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Journal and News Scan
This retrospective study evaluated recurrence patterns and management of recurrence after bimodality (chemoradiotherapy) for esophageal cancer in 276 pts. Local relapse alone developed in 23%, and 36% of those patients had salvage esophagectomy. Median survival for those undergoing salvage esophagectomy was 59 mos, whereas pts who were not offered salvage esophagectomy had a median survival of 9.5 mos. Over 90% of isolated relapses occured during the first 2 years.
This descriptive study presents the peri-operative and 1-year results of on-pump and off-pump surgery performed in patients enrolled in the Arterial Revascularization Trial (ART). Out of the 3102 patients randomised in the ART trial to undergo either single or bilateral mammary artery grafting, 41% had their surgery performed off-pump. The decision to perform on or off-pump surgery was at the discretion of the surgeon. A similar number of grafts were performed in off-pump and on-pump procedures. Both operative time and ventilation time were shorter in patients who had off-pump surgery. Blood loss and platelet transfusion requirements were also lower in the off-pump surgery group. There was no clinically significant difference in 30-day mortality, stroke, peri-operative myocardial infarction, need for repeat revascularization or 1-year mortality between the off-pump and on-pump groups (formal statistical hypothesis testing was not performed due to the study design).
This multi-institutional phase II trial (80 patients from 17 Canadian institutions) was performed to assess if a hypofractionated accelerated radiotherapy regimen for cytohistological-proven early stage NSCLC (peripherally located T1 to T3 N0 M0) has a good local control rate. They concluded that delivering 60 Gy in 15 fractions using a simple three-dimensional conformal radiotherapy technique resulted in favorable outcomes in patients with NSCLC who were medically inoperable or refused surgery. The actuarial rate of primary tumor control was 87.4% and overall survival was 68.7% at 2 years. This approach may be a good option for those centers that do not have SBRT/SABR capability.
The COPPS-2 trial evaluated the efficacy of oral colchicine in reducing a-fib, post-pericardiotomy syndrome, and pericardial/pleural effusion after cardiac surgery in 360 pts randomized to drug or placebo for 1 month postop. Colchicine reduced the incidence of post-pericardiotomy syndrome (20% vs 30%) but had no important effect on effusions or a-fib. Adverse events were more common in the Colchicine group (20% vs 12%).
OBJECTIVES Biological valves are the most commonly implanted prostheses for aortic valve replacement (AVR) surgery in the UK. The aim of this study was to compare performance of porcine and bovinepericardial valves implanted in AVR surgery with respect to survival and reintervention-free survival in a retrospective observational study.
CONCLUSIONS There were no differences in reintervention-free survival between bovine pericardial and porcine valves used in first-time AVR ± CABG up to a maximum of 10 years.
This controlled randomized trial examined the benefits of targeted PCI vs medical therapy alone for patients with stable CAD and stenosis who were found to have zones of fractional flow reserve of less than 0.8 at angiography. Patients without regions of FFR <0.8 were entered into a registry. The composite outcome was death, nonfatal MI, or urgent revascularization within 2 years. The PCI group had a lower incidence of the composite outcome, 8.1% vs 19.5%, driven by their lower rate of urgent revascularization. The registry group had a similar rate of the composite outcome as did the PCI group.
Screening for lung cancer with low-dose CT has been shown to save lives, but few people who qualify for screening actually receive it. This study examined the use of the electronic medical record to identify pts at risk due to a smoking history. Prior to initiation, the annualized rate of referral for screening was 16 pts. After initiation the annualized rate of referral was 188, 53% of whom were identifed by tobacco use screening.
This single institution study tracked outcomes of a unique lung cancer survivorship program facilitated by a nurse practitioner who was trained in survivorship care. The nurse took over follow-up care of early stage patients who survived disease-free for more than 1 year. 92% of eligible pts received follow-up care by the nurse. The program identified 72% of second primary cancers and 91% of cancer recurrences during scheduled follow-up CT scans. The program appeared effective and achieved high patient acceptance, and was an alternative to physician-led follow-up.
. – In contrast to the large body of information regarding graft patency, data regarding atherosclerosis progression and vessel patency in surgically bypassed native coronary arteries are less clear. The aim of this study was to determine native coronary artery patency 1 year after coronary artery bypass grafting, and to identify clinical and angiographic predictors for the development of a chronic total occlusion (CTO). Researchers found that CTO of surgically bypassed coronary arteries 1 year after coronary artery bypass grafting is extremely common.
- Of the 440 patients who underwent 1–year follow–up angiography as part of the multicenter RAPS (Radial Artery Patency Study), this study included 388 patients (88%) for whom angiograms were available for review.
- Angiograms were reviewed for native coronary artery patency in an independent blinded manner.
- On the pre–operative angiogram, CTO of at least 1 native coronary vessel was demonstrated in 240 patients (61.9%) having 305 occluded vessels.
- At 1 year after coronary artery bypass grafting, at least 1 new native coronary artery CTO occurred in 169 patients (43.6%).
- In 7.5% of patients, the native artery and the graft supplying that territory were both occluded.
- A new CTO was almost 5 times more likely to occur in coronary vessels with a pre–operative proximal stenosis >90% compared with vessels with proximal stenosis <90% (45.5% vs. 9.5%, respectively, p<0.001).
- Patients with a new CTO had significantly more baseline Canadian Cardiovascular Society class 4 angina compared with patients without a new CTO.
- A new CTO was less likely to occur in the left anterior descending artery (18.4%), supplied by the left internal thoracic artery.
- When comparing radial artery and saphenous vein grafts, neither the type of graft nor graft patency had any association with native coronary artery occlusion.
Dall CH, et al. – The authors compared the effects of 12 weeks' HIIT versus continued moderate exercise (CON) on exercise capacity and chronotropic response in stable HTx recipients >12 months after transplantation in a randomized crossover trial. In this study the 5–month washout showed a significant loss of improvement. high–intensity interval training (HIIT) was well tolerated, had a superior effect on oxygen uptake, and led to an unexpected increase in HRpeak accompanied by a faster HRrecovery. This indicates that the benefits of HIIT are partly a result of improved chronotropic response.