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Journal and News Scan
It has recently been reported that a longer interval to esophagectomy following induction therapy results in higher pathologic response rates. The current study used data from the CROSS trial to determine whether a longer interval to esophagectomy following induction therapy results in improved survival. Time to surgery (TTS) was a median of 48 days, and was primarily determined by logistic constraints. Increasing TTS after 45 days was associated with improved pCR and an increased risk of postoperative complications. There was no survival advantage associated with increasing TTS.
The Comprehensive Complication Index (CCI) was compared to more standard methods of categorizing complications for their utility in assessing outcomes after randomized surgical trials. The CCI outperformed standard methods in 2 of 3 published randomized trials (pancreatic and esophageal surgery), demonstrating significant differences in outcomes whereas none was reported in the original trials. The sample sizes needed to demonstrate differences using CCI are an order of magnitude lower than for traditional endpoints.
A right upper lobe sleeve lobectomy, uniportally.
CHICAGO -- September 30, 3014 -- Among patients aged 50 to 69 years who underwent aortic valve replacement with bioprosthetic or mechanical prosthetic valves, there was no significant difference in 15-year survival or stroke, although patients in the bioprosthetic valve group had a greater likelihood of re-operation but a lower likelihood of major bleeding.
The findings are published in the October 1 issue of JAMA.
In older patients, bioprosthetic valves pose a low lifetime risk of reoperation for structural degeneration and avoid many of the complications associated with mechanical prostheses. Bioprosthetic valves are therefore recommended in patients aged older than 70 years. However, the optimal prosthesis type for younger patients is less clear.
Yuting P. Chiang, Mount Sinai Hospital, New York, New York, and colleagues used a state-wide administrative database to quantify differences in long-term survival, stroke, re-operation, and major bleeding episodes after aortic valve replacement according to prosthesis type.
Optimal management of a VSD at the time of coarctation repair is controversial. The retrospective review of the Pediatric Cardiac Care Consortium 1982-2007 evaluated outcomes for 2,022 patients. The presence of a VSD increased operative mortality 4-fold to 8.3%. Patients underwent coarct repair and VSD closure at an older age (87 days) than for coarct repair and PA banding (22 days). Discharge mortality was about 9% for each group. Hospital mortality for patients who underwent coarct repair but no surgical VSD management had a discharge mortality of 7.9%.
This study assessed risk factors, frequency, and timing associated with readmission after cardiac surgery using data for 5,158 pts from 10 participating centers. The overall readmission rate was 19%, and was highest for combined CABG and valve operations. Readmissions were more common in the first 30 days after discharge (80% of total), and were most often due to fluid overload, infection, and arrhythmia. Baseline conditions associated with readmission were female sex, AKI, COPD, diabetes, anemia, and prolonged operating time.
Using a single institution database, the authors propensity score matched patients receiving wedge resection, wedge resection plus brachytherapy, or SBRT for early stage NSCLC. Survival was assessed at a median of 35 mos. Overall recurrence was higher for SBRT vs wedge (30% vs 9%), and recurrence-free and disease-free survival were better after wedge than SBRT. Male sex and SBRT were significant predictors of mortality and recurrence.
The New York State database was used to perform a retrospective analysis of outcomes for isolated AVR comparing bioprosthetic to mechanical valves. Propensity matching was used to create 1001 patient pairs. Survival and stroke rates were similar between the groups at an average of 10.8 years follow-up. The cumulative incidence of reoperation was higher in the bioprosthetic group (12.1% vs 6.9%) but the cumulative incidence of major bleeding was lower in that group (6.6% vs 13.0%).
This randomized double-blind multicenter study involving 667 pts evaluated the utility of IV fenoldopam in reducing the rate of renal replacement therapy for patients undergoing cardiac surgery who exhibit postoperative acute kidney injury. Fenoldopam did not importantly reduce the need for renal replacement therapy or 30 day mortality. Its use was asssociated with an increase in postoperative hypotension.
WASHINGTON D.C. -- September 16, 2014 -- Use of a dual-filter cerebral protection system reduces the number and volume of cerebral lesions in patients with severe aortic stenosis undergoing transaortic valve replacement (TAVR), according to prospective research presented at the 2014 Transcatheter Cardiovascular Therapeutics meeting (TCT).
“In patients with severe aortic stenosis who are at increased surgical risk, the use of [a] dual-filter cerebral protection system during TAVR significantly reduces the number and volume of cerebral lesions as determined by DW-MRI [diffusion-weighted magnetic resonance imaging] subtraction at 2 and 7 days after TAVR,” explained presenter Axel Linke, MD, University of Leipzig Heart Center, Leipzig, Germany, speaking here at a plenary session on September 13.
“Although results with TAVR have improved considerably over the last decade, stroke remains a major issue, and increases mortality by threefold,” Dr. Linke noted. He said also that neuro-imaging studies are revealing ischaemic brain lesions in more than two-thirds of these patients. “We know that those lesions are associated with a poorer neurocognitive outcome,” he added.