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Journal and News Scan
Interesting retrospective study evaluating the risk factors affecting the progression of ascending aorta dilatation in 133 patients with bicuspid aortic valve, focusing on aortic morphology and cusp fusion pattern. Dilatation at the level of the sinuses of Valsalva rather than no dilatation or dilatation confined to the ascending aorta appears to be a marker of more rapid progression.
The trial was a randomised, prospective, non-blinded, multi-institutional study of patients undergoing surgery for severe ischaemic mitral regurgitation with or without coronary revascularisation,” Dr Acker reported. A total of 251 patients were recruited, with approximately half undergoing mitral valve repair and half undergoing replacement. While there was no difference in efficacy or main safety outcomes, there was a difference in the percentage of patients experiencing a recurrence of IMR - 32.6% in the repair group versus 2.3% in the replacement group (p<0.001).
This study examined the rate of overdiagnosis (detection rate of indolent tumors) of lung cancer in the NLST. They found that 18% of all lung cancers detected were of the indolent type, and nearly 79% of the bronchioalveolar cancers were likely indolent.
This study of 389 pts receiving a continuous flow LVAD evaluated the risk of thromoembolic (TE)complications associated with preop AF. TE occured in 25% of pts; freedom from TE at 2 years was 46% in those with AF and 72% in those without AF (p<0.001). AF did not affect late survival.
This behavioral modification study covered 6 months at a single institution during which 144 pts underwent 510 transfusion events. Cardiac surgeons agreed on a Hgb cutoff value of 8 as an indication for transfusion (massive transfusions were excluded). Surgeons received weekly feedback as to their practice patterns. Compared to baseline, feedback resulted in a 63% reduction in transfusions and an increase in single transfusions from 77% to 90%.
Researchers at Tsinghua University in Beijing have taken a potentially wildly complicated problem and come up with a (relatively) simple solution by injecting the heart with gallium, a chemically stable metal that melts at about 85 degrees Fahrenheit. In other words, it has no problems flowing through the labyrinthine vessels of the heart.
This meta-analysis compared outcomes of PCI vs CABG in patients with multivessel disease, evaluating studies that were not individually powered to detect survival differences. 6 RTC including 6055 pts were analyzed. Significant benefits for CABG were associated with overall mortality, MI, and the need for revascularization.
The use of pharmaceutical strategies to prevent contrast-induced acute kidney injury continues to be an unresolved matter. In this manuscript the authors describe their findings of a systematic review with a meta-analysis on the prevention of this type of injury with ascorbic acid. They conclude that ascorbic acid appears to be nephro-protective against contrast-induced acute kidney injury.
This article describes outcomes of en bloc resection of superior sulcus tumors invading the spine in 48 pts from multiple centers operated on during a 22 year period. Most pts received induction chemotherapy and radiation therapy. Complete resection was achieved in 88%, and 5-year survival was 61%. Surgical mortality was 6%. The primary determinant of survival was complete response to induction therapy.
Bicuspid AV repair was performed in 146 pts over a period of 34 years; the primary indication was stenosis. Survival at 20 yrs was 88%. Freedom from reintervention at 18 yrs was 43%. 30 additional pts without reintervention had moderate to severe stenosis or moderate regurgitation at last follow-up.