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Journal and News Scan

Source: Annals of Thoracic Surgery
Author(s): James Huang, Amy E. Logue, Jamie S. Ostroff, Bernard J. Park, Mary McCabe, David R. Jones, Manjit S. Bains, Nabil P. Rizk, Mark G. Kris, Valerie W. Rusch

This single institution study tracked outcomes of a unique lung cancer survivorship program facilitated by a nurse practitioner who was trained in survivorship care.  The nurse took over follow-up care of early stage patients who survived disease-free for more than 1 year.  92% of eligible pts received follow-up care by the nurse.  The program identified 72% of second primary cancers and 91% of cancer recurrences during scheduled follow-up CT scans.  The program appeared effective and achieved high patient acceptance, and was an alternative to physician-led follow-up. 

Source: JACC Cardiovascular Interventions
Author(s): Pereg D, Fefer P, Samuel M, Wolff R, Czarnecki A, Deb S, Sparkes JD, Fremes SE, Strauss BH

 

 

 

. – In contrast to the large body of information regarding graft patency, data regarding atherosclerosis progression and vessel patency in surgically bypassed native coronary arteries are less clear. The aim of this study was to determine native coronary artery patency 1 year after coronary artery bypass grafting, and to identify clinical and angiographic predictors for the development of a chronic total occlusion (CTO). Researchers found that CTO of surgically bypassed coronary arteries 1 year after coronary artery bypass grafting is extremely common.

Methods

  • Of the 440 patients who underwent 1–year follow–up angiography as part of the multicenter RAPS (Radial Artery Patency Study), this study included 388 patients (88%) for whom angiograms were available for review.
  • Angiograms were reviewed for native coronary artery patency in an independent blinded manner.

 

Results

  • On the pre–operative angiogram, CTO of at least 1 native coronary vessel was demonstrated in 240 patients (61.9%) having 305 occluded vessels.
  • At 1 year after coronary artery bypass grafting, at least 1 new native coronary artery CTO occurred in 169 patients (43.6%).
  • In 7.5% of patients, the native artery and the graft supplying that territory were both occluded.
  • A new CTO was almost 5 times more likely to occur in coronary vessels with a pre–operative proximal stenosis >90% compared with vessels with proximal stenosis <90% (45.5% vs. 9.5%, respectively, p<0.001).
  • Patients with a new CTO had significantly more baseline Canadian Cardiovascular Society class 4 angina compared with patients without a new CTO.
  • A new CTO was less likely to occur in the left anterior descending artery (18.4%), supplied by the left internal thoracic artery.
  • When comparing radial artery and saphenous vein grafts, neither the type of graft nor graft patency had any association with native coronary artery occlusion.

 

Source: American Journal of Transplantation,
Author(s): American Journal of Transplantation,

 

 

Dall CH, et al. – The authors compared the effects of 12 weeks' HIIT versus continued moderate exercise (CON) on exercise capacity and chronotropic response in stable HTx recipients >12 months after transplantation in a randomized crossover trial. In this study the 5–month washout showed a significant loss of improvement. high–intensity interval training (HIIT) was well tolerated, had a superior effect on oxygen uptake, and led to an unexpected increase in HRpeak accompanied by a faster HRrecovery. This indicates that the benefits of HIIT are partly a result of improved chronotropic response.

 

Source: ABC News
Author(s): ABC news

 

Brighton Colorado in the story of -- dog who save lives but now need saving himself. K is an eight year old lab -- pit bull mix who spent several tours of duty sniffing out roadside bombs in Iraq and Afghanistan. With his handler army specialist Brandon Donahue at -- side.

They're everywhere he couldn't really go anywhere without finding one who is. And I estimated he saved a few thousand lives now -- much deserved retirement is threatened by -- tumor in his heart. Which if not corrected will likely kill the dog.

Surgery will cost more than 6000 dollars Donahue and his wife has started a fund raiser and are determined to get the job done. -- means a lot to me and no means a lot to him. To be able to -- live.

Source: ABC News
Author(s): ABC news

This remarkable dog served tours in Iraq and Afghanistan sniffing out bomb threats, and it is estimated he saved thousands of lives.  When he was diagnosed with a cardiac tumor, his handler decided to offer him heart surgery, and is raising money for this purpose. 

 

Source: Annals of Thoracic Surgery
Author(s): Tara Karamlou, Marshall L. Jacobs, Sara Pasquali, Xia He, Kevin Hill, Sean O'Brien, David Michael McMullan, Jeffrey P. Jacobs

The impact of center and surgeon volume on outcomes after arterial switch for TGV was investigated using data from the STS database. Median center and surgeon annual volumes were 4 and 2.   Both center and surgeon volume were important determinants of the composite outcome (death or major complication), with surgeon volume having the most important effect.

Source: Annals of Thoracic Surgery
Author(s): Jaimin R. Trivedi, Allen Cheng, Ramesh Singh, Matthew L. Williams, Mark S. Slaughter

The impact of continuous flow VAD on survival among patients awaiting heart transplant is not well known.  Pts on the UNOS list were propensity score matched 1:2 (HeartMate II vs no VAD). Wait list mortality was 10% during the 7.5 year study.  Use of a VAD improved survival to transplant at 1 (91% vs 77%) and 2 years (85% vs 68%).  Use of VAD as a bridge to transplant may improve survival and improve organ allocation.

Source: Annals of Thoracic Surgery
Author(s): Edward B. Savage, Paramita Saha-Chaudhuri, Craig R. Asher, J. Matthew Brennan, James S. Gammie

This study summarized data regarding valve use in over 1l,000 pts in the STS database who underwent aortic valve replacement for active endocarditis.  Nearly 75% of pts had no prior cardiac surgery.  Prior cardiac surgery was associated with a higher risk of root replacement (29.9% vs 7.2%), a higher rate of complications (68% vs 61%), and a substantially higher rate of operative mortality (21.1% vs 9.8%, unadjusted).  The use of biological valves increased over time. 

Source: Heart
Author(s): Khawaja MZ, Williams R, Hung J, Arri S, Asrress KN, Bolter K, Wilson K, Young CP, Bapat V, Hancock J, Thomas M, Redwood S.

In this retrospective study, the authors evaluate the effect of preprocedural significant mitral regurgitation (MR) on outcomes of patients undergoing transcatheter aortic valve implantation (TAVI) for sever aortic stenosis. In an overall series of 316 patients, 60 had been diagnosed with significant MR prior to the procedure. In multivariate Cox proportional hazards modelling, significant preprocedural MR was independently associated with 12-month and cumulative mortality. Following the procedure, 52.9% of the patients had less than grade 3 MR. Patients in whom MR improved had a better outcome than those with a worsening in MR.

Source: New England Journal of Medicine
Author(s): Otto CM, Prendergast B .

The authors of this review article provide an extensive overview of the curent state of play in the field of Aortic Stenosis. They discuss risk scores,treatment decisions, and up-to-date evidence of Transcatheter Aortic Valve Replacement.

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