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Journal and News Scan
This retrospective single institution review assessed the incidence of hiatal hernia after minimally invasive esophagectomy (MIE). Of 114 patients followed, 9 (8%) developed herniation, of whom 5 were symptomatic. All were repaired laparoscopically, except 2 who underwent emergent surgery, with good results.
POEM is being increasingly used for primary treatment of achalasia. This study evaluated POEM use for retreatment of 5 achalasia patients after prior laparoscopic esophageal myotomy and compared their results to 3 patients who underwent redo laparoscopic surgery. Both groups had similar low complication rates and improved symptoms at intermediate-term follow-up. The authors conclude that POEM is feasible for reoperative surgery for achalasia.
Interesting images of one of the very few reports on transeptal mitral valve implantation, in this case with a SAPIEN XT valve. The valve was implanted in a 72-year old female patient with previous aortic valve replacement and tricuspid valve annuloplasty. She had symptomatic mitral stenosis with severe calcification of the mitral annulus.
Stepped wedged cluster randomized control trial from the World Health Organization comparing outcomes in those who received a Checklist. Implementation of the WHO Surgical Safey Checklist decreased morbidty and hospital length of stay.
In this extensive review, the authors focus on extracorproreal membrane oxygenation (ECMO), both for cardiac and respiratory failure. They describe the explosive increase in ECMO use, the expanding indications, and the need for more evidence-based use. Moreover, they review the cannulation strategies, current indications and potential future applications.
Traditionally, patients undergoing TAVI are treated with dual antiplatelet therapy (DAPT). This strategy in not based on strong evidence. In this paper, the authors describe their findings in a randomized trial comparing outcomes (morbidity and mortality) in two groups of patients undergoing TAVI, one treated with aspirin only (ASA group) and another treated with aspirin and clopidogrel or ticlopidine (DAPT group). There were no significant differences in “all cause” and “cardiovascular” mortality at six months or in the VARC (Valve Academic Research Consortium) combined safety endpoints at 30 days. Nevertheless, at 30 days, vascular complications were significantly more frequent in the in the DAPT group. Based on their data, the authors suggest that, in patients undergoing TAVI, vascular complications may be reduced by the adoption of an antiplatelet therapy based only on aspirin.
Pts undergoing salvage esophagectomy after definitive chemoradiotherapy were evaluated for perdictors of survival. 5-year survival was 30%, which was related to tumor recurrence rather than residual tumor, complete resection, N status, M status, and dissection of more than 15 nodes. Additional neck dissection was not found to provide additional benefit.
This study evaluated over 200 RTCs of systemic therapy for NSCLC. There has been a steady increase in the number of trials reporting outcomes for progression-free survival. Over 50% of trials now report a positive outcome without meeting the primary endpoint of the trial. Although the sample size of the trials is increasing, the magnitude of reported survival gain is decreasing (now 2.5 mos).
The PORTICO trial has opened to evaluate the Portico Transcatheter Aortic Valve System. This prospective multicenter trial involving up to 40 sites will randomize pts to Portico vs another TAVR valve in the US.
The influence of continuous flow LVAD devices on heart transplant was examined using UNOS data, comparing outcomes of cfLVAD to pulsatile flow LVAD (pfLVAD) and no LVAD pts. cfLVAD pts spent longer time on the waitlist and were status IA for longer than either of the other groups. Waitlist survival was better for the cfLVAD pts. Post-transplant survival was similar among the 3 groups.