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Journal and News Scan
June 9, 2015
Submitted by: Philip McElnay
This insightful paper compares surgery for degenerative mitral valve disease over a number of different "eras." Interestingly, the most recent data in what the authors term "era 3" (2005-2011) demonstrates that patients are being operated on at an earlier stage in their disease- with less symptoms than historic eras. The in-hospital mortality, however, in this group of patients is at its lowest-ever: 0.043%. Whilst there, of course, will have been other confounders over the time periods investigated the authors explain that this data may demonstrate that earlier intervention in patients with degenerative mitral valve disease may be beneficial.
May 29, 2015
Submitted by: Mark Ferguson
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.
May 28, 2015
Submitted by: CTSNet Staff
A new cohort analysis looks at the use of functional imaging, in addition to coronary angiography, in preoperative planning for surgical revascularization.
May 27, 2015
Submitted by: J. Rafael Sadaba
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.
May 26, 2015
Submitted by: CTSNet Staff
The paper reviews the anatomy of spinal cord perfusion, strategies to shorten the intraoperative duration of ischemia of the spinal cord, to increase its ischemic tolerance, to detect ischemia and to improve its perfusion.
May 26, 2015
Submitted by: CTSNet Staff
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.
May 26, 2015
Submitted by: CTSNet Staff
This post hoc analysis of the Arterial Revascularization Trial (ART) on 3102 patients compares intraoperative parameters and 1-year outcome for on-pump and off-pump surgery. Both techniques show excellent results with differences only in a small number of secondary endpoints.
May 22, 2015
Submitted by: Mark Ferguson
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.
May 22, 2015
Submitted by: Mark Ferguson
This interesting article summarizes the potential benefits of exercise in patients with lung cancer, including improved exercise capacity and quality of life, and reduced postoperative complications and length of postoperative stay. This modality is safe, and is likely underutilized in this patient population.
May 21, 2015
Submitted by: Mark Ferguson
This prospective observational study followed 111 patients for 3 years after laparoscopic repair of a type III paraesophageal hernia. QOL improved at all postoperative time intervals from 28.5 preop to about 10. The radiographic recurrence rate was 27% at 1 year. Hernias involving most of the stomach were more likely to recur than smaller hernias.