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Journal and News Scan
The outcome of aortic valve replacement for patients with low gradient severe aortic stenosis and preserved ejection fraction is debated. The aim of the current study was to evaluate the effect of aortic valve intervention on survival in that group. The findings suggest that aortic valve intervention is associated with improved survival among patients with low gradient severe aortic stenosis and preserved left ventricle function. The presence of either a low or normal stroke volume index did not affect the mortality benefit.
Ischaemic heart disease is a major risk factor for heart failure. However, long–term benefit of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in those patients has not been well elucidated. In patients with heart failure with advanced coronary artery disease, CABG was a better option than PCI because CABG was associated with better survival benefit, particularly in more complex coronary lesions stratified by the SYNTAX score.
In this promising investigation, authors have found changes associated with airway cancerization in large airways in lung cancer patients, while these changes are absent in cancer-free smokers. And in addition, with shorter distance from tumors, airway cancerization expression increases statistically.
This study evaluated the use of ultrasound to assess diaphragm thickening, rather than diaphragm motion, to predict extubation success. Measurements were made in 63 ventilated patients, end-expiration and end-inspiration differences in thickness during spontaneous breathing were calculated, and the outcome was extubation within 48 hr. The ROC AUC was 0.79 for assessing weaning success (79% accuracy).
There are few instruments to assess patient-centered outcomes after lung transplant. The authors developed and validated a shortened version of the valued life activities disability scale for this population. The scale was devised using 140 lung transplant participants and was validated in 84 patients before and after transplant. The instrument takes only 3 min to complete, has good correlation with longer scales, has good internal consistency, correlates with physiologic parameters, and demonstrates expected improvement comparing before and after transplant states.
This manuscript reports on the 5-year outcomes in the 705 patients with left main (LM) lesions enrolled in the randomized arm of the SYNTAX trial. Follow-up data to 5 years were available in 96.9% of patients who underwent PCI and 92.5% of patients randomized to CABG. Total MACCE at 5 years was 36.9% in patients who received PCI compared with 31.0% in CABG patients (hazard ratio 1.23 [0.95, 1.59]; P=0.12) which was mainly related to differences in repeat revascularization. In the group of patients with high SYNTAX Scores (≥33), MACCE, as well as cardiac death, and revascularization were all significantly increased in patients receiving PCI; whereas stroke and MI occurred at similar rates between treatment arms. The findings suggest that PCI can provide equivalent long-term (to 5 years) death/stroke or MI to CABG, in particular in the subset of LM subjects with SYNTAX Scores <33.
This is an outstanding 20 minute video on all aspects of segmentectomy for lung cancer from one of the world's experts.
There is a whole free Journal on this issue which can be found at http://www.annalscts.com/issue/view/37
Bauters C, et al. – There are limited data on the prognosis of patients with stable coronary artery disease (CAD) in modern clinical practice. The mortality rate of patients with stable CAD in modern clinical practice is similar to that of the general population and is mostly due to noncardiovascular causes.
The purpose of this study was to assess the outcome of SA over 5 years and determine predictors for success over that period. This study demonstrated stable results of SA for AF over time with somewhat different predictors for 2– and 5–year NSR in a group of patients with complete follow–up at both time points. Accurate models to determine predictors for success of SA more than 2 years after surgery are essential to better understand long–term outcome for patients with AF.
Authors compared transcatheter aortic–valve replacement (TAVR), using a self–expanding transcatheter aortic–valve bioprosthesis, with surgical aortic–valve replacement in patients with severe aortic stenosis and an increased risk of death during surgery. In patients with severe aortic stenosis who are at increased surgical risk, TAVR with a self–expanding transcatheter aortic–valve bioprosthesis was associated with a significantly higher rate of survival at 1 year than surgical aortic–valve replacement.
- Authors recruited patients with severe aortic stenosis who were at increased surgical risk as determined by the heart team at each study center.
- Risk assessment included the Society of Thoracic Surgeons Predictor Risk of Mortality estimate and consideration of other key risk factors.
- Eligible patients were randomly assigned in a 1:1 ratio to TAVR with the self–expanding transcatheter valve (TAVR group) or to surgical aortic–valve replacement (surgical group).
- The primary end point was the rate of death from any cause at 1 year, evaluated with the use of both noninferiority and superiority testing.
- A total of 795 patients underwent randomization at 45 centers in the United States.
- In the as–treated analysis, the rate of death from any cause at 1 year was significantly lower in the TAVR group than in the surgical group (14.2% vs. 19.1%), with an absolute reduction in risk of 4.9 percentage points (upper boundary of the 95% confidence interval, -0.4; P<0.001 for noninferiority; P = 0.04 for superiority).
- The results were similar in the intention–to–treat analysis.
- In a hierarchical testing procedure, TAVR was noninferior with respect to echocardiographic indexes of valve stenosis, functional status, and quality of life.
- Exploratory analyses suggested a reduction in the rate of major adverse cardiovascular and cerebrovascular events and no increase in the risk of stroke.