Journal and News Scan

240 high risk patients undergoing cardiac surgery were randomized to remote ischemic preconditioning (3 5-min cycles of single upper extremity ischemia after anesthetic induction) or sham.  Preconditioning reduced the incidence of acute kidney injury by one-third and the need for renal replacement therapy by two-thirds.  These results were associated with changes in urinary insulinlike growth factor–binding protein 7 and tissue inhibitor of metalloproteinases 2.  No differences were found between the groups for other major complications.

In this manuscript the authors describe their finding after a systematic review and meta-analysis to explore the safety and efficacy of the Mitraclip procedure for patients with functional mitral regurgitation (FMR). Overall, 875 patients were included. Every patient underwent a follow-up of at least 6 months. The primary safety end point was a composite of all-cause death, rehospitalization for heart failure, and reinterventions during follow-up. The primary efficacy end point was the change in 6-minute walk test (6MWT). Secondary efficacy end points were change in left ventricle ejection fraction (EF), left ventricle volumes, pulmonary arterial pressure, and left atrial volumes, whereas the secondary safety end points were the single components of the primary composite one, cardiac death, and acute kidney injury during index hospitalization. The main findings were a net improvement in 6MWT, in NYHA functional class, and in reverse remodeling; a negative impact of AF diagnosis on positive effect in terms of remodeling; and low rates of procedural cardiac deaths. The authors conclude that Mitraclip is an effective treatment strategy for patients with heart failure and significant mitral regurgitation.

The procedure of transcatheter aortic valve implantation (TAVI) was analyzed in 2287 patients. About 11% needed surgical interventions, about 2% were converted to full sternotomy and about 1% required use of the heart lung machine. The authors advocate the presence of a cardiac surgeon at each TAVI and building experienced teams within specialized centres.

In this retrospective review of 336 patients treated surgically for early stage NSCLC, the prognostic value of PET SUV was evaluated.  Risks of recurrence and death increased steadily as SUV increased.