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Journal and News Scan
December 26, 2015
Submitted by: Arie Blitz
Using CMS CABG data as a denominator, the investigators examined the penetration, completeness, and representativeness of the STS database with respect to the CMS database. The investigators found that, in 2012--the most recent year analyzed--center-level penetration was 90% and patient-level penetration was 94%. These penetrations have increased substantially since 2000. By linking the two databases, a robust synergy may be created that will provide a powerful tool for analyzing long-term outcomes and costs for cardiothoracic surgery.
December 24, 2015
Submitted by: Mark Ferguson
Whether postoperative adjuvant therapy for node-positive residual disease after induction therapy and resection for esophageal cancer is unknown. This single institution study identified 101 node positive patients among 764 treated with induction therapy and surgery during 2000-2012. 45 of 101 patients who underwent adjuvant therapy, primarily chemotherapy were compared to the 56 patients who received no additional therapy. Median survival was better in the adjuvant group, 24 vs 18 mos (p=0.033). Determinants of survival were adjuvant therapy, hospital length of stay, and number of affected nodes.
December 24, 2015
Submitted by: Mark Ferguson
The impact of combined mitral stenosis and aortic atresia on outcomes of Norwood procedures for hypoplastic left heart syndrome was examined in a single institution. The incidence among 74 operated patients was 19%. Mortality for affected patients was 29% vs 7% for the other patients. The mechanism of mortality appeared to be myocardial ischemia. Preoperative angiography did not assist in risk-stratifying patients.
December 24, 2015
Submitted by: Mark Ferguson
Patients undergoing surgical ablation for afib were evaluated for recurrence using either intermittent monitoring using traditional methods or continuous monitoring using an implantable loop recorder (ILR). Compliance with ILR use was higher than with traditional monitoring methods (93% vs about 80%). Detection of afib was similar between ILR and traditional methods. Few symptomatic events actually represented afib.
December 24, 2015
Submitted by: Mark Ferguson
With the successful linking of the STS Adult Cardiac Surgery Database and the Centers for Medicare and Medicaid (CMS) database, the authors studied the extent to which the STS database represents national activity in CABG. The number of centers represented increased from 45% in 2000 to 90% in 2012. The number of CABG patients represented increased from 51% to 94% during the same period. The number of CABG patients operated on at STS sites and registered in the STS database increased from 88% to 98%.
December 23, 2015
Submitted by: Mark Ferguson
Intermediate term results of a single institution experience with POEM for management of achalasia are reported for the first 100 cases. Most patients were women (59%) and the overall mean age was 48 years. POEM was successfully completed in 94 pts and without complications. Clinical success was declared in 94.5%, although pH studies documented abnormal esophageal acid exposure in 53% of patients postoperatively and 24% of patients complained of heartburn.
December 23, 2015
Submitted by: Mark Ferguson
This longitudinal review of single institution experience with GEJ adenocarcinomas identified time-related trends. The proportion of GEJ tumors compared to all esophageal cancers increased from 22% to 36%. GERD increased from 7% to 11%. An increased in GERD was associated with an increased in the prevalance of Seiwert I tumors. There was a significant increase in the use of total gastrectomy to treat these cancers (20% vs 42%).
December 16, 2015
Submitted by: Arie Blitz
PREVENT IV trial participants who had undergone either a RIMA or LIMA to LAD anastomosis and underwent an angiogram at 1 to 1.5 years (n=1539) were analyzed for mammary graft failure (defined as >75% stenosis). Mammary graft failure occurred in 8.6% of patients, and independent predictors of graft failure were an LAD stenosis < 75% and the presence of a graft to the diagonal. These associations suggest competitive flow may play an important role in mammary graft failure and raise the question of whether LAD stenoses < 75% without evidence of ischemia should be bypassed and whether diagonal grafts should be more selectively performed.
December 13, 2015
Submitted by: J. Rafael Sadaba
In this prospective study on 377 patients, the authors evaluate the effect of the application of a patient-specific transcatheter heart valve (THV) selection algorithm, which suggests the use of a specific THV (CoreValve or SAPIEN XT) for specific anatomical subsets, on procedural outcomes. Among the 377 patients, 184 consecutive patients underwent TAVR with the THV selection algorithm (study group) and 193 consecutive patients without the algorithm (control group). The main finding of the study is that the application of the algorithm resulted in a reduction of the incidence of moderate/severe paravalvular regurgitation and the composite of aortic annular rupture, coronary occlusion and THV embolization after TAVR and provided higher device success.
December 10, 2015
Submitted by: Tom C. Nguyen
A growing body of evidence demonstrates improved short, mid, and long term outcomes with the use of arterial conduits for coronary revascularization. Despite this, less than 10% of patients receive more than 2 arterial grafts. This is the first set of guidelines by the STS focused on arterial revascularization with supporting levels of evidence.