This site is not optimized for Internet Explorer 8 (or older).
Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.
Journal and News Scan
Sun and colleagues investigated the relationship between low skeletal muscle mass and the prognosis of early-stage non–small cell lung cancer (NSCLC). In more than 300 patients with early-stage NSCLC, the truncal muscle index at the first lumbar vertebral level correlated with lower rates of recurrence-free and overall survival five years after resection. The authors conclude that the truncal muscle index could be useful to include in the preoperative assessment of patients for whom curative resection of NSCLC is planned.
Professor Yacoub and his team reported their experience with the use of the Mustard operation, in its original form and in a new modification designed to enhance the atrial functions and filling of the left ventricle.
In 5 years, 101 patients with transposition of the great arteries (TGA) underwent the Mustard operation, 86 with the new modification. The median age at operation was 16 months (6 months - 27 years), 75 patients were male (74.3%), and median preoperative oxygen saturation was 71%. There were no early deaths. Three patients died during a median follow-up of 24.2 months, all with large VSD and established pulmonary vascular disease. At latest follow up, all patients were in stable sinus rhythm. There were no baffle leaks. Seven patients had asymptomatic narrowing of the superior baffle, and one required balloon dilation. The authors report that follow-up is 100% complete and includes CT and MRI at regular intervals (75 patients to date). Analysis of representative subsets showed enhanced rate and pattern of left ventricle filling in the modified operation compared to the classic Mustard operation.
The authors conclude that the Mustard operation, particularly the modified technique, should play an important role in treating late-presenting patients with TGA. Improving the pattern of filling of the left ventricle could enhance the long-term results of the Mustard operation.
Heimeshoff and colleagues retrospectively analyzed the function of wearable cardioverter-defibrillators (WCDs) provided for 100 patients after cardiac surgery. Patients received a WCD if their left ventricular ejection fraction was 35% or lower, or if their implantable cardioverter-defibrillator (ICD) had been explanted. Left ventricular ejection fraction was improved from 28.9 ± 8% after surgery to 36.7 ± 11% at follow-up (p < 0.001). Ventricular arrhythmias occurred in 13% of patients. Three patients were successfully defibrillated, and WCDs did not give any inappropriate shocks. After the wearing period for the WCD was complete, 25 patients had an ICD implanted. The authors conclude that WCDs were effective in protecting patients against postoperative ventricular tachyarrhythmias.
The investigators published the final analysis of the MOMENTUM 3 trial comparing the fully magnetically levitated centrifugal continuous-flow HeartMate 3 pump to the mechanical-bearing axial continuous-flow HeartMate II pump. The composite primary end point was survival at two years free of disabling stroke or reoperation to replace or remove a malfunctioning device. The principal secondary end point was pump replacement at two years.
HeartMate 3 and HeartMate II were implanted in 516 and 512 patients, respectively. In the analysis of the primary end point, 397 patients (76.9%) with HeartMate 3, as compared with 332 (64.8%) with HeartMate II, remained alive and free of disabling stroke or reoperation to replace or remove a malfunctioning device at two years (relative risk, 0.84; 95% confidence interval [CI], 0.78 to 0.91; P<0.001 for superiority). Pump replacement was less common in the HeartMate 3 group than in the HeartMate II group (12 patients [2.3%] versus 57 patients [11.3%]; relative risk, 0.21; 95% CI, 0.11 to 0.38; P<0.001). The number of events per patient-year for stroke of any severity, major bleeding, and gastrointestinal hemorrhage were lower in patients with HeatMate 3 comparted to patients with HeartMate II.
These data show that among patients with advanced heart failure, the fully magnetically levitated centrifugal-flow HeartMate 3 was associated with less frequent need for pump replacement and superior survival free of disabling stroke or reoperation to replace or remove a malfunctioning device.
Raja and colleagues evaluated the return of symptoms and rate of reintervention following Heller myotomy for achalasia. Over a seven-year period, 248 patients underwent Heller myotomy. The majority of patients, 69%, experienced the return of at least one symptom during the follow-up period (median follow-up of 36 months), and 50 patients underwent 85 reinterventions. The majority of reinterventions were done endoscopically, and five-year freedom from reintervention was lowest for patients with type I achalasia. The authors conclude that it is important for patients to understand that Heller myotomy will likely only palliate achalasia symptoms, and they recommend lifelong postprocedural surveillance.
