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Journal and News Scan
November 9, 2014
Submitted by: Arie Blitz
The correlation between "field independence"--i.e., the ability to ignore distracting visual stimuli--and surgical skills was examined in this simulator model. Resident participants, after undergoing field dependence testing, were asked to place curved needles in a mitral valve model at 10 premarked sites. The residents were assessed on their ability to load the needle on the driver at the appropriate angle. The accuracy of needle loading correlated significantly with the relative field independence of the residents.
Questions:
1. If this methodology is validated in a larger study, would it prove useful in resident training?
2. How about as a factor in resident selection?
November 7, 2014
Submitted by: Arie Blitz
The Cardiothoracic Surgical Trials Network recently reported that a third of patients after mitral valve repair for ischemic MR developed at least moderate recurrent MR at 1 year following surgery. This begs the question as to which patients with ischemic MR would benefit from repair vs. replacement. The present publication explored the development of a model to discriminate those patients that were more likely to develop recurrent MR following repair. The model included the following preoperative variables: age, BMI, sex, race, EROA, basal aneurysm/dyskinesis, NYHA, history of CABG, PCI, or ventricular arrhythmias. The model demonstrated good discrimination with an area under the ROC curve of 0.82.
November 7, 2014
Submitted by: Arie Blitz
A multicenter, randomized, controlled trail including 900 patients divided patients into those undergoing on-pump versus off-pump CABG. Identical heparinization and heparin reversal protocols were followed. At angiography at 6 months following CABG, graft patency was inferior after off-pump as compared to on-pump revascularization. In the off-pump group, 21% of the grafts were either stenotic or occluded; in the on-pump group, 14% were either stenotic or occluded.
November 6, 2014
Submitted by: J. Rafael Sadaba
This is a new “real-world” study comparing bleeding risk in Medicare patients treated with dabigatran (n=1302) and warfarin (n=8102) for newly diagnosed atrial fibrillation. The use of dabigatran was associated with a significantly higher risk of any, major, and gastrointestinal bleeding when compared with warfarin. On the contrary, intracraneal bleeding was significantly less common among patients on dabigatran.
November 6, 2014
Submitted by: Mark Ferguson
The authors performed a single center review to assess outcomes of thoracentesis for inpatients. For 9,320 thoracenteses in 4,618 patients the incidence of adverse outcomes was quite low: pneumothorax 0.6%, reexpansion pulmonary edema 0.01%, and bleeding 0.2%. Current guidelines may not be aligned with outcomes of expert clinical practice.
November 5, 2014
Submitted by: Mark Ferguson
The authors examined cost-effectiveness in the National Lung Screening Trial (NLST), examining incremental cost-effectiveness ratio (ICER) and quality-adjusted life years (QALYs) associated with low dose CT screening. The ICER was $52,000 per life-year gained and the $81,000 per QALY gained. These values were very sensitive to variations in the screening algorithms.
November 5, 2014
Submitted by: Mark Ferguson
Long-term QOL outcomes were assessed in a single institution cohort of 63 patients undergoing colon interposition after esophagectomy. 48% of pts had a vagal sparing operation, and resection was performed for cancer in the majority of the pts. Followup median was 13 yrs. Mean SF36 scores were above the published average and GI QOL was 3 out of 4. 84% or more of pts were free of dysphagia, heartburn, and regurgitation. 40% had early satiety. 7 pts required reoperation for redundancy.
November 5, 2014
Submitted by: Mark Ferguson
The potential benefit of wedge resection vs anatomic resection for stage I and II lung cancer was examined using propensity score matching for pts from the STS Database. Over 3700 pts were matched in each group. Wedge resection was associated with fewer major complications (4.5% vs 9.0%) and lower mortality (1.2% vs 1.9%). Wedge resection reduced pulmonary but not cardiovascular or neurologic complications. The morality reduction for wedge resection was mainly evident in patients with impaired lung function. Cancer outcomes were not assessed, and the relative overall benefit of wedge vs anatomic resection remains to be determined.
November 5, 2014
Submitted by: Mark Ferguson
Challenges of balancing reduced costs and improved quality were explored for congenital heart surgery linking clinical data from STS Congenital Heart Surgery Database patients to administrative data from the Pediatric Health Information Systems Database. Excess costs associated with any complication were over $56,000, and this increased to more than $132,000 for major complications. The major contributors to excess cost were tracheostomy, pulmonary complications, renal failure, reoperation, and the need for mechanical circulatory support. The Norwood operation offered the greatest opportunity to reduce costs by reducing complications.
November 5, 2014
Submitted by: Mark Ferguson
The authors explored the impact of wait time for AVR in patients with severe symptomatic aortic stenosis using a single institution database. For patients who were recommended to undergo AVR, wait time mortality at 3 weeks was 1.2% for those scheduled for AVR and 6.9% for those who declined AVR. Wait time mortality for pts undergoing AVR was 3.7% at 3 mos and 11.6% at 6 mos. Prolonged wait time mortality was higher than surgical mortality.