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Journal and News Scan
The FDA approved the CoreValve TAVI device for use in the US. The approval was originally expected to occur in April 2014, but the panel decided that an independent review of data from the clinical study of extreme-risk patients in the CoreValve US Pivotal Trial was not needed at this time.
The authors studied over 5,700 pts undergoing CABG to assess the dynamics of changes in renal function and related such changes to mortality. Perioperative renal dysfunction was associated with increased long-term mortality. Recovery from renal dysfunction was associated with some improvement in long-term mortality risk. Alternative methods of classifying renal dysfunction may be more useful than creatinine in assessing long-term risk.
The authors compared outcomes for VATS lobectomy by experienced VATS surgeons to those for robotic lobectomies performed by the same surgeons who were learning robotic surgery. 69 pts were evenly divided between the approaches. Other than longer time required for robotic upper lobectomy, there were no differences between the groups in OR time, LOS, nodal harvest, morbidity, or mortality.
The use of mechanical circulatory support (MCS) for pediatric patients undergoing heart surgery was analyzed. Of over 96,000 operations, 2.4% were associated with MCS use. MCS use was associated with younger patients, a greater number of preoperative risk factors, and certain operations (Norwood, complex biventricular repair). Mortality associated with MCS was over 50%. MCS rates differed substantially across participating institutions.
37 pairs of matched patients were analyzed for short-term postoperative outcomes. Neurologic complications and pacemaker implant rates were similiar between the groups. Paravalvular leak rate was higher in the TAVI group (13.5% vs 0%). Survival at a mean f/u of 19 mos was better in the sutureless valve group (97% vs 87%). Better survival was associated with the absence of a paravalvular leak.
Outcomes of the Ross procedure in 55 children and adolescents performed over a 20 year period were reviewed. Median f/u was 5.5 years. Hospital mortality was 13%, and long-term survival was 85%. Freedom from reoperation for autograft failure at 10 years was 74%, and was 56% for RV outflow tract replacement.
This meta-analysis included over 5,000 pts in 28 studies and evaluated mortality and neurologic outcomes after aortic arch surgery. Unilateral and bilateral antegrade cerebral perfusion were associated with similar rate of mortality, temporary neurologic deficit, and permanent neurologic dysfunction.
52 patients undergoing thoracotomy were randomized to paravertebral catheter vs epidural catheter for pain management. Use of the paravertebral catheter was associated with better pain control and respiratory effort. Side effects typical of epidural catheters such as nausea, hypotension, and urinary retention were not seen in the paravertebral catheter group.
The authors reviewed their experience with 104 consecutive patients who underwent elective arch treatment with debranching and thoracic endovascular aortic repair between 2005-2013. Major complications at 30 days (death, stroke, and spinal cord ischemia) occurred in 6, 4, and 3 patients, respectively. At 1, 3, and 5 years survival rates were 89.0%, 82.8%, and 70.9%. Extension to ascending aorta (zone 0 landing) was the only multivariate independent predictor for perioperative mortality. Freedom from persistent endoleak was 96.1%, 92.5%, and 88.3% at 1,3, and 5 years. The authors conclude that the endovascular aortic arch repair presents a low rate of aorta-related deaths and reinterventions and acceptable midterm survival. One-third of the aneurysms decreased in diameter over 5 years. Retrograde type A dissection remains a major concern in the perioperative period.
The authors report their results with 50 consecutive patients who underwent TEVAR for management of acute complicated type B dissection between July 2005 and September 2012. In-hospital and 30-day mortality were 0%. The rates of stroke, permanent paraplegia/paraparesis, and new-onset dialysis were 2%, 2%, and 4%, respectively. Survival at 5 and 7 years was 84%. Thirteen (26%) patients required a total of 17 reinterventions; six were performed using open techniques and 11 with endovascular or hybrid methods. The authors report excellent outcomes of TEVAR for acute complicated type B dissection. Aortic reinterventions were required in one-quarter of patients, but no aortic-related deaths were observed, confirming the importance of life-long surveillance by an experienced aortic referral center.