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Journal and News Scan

Source: JAMA
Author(s): Joseph B. Muhlestein; Donald L. Lappé; Joao A. C. Lima; Boaz D. Rosen; Heidi T. May; Stacey Knight; David A. Bluemke; Steven R. Towner; Viet Le; Tami L. Bair; Andrea L. Vavere; Jeffrey L. Anderson

This trial randomized 900 pts with type 1 or 2 diabetes to screening with coronary computed tomography angiography (CCTA) or standard care and evaluated death and non-fatal coronary outcomes.  The major outcome was a composite of death, MI, and admission for management of unstable angina.  The secondary outcome was a composite of CAD-associated death, MI, or unstable angina.  CCTA screening did not influence the rate of major or secondary outcomes.

Source: American Journal of Cardiology
Author(s): Amat-Santos IJ, Dahou A, Webb J, Dvir D, Dumesnil JG, Allende R, Ribeiro HB, Urena M, Paradis JM, DeLarochellière R, Dumont E, Bergeron S, Thompson CR, Pasian S, Bilodeau S, Leipsic J, Larose E, Pibarot P, Rodés-Cabau J.

This is a matched case controlled study of 27 consecutive patients with severe symptomatic aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) with the SAPIEN 3 (SV3)device in 2 centers. These patients were matched with patients who had undergone TAVI with the 26-mm SAPIEN XT (SXTV) who were drawn from a prospective database of 270 consecutive patients.

The rate of balloon postdilation after valve implantation was higher in the SXTV group compared with the S3V group (p = 0.047). In the S3V group, only 2 patients (7%) had a paravalvular leak graded as mild or greater, compared with 42% of the patients in the SXTV group (p = 0.002). In the univariate analysis, the implantation of the S3V was the only factor associated with no/trace paravalvular leaks after TAVI.

Source: Circulation
Author(s): Vinet E, Pineau CA, Scott S, Clarke AE, Platt RW, Bernatsky S

The authors aimed to study whether systemic lupus erythematosus (SLE) resulted in an increased risk of congenital heart defects (CHD). Mothers with SLE were selected from a large Quebec healthcare database and matched to mothers without SLE. Children born to mothers with SLE were more likely to experience CHD (5.2% versus 1.9%). The odds ratio in a multivariable model was 2.62 (95% CI, 1.77-3.88). Moreover, children born to mothers with SLE also had an increased risk of a CHD repair procedure. 

Source: Annals of Surgery
Author(s): Kutup, Asad; Nentwich, Michael F.; Bollschweiler, Elfriede; Bogoevski, Dean; Izbicki, Jakob R.; Hölscher, Arnulf H.

This retrospective study evaluated results of transthoracic (TTE) vs transhiatal (THE) esophagectomy in patients with squamous cell cancer and adenocarcinoma from two high volume centers. Prospensity score matching was used.  TTE yielded a higher R0 resection rate and higher numbers of nodes dissection.  TTE was associated with improved survival for T3 tumors and for patients with node-positive disease.

Source: Annals of Surgery
Author(s): Bouras, George; Marie Burns, Elaine; Howell, Ann-Marie; Mark Bagnall, Nigel; Lee, Henry; Athanasiou, Thanos; Darzi, Ara

This article systematically reviewed the impact of surgical adverse events (SAEs) on quality of life after major GI surgery.  The mean difference in QOL between pts with and without SAEs was highest for esophagectomy (0.14; scale 0 to 1), while results for antireflux surgery were mixed. 

Source: Annals of Thoracic Surgery
Author(s): Craig H. Selzman, Jesse L. Madden, Aaron H. Healy, Stephen H. McKellar, Antigone Koliopoulou, Josef Stehlik, Stavros G. Drakos

Selzman and colleagues provide an outstanding overview of the state of the art of bridge to recovery, describing a paradigm shift that has been occurring.  A consistent theme over the years is that recovery likelihood is enhanced in younger patients, those with non-ischemic cardiomyopathy, and those who have had HF for shorter durations.  Although the INTERMACS database reflects that only about 1% of patients are successfully bridged to recovery, several studies have demonstrated that more patients may be recovered if a proactive approach is undertaken.  Such an approach necessarily includes the early identification of potential candidates for removal, the modification of the surgical approach to facilitate later device removal, an active surveillance program, the institution of intensive adjuvant medical therapy, the adoption of standardized weaning protocols, and further exploration of less invasive techniques for removal.  The authors effectively argue that only with a wholesale expansion of such a paradigm shift will more patients be successfully weaned.  The devil--of course--lays in the details. The ongoing RESTAGE-HF trial will hopefully elucidate some of these details.

 

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Diyar Saeed, Bujar Maxhera, Hiroyuki Kamiya, Artur Lichtenberg, Alexander Albert

The authors describe an alternative technique for insertion of a temporary RVAD so as to allow minimally invasive removal  without sternotomy after RV recovery.  An elongated graft is sewn to the PA and exited in the subxyphoid area at a site that is separate from the sternotomy incision.  After exiting, the graft is attached to an outflow cannula.  Inflow from the RA is accessed via a long cannula inserted percutaneously in the femoral vein.  At the time of RVAD removal, the graft is exposed in the subxyphoid space, where it is transected, ligated, and returned to the chest.  The femoral cannula is removed from the groin and pressue held at its entry site until hemostasis is achieved.

Innovative ways of allowing removal of a temporary RVAD without the need for sternotomy are of great value.  Surgeons should have these tools in their armamentarium.  Importantly, there are percutaneous RVADs on the horizon that may ultimately allow RVAD removal without necessarily a return trip to the OR.  Innovation and technology are playing a central role in rendering MCS surgery less invasive and therefore safer.

Source: Circulation
Author(s): Cuypers JA, Menting ME, Konings EE , Opić P, Utens EM, Helbing WA, Witsenburg M, van den Bosch AE, Ouhlous M, van Domburg RT, Rizopoulos D, Meijboom FJ, Boersma E, Bogers AJ, Roos-Hesselink JW

The authors of this article aimed to describe survival and clinical outcomes beyond 30 years of follow-up after surgical repair of Tetralogy of Fallot. They found a survival of 72% after 40 years. Health status was comparable to the Dutch population. Factors that were associated with late mortality included: a prior shunt operation, low temperature during surgery and early postoperative arrhythmias. They conclude that although many patients needed reoperation or developed arrhythmias, long-term survival was good, as was health status.

Source: BioMed Central Cancer
Author(s): Emily A Vucic, Kelsie L Thu, Larissa A Pikor, Katey SS Enfield, John Yee, John C English, Calum E MacAulay, Stephen Lam, Igor Jurisica and Wan L Lam

This study was conducted in 94 lung adenocarcinoma patients matching pairs from current, former and never smokers' lung adenocarcinoma and non-malignant lung parenchymal tissue.   Investigators discovered different smoking-specific microRNA differences. These findings may explain distinct tumorigenic processes influenced by different smoking and non-smoking expositions.

Source: Centers for Medicare & Medicaid Services
Author(s): CMS

CMS determined that the evidence of benefit for CT screening for lung cancer is sufficient to permit this as an annual benefit for Medicare and Medicaid recipients in the US.  The availability of such coverage will be limited, however, by the need to have the screening as part of a comprehensive counseling (smoking cessation, etc) visit with qualified physicians or non-physician practitioners.  Radiologists and imaging centers must meet specific criteria, and activity must be submitted to a registry.

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