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Journal and News Scan
The efficacy of deep hypothermic circulatory arrest (DHCA) on preserving neurocognitive function is uncertain. This study compared 29 pts undergoing aortic surgery with DHCA to 33 who did not require DHCA. Cognitive scores preop and postop were similar for both groups. A similar number of pts (11 vs 13) experienced neurocognitive deficits postoperatively, including a decline in types of memory function. Time under DHCA was not associated with the incidence of neurocognitive deficits. Overall, cardiac surgery caused some problems with memory. DHCA, when required, preserved neurocognitive function.
In the US, preoperative beta-blockade is a hospital quality metric that must be addressed at the time of each operation. This study reviewed STS Database data for isolated CABG in nearly 44,000 pts. After risk adjustment, beta-blockade had no effect on mortality, morbidity, or hospital resource utilization. The authors suggest that beta-blockade is not a useful quality metric for CABG.
This article is a transcription of a roundtable discussion on surgical management of esophageal cancer involving recognized experts in the field. Topics include conduit preparation, pyloric drainage, conduit preconditioning, postoperative reflux, the role of surgery in multimodality therapy, and the choice of incisions for esophagectomy.
This single-center study analyzed outcomes for 323 pts with esophageal adenocarcinoma who achieved a clinical CR after chemoradiotherapy to determine the prognostic value of pretreatment PET. Patients with an SUV >6 faired better with induction therapy and resection compared to definitive chemoradiotherapy. Those with an SUV <6 did equally well with either treatment regimen. PET SUV may facilitate determining whether bimodality or trimodality is optimal for patients with esophageal adenocarcinoma.
This trial of 2218 pts with STEMI being transported for PCI randomized pts to bivalirudin or standard therapy (LMW heparin with optional glycoprotein IIb/IIIa inhibitors). The primary outcome was death or major bleeding. Bivalirudin was associated with a significant reduction (40%) in the primary outcome incidence but had a 6-fold increase in the incidence of acute stent thrombosis. Death and reinfarction rates were similar.
This randomized trial included 148 pts with potentially resectable NSLCL. Mediastinal staging was randomized to EBUS-centered (EBUS possibly followed by EUS) or EUS-centered (EUS possibly followed by EBUS). Diagnostic accuracy and sensitivity were similar for both groups. Adding EBUS after initial EUS improved accuracy and sensitivity significantly, whereas adding EUS after initial EBUS did not significantly improve outcomes. The authors suggest that EBUS is the best first procedure in endoscopic mediastinal staging for potentially resectable lung cancer.
Of nearly 360,000 pts in England diagnosed with a first primary lung cancer, outcomes were assessed for 465 patients who underwent resection for small cell cancer. 5-year survival was 45% for resected NSCLC, 31% for resected SCLC, and was 3% for patients who didn't have resection. Survival was better for patients who had a resection for known SCLC compared to those whose histologic diagnosis wasn't made until after surgery. The authors conclude that resection should be offered to selected patients with SCLC.
Gastroesophageal reflux disease is a risk factor for esophageal adenocarcinoma and Barrett’s esophagus. Adenocarcinoma also may develop from Barrett’s esophagus. This multi-institutional study compares genome-wide association data to investigate the genetic architecture of esophageal adenocarcinoma, Barrett’s esophagus and gastroesophageal reflux. A high genetic correlation was found between esophageal adenocarcinoma and Barrett’s esophagus with significant polygenic overlap, which suggest that shared genes underlie the development of both lesions. On the contrary, no statistically significant results were obtained for gastroesophageal reflux.
In this manuscript the authors propose a strategy for the treatment of obstructive thrombosis of prosthetic heart valves based on a review of 30 studies published over a 17-year period. They suggest indications for thrombolysis and surgery in right and left sided prosthetic heart valve thrombosis.
This randomized controlled trial evaluated routine mural thrombus aspiration followed by PCI to PCI alone in 7,244 pts with STEMI undergoing PCI. Thrombus aspiration did not significantly decrease mortality, recurrent MI, or stent thrombosis. Stroke and neurologic complication rates were similar between the groups.