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Journal and News Scan
Proposed definitions for the 8th edition of the AJCC Cancer Staging Manual are presented.
This randomized trial evaluated the efficacy of postoperative metoprolol or losartan in preventing atrial fibrillation in patients with elevated N-terminal pro-brain natriuretic peptide who were undergoing lung resection for cancer. Among candidates, 29% (320) of patients had elevated NT-proBNP and were randomized. Both metoprolol and losartan reduced afib incidence compared to controls (6%, 12%, 40%).
The impact of radial artery vs saphenous vein in patients undergoing bilateral IMA grafting was evaluated in 275 and 489 pts, respectively, using propensity score matching. Operative mortality and survival at 5, 10, and 15 years were similar. There was no influence of patient age, R vs L coronary system grafting, diabetes, or ventricular dysfunction on outcomes comparing the two groups. Commentary: http://www.jtcvsonline.org/article/S0022-5223(16)30296-3/fulltext
This single institution study evaluated the accuracy of intraoperative TEE to identify residual intramural ventricular septal defects after repair of conotruncal defects. Intramural VSDs occurred in 10% of 337 pts; postoperative TTE identified all, intraoperative TEE identified 19. Of abnormalities requiring catheterization or reoperation, 6 of 7 were identified by TEE. Intraoperative TEE has most value in identfying defects that require reintervention. Commentary: http://www.jtcvsonline.org/article/S0022-5223(16)30272-0/fulltext
Physiologic effects of pulmonary endarterectomy (PEA) for chronic thromboembolic disease (CTED) were studied 1 year postop. PEA resulted in improved RV stroke volume response, heart rate response, and ventilatory efficiency related to exercise. Commentary: http://www.jtcvsonline.org/article/S0022-5223(16)30661-4/abstract
Data from two institutions were evaluated for the period 2002-2014 including 436 patients affected by endocarditis, of whom 18% were current intravenous drug users (IVDUs). IVDUs had a lower risk of operative mortality but had an increased rate of valve-related complications, mostly related to higher rates of reinfection. Commentary: http://www.jtcvsonline.org/article/S0022-5223(16)30322-1/fulltext and http://www.jtcvsonline.org/article/S0022-5223(16)30488-3/fulltext
July 25, 2016
Submitted by: J. Rafael Sadaba
The authors describe their findings in a multicenter retrospective review of clinical outcomes in 64 patients with severe mitral annular calcification considered poor candidates for traditional surgical mitral valve replacement, undergoing transcatheter mitral valve implantation with a balloon expandable prosthesis. There were procedural complications in 13 patients (20%): LVOT obstruction in 6, embolization in 4 and perforation in 3 cases. Periprocedural death occurred in 19 patients (29.7%). Most survivors reported significant improvement of symptoms. At 30 days, 21 of the 25 patients (84%) with 30-day clinical follow-up data were in NYHA functional class I or II. The authors concluded that transcatheter mitral valve implantation with balloon-expandable valves designed for aortic position is feasible in this extremely high-risk patient population. Technical success was achieved in most patients. Although there were important complications and a high 30-day mortality, these results are encouraging considering this represents the first human experience with a transcatheter heart valve not designed for the mitral position and used in an extremely high-risk patient population.
July 24, 2016
Submitted by: Joseph Basha
The authors, using 2 groups of patients, 32 ECMO and 53 non-ECMO, both with a diagnosis of ARDS, describe the two groups' severity of illness, medication regimen and use or nonuse of ECMO therapy. Utilizing adjusted multivariate linear regression model the authors conclude that only the APACHE II score was independently associated with the development of severe thrombocytopenia, but that ECMO use was not.
July 20, 2016
Submitted by: CTSNet Staff
Currently, there are few specific risk models available to predict mortality following congenital heart surgery in adults or to stratify operations on adult patients with congenital heart disease by relative risk of mortality. The study by Hӧrer and Kasnar-Samprec et al evaluates the predictive power of the common pediatric scores when applied to adult patients undergoing surgery for congenital heart disease. In addition, a new ‘grown-ups with congenital heart disease’ (GUCH) score, specifically intended for adults undergoing congenital heart surgery, is described and evaluated. View the invited commentary from Stephanie Fuller and Jeffrey P. Jacobs here.
July 18, 2016
Submitted by: Aristotle Protopapas
A handy mini-textbook on ECMO