Journal and News Scan

Long-term survival following coronary artery bypass grafting: off-pump versus on-pump strategies 
JACC - Journal of the American College of Cardiology, 04/18/2014  Evidence Based Medicine  Clinical Article

Although several large–scale clinical trials have compared the surgical outcomes between off–pump and on–pump CABG, the long–term survival has not been compared between the two surgical strategies in a reasonably sized cohort. To compare long–term survival after off–pump and on–pump coronary artery bypass grafting (CABG). In patients undergoing elective isolated CABG, on–pump strategy conferred a long–term survival advantage compared with off–pump strategy.

Methods

• Authors evaluated long–term survival data in 5203 patients (aged 62.9±9.1 years, 1340 females) who underwent elective isolated CABG (off–pump, n=2333; on–pump, n=2870) from 1989 through 2012.
• Vital statuses were validated from Korean National Registry of Vital Statistics.
• Long–term survival was compared with the use of propensity scores and inverse–probability–weighting to adjust selection bias.

Results

• Patients undergoing on–pump CABG had higher number of distal anastomoses than those undergoing off–pump CABG (3.7±1.2 vs. 3.0±1.1, P<0.001).
• Survival data were complete in 5167 patients (99.3%) with a median follow–up duration of 6.4 years (inter–quartile range, 3.7–10.5 years; maximum 23.1 years).
• During follow–up, 1181 patients (22.7%) died.
• After adjustment, both groups of patients showed a similar risk of death at 30–day (odds ratio, 0.70; 95% CI, 0.35–1.40; P=0.31) and up to one year (HR, 1.11; 95% CI, 0.74–1.65; P=0.62).
• For overall mortality, however, patients undergoing off–pump CABG were at a significantly higher risk of death (HR, 1.43; 95% CI 1.19–1.71; P<0.0001) compared with those undergoing on–pump CABG.
• In subgroup analyses, on–pump CABG conferred survival benefits in most demographic, clinical and anatomic subgroups compared with off–pump CABG

A brief case presentation is followed by an operative video detailing the technique for performing an aortic valve replacement in the setting of endocarditis. In this particular video, a pericardial patch is used to reconstruct the area of the commissure between the right and left coronary sinuses. A prosthetic tissue valve is then implanted. (Please see the companion video as well showing the operative technique for aortic root replacement in the setting of endocarditis: http://www.youtube.com/watch?v=5vPzaX... )

 The outcome of aortic valve replacement for patients with low gradient severe aortic stenosis and preserved ejection fraction is debated. The aim of the current study was to evaluate the effect of aortic valve intervention on survival in that group. The findings suggest that aortic valve intervention is associated with improved survival among patients with low gradient severe aortic stenosis and preserved left ventricle function. The presence of either a low or normal stroke volume index did not affect the mortality benefit.

In this promising investigation, authors have found changes associated with airway cancerization in large airways in lung cancer patients, while these changes are absent in cancer-free smokers. And in addition, with shorter distance from tumors, airway cancerization expression increases statistically.