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Journal and News Scan

Source: American Heart Association
Author(s): Dr Michael Acker

The trial was a randomised, prospective, non-blinded, multi-institutional study of patients undergoing surgery for severe ischaemic mitral regurgitation with or without coronary revascularisation,” Dr Acker reported. A total of 251 patients were recruited, with approximately half undergoing mitral valve repair and half undergoing replacement. While there was no difference in efficacy or main safety outcomes, there was a difference in the percentage of patients experiencing a recurrence of IMR - 32.6% in the repair group versus 2.3% in the replacement group (p<0.001).

Source: JAMA Internal Medicine
Author(s): Edward F. Patz Jr; Paul Pinsky; Constantine Gatsonis; JoRean D. Sicks; Barnett S. Kramer; Martin C. Tammemägi; Caroline Chiles; William C. Black; Denise R. Aberle; for the NLST Overdiagnosis Manuscript Writing Team

This study examined the rate of overdiagnosis (detection rate of indolent tumors) of lung cancer in the NLST.  They found that 18% of all lung cancers detected were of the indolent type, and nearly 79% of the bronchioalveolar cancers were likely indolent. 

Source: Annals of Thoracic Surgery
Author(s): John M. Stulak, Salil Deo, John Schirger, Keith D. Aaronson,Soon J. Park, Lyle D. Joyce, Richard C. Daly, Francis D. Pagani

This study of 389 pts receiving a continuous flow LVAD evaluated the risk of thromoembolic (TE)complications associated with preop AF.   TE occured in 25% of pts; freedom from TE at 2 years was 46% in those with AF and 72% in those without AF (p<0.001).  AF did not affect late survival.

Source: Annals of Thoracic Surgery
Author(s): Surgery Claude A. Beaty, Kara A. Haggerty, Madeline G. Moser, Timothy J. George,Chase W. Robinson, George J. Arnaoutakis, Glenn J. Whitman

This behavioral modification study covered 6 months at a single institution during which 144 pts underwent 510 transfusion events.  Cardiac surgeons agreed on a Hgb cutoff value of 8 as an indication for transfusion (massive transfusions were excluded).  Surgeons received weekly feedback as to their practice patterns.  Compared to baseline, feedback resulted in a 63% reduction in transfusions and an increase in single transfusions from 77% to 90%.   

Source: Gizmodo
Author(s): Ashley Feinberg

Researchers at Tsinghua University in Beijing have taken a potentially wildly complicated problem and come up with a (relatively) simple solution by injecting the heart with gallium, a chemically stable metal that melts at about 85 degrees Fahrenheit. In other words, it has no problems flowing through the labyrinthine vessels of the heart.

Source: JAMA Internal Medicine
Author(s): Ilke Sipahi; M. Hakan Akay; Sinan Dagdelen; Arie Blitz; Cem Alhan

This meta-analysis compared outcomes of PCI vs CABG in patients with multivessel disease, evaluating studies that were not individually powered to detect survival differences. 6 RTC including 6055 pts were analyzed. Significant benefits for CABG were associated with overall mortality, MI, and the need for revascularization.

Source: Journal of the American College of Cardiology
Author(s): Sadat U, Usman A, Gillard JH, Boyle JR.

The use of pharmaceutical strategies to prevent contrast-induced acute kidney injury continues to be an unresolved matter. In this manuscript the authors describe their findings of a systematic review with a meta-analysis on the prevention of this type of injury with ascorbic acid. They conclude that ascorbic acid appears to be nephro-protective against contrast-induced acute kidney injury.

Source: Journal of Thoracic Oncology
Author(s): Collaud, Stéphane; Waddell, Thomas K.; Yasufuku, Kazuhiro; Pierre, Andrew F.; Darling, Gail E.; Cypel, Marcelo; Rampersaud, Yoga R.; Lewis, Stephen J.; Shepherd, Frances A.; Leighl, Natasha B.; Cho, John; Bezjak, Andrea; Tsao, Ming Sound; Keshavjee, Shaf; de Perrot, Marc

This article describes outcomes of en bloc resection of superior sulcus tumors invading the spine in 48 pts from multiple centers operated on during a 22 year period. Most pts received induction chemotherapy and radiation therapy. Complete resection was achieved in 88%, and 5-year survival was 61%. Surgical mortality was 6%. The primary determinant of survival was complete response to induction therapy.

Source: Annals of Thoracic Surgery
Author(s): Javariah Siddiqui, Christian P. Brizard, Igor E. Konstantinov, John Galati, Gavin Wheaton, Michael Cheung, Stephen Horton, Yves d'Udekem

Bicuspid AV repair was performed in 146 pts over a period of 34 years; the primary indication was stenosis. Survival at 20 yrs was 88%. Freedom from reintervention at 18 yrs was 43%. 30 additional pts without reintervention had moderate to severe stenosis or moderate regurgitation at last follow-up.

Source: Annals of Thoracic Surgery
Author(s): Ho Young Hwang, Kwang Ree Cho, Ki-Bong Kim

The patency and clinical outcomes of the right internal thoracic artery (RITA) and right gastroepiploic artery (RGEA) as Y-grafts to the LIMA in situ were evaluated in 443 pts using propensity score matching. Graft patency, overall survival, and freedom from reintervention rates were similar for the two groups.