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Journal and News Scan
The authors compared the early and long-term survival in 9165 patients undergoing medical therapy (95%), open repair (2%), and thoracic endovascular aortic repair (TEVAR, 2.9%) for uncomplicated acute type B dissection. One- and 5-year survivals were 84% and 60% for medical therapy, 76% and 67% for open repair, and 85% and 76% for TEVAR (log-rank, P < .01). On risk-adjusted multivariable analysis, TEVAR had a significant survival benefit compared to medical therapy (hazard ratio, 0.68; 95% confidence interval, 0.6-0.8; P < .01). This study on survival after acute uncomplicated type B aortic dissection shows a survival advantage for TEVAR over medical therapy. These data add further evidence for a paradigm shift in the management of acute type B dissection in favor of early TEVAR.
Saito and colleagues evaluated the idea that anastomosis assist devices reduced complications for patients undergoing off-pump coronary artery bypass grafting. Their study is a one-to-one propensity scores matched analysis including 7,348 pairs of patients comparing the outcomes of anastomosis assist devices with a side-biting clamp. The authors found no difference in 30-day mortality or stroke. However, transient ischemic attack occurred more frequently in the side-clamp group.
This single institution retrospective study examined the utility of using nonpledgeted sutures for aortic valve replacement. In short-term follow-up, 3.6% of patients had insignificant perivalvular leak and 0.9% had significant perivalvular leak requiring reoperation. This technique has the potential benefits of reduced cross-clamp time, reduced risk of decreasing the effective orifice area, reduced cost, and reduced indwelling foreign body.
Brown and colleagues evaluated levels of six biomarkers to determine if they improved the prediction of readmission after cardiac surgery: ST2, galectin-3, N-terminal pro-brain natriuretic peptide, cystatin C, interleukin-6, and interleukin-10. The addition of these biomarkers to a model based on only clinical risk factors improved the predictive ability of the model in the derivation cohort (area under the receiver-operating characteristics curve (AUROC) of 0.74 versus 0.66), but it did not improve prediction in an external validation cohort (AUROC of 0.52 versus 0.48).
Primary focal hyperhidrosis (PFH) may lead to psychosocial deficits. One of the minimally invasive treatment methods is endoscopic thoracic sympathectomy, an effective therapeutic option that the authors hypothesized might lead to decreased psychotropic medications usage. Li and colleagues looked at psychiatric symptomatology and medication usage in 106 patients with PFH, comparing this with 213 patients without PFH. Additionally, they evaluated medication usage, anxiety, and depression before and after surgical intervention in PFH patients, finding improvements following endoscopic thoracic sympathectomy.
Soquet and colleagues reviewed records from 289 pediatric patients who underwent 376 cavopulmonary connection (CPC) procedures to determine the incidence and associated complications of chylothorax following these procedures. The authors found that the incidence of postoperative chylothorax was high in these patients (19.7%), and they confirmed that chylothorax was indicative of a worse postoperative course. The presence of a systemic right ventricle was a risk factor for chylothorax (odds ratio 2.49).
Conzelmann and colleagues aimed to gain information about outcomes of transcatheter aortic valve replacement (TAVR) procedures in patients with coronary heights less than 7 mm. These procedures are not common, as one of the contraindications for TAVR is a low coronary height. Among more than 3,000 TAVR patients from the Karlsruhe registry, 86 had an average coronary height of 6.4 mm. Within 30 days, there were four cardiac deaths, three noncardiac deaths, and three coronary obstructions in this patient group. The authors concluded that coronary-related complications in TAVR with coronary heights less than 7 mm occurred infrequently, however they were serious when they occurred.
Patient Care and General Interest
An accident during a sword swallowing trick was bad news for the performer’s esophagus.
An imaging case study from Medscape walks through the echocardiography of a patient with rheumatic disease involving all four valves.
Disagreement between four different hospital ranking systems regarding cardiac surgery quality in the USA could cause confusion for patients trying to understand this publicly available data.
Research, Trials, and Funding
Researchers in the UK find unexpectedly high levels of cancer-associated mutations in normal esophageal tissue.
Researchers from Washington, DC, in the USA presented the prototype of their miniature pacemaker at the recent American Heart Association’s Annual Meeting, a device that they hope allows for less invasive placement of pacemaker leads on infants’ hearts.
An interesting randomized controlled trial asserting robustly that endoscopic harvesting of saphenous vein is: (1) better for leg dehiscence and (2) at least noninferior for MACE compared to the conventional open "full touch" method. Somewhat puzzling are the high mortalities and revascularization rates in both arms, across a median follow up less than three years. The requisite hour or more to harvest the vein(s) openly also seems a bit long for experienced operators, even if we include closure of the incision.
In this randomized controlled trial, Padmanabhan and colleagues focused on the ability of iron given intravenously to increase hemoglobin levels before elective cardiac surgery, comparing this with iron given orally. The study included 50 anemic patients who were scheduled for cardiac surgery. Ferritin levels increased significantly in patients with intravenous iron administration. Iron administration did not influence hemoglobin level, regardless of the method of administration.