, Lauren Truby, Kevin Fujita, Ajay J. Kirtane, Linda Mongero, Melana Yuzefpolskaya, Paolo C. Colombo, Ulrich P. Jorde, Paul A. Kurlansky, Koji Takeda, Yoshifumi Naka

The Columbia University group performed this retrospective review of femoral VA ECMO at their institution from 2007-2013, and analyzed short-term outcomes based on the size of the arterial cannula.  They compared two groups of patients:  those undergoing femoral cannulation with a size 17F or larger cannula versus those undergoing cannulation with a 15F cannula. Despite higher flows in the larger cannula group, at 24 hours of support there were no differences in hemodynamic or laboratory parameters or in the use of vasoactive medications.  There was also no difference in 30-day survival.  Importantly, however, there was a significant reduction in bleeding complications in the group receiving the smaller arterial cannula.

 

Source: ASAIO Journal
Author(s): Gray, Brian W.; Haft, Jonathan W.; Hirsch, Jennifer C.; Annich, Gail M.; Hirschl, Ronald B.; Bartlett, Robert H.

Extracorporeal membrane oxygenation (EMCO) offers a therapeutic option for moribund patients of all ages with acute pumonary or cardiac failure.  The authors present a retrospective analysis of the largest single institution experience with ECMO support, and present their perspective on the evolving use of ECMO supported by four decades of clinical results.  The authors compare outcomes of the initial 1,000 patients versus most recent group of 1,000 patients receiving ECMO support, discuss the evolving indication for this therapy, and identify factors that have resulted in improved survival in specific patient populations.

Source: Journal of Cardiothoracic Surgery
Author(s): Halit Yerebakan, Robert A Sorabella, Marc Najjar, Estibaliz Castillero, Linda Mongero, James Beck, Maliha Hossain, Hiroo Takayama, Mathew R Williams, Yoshifumi Naka, Michael Argenziano, Emile Bacha, Craig R Smith and Isaac George*

In this recently published clinical study investigators from Columbia University, New York Presbyterian Hospital evaluated the safety of Del Nido cardioplegia in high-risk CABG surgery after AMI. The comparisons are made between commonly used wshole blood cardioplegia and the Del Nido solution.  The authors report no differences in transfusion rates, length of stay, need for pharmacologic or mechanical support post pump, or 30 day mortality between the two groups. However, the investigators do report shorter cross clamp, CPB and overall operative times due to the lack of interruption inherent to standard whole blood cardioplegia, which requires re-dosing.  The investigators discuss the biochemical and metabolic changes seen in AMI and further explain the potential advantages the Del Nido solution affords in stabilizing these derangements, which may lead to improved outcomes. 

Source: New England Journal of Medicine
Author(s): Stefan Verheye, E. Marc Jolicœur, Miles W. Behan, Thomas Pettersson, Paul Sainsbury, Jonathan Hill, Mathias Vrolix, Pierfrancesco Agostoni, Thomas Engstrom, Marino Labinaz, Ranil de Silva, Marc Schwartz, Nathalie Meyten, Neal G. Uren, Serge Doucet, Jean-François Tanguay, Steven Lindsay, Timothy D. Henry, Christopher J. White, Elazer R. Edelman, and Shmuel Banai

104 patients with class III or IV angina who were not candidates for revascularization were randomized to a sham procedure or to placement of a coronary sinus narrowing device.  35% of those in the device group improved their angina 2 classes, and 71% improved by 1 class, compared to 15% and 42% in the sham group.  Quality of life improved more in the treatment group.  Improvement in exercise capacity and in ventricular wall motion were similar between the groups.

Source: Annals of Oncology
Author(s): M.E. Caplin, E. Baudin, P. Ferolla, P. Filosso, M. Garcia-Yuste, E. Lim, K. Oberg, G. Pelosi, A. Perren, R. Elisa Rossi, W.D. Travis, the ENETS consensus conference participants

This consensus statement from the European Neuroendocrine Society is based on extensive bibliographic searches and systematic review.  Surgery is the mainstay of therapy for most tumors, and includes resection of metastases when this can be accomplished in a curative manner.  Somatostatin analogues are considered first line therapy for unresectable carcinoids, whereas systemic chemotherapy is most appropriate for progression of disease.

Source: Annals of Thoracic Surgery
Author(s): Evolution and Impact of Ventricular Assist Device Program on Children Awaiting Heart Transplantation

This single instutition study evaluated the impact of mechanical support in children awaiting heart transplant, comparing the pre-support era (1995-2005 and the post-support era (2005-2013); the latter era marked the transition to being able to provide support without concern for pt size.  Support increased from 13% to 37%.  Wait list mortality was decreased by more than 50%.   Median duration of support increased more than 6-fold, and the percentage of long-term devices nearly doubled to 98%.  Survival after transplant improved substantially but not significantly.

Source: Annals of Thoracic Surgery
Author(s): Francesco Nicolini, Giovanni Andrea Contini, Daniela Fortuna, Davide Pacini, Davide Gabbieri, Luigi Vignali, Gianluca Campo, Antonio Manari, Claudio Zussa, Paolo Guastaroba, Rossana De Palma, Tiziano Gherli

Propensity-score matched patients undergoing PCI or CABG in regional centers in Emilia-Romagna, Italy, 2002-2008 were evaluated for long-term outcomes. The PCI group had worse outcomes for MI, cardiac mortality, and the need for target vessel revascularization.  CABG was particularly superior in the elderly, those with prior MI, patients with CHF or renal insufficiency, those with peripheral vascular disease, and patients with triple-vessel disesase.

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