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Journal and News Scan
August 14, 2015
Submitted by: J. Rafael Sadaba
This is an observational outcome study for the comparative effectiveness of SAVR–TAVR procedures for the treatment of severe aortic stenosis at 93 Italian centers. From the entire cohort of 5468 patients, 650 pairs of patients who underwent SAVR and transfemoral TAVR with similar baseline demographic and clinical characteristics were obtained using a propensity score method.
The primary endpoints of this analysis were death from any cause, and major adverse cardiac and cerebrovascular events (MACCE) at 1 year. Transfemoral TAVR was comparable to surgical replacement with respect to 1-year rates of death from any cause, MACCE, and repeat hospitalization due to cardiac reasons. Nevertheless, in the TAVR group there was a higher incidence of paravalvular leak, major vascular damage and need for pacemaker.
August 14, 2015
Submitted by: Arie Blitz
The Texas Heart Institute reports its experience with 27 patients with prior continuous flow LVADs who had undergone varying degrees of device explantation. Although the numbers are small, the explantation methods ranged from near-complete device removal to driveline transection and removal. In general, the device explantation technique has evolved over time to a progressively less invasive option. This experience provides justification for a tailored approach, but lesser degrees of device removal appear to be well tolerated. The exception may be patients with chronic device infection: 6 of 10 patients with superficial driveline infection required further procedures for either debridement or removal of infected device material. More radical explantation of device material is recommended in these patients.
August 12, 2015
Submitted by: Arie Blitz
A single institution retrospectively reviewed the correlation of preoperative serum albumin level with outcomes after LVAD implantation from 2006 to 2014. A lower albumin level was associated with a significant increase in postop renal failure and prolonged hospitalization, but not overall short-term and long-term survival.
August 11, 2015
Submitted by: Mark Ferguson
This single institution retrospective study evaluated the relationship of adenocarcinoma subtype to long-term survival after resection of stage I lung cancer. Patients with solid-predominant tumors experienced recurrences earlier, more often in distant sites, and more often in multiple locations. This subtype was also independently associated with worse post-recurrence survival.
August 9, 2015
Submitted by: Lisa Brown
Case series of 500 consecutive patients undergoing POEM from September 2008 through November 2013 at a tertiary referral center in Japan. At 2 month follow-up, the success rate was 91.3% (defined as Eckardt score < 2 or reduced > 4 points). Two hundred sixty-eight patients had esophagitis on endoscopy (64.7%), but only 71 (16.8%) had reflux symptoms. At 1-2 years, the success rate was 91%, 9 of 16 patients has esophagitis on endoscopy, and 19.4% had heartburn symptoms. Lastly, at 3 years the success rate was 88.5%, again 9 of 16 patients had esophagitis on endoscopy, and 56.3% had heartburn symptoms. Complications occurred in 16 patients (3.2%), the most severe being 1 pneumothorax requiring a chest tube and 1 case of bleeding controlled endoscopically but requiring blood transfusion; there were no deaths. The authors point out that one advantage of POEM over Heller myotomy is that the length of the myotomy can be better tailored to the individual patient.
August 6, 2015
Submitted by: Arie Blitz
This retrospective analysis of the BTT continuous flow (CF) LVAD experience from Harefield Hospital addresses the question: "What are the predictors of the requirement for an RVAD at the time of LVAD implantation?" Of the 152 patients included in the study, 23% underwent RVAD implantation. Of all the univariate predictors of the requirement of an RVAD, the two significant independent variables on multivariate analysis were the preop TAPSE (tricuspid annular plane systolic excursion) and the left atrial diameter. Of note, a TAPSE value of <12.5 mm had an 84% sensitivity and 75% specificity for predicting the requirement for an RVAD.
August 3, 2015
Submitted by: J. Rafael Sadaba
In this manuscript the authors describe their findings in a retrospective review of prospectively obtained 5-year follow up data on 353 patients undergoing transcatheter aortic valve implantation (TAVI) with the CoreValve prosthesis in 8 Italian centres.Transfemoral access was used in 317 patients (89.8%); in the rest of the patients in whom the transfemoral approach was not feasible, a trans-subclavian access was employed. During follow-up, there were 241 re-hospitalizations for cardiovascular reasons in 164 (46%) patients. Acute heart failure was the most frequently reason reported (42.7%), followed by requirement of permanent pacemaker implantation (17.4%). On transthoracic echocardiography, mean pressure gradients decreased from 55.6 ±16.8 mm Hg (pre-TAVI) to 10.3±6.5 mm Hg (in-hospital post-TAVI) (p < 0.001). Five-year survival was 45% and freedom from re-hospitalization for cardiac reasons was 54%. Signs of prosthetic failure were observed in 15 patients (4.2%). The presence of moderate or severe paravalvular regurgitation after TAVI was associated with increased late mortality. The authors concluded that the procedure appears to be an adequate and lasting resolution of aortic stenosis in selected high-risk patients.
August 3, 2015
Submitted by: Ruben Osnabrugge
The authors evaluated long-term outcomes of 468 patients who have undergone a Mustard- or Senning operation for transposition of the great arteries (TGA). They found that perioperative mortality was 30%, but 60% were still alive after 30 years of follow-up. Perioperative mortality increased with the presence of a ventricular septum defect, early experience with the procedure, and left-ventricular outflow obstruction After patients had survived the postoperative period, only pacemaker implantation was a predictor of long-term outcome (HR=1.90, p=0.04).
July 30, 2015
Submitted by: Mark Ferguson
The ESMO Guidelines Committee provides an update to its guidelines for evaluation and management of malignant pleural mesothelioma. They recommend against screening. A biopsy demonstrating tissue invasion is required for a definitive diagnosis. Definitions for different extents of surgical radicality are provided. No specific recommendations for the extent of surgery are provided, indicating the presence of equipoise at this time.
July 29, 2015
Submitted by: Arie Blitz
The University of Virginia group retrospectively analyzed all non-emergent cardiac cases performed at their center from 2008 to 2013, and separated the nonemergent cases into two groups: "Early start" cases had an incision time before 3 PM, and "late start" cases, after 3 PM. After controlling for case type, surgeon, year, and risk, late cases resulted in greater than double the operative mortality of early cases.