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Journal and News Scan

Source: Annals of Thoracic Surgery
Author(s): Terry Shih, Justin B. Dimick
Quality metrics based on administrative databases are sometimes unreliable. This study examined data from nearly 245,000 Medicare patients undergoing CABG to determine the reliability of 30-day readmission rates and whether that metric is an appropriate indicator of hospital quality. The median readmission rate was 17.6%, but less than half lf the rate was attributed to the true signal, the rest being measurement noise. Less than 5% of hospitals had sufficient CABG volume to achieve reliable measurement of readmission rates.
Source: JAMA
Author(s): JM Rohde, DE Dimcheff, N Blumberg, S Saint, KM Langa, L Kuhn, A Hickner, MAM Rogers.

This meta-analysis of 18 randomized trials investigated the risk of infection related to blood transfusions given according to liberal or restrictive criteria. The restrictive strategy (Hgb <7) was associated with an 18% reduction in the risk of serious infection (11.8% vs 16.9%). The effects were most pronounced in patients with sepsis and in those undergoing orthopedic surgery. No difference was evident among patients with heart disease, critical illness, or GI bleeding.
 

Source: The Annals of Thoracic Surgery
Author(s): Richard A. Hopkins, Gary K. Lofland, Jennifer Marshall, Diana Connelly,Gayathri Acharya, Pamela Dennis, Richard Stroup, Chris McFall, James E. O'Brien

In this observational study, the utility of decellularized allogeneic pulmonary artery patches for pulmonary arterioplasty was evaluated in 108 patients. No device failures or adverse events were detected. An historical comparison cohort in whom conventional materials were used experienced a 14% failure rate.

Source: New England Journal of Medicine
Author(s): DH Adams and others for the US CoreValve Clinical Investigators
Transcatheter AVR (TAVR) was compared to surgical AVR for treatment of aortic stenosis in 795 high risk patients. TAVR was associated with a decreased risk of death at 1 year (14% vs 19%; p<0.04). This was likely due to a reduction in the risk of adverse cardiovascular and cerebrovascular events.
Source: New England Journal of Medicine
Author(s): PJ Devereaux and other for the POISE-2 Investigators
This randomized trial including more than 10,000 patients undergoing noncardiac surgery evaluated the use of perioperative aspirin in patients at increased risk for vascular complications. The end points were death or MI. The end points occurred in equal numbers (7%) in both groups. Bleeding complications were more common in the aspirin group (4.6% vs 3.8%).
Source: Journal of the American College of Cardiology
Author(s): Duk-Hyun Kang; Sung-Ji Park; Byung Joo Sun; Eun Jeong Cho; Dae-Hee Kim; Sung-Cheol Yun; Jong-Min Song; Seung Woo Park; Cheol-Hyun Chung; Jae-Kwan Song; Jae-Won Lee; Pyo-Won Park
The authors of this article sought to compare long-term outcome with early surgery with a conventional treatment strategy in patients with asymptomatic severe mitral regurgitation. In a propensity matched analysis of 207 pairs, they found that early surgery was associated with a lower risk of mortality (p=0.033) and cardiac events (p=0.002) than conventional treatment. In additional Cox proportional hazard analyses, the benefit of early early surgery seemed to be restricted to patients >50 years old.
Source: JAMA
Author(s): Mohamed Abdel-Wahab; Julinda Mehilli; Christian Frerker; Franz-Josef Neumann; Thomas Kurz; Ralph Tölg; Dirk Zachow; Elena Guerra; Steffen Massberg; Ulrich Schäfer; Mohamed El-Mawardy; Gert Richardt; for the CHOICE investigators
Randomized trial in high risk patients (n=121) with severe aortic stenosis comparing a balloon-expandable valve (Edwards Sapien XT) versus a self-expandable valve (Medtronic CoreValve). Higher device success and lower PPM implantation was appreciated in the ballon-expandable group.
Source: JAMA
Author(s): Mohamed Abdel-Wahab; Julinda Mehilli; Christian Frerker; Franz-Josef Neumann; Thomas Kurz; Ralph Tölg; Dirk Zachow; Elena Guerra; Steffen Massberg; Ulrich Schäfer; Mohamed El-Mawardy; Gert Richardt; for the CHOICE investigators
Randomized trial in high risk patients (n=121) with severe aortic stenosis comparing a balloon-expandable valve (Edwards Sapien XT) versus a self-expandable valve (Medtronic CoreValve). Higher device success and lower PPM implantation was appreciated in the ballon-expandable group.
Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Curt Tribble and Walter H. Merrill
Recognized educational leaders Dr. Curt Tribble and Dr. Walter Merrill describe how to effectively use language during teaching, specifically the language of science, performance, and memory.
Source: Circulation
Author(s): Gregory J. Dehmer; James C. Blankenship; Mehmet Cilingiroglu; James G. Dwyer; Dmitriy N. Feldman; Timothy J. Gardner; Cindy L. Grines; and Mandeep Singh
Consensus guidelines on performing PCI without on-site surgery backup. The document outlines best practices and requirements for centers performing PCI without on-site surgery and evaluates the role of PCI without on-site surgery within the context of the US healthcare system.

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