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Journal and News Scan
In this propensity matched analysis, Hlatky et al, investigate the adoption patterns of IMA grafting in the United States and study the association with clinical outcomes. They matched 60,896 Medicare patients with and without IMA grafts. The investigators found that IMA use was associated with lower rates of death (HR=0.77), death/MI (HR=0.77) and repeat revascularizations over a 5-year timeframe (8% vs. 9%, p<0.001). Also, IMA adoption grew between 1988 and 2008, and showed considerable geographic variation.
The authors of this multicenter trial performed a post-hoc analysis of a randomized trial comparing open and endovascular abdominal aortic aneurysm repair. 351 patients were randomly assigned to undergo either open abdominal aortic aneurysm repair or endovascular repair. Patients who were on lipid-lowering medication at registration in the trial (n = 135) were compared with those who were not (n = 216). During 6 years of follow-up, statin therapy at registration in the trial was independently associated with better overall survival after open or endovascular aneurysm.
The authors reviewed their experience with the stainless steel-based graft - Zenith Pro-Form TX2 stent grafts (Cook Medical, Bloomington) - in treating aoertic pathology involving the distal arch.
They compared 19 patients so grafted to 19 patints treated with Zenith Z-Trak stent grafts.
CTA scans were analyzed at baseline, and then at 1, 6, and 12 months postoperatively. Arch angulation and bird-beak configuration were evaluated according to sealing zones of attachment.
The treated diseases included chronic type B dissections and degenerative aneurysmal disease.
The authors conclude that aortic remodeling after stainless steel stent grafting of aortic pathology is a continuous process with significant aortic arch transformation over zone 2 and left subclavian artery.
In the Pro-Form platform, a preoperative zone 2 angle <151.1° was a better estimation of the presence of a postoperative bird-beak configuration
Unilateral diaphragm dysfunction can result from phrenic nerve injury and often results in respiratory symptoms. This study evaluated 92 pts for the presence of residual nerve activity and assigned them to phrenic nerve restorative surgery (PS) or no intervention, while a set of patients who underwent diaphragm plication (DP) was culled from the literature for comparison. Improvements in spirometry were similar in the PS and DP groups (13-14% vs 16-17%). Nerve conduction and signal strength were substantially improved by PS. There was a 28% improvement in function in the PS group based on SF-36.
The effect of blood transfusion (Tx; 1-2 units only) on mortality after isolated CABG was evaluated in nearly 17,000 pts in Michigan. Operative mortality was 0.5% for no Tx and 1.3% for Tx (p<0.0001). Nine other adverse postoperative outcomes were significantly increased in pts receiving Tx. Aggressive attempts at reducing even small Tx amounts may result in substantial outcomes improvement.
The outcomes of failed mitral clipping were evaluated in 19 pts. Surgical risk score increased significantly between the time of clipping and subsequent remedial surgery. Severe valve tissue damage as a result of clip application was evident in most patients. Valve repair was possible in 83% of pts who had a single clip, whereas only 23% of patients with more than one clip could have valve repair. One year survival was 68%.
A multivariable analysis was performed on data from 4 European centers for outcomes comparing trans-apical (TA; 10%) and transfemoral (TF; 90%) AVI. TA-AVI pts had higher predicted risk and more comorbidities. TA-AVI was associated with increased complications, hospital stay, 30 day mortality, and all cause long-term mortality.
The aim of this genetic study conducted on a large lung transplant population is to demonstrate the relationship between some genetic variants of IL-17 and IL-23 and the risk of development of chronic allograft rejection. This association could lead to new ways of prevention and treatment.
This is a multicentre retrospective study of 1556 patients undergoing transcatheter aortic valve implantation (TAVI) with self expandable valves (SEV) and balloon expandable valves (BEV), evaluating the effect of permanent pacemaker implantation (PPI) on outcomes at two years. 15.4% of the patients required PPI. Not surprisingly, the need for PPI was significantly higher in patients receiving a SEV (25,5%) than in patients receiving a BEV (7,1%). There was no difference in the primary outcome of the study, which was defined as a composite of all-cause mortality and hospitalization due to heart failure at last follow-up. Interestingly, there was a lower rate of unexpected death in patients with PPI. Left ventricular ejection fraction improved in patients with no PPI but worsened in those patients with PPI.
This retrospective analysis compares outcomes in patients with aortic intramural hematoma type B (IMHB) to those with type B aortic dissection (ABAD) in patients enrolled in the International Registry of Acute Aortic Dissection (IRAD). There was no difference in in-hospital mortality between the two groups. Patients with IMHB required surgical intervention less frequently than ABAD, with the indications for intervention being the same for the two groups (rupture, malperfusion, refractory pain or hypertension). Periaortic hematoma was observed more often in patients with IMHB and was identified as a risk factor for rupture. Patients with ABAD had significantly more dilation of the descending aorta during follow up and more often had extension into the abdominal aorta than those with IMHB. The authors concluded that IMHB may have a more indolent clinical course than ABAD.