Andreas and colleagues report their experience of aortic valve replacement with rapid-deployment surgical aortic valves prostheses in 500 patients over seven years. The authors found a 0.8% 30-day mortality, and the valves showed excellent hemodynamic performance, durability, and safety with a median follow-up time of 12 months. Minimally invasive access was achieved in 47% of patients.
To date, there has been no unianimous method to calculate the diameter of the aorta prior to the occurence of type A aortic dissection. In this study, reseachers from Osaka, Japan, reported the efforts in developing equations for estimating the predissection diameters of the ascending aorta and the arch based on postdissection measurements. These equations have the potential of determining the size of stent grafts in the management of patients with type A dissection.
Endospan announced that it has received European CE Mark approval for its Nexus stent graft system for the endovascular repair of aortic arch disease comprising both aneurysms and dissections.
Nexus is a low-profile branched stent-graft designed and engineered specifically for the aortic arch to allow ease of deployment while achieving a durable effective repair and importantly minimizing the risk of stroke and other cardiovascular complications. It represents a major milestone, being the first low-profile branched endovascular stent-graft to be available off-the-shelf in Europe for endovascular repair of the aortic arch, especially for high-risk partients with complex arch pathologies.
Researchers of the Canadian Thoracic Aortic Collaborative (CTAC) analyzed the operative outcomes in 1653 patients (30% women) undergoing thoracic aortic surgery with hypothermic circulatory arrest between 2002 and 2017 in 10 institutions. Outcomes of interest were in-hospital death, stroke, and a modified Society of Thoracic Surgeons-defined composite (STS-COMP) for mortality or major morbidity (stroke, renal failure, deep sternal wound infection, reoperation, prolonged ventilation).
Compared with men, women were older (66 versus 61 years; P < 0.001) and had more hypertension and renal failure, but they had less coronary disease, less previous cardiac surgery, and higher ejection fractions. Rates of aortic dissection were similar between two genders, as were rates of hemiarch, total arch, and thoracoabdominal aortic repair. However, women had less aortic root reconstruction, including aortic root replacement, Ross, or valve-sparing root operations (29% versus 45%; P < 0.001). Men had longer cross-clamp and cardiopulmonary bypass times than women, but they had similar durations of circulatory arrest, methods of cerebral perfusion, and nadir temperatures. Women had a higher rate of death (11% versus 7.4%; P = 0.02), stroke (8.8% versus 5.5%; P = 0.01), and STS-COMP (31% versus 27%; P = 0.04). On multivariable analyses, female sex was an independent predictor of mortality (odds ratio [OR], 1.81; P < 0.001), stroke (OR, 1.90; P < 0.001), and STS-COMP (OR, 1.40; P < 0.001).
Given the worse outcomes in women, the authors call for earlier surgery once diagnosis of thoracic aortic disease is made in women and further investigation to better delineate which measures may reduce sex-related outcome differences after complex aortic surgery.
Yanagawa and colleagues evaluated the experience of 10 centers in Ontario, Canada, participating in the Ontario Transfusion Coordinator (ONTraC) program to determine if red blood cell transfusion rates were reduced by patient participation in the program and optimization of hemoglobin prior to coronary artery bypass grafting (CABG). The authors discuss the ONTraC program, noting that the first 60 consecutive patients undergoing CABG at each center each year were referred for assessment. After this, patients were referred only upon physician request. Over the 10 years following the start of the program, overall transfusion rates fell from 40.1% to 26.2%. Patients who were assessed by an ONTraC coordinator were more likely to be older, to be women, and to be anemic, but despite this, no differences were found in overall transfusion rates between patients who were and were not assessed. When patients were stratified by World Health Organization Anemia Classification, patients with both mild and moderate-to-severe anemia who were assessed prior to CABG had lower transfusion rates than patients with anemia who were not assessed.