Journal and News Scan

Case series of 500 consecutive patients undergoing POEM from September 2008 through November 2013 at a tertiary referral center in Japan.  At 2 month follow-up, the success rate was 91.3% (defined as Eckardt score < 2 or reduced > 4 points). Two hundred sixty-eight patients had esophagitis on endoscopy (64.7%), but only 71 (16.8%) had reflux symptoms. At 1-2 years, the success rate was 91%, 9 of 16 patients has esophagitis on endoscopy, and 19.4% had heartburn symptoms. Lastly, at 3 years the success rate was 88.5%, again 9 of 16 patients had esophagitis on endoscopy, and 56.3% had heartburn symptoms. Complications occurred in 16 patients (3.2%), the most severe being 1 pneumothorax requiring a chest tube and 1 case of bleeding controlled endoscopically but requiring blood transfusion; there were no deaths. The authors point out that one advantage of POEM over Heller myotomy is that the length of the myotomy can be better tailored to the individual patient. 

In this manuscript the authors describe their findings in a retrospective review of prospectively obtained 5-year follow up data on 353 patients undergoing transcatheter aortic valve implantation (TAVI) with the CoreValve prosthesis in 8 Italian centres.Transfemoral access was used in 317 patients (89.8%); in the rest of the patients in whom the transfemoral approach was  not feasible, a trans-subclavian access was employed. During follow-up, there were 241 re-hospitalizations for cardiovascular reasons in 164 (46%) patients. Acute heart failure was the most frequently reason reported (42.7%), followed by requirement of permanent pacemaker implantation (17.4%). On transthoracic echocardiography, mean pressure gradients decreased from 55.6 ±16.8 mm Hg (pre-TAVI) to 10.3±6.5 mm Hg (in-hospital post-TAVI) (p < 0.001). Five-year survival was 45% and freedom from re-hospitalization for cardiac reasons was 54%. Signs of prosthetic failure were observed in 15 patients (4.2%). The presence of moderate or severe paravalvular regurgitation after TAVI was associated with increased late mortality. The authors concluded that the procedure appears to be an adequate and lasting resolution of aortic stenosis in selected high-risk patients.

The ESMO Guidelines Committee provides an update to its guidelines for evaluation and management of malignant pleural mesothelioma.  They recommend against screening.  A biopsy demonstrating tissue invasion is required for a definitive diagnosis.  Definitions for different extents of surgical radicality are provided.  No specific recommendations for the extent of surgery are provided, indicating the presence of equipoise at this time.

This article offers a much needed comprehensive overview of temporary pacing strategies specific to cardiac surgical patients.  In addition to discussing standard pacing content such as device settings and connections, it offers strategies and rationale for epicardial pacing unique to this population, as well as clear depictions of unipolar versus bipolar lead systems and an introduction to biventricular temporary pacing.  Content regarding use of atrial pacing wires for performing atrial ECG's and rapid atrial pacing of arrhythmias are well described.  This paper is an excellent resource for both basic and advanced cardiac surgical providers that will be widely reviewed.