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Journal and News Scan
Donor lungs undergoing EVLP were more injured, but long-term outcomes of transplant were similar between EVLP and non-EVLP lungs, including the incidence of graft dysfunction and survival.
A medium-size RCT on the growing research question of efficacy of peroral myotomy for achalasia, with a 17% failure to improve symptoms in the peroral endoscopic myotomy (POEM) arm, is discussed in this article. It recognizes a quite sobering incidence of endoscopically-evidenced reflux esophagitis in both arms, bafflingly improving between 3 and 24 months in the POEM group and increasing in the controls (Dor), while the incidence in the POEM arm was double!
The PulMiCC is a randomized clinical trial that tried to build more evidence for performing pulmonary metastasectomy in patients affected by advanced colorectal cancer and previously treated with curative intent. Unfortunately, the trial was stopped earlier becasue of poor recruitment and high drop out rate. The resuts are now published, and the authors question the relevance of performing pulmonary metastasectomy in order to prolong survival.
This is a report on outcomes after thoracic endovascular aortic repair (TEVAR) for uncomplicated type B dissection in 751 patients. Ten-year survival was 83% and the 10-year reintervention rate was 10%. The authors concluded that TEVAR may be considered a first choice for patients with uncomplicated type B dissection.
This review demonstrates that preoperative anemia is associated with increased mortality, AKI, CVA, and infection after cardiac surgery. Preoperative anemia appears to be a modifiable risk factor.
Performance of curative surgery for early stage cancer varied considerably among counties in the US, and was related to socioeconomic factors, availability of surgeons, and non-metropolitan status.
Medicare claims data were reviewed for patients in Michigan who underwent inpatient surgery. Some patients were enrolled in prehabilitation programs consisting of home-based walking exercise, nutrition, smoking cessation, and stress reduction. Patients undergoing prehabilitation were compared to similar patients undergoing surgery at the same hospitals but who did not enroll in the program. Patients undergoing prehabilitation had shorter LOS, lower costs of care, and were more likely to be discharged to home.
The authors analyzed the outcomes of the continuous-flow left ventricular assist devices. The study includes 105 patients supported with HM2 (N=54), HM3 (N=25), and HW (N-26). Eighteen-month data suggested that HM3 had a better prognostic and adverse-event profile over other devices.
On December 9, the US Preventive Services Task Force (USPSTF) published updated recommendations on the screening of abdominal aortic aneurysm (AAA) based on patient's gender, age, history of smoking, and family history of AAA for symptomatic adults:
- In men aged 65-75 years who have EVER smoked => One-time screening for AAA with ultrasonography (B recommendation);
- In men aged 65-75 years who have NEVER smoked => Selective screening for AAA with ultrasonography (C recommendation);
- In women who have NEVER smoked and have NO family history of AAA => Routine ultrasonographic screening for AAA is NOT recommended (D recommendation);
- Current evidence is insufficient to assess the balance of benefits and harms of screening for AAA with ultrasonography in women aged 65-75 years who have ever smoked or have a family history of AAA (I statement).
Following the withdrawal of Professor Taggart’s name from the author list of the EXCEL trial, the BBC in the UK have filmed a full exposé of some of the background to this decision. Secretary General of EACTS, Dominic Pagano, has stated that if the allegations are true, then perhaps support should be withdrawn for the current guidelines that PCI is equivalent to bypass grafting.
It looks like the published results of this trial in The New England Journal of Medicine are unravelling and either this paper will need to be withdrawn and re-published, or extensive modifications must be made. Let us know what you think after reading this article.