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Journal and News Scan

Source: Circulation
Author(s): De Bonis M, Lapenna E, Maisano F, Barili F, La Canna G, Buzzatti N, Pappalardo F, Calabrese M, Nisi T, Alfieri O.

In this retrospective review, the authors evaluate the long-term outcome of 61 patients undergoing edge-to-edge mitral valve repair without annuloplasty ring for degenerative mitral regurgitation (MR). The reasons for not performing annuloplasty were either severe annular calcification or absence of significant annular dilatation. Follow up was 100%. Overall survival at 12 years was 51±7%, and freedom from MR ≥3+ was 43±7.6%. Twenty-one patients required reoperation during the follow up period. These findings lead the authors to conclude that in degenerative MR, the overall long-term results of the surgical edge-to edge technique without annuloplasty are not satisfactory. The authors underscore the relevance this may have in transcatheter mitral valve repair procedures.

Source: Annals of Surgery
Author(s): Patel, Himanshu J; Williams, David M; Drews, Joseph D; Dasika, Narasimham L; Eliason, Jonathan L; Passow, Mary C; Deeb, G Michael

This retrospective review summarizes a single institution experience with thoracic aortic endovascular stenting in 420 pts over 20 years.  Indications were aneurysm (238), dissection (100) and trauma (39).  78% of pts were deemed to be at high risk for open repair.  Mortality was 4.8%, stroke incidence was 5%, and cord ischemia was temporary in 7.9% and permanent in 1.7%.  10 year freedom from failure was 63%; failure was predicted by pre-existing renal failure, presentation with rupture, or need for arch intervention. 15 year survival was 32%. 

Source: Annals of Surgery
Author(s): Sugarbaker, David J; Richards, William G; Bueno, Raphael

This retrospective review of pts undergoing complete resection by extrapleural pneumonectomy 1998-2011 for malignant mesothelioma focused on stage predictors of survival.  Surgical mortality was 5%.  Overall survival at 5 years was 14%, and median survival was 18 mos.   Median survival for N1 or N2 disease was 17 and 13 mos, respectively.  Nodal staging is important for estimating prognosis and for patient selection.

Source: Journal of Clinical Oncology
Author(s): Kazuki Sudo, Lianchun Xiao, Roopma Wadhwa, Hironori Shiozaki, Elena Elimova, Takashi Taketa, Mariela A. Blum, Jeffrey H. Lee, Manoop S. Bhutani, Brian Weston, William A. Ross, Ritsuko Komaki, David C. Rice, Stephen G. Swisher, Wayne L. Hofstetter, Dipen M. Maru, Heath D. Skinner and Jaffer A. Ajani

This retrospective study evaluated recurrence patterns and management of recurrence after bimodality (chemoradiotherapy) for esophageal cancer in 276 pts.  Local relapse alone developed in 23%, and 36% of those patients had salvage esophagectomy.  Median survival for those undergoing salvage esophagectomy was 59 mos, whereas pts who were not offered salvage esophagectomy had a median survival of 9.5 mos.  Over 90% of isolated relapses occured during the first 2 years. 

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Taggart DP, Altman DG, Gray AM, Lees B, Nugara F, Yu L-M and Flather M on behalf of the ART Investigators.

This descriptive study presents the peri-operative and 1-year results of on-pump and off-pump surgery performed in patients enrolled in the Arterial Revascularization Trial (ART). Out of the 3102 patients randomised in the ART trial to undergo either single or bilateral mammary artery grafting, 41% had their surgery performed off-pump. The decision to perform on or off-pump surgery was at the discretion of the surgeon. A similar number of grafts were performed in off-pump and on-pump procedures. Both operative time and ventilation time were shorter in patients who had off-pump surgery. Blood loss and platelet transfusion requirements were also lower in the off-pump surgery group. There was no clinically significant difference in 30-day mortality, stroke, peri-operative myocardial infarction, need for repeat revascularization or 1-year mortality between the off-pump and on-pump groups (formal statistical hypothesis testing was not performed due to the study design).

