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Journal and News Scan
April 3, 2016
Submitted by: Aristotle Protopapas
Neil Moat, one of the busiest British surgeons involved directly and consistently in TAVR, discusses PARTNER 2 and SURTAVI, paying particular attention to the health economics of low-risk TAVR and the implication of reduced profile devices.
April 3, 2016
Submitted by: Stuart Head
The PARTNER 2A trial randomized 2032 patients at intermediate operative risk (mean STS score of 6) to undergo either transcatheter or surgical aortic valve replacement. The primary endpoint of all-cause death or disabling stroke at 2 years was comparable for the two treatments: TAVR 19.3% versus SAVR 21.1%. A subgroup analysis of patients eligible for transfemoral aortic valve replacement even suggested superior outcomes for TAVR as compared to surgery (HR 0.79, 95% CI 0.62-1.00, P=0.05).
April 3, 2016
Submitted by: Stuart Head
In a propensity-matched analysis, Rosenblum and colleagues found that hybrid revascularization as compared with coronary artery bypass grafting with either single or bilateral internal mammary artery grafts was superior in terms of secondary short-term outcomes (e.g. renal failure, prolonged mechanical ventilation, blood transfusions) and postoperative length-of-stay. After a median of 2.8 years of follow-up, there were no differences in all-cause mortality between any of the groups. It should be noted that groups were small (n=306 each) and that randomized data is imperative before the more widespread adoption of hybrid revascularization.
March 31, 2016
Submitted by: Aristotle Protopapas
The fourth (re- )classification of cardiopericardial tumours came from the World Health Organisation last year, 11 years after the third. In particular, the malignant fibrous histiocytomas are re classified as undifferentiated pleomorphic sarcomas.
March 31, 2016
Submitted by: Aristotle Protopapas
A commentary and follow-up comment on last year's ERICCA and RIPHeart- related publications in the NEJM. The Kansas colleagues re iterate the negative findings on the utility of ischemic preconditioning in these two European RCT's performed in 'everyday polymorbid' patients. They also lament the trials and tribulations of translational research using ischemic preconditioning as an example.
March 28, 2016
Submitted by: Aristotle Protopapas
A refreshing , adequately supported by pragmatic imaging, 22 minute presentation from an Arizona meeting that many surgeons would find quite informative and educating. Dr. Gellert offers the view of the anaesthetist performing the intraoperative TEE (TOE) addressing his interventional cardiologist colleagues, yet I find he covers what the mitral surgeon needs to learn in order to communicate with both anaasthetists and cardiologists before, during and after an operation. I found particularly germane to our surgical practice the balanced analysis of SAM post-TAVR and the pitfalls of 2-D echo.
March 27, 2016
Submitted by: Joseph Basha
Norepinephrine is often used to maintain the mean pressure during open heart surgery but it is said that it could constrict cerebral arteries, reducing cerebral blood flow. Is it true? The authors explored the association of Norepi doses and rSO2 measured using near-infrared spectroscopy. The results showed that no statistically significant association was found. Therefore, the investigators concluded that Norepi is safe to be used during CPB to increase the mean pressures without reducing rSO2.
March 27, 2016
Submitted by: Lisa Brown
The authors provide a comprehensive and exhaustive review of the literature comparing lobectomy to sublobar resection for treatment of early stage NSCLC. The focus of the study was to highlight the methodological differences used and determine if comparisons between studies can be made. Twenty-three studies met the inclusion criteria for this review, 4 showing no difference in survival between lobectomy and sublobar resection, 13 favoring lobectomy, and 6 favoring sublobar resection. The authors point out that selection bias likely occurred as these studies were all observational. Given the heterogeneity in study design and data analysis among these 23 studies, the authors were unable to provide a metaestimate comparing the two resection strategies and suggest that standardizing study design, analysis, and reporting of outcomes may allow for better comparison.
March 27, 2016
Submitted by: J. Rafael Sadaba
Therapy with b-blockers has shown a beneficial effect in reducing aortic dilation progression and has been proposed as the standard treatment for Marfan´s syndrome (MFS). However, angiotensin II-receptor blockers are emerging as potential alternatives to b-blockers. In this manuscript the authors describe the results of a phase IIIb randomized, parallel, double-blind study of 140 MFS patients comparing the effect of losartan and atenolol. Primary end-points were changes in aortic root and ascending aorta diameter indexed by body surface area (BSA) on MRI after 36 months of treatment. Results showed no differences in the effects of losartan and atenolol on changes in aortic root and ascending aorta diameters in MFS patients.
March 24, 2016
Submitted by: Mark Ferguson
For you chocolate lovers out there, hard evidence that dark chocolate can boost endurance performance.