Journal and News Scan

This editor hastes to submit to JANS this manuscript on the 5 year follow -up of the ART trial. It is guaranteed to be widely cited, probably hotly debated and certainly a disappointment to many of us!

We would not like to pre-empt the ctsnet readers' opinions on this important publication, but we are allowed to comment on the positive findings on skeletonisation, a technique I find has been somewhat controversial, and the methodological disappointment of more than 15 in a 100 subjects randomised to BIMA (BITA) not in fact receiving two arterial grafts!

I personally remember caring, operating and following-up early ART-enrolled patients in Edinburgh Scotland and look forward to the heated discussions this manuscript will immediately generate.

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.

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.

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.