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Journal and News Scan

Source: Journal of the National Cancer Institute
Author(s): Daniel Ajona, María J. Pajares, Leticia Corrales, Jose L. Perez-Gracia, Jackeline Agorreta, Maria D. Lozano, Wenceslao Torre, Pierre P. Massion, Juan P. de-Torres, Eloisa Jantus-Lewintre, Carlos Camps, Javier J. Zulueta, Luis M. Montuenga and Ruben Pio

In this promising investigation, investigators found that C4d, a degradation product of complement activation, assessed in bronchoalveolar lavage and plasma, predicts the presence of lung cancer compared with non-cancer patients. They found a shorter survival in patients with high levels in the plasma.  Plasma C4d levels were reduced after surgical resections, which means C4d may be useful as a marker of recurrence after resection.

Source: Itunes store
Author(s): Vinayat Bapat

An instant guide to Valve in Valve procedures for clinicians

Quick, clear and concise information about heart valves and Valve in Valve therapy. A guide you wish you always had at your fingertips.

About

Valve in Valve app was developed as a collaboration between the technology company UBQO and Dr. Vinayak (Vinnie) Bapat, Consultant Cardiac Surgeon at St. Thomas' Hospital, London, UK.

Valve in Valve app provides information specific for a clinical scenario, quickly and simply. This will help in the planning of and performing a Valve in Valve case. The application navigates the user through important aspects of surgical and TAVI valve design, which are vital for a successful Valve in Valve procedure. The app logically steps through the possible combinations to give the user specific information needed to perform the procedure.

Success of a Valve in Valve procedure is based on correct identification of the surgical valve, choosing the correct size of the TAVI valve and its subsequent accurate placement. Surgical valves vary in appearance under fluoroscopy and also in their internal diameter. Similarly TAVI valves differ in their appearances and available sizes.

Knowledge about all the surgical valves that have been implanted in the last two decades is minimal but relevant to the Valve in Valve therapy. Users can now familiarise themselves with important design information about surgical and TAVI valves; they can also select the valve and find out which size of TAVI valve could be used and how it is best placed during a Valve in Valve procedure.

If the valve type is unknown, the App also guides the user through a series of steps where they can identify the surgical valve type and then use the information available for it.

The Valve In Valve app can be used to plan a case and confirm suitability for this procedure and reduces the need to trawl through vast amounts of literature to find information specific to the clinical scenario. The information is also available without the need for an internet connection and will enhance the users understanding of various aspects of this procedure. We hope this will result in improved results and better outcomes for patients.

Key features

- Design information for multiple types of surgical valve
- Sizing information for multiple types of surgical valve
- Real life and fluoroscopic images of all the surgical valves
- Design information about TAVI valve designs
- Sizing information for these TAVI valves
- Guides the user through a stepped process to help choose a specific valve, then the size and lastly the important dimensions to plan a Valve in Valve procedure
- Image based guidance for the ideal placement of a TAVI valve
- Video examples of actual placement of a TAVI valve
- Discusses important design considerations in detail to improve understanding of the Valve in Valve procedure

Source: JACC Heart Failure
Author(s): Peter Carson; John Wertheimer; Alan Miller; Christopher M. O'Connor; Ileana L. Pina; Craig Selzman; Carla Sueta; Lilin She; Deborah Greene; Kerry L. Lee; Robert H. Jones; Eric J. Velazquez

The STICH trial compares medical therapy to medical therapy + CABG for ischemic cardiomyopathy.  In this study of over 1,200 there were 462 deaths during a median f/u period of nearly 5 years.  CABG reduced the risk of sudden death and death due to pump failure; overall cardiovascular death was reduced by CABG but not significantly (p=0.09).  There was a substantial early increase in mortality in pts undergoing CABG; the protective effects of CABG were evident primarily after 2 years.

Source: JAMA Internal Medicine
Author(s): Thanh N. Huynh; Eric C. Kleerup; Joshua F. Wiley; Terrance D. Savitsky; Diana Guse; Bryan J. Garber; Neil S. Wenger

After developing a definition of futile care, intensivists were surveyed in 5 ICUs for a period of 3 months, during which 1136 pts were treated.  19% of patients were perceived as receiving futile or probably futile care.  Of those receiving what was perceived as futile care, the 6 month mortality rate was 85%, and the cost of treatment was $2.6 million. 

