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Journal and News Scan
October 25, 2016
This single center review assessed the need for reintervention after pulmonary valve replacement with bioprostheses for congenital heart disease. Most patients had TOF, and most were in their teens or twenties. After correction for age, the Sorin Mitroflow valve required reintervention sooner and more often than the other two valves (Carpentier-Edwards Magna and MagnaEase, Carpentier-Edwards Perimount). Valve type was the only independent predictor of reintervention. See also: Pulmonary valve replacement for congenital heart disease: What valve substitute should we be using?
October 25, 2016
This retrospective single institution report examined outcomes of repair of large airway defects with bioprothetic materials. 8 patients underwent repair with aortic homograft or acellular dermal matrix, 5 of whom suffered from airway-enteric fistulae. Most repairs were buttressed with muscle or omentum. All airways healed; 2 required debridement of granulation tissue and 1 required dilation. See also: The search for a long-lasting circumferential tracheal conduit: Belsy's problem and ours
One-hundred eleven patients who underwent surgical repair of acute type A aortic dissection without preoperative malperfusion are analyzed for outcome with regard to arterial cannulation site, route of cerebral perfusion and surgeon’s specific experience. Potential biases are discussed.
The retrospective study includes 434 patients with total cavopulmonary connection. Clinical results and factors influencing the outcome are analyzed.
This retrospective monocenter analysis compares 30 patients with intraventricular rerouting and 29 patients with repair on arterial level for transposition of the great arteries associated with ventricular septal defect and left ventricular outflow tract (LVOT) obstruction. The strategy was chosen according to the individual anatomical situation. Freedom from reoperations on the right ventricular outflow tract was lower for patients with intraventricular rerouting whereas survival at 5, 10 and 15 years and LVOT reoperation rates were similar for both groups.
All patients undergoing surgical therapy for esophageal or gastric cancer in France 2010-2012 were evaluated for postoperative mortality stratified by comorbidity score and assessed by medical center volume (low, medium, high, very high). Most operations were performed in low volume centers. Mortality decreased linearly with increasing center volume. The linear decrease was present regardless of comorbidity score. Comparing low to very high volume centers, a 70% reduction in relative risk was present.
The authors explored the relationship of nodal region and survival from adenocarcinoma of the esophagus/GEJ in patients undergoing induction therapy and transthoracic resection. Survival diminished related to nodal status/region: highest for no nodes, followed in order by: local/regional, truncal, upper thoracic, and combined truncal and upper thoracic. They suggest that nodal location should be considered in future staging systems.
In this retrospective review, the authors queried whether a hiatal hernia (HH; >5cm) was associated with adverse outcomes after esophagectomy for cancer. After adjustment, they found that HH patients had a lower rate of complete resection and lower median survival. They also found that in patients with HH who received induction therapy the rate of perioperative mortality was higher than those without HH who underwent induction therapy, largely due to increased cardiopulmonary complications.
October 13, 2016
Submitted by: J. Rafael Sadaba
This is the first report of the use of a balloon expandable transcatheter heart valve (Edwards Sapiens 3) for TAVI in chronic aortic regurgitation (AR) involving non-calcified native valves. The authors implanted Edwards Sapiens 3 prostheses in three patients with severe AR deemed inoperable by the heart team. After the procedure, there was no more than trivial AR in any of the patients (one required post-procedure dilation). At one month all three patients were alive and in New York Heart Association functional class I or II. Transthoracic echocardiograms failed to show any valve displacement or paravalvular AR. The authors advise positioning the valve more ventricular than what is recommended for aortic stenosis and use of a balloon “slow inflation” technique.
October 13, 2016
Submitted by: Arie Blitz
This single-center study explored the relationship between spontaneous echo contrast (SEC) and the incidence of thromboembolism and CVA in 98 patients undergoing peripheral VA ECMO. Twenty-two percent of patients had SEC while they were on ECMO. Those exhibiting SEC had significantly higher rates of intracardiac thrombus (46% v. 13%, p = 0.002) and CVA (36% v. 7.9%, p = 0.002). The patients who showed SEC had a lower EF and less frequent aortic valve opening. Comment: Should we be venting the LV more frequently in VA ECMO? If so, how should we vent the LV? Alternatively, should we maintain a baseline level of inotropic support on these patients to discourage stasis in the LV?