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Journal and News Scan
The study aims to compare outcomes between minimally invasive coronary artery bypass (MINI–CAB) and drug–eluting stent (DES) implantation for isolated left anterior descending (LAD) disease. Given the available evidence, MINI–CAB results in lower TVR rates, but otherwise similar clinical outcomes when compared with DES in patients with LAD disease.
- Randomized and observational comparative publications were identified using Medline and Google Scholar databases (January 2003 until December 2013).
- Studies without outcome data, without DES use, or utilizing conventional bypass surgery, were excluded.
- Outcomes of interest were cardiac death, myocardial infarction (MMI), target vessel revascularization (TVR) and peri-procedural stroke.
- Data were compared using the Mantel Haenszel methods, and presented as odds ratio (OR) with 95% confidence interval, and number needed to treat (NNT).
- From 230 publications, the authors identified 4 studies (2 randomized and 2 observational) that included a total of 941 patients (478 underwent MINI-CAB, and 463 received DES).
- The incidence of TVR at maximum follow-up (6-60 months) was significantly lower in the MINI-CAB group (OR:0.16 [0.08-0.30], p<0.0001, NNT=13).
- Cardiac mortality and MI were similar between MINICAB and DES at follow-up (OR:1.05 [0.44-2.47] and OR:0.83 [0.43-1.58], respectively). In addition, similar peri-procedural death (OR: 0.85 [0.21-3.47], p=0.82), MI (OR: 0.98 [0.38-2.58], p=0.97) and stroke (OR: 1.36 [0.28-6.70], p=0.70) were observed between the two treatment modalities.
Bioprinting, the production of tissue by 3D printing, is a rapidly emerging technology with high potential for tissue engineering also in cardiac surgery. The paper provides insight in currently available techniques, opportunities for application and perspectives of this revolution in medicine.
The European system for cardiac operative risk evaluation II (EuroSCORE II) and the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) were validated for overall in-hospital mortality in an US cardiac surgery database comprising >50.000 patients. More reliable results were achieved with the STS-PROM. However, also the EuroSCORE II was found to be reliable in low-risk patients. The authors advert to the risk of overtreatment in these patients referring to the use of (investigational) transcatheter aortic valve implantation and advocate decision making by multidisciplinary heart teams.
2151 cases of surgery for thymomas were analyzed based on a retrospective EACTS database. Recurrence rate and survival were negatively associated with Masaoka stages III–IV, incomplete resection and non-thymoma histology, whereas adjuvant therapy after complete resection correlated to improved survival.
In this manuscript, the authors describe their experience with the treatment of 8 high risk patients with pure, severe aortic valve regurgitation, using the self-expandable Acurate TA prosthesis through a transapical approach. All procedures were carried out successfully with no 30-day mortality or stroke. None of the patients had more that grade I residual aortic regurgitation and none of them required permanent pacemaker implantation.
Bakaeen and colleagues have retrospectively reviewed the use of off-pump surgery among 2137841 primary isolated CABG operations in the Society of Thoracic Surgeons Database. They showed that off-pump procedures peaked in 2002 with 23% of CABG operations, after which it declined to 17% in 2012. In 2012, 34% of surgeons performed no off-pump operations and 86% of surgeons performed <20 off-pump operations per year. These data are important to establish the most appropriate infrastructure and resources related to off-pump CABG operations.
In a two-part review, Bax and many other authorities on transcatheter aortic valve implantation (TAVI) provide an extensive overview of the open issues related to patient selection, treatment strategy, and procedural aspects that will help further improve outcomes after TAVI.
In this multi-institution randomized trial, patients with heart failure underwent daily telemonitoring and standard care or just standard care. At 1 year, fewer patients in the telemonitoring group had worsened composite score (19% vs 27%) and experienced fewer deaths (10 vs 27 pts).
This retrospective study involving 7 institutions evaluated the utility of PET for mediastinal staging in patients who had undergone resection of pulmlonary carcinoid tumors and nodal dissection. 88% of pts had typical carcinoid tumors. The sensitivity of PET was only 33%, whereas the specificity was 94%.
This double-blind placebo-controlled trial involved 153 pts undergoing elective endovascular aortic aneurysm repair, of whom half received methylprednisolone preoperatively. The intervention reduced the systemic inflammatory response from 92% to 27%, plasma IL-6 was decreased by 90%, and CRP, body temperature, IL-8, and TNF were also reduced. MMP-9, D-dimer, and myeloperoxidase were unchanged. Medical and surgical morbidity were similar between the groups. The intervention reduced time to meet discharge criteria from 3 to 2 days.