Source: Journal of the National Cancer Institute
Author(s): Patrick Cheung, Sergio Faria, Shahida Ahmed, Pierre Chabot, Jonathan Greenland, Elizabeth Kurien, Islam Mohamed, James R. Wright, Helmut Hollenhorst, Catherine de Metz, Holly Campbell, Thi Toni Vu, Anand Karvat, Elaine S. Wai, Yee C. Ung, Glenwood Goss, Frances A. Shepherd, Patti O’Brien, Keyue Ding and Chris O’Callaghan

This multi-institutional phase II trial (80 patients from 17 Canadian institutions) was performed to assess if a hypofractionated accelerated radiotherapy regimen for cytohistological-proven early stage NSCLC (peripherally located T1 to T3 N0 M0) has a good local control rate. They concluded that delivering 60 Gy in 15 fractions using a simple three-dimensional conformal radiotherapy technique resulted in favorable outcomes in patients with NSCLC who were medically inoperable or refused surgery.  The actuarial rate of primary tumor control was 87.4%  and overall survival was 68.7% at 2 years. This approach may be a good option for those centers that do not have SBRT/SABR capability.

Source: JAMA
Author(s): Massimo Imazio and others for the COPPS-2 Investigators

The COPPS-2 trial evaluated the efficacy of oral colchicine in reducing a-fib, post-pericardiotomy syndrome, and pericardial/pleural effusion after cardiac surgery in 360 pts randomized to drug or placebo for 1 month postop.  Colchicine reduced the incidence of post-pericardiotomy syndrome (20% vs 30%) but had no important effect on effusions or a-fib.  Adverse events were more common in the Colchicine group (20% vs 12%).

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Graeme L. Hickey, Stuart W. Grant, Ben Bridgewater, Simon Kendall, Alan J. Bryan, James Kuo and Joel Dunning

OBJECTIVES Biological valves are the most commonly implanted prostheses for aortic valve replacement (AVR) surgery in the UK. The aim of this study was to compare performance of porcine and bovinepericardial valves implanted in AVR surgery with respect to survival and reintervention-free survival in a retrospective observational study.

CONCLUSIONS There were no differences in reintervention-free survival between bovine pericardial and porcine valves used in first-time AVR ± CABG up to a maximum of 10 years.




Source: New England Journal of Medicine
Author(s): Bernard De Bruyne, William F. Fearon, Nico H.J. Pijls, Emanuele Barbato, Pim Tonino, Zsolt Piroth, Nikola Jagic, Sven Mobius-Winckler, Gilles Riouffol, Nils Witt, Petr Kala, Philip MacCarthy, Thomas Engström, Keith Oldroyd, Kreton Mavromatis, Ganesh Manoharan, Peter Verlee, Ole Frobert, Nick Curzen, Jane B. Johnson, Andreas Limacher, Eveline Nüesch, and Peter Jüni for the FAME 2 Trial Investigators

This controlled randomized trial examined the benefits of targeted PCI vs medical therapy alone for patients with stable CAD and stenosis who were found to have zones of fractional flow reserve of less than 0.8 at angiography.  Patients without regions of FFR <0.8 were entered into a  registry.  The composite outcome was death, nonfatal MI, or urgent revascularization within 2 years.  The PCI group had a lower incidence of the composite outcome, 8.1% vs 19.5%, driven by their lower rate of urgent revascularization.  The registry group had a similar rate of the composite outcome as did the PCI group.

Source: Annals of Thoracic Surgery
Author(s): Dan J. Raz, Rachel Dunham, Brian Tiep, Argelia Sandoval, Frederic Grannis, Arnold Rotter, Jae Y. Kim

Screening for lung cancer with low-dose CT has been shown to save lives, but few people who qualify for screening actually receive it.  This study examined the use of the electronic medical record to identify pts at risk due to a smoking history.  Prior to initiation, the annualized rate of referral for screening was 16 pts.  After initiation the annualized rate of referral was 188, 53% of whom were identifed by tobacco use screening.