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Journal and News Scan
July 15, 2014
Submitted by: Joel Dunning
– The aim of this study was to evaluate the effect of vein graft preservation solutions on vein graft failure (VGF) and clinical outcomes in patients undergoing coronary artery bypass graft (CABG) surgery. These researchers concluded that patients undergoing CABG whose vein grafts were preserved in a buffered saline solution had lower VGF rates and showed trends toward better long–term clinical outcomes compared with patients whose grafts were preserved in saline– or blood–based solutions.
Methods
- Researchers used data from the Project of Ex–Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) study, a phase 3, multicenter, randomized, double–blind, placebo–controlled trial that enrolled 3014 patients at 107 US sites from August 1, 2002, through October 22, 2003.
- Eligibility criteria for the trial included CABG surgery for coronary artery disease with at least 2 planned vein grafts.
- Interventions included preservation of vein grafts in saline, blood, or buffered saline solutions.
- Main outcomes measures included 1–year angiographic VGF and 5–year rates of death, myocardial infarction, and subsequent revascularization.
Results
- Most patients had grafts preserved in saline (1339 [44.4%]), followed by blood (971 [32.2%]) and buffered saline (507 [16.8%]).
- Baseline characteristics were similar among groups.
- Researchers found that 1–year VGF rates were much lower in the buffered saline group than in the saline group (patient–level odds ratio [OR], 0.59 [95% CI, 0.45–0.78; P<0.001]; graft–level OR, 0.63 [95% CI, 0.49–0.79; P<0.001]) or the blood group (patient–level OR, 0.62 [95% CI, 0.46–0.83; P=0.001]; graft–level OR, 0.63 [95% CI, 0.48–0.81; P<0.001]).
- Use of buffered saline solution also tended to be associated with a lower 5–year risk for death, myocardial infarction, or subsequent revascularization compared with saline (hazard ratio, 0.81 [95% CI, 0.64–1.02; P=0.08]) and blood (0.81 [0.63–1.03; P=0.09]) solutions.
July 14, 2014
Submitted by: J. Rafael Sadaba
The timing of surgery in patients with asymptomatic severe aortic stenosis (AS) remains a matter of debate. In this study, the authors evaluate the prognostic value of plasma levels of B-type natriuretic peptide (BNP) during exercise in 211 patients with asymptomatic AS. In multivariate analysis, second and third tertiles of peak-exercise BNP were strong predictors of death or aortic valve replacement motivated by development of symptoms or LV dysfunction, compared with the first tertile. Patients with asymptomatic severe AS and a high peak BNP values may require closer follow up and may benefit from earlier surgery.
July 12, 2014
Submitted by: Mark Ferguson
Volume-outcomes relationships for operative mortality were first identified more than a decade ago. This study updated the data using Medicare claims for more than 3 million patients. The inverse relationship between volume and outcomes was confirmed for all 8 procedures studied. The inverse ratio actually increased for 5 of 8 procedures despite overall improvements in outcomes. For esophagectomy mortality the OR for very low compared to very high volumes was 2.25 in 2000-2001 and 3.68 in 2008-2009.
July 12, 2014
Submitted by: Mark Ferguson
This single institution study evaluated differences in 30-day and 90-day mortality after esophagectomy in nearly 1300 patients. 30-day mortality was 2.9%, hospital mortalit was 5.1%, and 90-day mortality was 7%. Late deaths were related to surgery (particularly the occurrence of anastomotic leakage), sudden death, and recurrent cancer. The sensitivity of 30-day mortality in detecting surgery-related deaths was only 33%.
July 12, 2014
Submitted by: Mark Ferguson
A risk model of mortality associated with esophagectomy in Japan was developed using variables identified in the ACS NSQIP program. 30-day and overall surgical mortality rates were 1.2% and 3.4%, and the morbidity rate was 42%. Morbidity was higher after minimally invasive esophagectomy. Mortality was related to difficulty with ADLs, recent smoking, greater preoperative weight loss, male sex, and COPD.
Endoscopic Harvesting Device Type and Outcomes in Patients Undergoing Coronary Artery Bypass Surgery
July 12, 2014
Submitted by: Mark Ferguson
This prospective multiinstitutional study evaluated outcomes of different devices used for endoscopic vein harvesting classified as open or closed tunnel devices. There was no difference in the incidence of early graft failure or late clinical outcomes. The poorer graft outcomes related to endoscopic vein harvesting are not attributable to device type.
July 12, 2014
Submitted by: Mark Ferguson
This editorial, authored by a number of presidents/leaders of prominent medical societies, laments a recent position paper of the ESMO espousing medical oncologists as the natural team leaders of multidisciplinary oncologic care. It cautions other cancer specialists not to abandon their roles as advocates for their cancer patients.
July 9, 2014
Submitted by: Stuart Grant
The objective of this study was to investigate whether the consequences of patient prosthesis mismatch (PPM) following aortic valve replacement (AVR) differ according to patient age. The authors hypothesised that in older patients (aged 70 and above) the implications of PPM may be less important due to lower baseline physical function and competing mortality risks. This single centre study included 707 patients who underwent first-time AVR with follow-up out to 17.5 years. The incidence of PPM was 68% in patients aged 70 or older compared to 26% in patients aged less than 70. The authors found that in patients aged less than 70 with left ventricular dysfunction PPM was associated with reduced survival and increased congestive heart failure. Post-operative left ventricular mass regression was impaired in older patients in general and in those with PPM aged 70 or over with left ventricular dysfunction.
July 8, 2014
Submitted by: Ruben Osnabrugge
The consortium of authors of this paper determined the survival after Transcatheter valve in valve implantation inside a failed surgical bioprosthesis. The authors report a 1 month mortality rate of 7.6% and a major stroke rate of 1.7%. One-year survival was 83.2%, and 313 (92.6%) of survivors had a good functional status (NYHA I/II). Patients who had an aortic stenosis (n=181) had worse 1-year survival (76.6%) than patients with aortic regurgitation (91.2%) or combined stenosis/regurgigation (83.9%; p=0.01). Moreover, a small surgical bioprosthesis was associated with higher mortality.
July 8, 2014
Submitted by: Joel Dunning
It is with great sadness that we report the death of Donald Ross on the 7th of July 2014 in London. As well as creating the Ross procedure, he performed the UK's first heart transplant, which was the world's 10th heart transplant.
We would like to invite you to add your memories of this pioneer of cardiac surgery to the comments section below.