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Journal and News Scan
This is a prospective, randomised, open-label, non-inferiority trial comparing CABG versus PCI in patients with unprotected left main stenosis. The study was carried out at 36 hospitals in Latvia, Estonia, Lithuania, Germany, Norway, Sweden, Finland, the UK, and Denmark. In total, 1201 patients were randomly assigned, 598 to PCI and 603 to CABG, and 592 in each group entered analysis by intention to treat up to 5 years of follow up. Interestingly, only 8% of the patients in the CABG group had the right internal mammary artery used as a graft (93% had the left ITA used). The primary endpoint was a composite of major adverse cardiac and cerebrovascular events (MACCE; death from any cause, non-procedural myocardial infarction,14 repeat revascularisation, or stroke). The key findings of the NOBLE study are that CABG was better than PCI for the composite endpoint of MACCE; all-cause mortality was similar between the two groups; non-procedural myocardial infarction and need for repeat revascularisation were increased after PCI; a higher rate of stroke was observed in the CABG group after 30 days than in the PCI group, but an unexpected, numerically higher rate of stroke was found in PCI-treated patients in 5 year estimates; maximum angina pectoris score was higher after PCI at up to 5 years follow-up.
An interesting case series of cardiotoxicity of modern chemotherapy attempting to elucidate mechanisms of heart failure. This pilot study could well lead to further investigation of finite pathways related to surgical aspects of transplanation, anti-rejection therapy in particular: The authors propose that the immune system is a mediator of cardiac dusfunction.
This single institution study evalated the effect of prosthesis choice on regression of LV mass after AVR in patients with AS. The St. Jude Trifecta performed better than the Edwards Perimount Magna Ease in terms of LV mass regression and intermediate-term clinical outcomes such as valve gradients, freedom from readmission, and all-cause mortality.
The authors examined the concordance of clinical and pathological staging using prospectively collected data from the Dutch Lung Surgery Audit, examining patients with clinical stage I disease. Among 1,555 patients, the concordance of cTNM and pTNM was 60%. 22.6% of patients were upstaged after resection, . The difference was more evident in patients with T2a tumors.
This database study evaluated outcomes of delayed sternal closure for infants undergoing surgery on cardiopulmonary bypass. Delayed closure was associated with a 3-fold increase in infectious complications. Time to closure was associated with an increasing rate of infectious complications. Location of closure (OR, ICU) was not associated with adverse outcomes.
This single institution study explored the frequency and time course of failure of mitral valve repair for MR caused by prolapse using longitudinal echocardiography. Recurrent MR developed in 49 (5.7%) patients at a mean of 3.1 years; 6 had prolapse and 43 did not. Severe MS occurred in 3. Reoperation was performed in 21 patients, and was most commonly valve replacement.
This single institution retrospective study evaluated outcomes of valve replacement for degenerated bioprosthetic aortic valves comparing surgical AVR (SAVR) to transcatheter valve-in-valve procedures (TViV). Patients were matched into 2 groups of 22 according to STS risk scores. Operative mortality, stroke rate, and 3-year survival were similar between the groups.
This single center review assessed the need for reintervention after pulmonary valve replacement with bioprostheses for congenital heart disease. Most patients had TOF, and most were in their teens or twenties. After correction for age, the Sorin Mitroflow valve required reintervention sooner and more often than the other two valves (Carpentier-Edwards Magna and MagnaEase, Carpentier-Edwards Perimount). Valve type was the only independent predictor of reintervention.
This retrospective single institution report examined outcomes of repair of large airway defects with bioprothetic materials. 8 patients underwent repair with aortic homograft or acellular dermal matrix, 5 of whom suffered from airway-enteric fistulae. Most repairs were buttressed with muscle or omentum. All airways healed; 2 required debridement of granulation tissue and 1 required dilation.
One-hundred eleven patients who underwent surgical repair of acute type A aortic dissection without preoperative malperfusion are analyzed for outcome with regard to arterial cannulation site, route of cerebral perfusion and surgeon’s specific experience. Potential biases are discussed.