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Journal and News Scan
December 7, 2014
Submitted by: J. Rafael Sadaba
This manuscript reports on the findings of a meta-analysis of retrospective observational studies comparing clinical outcomes at 1-year in patients treated by either transfemoral (TF) or transapical (TA) transcatheter aortic valve implantation for sever aortic stenosis. Major vascular complications were more common in the TF group and 30-day hospital mortality was higher in the TA group. There were no significant differences at 1-year in all-cause mortality, incidence of myocardial infarction or incidence of stroke.
December 7, 2014
Submitted by: J. Rafael Sadaba
In this retrospective, multicentre study, the authors evaluate clinical outcomes in 139 patients with bicuspid aortic valves undergoing transcatheter aortic valve implantation (TAVI) with either a self or a balloon-expandable prosthesis. Short and intermediate clinical outcomes were encouraging, demonstrating the feasibility of TAVI in this group of patients. The mean finding was a high prevalence (28.4%) of post procedural more than grade II aortic regurgitation (AR). Nevertheless, when the measures for sizing had been obtained with multislice computed tomography, more than grade II AR was detected in 17.4% of the patients. No significant differences were found between self and balloon-expandable prosthesis.
December 7, 2014
Submitted by: J. Rafael Sadaba
In this prospective randomized study from the Cardiothoracic Trials Network Investigators, the authors compare the results between CABG alone and CABG plus mitral valve repair in 301 patients with ischemic moderate mitral insufficiency and coronary artery disease. In these patients, the addition of mitral valve repair with a rigid or semirigid complete annuloplasty ring to CABG, was not associated with greater improvement in the left ventricular end-systolic volume index (primary endpoint) at 1 year. There were also no significant differences between the groups in mortality, the composite end point of cardiac or cerebrovascular events, readmissions, or quality of life. There were more neurological events in the CABG plus repair group. The authors conclude that, at one-year follow up, there is no meaningful advantage in adding mitral valve annuloplasty in patients with moderate ischemic mitral insufficiency undergoing CABG.
December 6, 2014
Submitted by: Mark Ferguson
A hot topic at the recent meeting of the RSNA (Radiological Society of North America) was the implementation of LungRADS, a scoring system for categorizing lesions on CT, to be utilitized as part of CT screening for lung cancer. Scans are assigned to one of 5 categories, ranging from incomplete to 4A (suspicious, follow-up or further testing warranted) and 4B (highly suspicious, further evaluation warranted).
December 3, 2014
Submitted by: Mark Ferguson
This single institution study evaluated the effects of 24-hr in hospital congenital cardiac surgery coverage on outcomes for perioperative congenital heart surgery ECMO. Institution of 24-hr coverage reduced hospital mortality from 68% to 43% as well as rates of cardiac arrhythmias and pneumonia. 24-hr coverage was independently associated with a reduced risk of mortality.
December 3, 2014
Submitted by: Mark Ferguson
This study used data from the International Registry of Acute Aortic Dissection to explore the rates and outcomes of root replacement vs more conservative management in patients with acute type A dissections. Root replacement patients were younger, had greater root diameter, were more often affected by Marfans, had a higher incidence of AI, and were more often affected by shock/hypotension/tamponade. Root replacement had no detrimental affect on hospital mortality or 3-year survival.
December 3, 2014
Submitted by: Mark Ferguson
This study examined the effect of the introduction of TAVR on overall AVR rates in the US using the STS and STS/ACC registries. From 2008 to 2013, AVR rates increased at hospitals performing TAVR by 69%, including a 22% increase in surgical AVR; the latter increase was primarily in low- and moderate-risk patients. In contrast, non-TAVR hospital AVR volume increased by 16%. Overall survival rates improved during the period in both settings.
December 3, 2014
Submitted by: Mark Ferguson
Program directors from 6 distinctly different training centers assessed educational costs for CT resident training. Before formal accounting information was explored, the PDs estimated the annual cost per resident to be $250,000. The actual costs per year per resident ranged from $330,000 to $667,000, with a mean of $483,000. Faculty teaching costs made up more than half of the total costs, whereas simulation costs comprised 0 to $80,000. The contributions of the residents to program savings averaged $37,000.
December 3, 2014
Submitted by: Mark Ferguson
This study explored recent patterns of surveillance imaging 4-8 mos after surgical treatment of early stage lung cancer using the SEER database. Initial imaging consisted of CXR (60%), CT (25%) and PET (3%). 13% of patients received no imaging. NCCN guidelines adherence for receipt of CT was 47%, but increased from 28% to 60% over the period of study. Adherence was reduced in pts with stage I disease and those who had surgery as a single treatment modality.
December 3, 2014
Submitted by: Mark Ferguson
This study determined the relationship of pre-hospital use of epinephrine during resuscitation to survival in patients who experienced return of spontaneous circulation after out of hospital cardiac arrest. 73% received epinephrine, and 17% of those patients experienced a good outcome (discharged alive with good neurologic status). Of those who did not received epinephrine, 63% had a good outcome. There was a dose-response effect. Delayed administration of epinephrine had the worst outcomes.