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Journal and News Scan
The FDA-approved use of TAVR has now expanded to low-risk patients with severe aortic stenosis. This includes both Edwards Lifesciences' Sapien 3 and Sapien 3 Ultra as well as Medtronic's Evolut R and Evolut PRO.
Nelson and colleagues analyzed data from The Society of Thoracic Surgeons Congenital Heart Surgery Database on 3446 aortic valve replacement procedures performed between 2000 and 2016. The authors found that practice patterns varied widely, though autograft usage was higher at high-volume centers. Additionally, homografts were found to have higher rates of mortality and major complications than other valve types.
Using a machine learning algorithm, resource utilization among more than 1 million Medicare patients undergoing one of 6 operations including CABG and lung resection was analyzed. Super users comprised 4.8% of the cohort but consumed 31.7% of the resources. Risk factors for super use included paraplegia/hemiplegia, weight loss, and CHF combined with chronic kidney disease.
Regionalization of care for complex problems remains an open question in most countries. This review demonstrated that, for high risk cancer operations in the US, the Leapfrog group's volume standards did not differentiate between surgical mortality outcomes for lung and esophageal cancer surgery. However, differences were evident comparing lowest and highest volume quintiles for operative mortality associated with these procedures. The percentage of hospitals meeting Leapfrog volume criteria increased for lung cancer surgery but recently decreased for esophageal cancer surgery; the latter finding is a reversal of an organic trend towards regionalization of esophageal cancer care over the prior decade and is of concern.
A comprehensive audio lecture from an academic pathologist on non-malignant pulmonary lesions.
The translational value for cardiac transplantation of this prospective multi-centre clinical study of vasodilation in amyloidosis remains to be evaluated.
A most educative cross-Atlantic retrospective study on an always important question. The short accompanying video is also valuable!
Colleagues from Italy and Germany compared the short- and mid-term outcomes of the straight tube graft (David-I) and the Valsalva graft in 232 patients undergoing an isolated David procedure. The two groups did not differ significantly in 30-day mortality (1% vs 2%), late survival (p = 0.799), or valve-related reoperation (p = 0.241). Although with more cusp repairs (22% vs 4%), patients with Valsalva graft showed a higher incidence of aortic insufficiency ≥ II° after surgery (17% vs 0%) and at follow-up (39% vs 22%). This study also identified bicuspid aortic valve (OR = 3.435, p = 0.005) and postoperative aortic insufficiency ≥ II° (OR = 5.988, p < 0.001) as risk factors for reoperation on the aortic valve.
The authors in this study performed a post-hoc analysis of the coronary artery bypass grafting (CABG) cohort in the multicenter randomized EXCEL trial, comparing patients undergoing on-pump versus off-pump procedures for left main disease. Of note, in both groups some of the most experienced CABG surgeons in the world participated. The 3-year outcomes of the two CABG groups were compared using inverse-probability-of-treatment weighting for treatment effect estimation. For the 923 CABG patients, 71% and 29% underwent on-pump versus off-pump CABG, respectively.
Outcomes: Off-pump CABG was associated with a lower rate of revascularization of both the circumflex and right coronary artery territories in patients with obstruction of those territories. Moreover, the 3-year all-cause death was roughly double for the off-pump group as compared to the on-pump group (8.8% versus 4.5%, p = 0.02).
Retrospectively using a longitudinal echocardiography database, the authors analyzed the data of 3,276 patients with isolated severe tricuspids regurgitation (TR) from 2001 through 2016. Of these patients, 5% underwent tricuspid valve surgery. Within the group undergoing surgery, 84% of patients underwent a repair versus 16% who underwent a replacement. The authors found, in a propensity-matched sample, that there was no difference in long-term survival between patients treated medically versus surgically. In addition, there was no difference in survival between those undergoing repair versus replacement.