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Journal and News Scan

Source: Journal of Clinical Oncology
Author(s): Rodney J. Landreneau, Daniel P. Normolle, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich and Matthew J. Schuchert

This single-institution retrospective study used propensity score matching to compare long-term outcomes of anatomic segmentectomy vs lobectomy for early stage non-small cell lung cancer.   A total of 312 pts were matched in each group.  Locoregional and overall recurrence rates were similar between the groups.  Freedom from recurrence (70% for segmentectomy vs 71% for lobectomy) at 5 years was similar.  5-year survival was also similar (54% vs 60%). 

Source: Journal of Clinical Oncology
Author(s): Christophe Mariette, Laetitia Dahan, Françoise Mornex, Emilie Maillard, Pascal-Alexandre Thomas, Bernard Meunier, Valérie Boige, Denis Pezet, William B. Robb, Valérie Le Brun-Ly, Jean-François Bosset, Jean-Yves Mabrut, Jean-Pierre Triboulet, Laurent Bedenne and Jean-François Seitz

This randomized trial involving 30 centers in France compared outcomes after induction chemoradiotherapy followed by resection to resection alone for stage I or II esophageal cancer.  The R0 resection rate was similar between the groups.  Postoperative mortality was higher in the induction therapy group (11.1% vs 3.4%).  Long-term survival was similar between the groups. 

Source: Circulation
Author(s): Cohen DJ, Osnabrugge RL, Magnuson EA, Wang K, Li H, Chinnakondepalli K, Pinto D, Abdallah MS, Vilain KA, Morice MC, Dawkins KD, Kappetein AP, Mohr FW, Serruys PW.

In this study the cost-effectiveness of CABG vs. DES-PCI was analysed from a U.S. Healthcare perspective. Using 5-year cost and quality-of-life data from the SYNTAX trial and lifetime extrapolations, the authors found that CABG was an economically attractive treatment option for most patients with 3-VD or left main CAD disease. 

Source: Thorax
Author(s): Amelia O Clive, Brennan C Kahan, Clare E Hooper, Rahul Bhatnagar, Anna J Morley, Natalie Zahan-Evans, Oliver J Bintcliffe, Rogier C Boshuizen, Edward T H Fysh, Claire L Tobin, Andrew R L Medford, John E Harvey, Michel M van den Heuvel, Y C Gary Lee, Nick A Maskell

The authors developed and validated a survival predictive score for patients with malignant pleural effusion using 3 large international cohorts of patients.  The LENT score is based on LDH level, ECOG performance status, neutrophil to lymphocyte ratio, and tumor type.  Low risk patients had a median survival of 319 days, moderate risk group survival was 130 days, and median survival in the high risk group was 44 days.  Among the high risk patients, mortality at 1 month was 35% and at 6 months was 97%.  Use of this score may help in selecting appropriate interventions for this patient population.

Source: American Journal of Cardiology
Author(s): Kochman J, Huczek Z, Scisło P, Dabrowski M, Chmielak Z, Szymański P, Witkowski A, Parma R, Ochala A, Chodór P, Wilczek K, Reczuch KW, Kubler P, Rymuza B, Kołtowski L, Scibisz A, Wilimski R, Grube E, Opolski G.

Bicuspid aortic valve (BAV) stenosis has been regarded as a relative contraindication for transcatheter aortic valve implantation (TAVI). In this retrospective study of patients from 5 different centres undergoing TAVI for severe aortic stenosis, the authors compare outcomes between a group of 28 patients with BAV and a 1:3 matched group of 84 patients with tricuspid aortic valves (TAV). Uneven expansion of the bioprosthesis was commonly observed in the BAV group. However, this did not influence the overall procedural outcomes. There were no significant differences in 30-day mortality, one-year all-cause mortality, 30-day combined safety end points, and more than mild aortic regurgitation between the two groups. Based on this data, the authors suggest that selected patients with stenotic BAV, can be successfully treated with TAVI.

