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Journal and News Scan

Source: J Thorac Cardiovasc Surg. 2016 Apr;151(4):1081-9
Author(s): Rosenblum JM, Harskamp RE, Hoedemaker N, Walker P, Liberman HA, de Winter RJ, Vassiliades TA, Puskas JD, Halkos ME
This article is a propensity matched analysis comparing patients undergoing hybrid coronary revascularization (HCR) with minimally invasive left internal mammary artery to left anterior descending artery (LAD) bypass and percutaneous coronary intervention (PCI) to non-LAD arteries to patients undergoing conventional coronary artery bypass grafting (CABG) with either single (SIMA) or bilateral internal mammary arteries (BIMA).  A total of 306 patients underwent HCR from 2003 to 2013 compared with 8254 patients undergoing CABG.  In the HCR group LIMA harvest was performed endoscopically before 2009 and with robotic assistance thereafter.   In the matched study populations, cardiopulmonbary bypass was used in 0% of patients in HCR group, 21% in SIMA group and 7% in BIMA group.  Patient factors that were associated with HCR use were older age, lower body mass index, history of PCI, and 2-vessel coronary disease. In the HCR group, 84% of non-LAD lesions were treated with drug eluting stents.  At 30 days, there was no significant difference in major cerebrovascular and cardiac events between groups.  In hospital complications,  the need for blood transfusions, and hospital stay duration were lower for the HCR group.  There was no difference in survival between the matched groups at midterm followup (median follow-up 2.8 years).   The authors conclude that HCR in selected patients may be a safe and less invasive alternative to conventional CABG with similar short and midterm outcomes.
Source: JACC: Heart Failure
Author(s): Jacqueline Baras Shreibati, Jeremy D. Goldhaber-Fiebert, Dipanjan Banerjee, Douglas K. Owens, Mark A. Hlatky
With the everpresent question of potentially extending LVAD therapy to ambulatory patients with advanced heart failure, the authors--using a Markov model--projected the incremental cost-efffectiveness ratio (ICER) of DT LVADs in this population as compared to conventional medical therapy.   The authors find that, although LVADs clearly extend quality-adjusted life-years (QALYs), the ICER is >$200K per QALY.  (Conventional cut-offs for ICER acceptability range from <$50K to <$100K.)  This ICER is thus cost-ineffective at present.   The study finds that this excessive cost is driven predominantly by follow-up care and readmissions, which suggests a potential target for improving ICER in the future.
Source: AORTA, August 2016, Volume 4, Issue 4:124-130
Author(s): Curtis AE, Smith TA, Ziganshin BA, Elefteriades JA
A comprehensive discussion on an important parameter for cardiologists and surgeons dealing with congenital and structural / valve disease, as applicable to the systemic circulation 
Source: The Thoracic and Cardiovascular Surgeon
Author(s): Henning Gaissert, Susan R. Wilcox
 This review discusses diaphragmatic disorders and postoperative respiratory failure caused by unilateral or bilateral diaphragmatic impairment. 
Source: European Journal Cardio-Thoracic Surgery
Author(s): Luis Angel Hernandez-Arenas, Lei Lin, Yang Yang, Ming Liu, William Guido, Diego Gonzalez-Rivas, Gening Jiang, and Lei Jiang
There is a rediscovered interest in use of a subxiphoid incision to perform lung surgery. This work follows a review of 105 lobectomies published in March 2016 in the Journal of Thoracic Disease from the same institution, Shanghai Pulmonary Hospital. Although technical limitations exist when compared with transthoracic VATS and despite patient selction being more restrictive than for traditional surgery, the authors demonstrate the feasibility of anatomical lung resection for benign or malignant disease through the subxyphoid port. The conversion rate is acceptable (5.2%) and no post operative mortality in 153 cases (lobectomies and segmental resections) was observed. One of the main outcomes considered is post operative pain.
Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Blackstone EH
A most easily read brief editorial explaining in simple terms the power of a study, bootstrapping and the CLINICAL significance of risk factors in multivariate analysis. The author explains that the number of events defines the effective desirable sample size, not the number of individuals included in studies.
Source: The American Journal of Cardiology
Author(s): Nara Y, Watanabe Y, Kozuma K, Kataoka A, Nakashima M, Hioki H, Kawashima H, Nagura F, Shirai S, Tada N, Araki M, Naganuma T, Yamanaka F, Yamamoto M, Hayashida K.
The authors report on their findings an ongoing Japanese multicentre prospective registry. They evaluate outcomes in 478 patients undergoing transfemoral  TAVI and treated with percutaneous puncture using an expandable sheath, Edwards Sapien XTprosthesis and a Perclose ProGlide system. The primary outcome was percutaneous closure device (PCD) failure. The secondary outcome was the relation between PCD failure and the clinical outcomes (30-day and mid-term mortality rates and the length of hospital stay). PCD failures occurred in 36 patients (8%) and were not associated with the 30-day or the mid-term mortality rates. PCD failures can be predicted by the sheath-to-femoral artery ratio (SFAR). An SFAR threshold of ≥ 1.03 is the recommended cut-off point when PCD and an eSheath are used. Thus, this cut-off value may contribute to the selection of the sheath size, vascular access site, and method of approach.
Source: Journal of Cardiac Surgery
Author(s): Piotr Mazur, Salvior Mok, Amar Krishnaswamy, Samir Kapadia, Jose L. Navia
Mitral valve disruption is a rare but serious complication of MitraClip insertion. This review provides an update on surgical interventions following MitraClip failure, and discusses possible valve injuries and surgical approaches.
Source: Journal of Cardiac Surgery
Author(s): Zhiwei Xu, Qiuxia Shi, Ju Mei, Yan Tan
This study examines the outcomes of bioprosthetic tricuspid valve replacement in patients with tricuspid valve infective endocarditis. Full text available.   
Source: Annals of Thoracic Surgery
Author(s): Alfonso Fiorelli, Giovanni Messina, Paolo Chiodini, Saveria Costanzo, Andrea Viggiano, Marcellino Monda, Giovanni Vicidomini, Mario Santini
Physiologic changes associated with sympathectomy for palmar hyperhidrosis were assessed in this randomized trial comparing T3 ganglionectomy to division of the sympathetic chain at T2 and T3.  Outcomes were assessed using Holter monitoring.  Clinical outcomes were similar between the groups.  Electrophysiologic changes representing vagal activity measurements were more common in the ganglionectomy group.