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Journal and News Scan
April 28, 2016
Submitted by: Stuart Head
In a large multi-center, propensity-matched study, Paparella et al found that antiplatelet therapy as opposed to oral anticoagulation therapy initiated after mitral valve repair as antithrombotic prophylaxis caused significantly less major bleeding, which also caused mortality to be less by a 5-fold than with anticoagulation therapy.
April 23, 2016
Submitted by: Aristotle Protopapas
An editorial discussion of the impressive 10-year benefits of CABG for ischemic cardiomyopathy as found in the STICH trial.
April 21, 2016
Submitted by: Arie Blitz
These authors analyzed retrospectively the effect of postoperative fibrinogen level on bleeding after heart surgery in their database of 2,800 patients. They found that serum fibrinogen levels lower than 220 mg/dl more than doubled the risk of postoperative bleeding.
Is it time to standardize the measurement of postop fibrinogen in cardiac surgery?
April 12, 2016
Submitted by: Mark Ferguson
Results of an audit of the National Congenital Heart Disease database were evaluted to determine characteristics of patients undergoing reoperation within 30 days of their primary procedure. Among over 18,000 patients, 3.5% had early reoperations. The reoperations were most commonly arterial shunt, PA band, and VSD procedures. 60 day mortality was 5-fold higher than among patients who did not have an early reoperation.
April 12, 2016
Submitted by: Mark Ferguson
The association of acute kidney injury (AKI) with adverse outcomes after cardiac surgery is well known. This study compared the association of AKI and the elevation of cystatin C, another filtration marker, with long-term survival after cardiac surgery. 30% of patients experienced an abnormal increase in creatinine postop compared to 15% who had an abnormal rise in cystatin C. A rise in cystatin C was better predictive of decreased long-term survival than was creatinine.
April 12, 2016
Submitted by: Mark Ferguson
The authors used a single institution data base to assess very long-term outcomes after AVR to determine the effects of prosthesis-patient mismatch. Among 673 pts, 24% had mismatch. Mean follow-up was nearly 18 years. On multivariable analysis, mismatch was not a significant determinant of long-term survival.
April 12, 2016
Submitted by: Mark Ferguson
Whether adding radiotherapy to induction chemotherapy prior to esophagectomy adds a survival benefit is uncertain. The authors assessed outcomes of 214 patients with T3N1M0 adenocarcinoma among three institutions who underwent induction therapy followed by esophagectomy. 114 patients had chemotherapy and 100 patients had chemoradiotherapy. 90-day mortality did not differ between the groups (5.3% vs 4.0%), and median survival between the groups was similar (31.2 vs 39.2 months). The role of radiotherapy as part of induction therapy for management of adenocarcinoma of the esophagus requires further exploration.
April 8, 2016
Submitted by: Joseph Basha
ECMO is widely used for cardiogenic shock treatment. Since peripheral V-A ECMO will increase LV afterload and IABP therapy can counterbalance it, will IABP combined with ECMO improve the outcomes? A total of 529 patients (227 ECMO alone and 302 combined IABP plus ECMO) were included. Compared with ECMO alone, combined IABP and ECMO treatment did not improve outcomes. Limitation: this is an observational cohort study, large scale randomized controlled standardized trial is needed.
April 5, 2016
Submitted by: J. Rafael Sadaba
In this manuscript the authors report on their findings in a systematic review and meta-analysis of 18 studies looking into the effect on outcomes of balloon predilatation in patients undergoing transcatheter aortic valve implantation (TAVI). Patients in whom balloon predilatation was performed were more likely to require permanent pacemaker implantation, to have grade 2 or more aortic regurgitation, to suffer stroke, and had a higher 30-day mortality than those patients in whom balloon predilatation was not carried out. Interestingly, the subgroup analysis revealed that patients receiving the Medtronic CoreValve prosthesis appear to benefit more from the no predilatation strategy than those receiving an Edwards Sapien prosthesis.
April 3, 2016
Submitted by: Aristotle Protopapas
Neil Moat, one of the busiest British surgeons involved directly and consistently in TAVR, discusses PARTNER 2 and SURTAVI, paying particular attention to the health economics of low-risk TAVR and the implication of reduced profile devices.