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Journal and News Scan
September 4, 2015
Submitted by: Mark Ferguson
This study from the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative evaluated outcomes of CABG in 33 hospitals 2011-2013, assessing the association of blood transfusion (39.9% of pts) and the incidence of postoperative pneumonia (3.6% of pts). Blood transfusion was associated with an increased risk of pneumonia (OR 3.4), and there was a dose-response relationship between the number of units transfused and pneumonia risk.
September 4, 2015
Submitted by: Mark Ferguson
Short- and mid-term outcomes of TAVR for nonagenarian (>90 years) patients in the PARTNER-1 trial were assessed for 531 pts. MACE occurred in 35% including stroke in 3.6%. Important paravalvular leak occurred in 1.4%. 30-day mortality was 4% and 3-year mortality was 48%, which compared to 44% in a matched population. QOL stabilized at 6 months and was better than preop. A trans-apical approach had a higher risk of 30-day and 3-year mortality.
September 4, 2015
Submitted by: Mark Ferguson
Long-term outcomes of endovascular (EVAR) and open repair of abdominal aortic aneurysm (AAA) were compared using a California-based dataset including more than 23,000 pts. Postoperative outcomes were better with EVAR, and survival at 3 years was better with EVAR. After 3 years, mortality was higher for EVAR, and EVAR was associated with higher rates of reintervention and of late AAA rupture.
September 3, 2015
Submitted by: Ruben Osnabrugge
The authors of this study compared quality of life in patients at increased surgical risk who underwent either transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). Quality of life was assesed in 795 randomized patients using the Kansas City Cardiomyopathy Questionnaire, the Medical Outcomes Study Short-Form 12 Questionnaire, and EuroQOL 5-dimension questionnaire. They found that quality of life at 1 year was similar in the two groups. However, sooner after the procedure (1 month) there was a quality of life benefit of femoral TAVR compared with SAVR. This early benefit over SAVR was not seen in patients that were treated with non-iliofemoral TAVR.
August 30, 2015
Submitted by: Tom C. Nguyen
Multicenter trial examining the efficacy of a miniaturized and fully self-contained leadless pacemaker percutaneously implanted into the right ventricle. The leadless pacemaker met prespecified pacing and sensing requirements with 1 in 15 patients experiencing adverse device related events.
August 26, 2015
Submitted by: Marcelo Jimenez
Investigators from Stanford developed a nine-gene expression predictor for survival outcome in early-stage nonsquamous NSCLC. They developed and validated a quantitative real-time polymerase chain reaction assay easily applicable to routinely obtained paraffin-embedded tumor specimens. Because the molecular prognostic index provides independent prognostic information when compared with standard clinical and pathologic covariates (age, sex, and stage), the authors decided to combine both in order to create a more robust risk index. These findings will be useful for assessing recurrence risk for patients with nonsquamous NSCLC and could guide indications for adjuvant treatment in order to improve outcomes for high-risk patients.
August 22, 2015
Submitted by: Mark Ferguson
Outcomes of robotic vs nonrobotic cardiac surgery were evaluated using 1:2 propensity score matching of patients in the Nationwide Inpatient Sample. Operations included valves/septae (10%), coronary arteries (47%), and other. Mean costs were 7.5% higher for robotic cases. Robotic procedures had shorter length of stay (5 vs 6 days), lower mortality (1.0% vs 1.9%), and fewer complications (27% vs 30%).
August 22, 2015
Submitted by: Mark Ferguson
Among patients with blunt trauma, the authors studied the implications of pneumomediastinum identified on CT. The incidence was 2.2%. Pneumomediastinum was associated with a 4-fold increase in mortality, a 2-fold increase in length of stay, and a 3-fold increase in ICU stay. Air in the posterior mediastinum, air in all mediastinal compartments, and pneumomediastinum associated with a hemothorax were each associated with an increased risk of mortality.
August 22, 2015
Submitted by: Mark Ferguson
This comprehensive review outlines changes in the WHO classification of lung tumors, chagnes that will affect our clinical practice in the near future.
August 20, 2015
Submitted by: Lisa Brown
Thus far, only 3 randomized controlled trials (RCTs) have compared stereotactive ablative radiotherapy (SABR) versus surgery in patients with early stage NSCLC (STARS trial, ROSEL trial, and ACOSOG Z4099 trial). Unfortunately all 3 were unable to meet the accrual goals and were closed early. The current study is a pooled analysis of patients in the STARS trial and ROSEL trial (n=31 in SABR group and n=27 in surgery group). All patients had clinical stage I NSCLC (<4 cm) and were surgical candidates for lobectomy with a performance status of 0 to 2. Of note, patients in the STARS trial required histologic confirmation of NSCLC prior to randomization, but patients in the ROSEL trial did not. Overall 1 and 3-year survival was 100% and 95% in the SABR group and 88% and 79% in the surgery group. There was no significant difference in local, regional, or distant metastases or recurrence-free survival between the two groups. In terms of complications, in the SABR group, 3 (10%) patients had treatment related grade 3 adverse events. In the surgery group, one patient died of complications and 12 (44%) had postoperative grade 3-4 adverse events. The authors concluded that SABR is better tolerated and may lead to improved survival over surgery in patients with stage I NSCLC.