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Journal and News Scan
This prospective multiinstitutional study evaluated outcomes of different devices used for endoscopic vein harvesting classified as open or closed tunnel devices. There was no difference in the incidence of early graft failure or late clinical outcomes. The poorer graft outcomes related to endoscopic vein harvesting are not attributable to device type.
This editorial, authored by a number of presidents/leaders of prominent medical societies, laments a recent position paper of the ESMO espousing medical oncologists as the natural team leaders of multidisciplinary oncologic care. It cautions other cancer specialists not to abandon their roles as advocates for their cancer patients.
The objective of this study was to investigate whether the consequences of patient prosthesis mismatch (PPM) following aortic valve replacement (AVR) differ according to patient age. The authors hypothesised that in older patients (aged 70 and above) the implications of PPM may be less important due to lower baseline physical function and competing mortality risks. This single centre study included 707 patients who underwent first-time AVR with follow-up out to 17.5 years. The incidence of PPM was 68% in patients aged 70 or older compared to 26% in patients aged less than 70. The authors found that in patients aged less than 70 with left ventricular dysfunction PPM was associated with reduced survival and increased congestive heart failure. Post-operative left ventricular mass regression was impaired in older patients in general and in those with PPM aged 70 or over with left ventricular dysfunction.
The consortium of authors of this paper determined the survival after Transcatheter valve in valve implantation inside a failed surgical bioprosthesis. The authors report a 1 month mortality rate of 7.6% and a major stroke rate of 1.7%. One-year survival was 83.2%, and 313 (92.6%) of survivors had a good functional status (NYHA I/II). Patients who had an aortic stenosis (n=181) had worse 1-year survival (76.6%) than patients with aortic regurgitation (91.2%) or combined stenosis/regurgigation (83.9%; p=0.01). Moreover, a small surgical bioprosthesis was associated with higher mortality.
It is with great sadness that we report the death of Donald Ross on the 7th of July 2014 in London. As well as creating the Ross procedure, he performed the UK's first heart transplant, which was the world's 10th heart transplant.
We would like to invite you to add your memories of this pioneer of cardiac surgery to the comments section below.
This is an interesting opinion piece about misplaced fears on the part of physicians and patients/families regarding the dangers of radiation exposure as part of diagnostic imaging.
To illustrate the potential need for regional quality improvement efforts in thoracic surgery, the authors conducted a study of lung resection in Washington state using a discharge database including nearly 8,500 pts over a 12-year period. Inpatient mortality decreased over time but there was no change in the incidence of prolonged length of stay. Costs increased over time. Hospitals were widely distributed into categories including fewer deaths/lower costs, fewer deaths/higher costs, more deaths/lower costs, and more deaths/higher costs. The data illustrate ample opportunity for improving quality and value modeled on hospitals with fewer deaths/lower costs.
Neuroprotection strategies during deep hypothermic circulatory arrest (DHCA) in infants undergoing cardiac surgery are varied. This single institution retrospective study compared uninterrupted DHCA (24 pts) to DHCA with intermittent perfusion (16 pts). Total DHCA duration did not predict neurodevelopmental outcomes at 24 mos of age. Intermittent perfusion was associated with similar outcomes to uninterrupted DHCA despite the longer exposure to DHCA in this group. Outcomes were related to important comorbidites, length of stay and ICU stay, and multiple procedures requiring DHCA.
The timing of repair of blunt aortic injury in patients with concomitant traumatic brain injury is controversial. This single institution retrospective review analyzed outcomes in 75 pts with blunt aortic injury and traumatic brain injury, comparing early repair (<24 hrs after admission) to delayed repair. Pts undergoing early repair suffered worsening of traumatic brain injury regardless of whether repair was open or endovascular, whereas delayed repair pts did not suffer progression of traumatic brain injury. Early repair was also associated with increased morbidity and mortality.
The PARTNER trial reported reduced mortality in pts with prior CABG who underwent surgical AVR compared to TAVR. This study further explores the 288 pts in these two groups. The groups were similar in their clinical presentation and had similar instances of procedure-related mortality, stroke, and MI. The TAVR pts had more paravalvular leak, at 2 years trended towards higher all-cause mortality, experienced more rehospitalizations, and had higher rates of mortality associated with death/rehospitalization and death/stroke. Outcomes in pts with prior CABG were better after surgical AVR than after TAVR, the causes for which are not completely understood.