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Journal and News Scan
An Interview with Michael Mack, Patrick Surrys, Fredrick Mohr, and Dr van Miegham over the options of revascularization and the debate between PCI and CABG.
This was recorded at EACTS 2013 in Vienna
This is a video of VATS diaphragmatic Plication using CO2, and 3 10mm ports. It also features the endostitch to create the plication sutures and these sutures are pledgeted during the procedure.
Finally we also use the SILS clinch device that can grasp tissue at any angle and together this all make the procedure very straightforward indeed.
The patient had an NG tube during surgery and was discharged on day 4
This important article describes the initial US commercial experience of transcatheter aortic valve replacement (TAVR) since this therapy was approved by the FDA in 2011. It reports the results of 7710 eligible patients that underwent TAVR for high-risk or inoperable status in 250 centers and were included in the STS/ACC TVT Registry. The median age of the patients was 84 years; 20% were defined as inoperable for standard aortic valve replacement and 80% were considered high operative risk. Of all procedures, 64% were transfemoral, 29% transapical, and the rest performed using other approches. The device was successfully implanted in 92% of cases. In-hospital mortality was 5.5% with risk of stroke being 2%. Conversion to open heart surgery (1%) was associated with very high in-hospital mortality (49%). The authors conclude that US outcomes in the commercial TAVR era are similar to the previously published outcomes from the PARTNER trial and from European trials. Long-term follow-up is needed.
455 patients with a-fib or VTE were randomized to pharmacogenetic-directed warfarin therapy for the first 5 days or a 3-day loading regimen. Genotype-based dosing resulted in a 10% higher rate of being in the therapeutic range, a shorter time to reach a therapeutic INR, and fewer instances of excessive anticoagulation.
251 pts with severe ischemic MR were randomized to MV repair or chordal-sparing MV replacement. The end point was LVESVI at 12 mos. LVESVI and mortality were similar between the groups at follow-up. Recurrent MR was more common in the repair group (32.6% vs 2.3%). Other outcomes including major adverse events and QOL were similar between the groups.
Pts with acute MI complicated by shock who were being treated with optimal medical therapy and for whom early revascularization was planned were assigned to IABP vs control. 600 patients were randomized. Death rates at 12 mos in the IABP and control groups were 52% vs 51%. Reinfarction, recurrent revascularization, stroke, and quality of life did not differ between the groups.
This 2 year trial randomizing pts between e-cigarettes, placebo e-cigarettes, and nicotine patches was conducted in 657 people. Abstinence from smoking was achieved in 7.3% for e-cigarettes, 5.8% for patches, and 4.1% for placebo. Abstinence rates were strikingly low, and aids to smoking cessation offered no important advantage in this small study.
This trial of hypothermia for unconsious survivors of out-of-hospital cardiac arrest randomized 1359 patients to prehospital cooling and hospital cooling. Prehospital cooling achieved a 1.2º - 1.3º C. decrease in core temperature by the time of arrival to the hospital and reduced time to adequate cooling by 1 hour, but was associated with an increased risk of rearrest prior to hospital arrival. Survival to hospital discharge (62.7% vs 64.3%) and neurologic status at the time of discharge were similar between the 2 groups.
Hypothermia is recommended for unconscious survivors of out-of-hospital cardiac arrest to preserve heart and neurologic function. This study randomized 950 pts to determine whether 33º C or 36º C is the most appropriate target temperature. Mortality was similar (50% vs 48%) and outcomes at 180 days for mortality and poor neurologic function were also similar (54% vs 52%).
This study presents a comparison between PerOral Endoscopic Myotomy (POEM) and Standard Laparoscopic Approach in the treatment of achalasia. The authors report satisfactory results of the postoperative course and for grade of patients satisfaction with POEM. The complication incidence was similar for both procedures.