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Journal and News Scan
Using STS/ACC registry data, the authors updated 30-day outcomes and present 1 year outcomes for TAVR pts. Over 12,000 pts were in the registry; median age was 84, and STS predicted operative mortality risk was 7.1%. 30-day mortality was 7.0%, 1-year mortality was 23.7%. 1-year mortality was associated with advanced age, male sex, end-stage renal disease, COPD, non-transfemoral access, high predicted risk, and preoperative afib.
With the increase in solitary pulmonary nodule identification anticipated with increased CT screening, the authors devised a novel method of bronchoscopically biopsying nodules not adjacent to airways. Using endoscopic instruments, a transparenchymal tunnel was created between a bronchial entry point to the nodule, and biopsies were obtained. The procedure was successful in 10/12 pts and the histologic results were well correlated with surgical findings. No complications occurred.
This is a very provocative British study that examined whether a more liberal (Hgb < 9 g/dL) versus a more restrictive (Hgb < 7.5 g/dL) transfusion threshold after cardiac surgery is associated with higher morbidity and costs. The authors conducted a multicenter, prospective randomized trail by randomizing patients who had a Hgb < 9 g/dL after heart surgery to one of the two groups. Over 2,000 patients were enrolled in the study. Interestingly, the group with the more liberal transfusion protocol had no worse outcomes and no higher costs than the restrictive group. Moreover - even more provocatively - the secondary outcome of 90-day all-cause mortality was 64% more likely to occur in the restrictive transfusion threshold group.
Samples from tissue microarrays of 552 NSCLC patients were analyzed to measure the levels of 3 different tumor-infiltrating lymphocytes (TILs): CD3, CD8, and CD20. An elevated level of CD3 or CD8 was associated with longer survival. This finding might be useful to evaluate response or assess the local immune effect of anticancer immune inhibitors.
A review of the National Cancer Data Base was undertaken to determine the impact of postoperative radiation therapy on survival for patients with pathologic stage IIIA NSCLC in the setting of adjuvant chemotherapy. The authors point out that some prior analyses demonstrated a decrease in survival with postoperative radiation therapy likely due to the inclusion of patients with N0 or N1 disease and toxicity associated with outdated radiation treatment regimens. The main results of this study were that in patients with completely resected stage IIIA NSCLC, there was an improvement in median overall survival and 5-year overall survival with postoperative radiation therapy (45.2 months and 39.3%) over adjuvant chemotherapy alone (40.7 months and 34.8%). Furthermore, when other factors associated with overall survival were controlled for, the survival benefit of postoperative radiation therapy, although modest, continued to be significant.
This video demonstrates a transaortic approach for TAVR, through the second intercostal space. Illustrations, photos, 3D CAT scan images, and rotating fluoroscopic images are used to demonstrate this approach.
This propensity matched single institution study compared conventional aortic valve replacement via a full sternotomy (CAVR) to minimal access aortic valve replacement (MAAVR) via an upper hemisternotomy. Over the eleven year study period a total of 2103 patients underwent isolated aortic valve replacement. After propensity matching, 585 patients were included in each group. Patient characteristics were well balanced between the two groups. There was no difference between the groups with respect to cross-clamp time although the MAAVR group had a longer average bypass time. The MAAVR group had a lower average volume of autologous blood transfusion, intubation time, post-operative renal complications and rate of respiratory insufficiency. There was no difference between the groups with regards to re-exploration for bleeding, ICU or hospital length of stay, early mortality of survival. The authors conclude that MAAVR is their procedure of choice for isolated aortic valve replacement.
The impact of the new Lung Allocation Score (implemented in 2005) on outcomes of single and double lung transplants for IPF and COPD was explored. After controlling for confounders with propensity score techniques, DLT was associated with better graft survival for IPF but there was no difference in graft survival between DLT and SLT for COPD patients.
This meta-analysis compares short-term mortality, neurological dysfunction and malperfusion in patients who underwent acute type A aortic dissection (AAD) repair with axillary artery cannulation (AXC) compared to femoral artery cannulation (FAC).
In in-vitro experiments, human cardiac extracellular matrix supported proliferation and cardiomyocyte differentiation of murine embryonic stem cells and induced pluripotent stem cells. Artificial matrices did not promote differentiation.