Journal and News Scan

Data from 20 observational studies including nearly 3000 pts were reviewed to assess the prevalence of pre-frailty/frailty and clinical outcomes in older cancer patients.  Frailty was identified in 42% and pre-frailty in 43% of patients.  Combined frailty was associated with increased all cause mortality (5-yr HR 1.57), postoperative mortality, and postoperative complications.

This is a matched case controlled study of 27 consecutive patients with severe symptomatic aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) with the SAPIEN 3 (SV3)device in 2 centers. These patients were matched with patients who had undergone TAVI with the 26-mm SAPIEN XT (SXTV) who were drawn from a prospective database of 270 consecutive patients.

The rate of balloon postdilation after valve implantation was higher in the SXTV group compared with the S3V group (p = 0.047). In the S3V group, only 2 patients (7%) had a paravalvular leak graded as mild or greater, compared with 42% of the patients in the SXTV group (p = 0.002). In the univariate analysis, the implantation of the S3V was the only factor associated with no/trace paravalvular leaks after TAVI.

This retrospective study evaluated results of transthoracic (TTE) vs transhiatal (THE) esophagectomy in patients with squamous cell cancer and adenocarcinoma from two high volume centers. Prospensity score matching was used.  TTE yielded a higher R0 resection rate and higher numbers of nodes dissection.  TTE was associated with improved survival for T3 tumors and for patients with node-positive disease.

Selzman and colleagues provide an outstanding overview of the state of the art of bridge to recovery, describing a paradigm shift that has been occurring.  A consistent theme over the years is that recovery likelihood is enhanced in younger patients, those with non-ischemic cardiomyopathy, and those who have had HF for shorter durations.  Although the INTERMACS database reflects that only about 1% of patients are successfully bridged to recovery, several studies have demonstrated that more patients may be recovered if a proactive approach is undertaken.  Such an approach necessarily includes the early identification of potential candidates for removal, the modification of the surgical approach to facilitate later device removal, an active surveillance program, the institution of intensive adjuvant medical therapy, the adoption of standardized weaning protocols, and further exploration of less invasive techniques for removal.  The authors effectively argue that only with a wholesale expansion of such a paradigm shift will more patients be successfully weaned.  The devil--of course--lays in the details. The ongoing RESTAGE-HF trial will hopefully elucidate some of these details.