Source: JAMA
Author(s): Arthur R. H. van Zanten; François Sztark; Udo X. Kaisers; Siegfried Zielmann; Thomas W. Felbinger; Armin R. Sablotzki; Jan J. De Waele; Jean-François Timsit; Marina L. H. Honing; Didier Keh; Jean-Louis Vincent; Jean-Fabien Zazzo; Harvey B. M. Fijn; Laurent Petit; Jean-Charles Preiser; Peter J. van Horssen; Zandrie Hofman

This prospective trial from 14 ICUs in northern Europe evaluated the potential benefit of adding immune-modulating nutrients (IMHP) to standard enteral nutrition in reducing infectious complications in ventilated patients.  The addition of IMHP did not alter the incidence of infectious complications, but was associated with much worse 6 month survival (35% vs 54%). 

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Furukawa N, et al.

 

 – This study aimed to perform a risk–adjusted comparison of mortality, rate of stroke and perioperative morbidity of aortic valve replacement (AVR) conducted through either partial ministernotomy or conventional sternotomy. This study suggests that, AVR can be safely conducted through a partial ministernotomy. This approach is not associated with an increased rate of complications. However, wide CIs reflect the still prevailing statistical uncertainty in estimates, not excluding patient–relevant differences between approaches.

Methods

  • Between July 2009 and July 2012, data from 984 consecutive patients undergoing isolated AVR were prospectively recorded.
  • In 44.3% (n = 436), the less invasive partial ministernotomy was used.
  • Propensity score matching was performed based on 15 preoperative risk factors to correct for selection bias.
  • In–hospital mortality, stroke rate as well as other major complications in the minimally invasive group and conventional sternotomy group were compared in 404 matched patient pairs (total 808).

 

Results

  • In–hospital mortality and rate of postoperative intra–aortic balloon pump use were identical for propensity–matched patients, 1.0% (4 in each group).
  • The rate of stroke [OR (95% confidence interval (CI)): 0.80 (0.22–2.98)], perioperative myocardial infarction [OR (95% CI): 2.00 (0.18–22.06)], low–output syndrome [OR (95% CI): 0.90 (0.37–2.22)], new onset of dialysis [OR (95% CI): 1.25 (0.49–3.17)] and re–exploration for bleeding [OR (95% CI): 0.88 (0.50–1.56)] were similar.
  • Likewise, resource utilization (operation time, duration of stay in the intensive care unit and in–hospital stay) and valve selection (type and size) was not affected by the surgical approach either.

 

Source: Annals of Thoracic Surgery
Author(s): Catherine M. Avitabile, David J. Goldberg, Kathryn Dodds, Yoav Dori, Chitra Ravishankar, Jack Rychik

The formation of endotracheal casts comprised of inflammatory debris (plastic bronchitis) is a rare but life-threatening complication of the Fontan procedure.  This summary of 14 pts so affected demonstrated a mean interval to development of plastic bronchitis of 1.5 years.  Casts were treated with outpt t-PA (13 pts) and pulmonary vasodilators.  Lesions of the Fontan pathway were hemodynamically significant in 12 pts, and 3 pts required heart transplantation.  2 transplant pts and 6 t-PA pts were asymptomatic at last follow-up.   

Source: Annals of Thoracic Surgery
Author(s): Bartosz Rylski, Joseph E. Bavaria, Rita K. Milewski, Prashanth Vallabhajosyula, William Moser, Emily Kremens, Alberto Pochettino, Wilson Y. Szeto, Nimesh D. Desai

The outcomes of repair of acute type A dissection using aortic valve resuspension and sinus of Valsalva reinforcement were tracked in 489 pts operated 1993-2013.  Hospital mortality was 11%.  5-year survival was 69%, and freedom from proximal reoperation was 96% at 5 years.

Source: Annals of Thoracic Surgery
Author(s): Damien J. LaPar, Ravi K. Ghanta, John A. Kern, Ivan K. Crosby, Jeffrey B. Rich, Alan M. Speir, Irving L. Kron, Gorav Ailawadi

This study investigated failure to rescue from cardiac arrest after cardiac surgery in a data set of nearly 80,000 pts in order to determine whether variability in this outcome might provide an opportunity for quality improvement in low-performing hospitals.  The overall failure to rescue rate was 60% among over 4,100 pts who experienced postoperative cardiac arrest.  The rate ranged from 50% to 83%, with the rate varying primarily according to insitutional rather than pt factors.  Identification of best practices at high performing hospitals may offer a means to improve outcomes elsewhere.

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