Journal and News Scan

The Comprehensive Complication Index (CCI) was compared to more standard methods of categorizing complications for their utility in assessing outcomes after randomized surgical trials.  The CCI outperformed standard methods in 2 of 3 published randomized trials (pancreatic and esophageal surgery), demonstrating significant differences in outcomes whereas none was reported in the original trials.  The sample sizes needed to demonstrate differences using CCI are an order of magnitude lower than for traditional endpoints.

CHICAGO -- September 30, 3014 -- Among patients aged 50 to 69 years who underwent aortic valve replacement with bioprosthetic or mechanical prosthetic valves, there was no significant difference in 15-year survival or stroke, although patients in the bioprosthetic valve group had a greater likelihood of re-operation but a lower likelihood of major bleeding.

The findings are published in the October 1 issue of JAMA.

In older patients, bioprosthetic valves pose a low lifetime risk of reoperation for structural degeneration and avoid many of the complications associated with mechanical prostheses. Bioprosthetic valves are therefore recommended in patients aged older than 70 years. However, the optimal prosthesis type for younger patients is less clear.

Yuting P. Chiang, Mount Sinai Hospital, New York, New York, and colleagues used a state-wide administrative database to quantify differences in long-term survival, stroke, re-operation, and major bleeding episodes after aortic valve replacement according to prosthesis type.

This study assessed risk factors, frequency, and timing associated with readmission after cardiac surgery using data for 5,158 pts from 10 participating centers.  The overall readmission rate was 19%, and was highest for combined CABG and valve operations.  Readmissions were more common in the first 30 days after discharge (80% of total), and were most often due to fluid overload, infection, and arrhythmia.  Baseline conditions associated with readmission were female sex, AKI, COPD, diabetes, anemia, and prolonged operating time.

The New York State database was used to perform a retrospective analysis of outcomes for isolated AVR comparing bioprosthetic to mechanical valves.  Propensity matching was used to create 1001 patient pairs.  Survival  and stroke rates were similar between the groups at an average of 10.8 years follow-up.  The cumulative incidence of reoperation  was higher in the bioprosthetic group (12.1% vs 6.9%) but the cumulative incidence of major bleeding was lower in that group (6.6% vs 13.0%).