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Journal and News Scan

Source: NY Daily news
Author(s): David Boroff

We are in the wrong specialty !! 

Source: American Journal of Cardiology
Author(s): Ersboll M, Schulte PJ, Al Enezi F, Shaw L, Køber L, Kisslo J, Siddiqui I, Piccini J, Glower D, Harrison JK, Bashore T, Risum N, Jollis JG, Velazquez EJ, Samad Z.

In this manuscript, the authors report on a retrospective study looking at the progression of aortic stenosis (AS) in 1558 patients with mild, moderate and severe AS and preserved left ventricular function. They conclude that the progression of severity depends significantly on the severity of the AS at baseline. Although the average rate of progression in AS mean gradient is slower than previously reported, a significant proportion of patients were observed to progress to higher grades of severity or AVR within the recommended time frames for echocardiographic follow-up. In this model, few clinical variables were associated with significantly accelerated progression: in patients with mild AS only age and gender and in patients with moderate AS renal disease and hyperlipidemia beyond age and gender.

Source: Annals of Thoracic Surgery
Author(s): Matthew A. Schechter, Chetan B. Patel, Laura J. Blue, Ian Welsby, Joseph G. Rogers, Jacob N. Schroder, Carmelo A. Milano

In this Duke study, all CF LVAD implantations during the 2005 to 2013 era were analyzed, and those patients who underwent CF LVAD implantation and later replacement were reviewed.  Two groups of patients were compared:  those undergoing VAD replacement via a resternotomy approach (n=20) and those undergoing VAD replacement via a nonsternotomy approach (n=22).  After VAD replacement, the latter group exhibited improved survival and reduced morbidity as compared to the former.  Hence, it may be preferable to replace LVADs via a nonsternotomy approach if concomitant cardiac conditions do not need to be addressed.

Source: Annals of Thoracic Surgery
Author(s): Steinar Lundemoen, Venny Lise Kvalheim, Øyvind Sverre Svendsen, Arve Mongstad, Knut Sverre Andersen, Ketil Grong, Paul Husby

Provocative study that analyzes lower body perfusion in a porcine model during cardiopulmonary bypass with an actuated IABP in place to effect pulsatile perfusion.  Parameters of distal perfusion including measurement of pressures and microsphere perfusion indicate that flow distal to the balloon pump may be impaired. 

Author(s): Anand Gaikwad, Carolina A. Souza, Joao R. Inacio, Ashish Gupta, Harmanjatinder S. Sekhon, Jean M. Seely, Carole Dennie, Marcio M. Gomes

This interesting article summarizes the evidence from clinical, radiologic and pathologic investigations that lung cancer, specifically adenocarcinoma, may metastasize through the airways, defined as discontinuous spread of cancer cells from the primary tumor through the airways to adjacent or distant lung parenchyma. The presence of persistent or growing centrilobular nodules on CT images may be considered suspicious for aerogenous spread in patients with primary lung adenocarcinoma. This form of intrapulmonary metastasis would have significant implications in treatment and adds new opportunities in lung cancer research.

Source: American Journal of Cardiology
Author(s): Panchal HB, Ladia V, Amin P, Patel P, Veeranki SP, Albalbissi K, Paul T.

This manuscript reports on the findings of a meta-analysis of retrospective observational studies comparing clinical outcomes at 1-year in patients treated by either transfemoral (TF) or transapical (TA) transcatheter aortic valve implantation for sever aortic stenosis. Major vascular complications were more common in the TF group and 30-day hospital mortality was higher in the TA group. There were no significant differences at 1-year in all-cause mortality, incidence of myocardial infarction or incidence of stroke.

Source: Journal of the American College of Cardiology
Author(s): Mylotte D, Lefevre T, Søndergaard L, Watanabe Y, Modine T, Dvir D, Bosmans J, Tchetche D, Kornowski R, Sinning JM, Thériault-Lauzier P, O'Sullivan CJ, Barbanti M, Debry N, Buithieu J, Codner P, Dorfmeister M, Martucci G, Nickenig G, Wenaweser P, Tamburino C, Grube E, Webb JG, Windecker S, Lange R, Piazza N.

In this retrospective, multicentre study, the authors evaluate clinical outcomes in 139 patients with bicuspid aortic valves undergoing transcatheter aortic valve implantation (TAVI) with either a self or a balloon-expandable prosthesis. Short and intermediate clinical outcomes were encouraging, demonstrating the feasibility of TAVI in this group of patients. The mean finding was a high prevalence (28.4%) of post procedural more than  grade II aortic regurgitation (AR). Nevertheless, when the measures for sizing had been obtained with multislice computed tomography, more than grade II AR was detected in 17.4% of the patients. No significant differences were found between self and balloon-expandable prosthesis.

Source: New England Journal of Medicine
Author(s): Smith PK, Puskas JD, Ascheim DD, Voisine P, Gelijns AC, Moskowitz AJ, Hung JW, Parides MK, Ailawadi G, Perrault LP, Acker MA, Argenziano M, Thourani V, Gammie JS, Miller MA, Pagé P, Overbey JR, Bagiella E, Dagenais F, Blackstone EH, Kron IL, Goldstein DJ, Rose EA, Moquete EG, Jeffries N, Gardner TJ, O'Gara PT, Alexander JH, Michler RE; Cardiothoracic Surgical Trials Network Investigators.

In this prospective randomized study from the Cardiothoracic Trials Network Investigators, the authors compare the results between CABG alone and CABG plus mitral valve repair in 301 patients with ischemic moderate mitral insufficiency and coronary artery disease. In these patients, the addition of mitral valve repair with a rigid or semirigid complete annuloplasty ring to CABG, was not associated with greater improvement in the left ventricular end-systolic volume index (primary endpoint) at 1 year. There were also no significant differences between the groups in mortality, the composite end point of cardiac or cerebrovascular events, readmissions, or quality of life. There were more neurological events in the CABG plus repair group. The authors conclude that, at one-year follow up, there is no meaningful advantage in adding mitral valve annuloplasty in patients with moderate ischemic mitral insufficiency undergoing CABG.

Source: MedPage Today
Author(s): Ed Susman

A hot topic at the recent meeting of the RSNA (Radiological Society of North America) was the implementation of LungRADS, a scoring system for categorizing lesions on CT, to be utilitized as part of CT screening for lung cancer.  Scans are assigned to one of 5 categories, ranging from incomplete to 4A (suspicious, follow-up or further testing warranted) and 4B (highly suspicious, further evaluation warranted). 

Source: Annals of Thoracic Surgery
Author(s): Syed M. Peer, John P. Costello, Joshua C. Klein, Alyson M. Engle, David Zurakowski, John T. Berger, Richard A. Jonas, Dilip S. Nath

This single institution study evaluated the effects of 24-hr in hospital congenital cardiac surgery coverage on outcomes for perioperative congenital heart surgery ECMO.  Institution of 24-hr coverage reduced hospital mortality from 68% to 43% as well as rates of cardiac arrhythmias and pneumonia.  24-hr coverage was independently associated with a reduced risk of mortality.