Source: Thorax
Author(s): Pierre-Olivier Bridevaux, J-D Aubert, P M Soccal, J Mazza-Stalder, C Berutto, T Rochat, L Turin, S Van Belle, L Nicod, P Meylan, G Wagner, Laurent Kaiser

This prospective study tracked viral infections and their outcomes in lung transplant patients 2008-2011 in a single institution.  Respiratory viruses were identified in 174 of 903 encounters, 34 via BAL.  Viral infection rates were 14% for non-emergency visits and 34% for emergency visits.  Most viral infections were associated with symptoms and with transient lung function loss.

Source: JAMA Surgery
Author(s): Faisal G. Bakaeen; Rosemary F. Kelly; Danny Chu; Michael E. Jessen; Herbert B. Ward; William L. Holman

This retrospective study from the US Veterans Affairs Surgical Quality Improvement Program evaluated the use of off-pump bypass over time for primary isolated CABG.  Peak use in 2003 was 24%, which then decreased and stabilized at 19%.  Conversion rates steadily declined to a stable rate of under 3.5%.  Mortality for on-pump and off-pump CABG has remained below 2% since 2006. 

Source: Liverpool Cardiothoracic Centre
Author(s): Paul Modi

See a professionally filmed documentary on Paul modi and his patient undergoing port access mitral valve surgery.

Ken Williams came to him as he could manage only 12 holes prior to surgery because he got SOB.

He managed 18 holes when he caddied at 2 weeks post op.

Might be a very good resource for patients thinking about this operation

Source: Clinical Therapeutics,
Author(s): Kang S et al.

Effects of aggressive statin therapy on patients with coronary saphenous vein bypass grafts: a systematic review and meta-analysis of randomized, controlled trials – The aim of this study was to investigate the effectiveness and safety of aggressive statin versus moderate statin therapy on patients with saphenous vein grafts (SVGs) in randomized, controlled trials (RCTs). Compared with moderate statin therapy, long–term aggressive statin lowered the LDL–C level significantly, further decreased the atherosclerotic progression of SVG, reduced the risks of repeated myocardial infarction and coronary revascularization after CABG, and revealed similar patient compliance and statin–related adverse effects but slightly increased myopathy events and aminotransferase levels. Methods The authors searched MEDLINE (1980–June 2012), the Cochrane Controlled Trials Register, EMBASE, Science Citation Index, and PubMed (to June 2012), and found 10 relevant RCTs, including 7 substudy analyses from a Post-CABG trial, and 1 pooled analysis of the PROVE-IT TIMI 22 trial (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 Investigators) and A to Z trial. Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes; phase Z of the A to Z trial. Results A total of 6645 of participants, ages ranging from 21 to 75 years old, were treated with coronary artery bypass graft (CABG) and were followed for 2 to 5 years. Eight studies showed that aggressive statin therapy had lower LDL-C levels and a decrease of 39% in graft atherosclerotic progression, 12% in new occlusions, and 19% in new lesions more than moderate statin therapy. Three reports indicated that aggressive statin therapy lowered the risk of repeated myocardial infarction more than moderate statin therapy for coronary revascularization (95% CI, 0.66–0.95; risk ratio [RR] = 0.80; and 95% CI, 0.66–0.85; RR = 0.75) and lowered the risk of cardiac death as well (95% CI, 0.64–1.08; RR = 0.83). Aggressive statin therapy had safety similar to that of moderate statin therapy except for a slight increase in myopathic events and aminotransferase levels. Seventy percent to 90% of patients took statin treatment as prescribed in long-term.

Source: British Medical Journal
Author(s): Hans Van Brabandt,

Catheter ablation is an increasingly used treatment for atrial fibrillation but Hans Van Brabandt, Mattias Neyt, and Carl Devos argue that enthusiasm for the procedure is not justified by the evidence on efficacy and cost effectiveness and its use should be strictly limited

Source: European Heart Journal
Author(s): Petr Budera

Budera P et al. – Surgical ablation improves the likelihood of SR presence post–operatively without increasing peri–operative complications. However, the higher prevalence of sinus rhythm (SR) did not translate to improved clinical outcomes at 1 year.

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