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Journal and News Scan

Source: Annals of Thoracic Surgery
Author(s): Meyeon Park, Michael G. Shlipak, Heather Thiessen-Philbrook, Amit X. Garg, Jay L. Koyner, Steven G. Coca, Chirag R. Parikh, for the Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury (TRIBE-AKI) Consortium
The association of acute kidney injury (AKI) with adverse outcomes after cardiac surgery is well known.  This study compared the association of AKI and the elevation of cystatin C, another filtration marker, with long-term survival after cardiac surgery.  30% of patients experienced an abnormal increase in creatinine postop compared to 15% who had an abnormal rise in cystatin C.  A rise in  cystatin C was better predictive of decreased long-term survival than was creatinine.
Source: Annals of Thoracic Surgery
Author(s): Ben M. Swinkels, Bas A. de Mol, Johannes C. Kelder, Freddy E. Vermeulen, Jurriën M. ten Berg
The authors used a single institution data base to assess very long-term outcomes after AVR to determine the effects of prosthesis-patient mismatch.  Among 673 pts, 24% had mismatch.  Mean follow-up was nearly 18 years.  On multivariable analysis, mismatch was not a significant determinant of long-term survival.
Source: Annals of Thoracic Surgery
Author(s): Jonathan D. Spicer, Brendon M. Stiles, Monisha Sudarshan, Arlene M. Correa, Lorenzo E. Ferri, Nasser K. Altorki, Wayne L. Hofstetter
Whether adding radiotherapy to induction chemotherapy prior to esophagectomy adds a survival benefit is uncertain.  The authors assessed outcomes of 214 patients with T3N1M0 adenocarcinoma among three institutions who underwent induction therapy followed by esophagectomy.   114 patients had chemotherapy and 100 patients had chemoradiotherapy.  90-day mortality did not differ between the groups (5.3% vs 4.0%), and median survival between the groups was similar (31.2 vs 39.2 months).  The role of radiotherapy as part of induction therapy for management of adenocarcinoma of the esophagus requires further exploration.
Source: Scientific Reports
Author(s): Lin LY, Liao CW, Wang CH, Chi NH, Yu HY, Chou NK, Hwang JJ, Lin JL, Chiang FT, Chen YS.
ECMO is widely used for cardiogenic shock treatment.  Since peripheral V-A ECMO will increase LV afterload and IABP therapy can counterbalance it, will IABP combined with ECMO improve the outcomes? A total of 529 patients (227 ECMO alone and 302 combined IABP plus ECMO) were included.  Compared with ECMO alone, combined IABP and ECMO treatment did not improve outcomes.  Limitation: this is an observational cohort study, large scale randomized controlled standardized trial is needed.
Source: The American Journal of Cardiology
Author(s): Liao YB, Meng Y, Zhao ZG, Zuo ZL, Li YJ, Xiong TY, Cao JY, Xu YN, Feng Y, Chen M.
In this manuscript the authors report on their findings in a systematic review and meta-analysis of 18 studies looking into the effect on outcomes of balloon predilatation in patients undergoing transcatheter aortic valve implantation (TAVI). Patients in whom balloon predilatation was performed were more likely to require permanent pacemaker implantation, to have grade 2 or more aortic regurgitation, to suffer stroke, and had a higher 30-day mortality than those patients in whom balloon predilatation was not carried out. Interestingly, the subgroup analysis revealed that patients receiving the Medtronic CoreValve prosthesis appear to benefit more from the no predilatation strategy than those receiving an Edwards Sapien prosthesis.
Source: New England Journal of Medicine
Author(s): Moat NE
Neil Moat, one of the busiest British surgeons involved directly and consistently in TAVR, discusses PARTNER 2 and SURTAVI, paying particular attention to the health economics of low-risk TAVR and the implication of reduced profile devices.
Source: N Engl J Med
Author(s): Martin B. Leon, Craig R. Smith, Michael J. Mack, Raj R. Makkar, Lars G. Svensson, Susheel K. Kodali, Vinod H. Thourani, E. Murat Tuzcu, D. Craig Miller, Howard C. Herrmann, Darshan Doshi, David J. Cohen, Augusto D. Pichard, Samir Kapadia, Todd Dewey, Vasilis Babaliaros, Wilson Y. Szeto, Mathew R. Williams, Dean Kereiakes, Alan Zajarias, Kevin L. Greason, Brian K. Whisenant, Robert W. Hodson, Jeffrey W. Moses, Alfredo Trento, David L. Brown, William F. Fearon, Philippe Pibarot, Rebecca T. Hahn, Wael A. Jaber, William N. Anderson, Maria C. Alu, and John G. Webb, for the PARTNER 2 Investigators
The PARTNER 2A trial randomized 2032 patients at intermediate operative risk (mean STS score of 6) to undergo either transcatheter or surgical aortic valve replacement. The primary endpoint of all-cause death or disabling stroke at 2 years was comparable for the two treatments: TAVR 19.3% versus SAVR 21.1%. A subgroup analysis of patients eligible for transfemoral aortic valve replacement even suggested superior outcomes for TAVR as compared to surgery (HR 0.79, 95% CI 0.62-1.00, P=0.05).
Source: J Thorac Cardiovasc Surg
Author(s): Rosenblum JM, Harskamp RE, Hoedemaker N, Walker P, Liberman HA, de Winter RJ, Vassiliades TA, Puskas JD, Halkos ME
In a propensity-matched analysis, Rosenblum and colleagues found that hybrid revascularization as compared with coronary artery bypass grafting with either single or bilateral internal mammary artery grafts was superior in terms of secondary short-term outcomes (e.g. renal failure, prolonged mechanical ventilation, blood transfusions) and postoperative length-of-stay. After a median of 2.8 years of follow-up, there were no differences in all-cause mortality between any of the groups. It should be noted that groups were small (n=306 each) and that randomized data is imperative before the more widespread adoption of hybrid revascularization. 
Source: Journal of Thoracic Oncology
Author(s): Burke A, Tavora F
The fourth (re- )classification of cardiopericardial tumours came from the World Health Organisation last year, 11 years after the third. In particular, the malignant fibrous histiocytomas are re classified as undifferentiated pleomorphic sarcomas.  
Source: Circulation Research
Author(s): Samantha A, Buddhadeb D
A commentary and follow-up comment on last year's ERICCA and RIPHeart- related publications in the NEJM. The Kansas colleagues re iterate the negative findings on the utility of ischemic preconditioning in these two European RCT's performed in 'everyday polymorbid' patients. They also lament the trials and tribulations of translational research using ischemic preconditioning as an example.