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Journal and News Scan
August 5, 2014
Submitted by: Joel Dunning
– This study aimed to perform a risk–adjusted comparison of mortality, rate of stroke and perioperative morbidity of aortic valve replacement (AVR) conducted through either partial ministernotomy or conventional sternotomy. This study suggests that, AVR can be safely conducted through a partial ministernotomy. This approach is not associated with an increased rate of complications. However, wide CIs reflect the still prevailing statistical uncertainty in estimates, not excluding patient–relevant differences between approaches.
Methods
- Between July 2009 and July 2012, data from 984 consecutive patients undergoing isolated AVR were prospectively recorded.
- In 44.3% (n = 436), the less invasive partial ministernotomy was used.
- Propensity score matching was performed based on 15 preoperative risk factors to correct for selection bias.
- In–hospital mortality, stroke rate as well as other major complications in the minimally invasive group and conventional sternotomy group were compared in 404 matched patient pairs (total 808).
Results
- In–hospital mortality and rate of postoperative intra–aortic balloon pump use were identical for propensity–matched patients, 1.0% (4 in each group).
- The rate of stroke [OR (95% confidence interval (CI)): 0.80 (0.22–2.98)], perioperative myocardial infarction [OR (95% CI): 2.00 (0.18–22.06)], low–output syndrome [OR (95% CI): 0.90 (0.37–2.22)], new onset of dialysis [OR (95% CI): 1.25 (0.49–3.17)] and re–exploration for bleeding [OR (95% CI): 0.88 (0.50–1.56)] were similar.
- Likewise, resource utilization (operation time, duration of stay in the intensive care unit and in–hospital stay) and valve selection (type and size) was not affected by the surgical approach either.
August 5, 2014
Submitted by: Mark Ferguson
The formation of endotracheal casts comprised of inflammatory debris (plastic bronchitis) is a rare but life-threatening complication of the Fontan procedure. This summary of 14 pts so affected demonstrated a mean interval to development of plastic bronchitis of 1.5 years. Casts were treated with outpt t-PA (13 pts) and pulmonary vasodilators. Lesions of the Fontan pathway were hemodynamically significant in 12 pts, and 3 pts required heart transplantation. 2 transplant pts and 6 t-PA pts were asymptomatic at last follow-up.
August 5, 2014
Submitted by: Mark Ferguson
The outcomes of repair of acute type A dissection using aortic valve resuspension and sinus of Valsalva reinforcement were tracked in 489 pts operated 1993-2013. Hospital mortality was 11%. 5-year survival was 69%, and freedom from proximal reoperation was 96% at 5 years.
August 5, 2014
Submitted by: Mark Ferguson
This study investigated failure to rescue from cardiac arrest after cardiac surgery in a data set of nearly 80,000 pts in order to determine whether variability in this outcome might provide an opportunity for quality improvement in low-performing hospitals. The overall failure to rescue rate was 60% among over 4,100 pts who experienced postoperative cardiac arrest. The rate ranged from 50% to 83%, with the rate varying primarily according to insitutional rather than pt factors. Identification of best practices at high performing hospitals may offer a means to improve outcomes elsewhere.
August 5, 2014
Submitted by: Mark Ferguson
Optimal management of superior sulcus tumors remains challenging. This SWOG protocol was a feasibility study of the utility of consolidation therapy with docetaxel in addition to cisplatin-etoposide, 45Gy, and possible resection. Of 46 registered pts, 86% completed induction therapy, 66% underwent resection, and 45% completed consolidation therapy. The R0 resection rate in surgical pts was 97%, and the complete or near-complete pathologic response rate in resected patients was 72%. Overall 3-year survival was 61%.
August 3, 2014
Submitted by: Joel Dunning
There is growing fear in the medical community and the pharmaceutical industry that an increasing number of people who participate in clinical trials may indeed compromise research by chatting about treatments, side effects and enrollment tips on Facebook, online forums and blogs, according to The Wall Street Journal.
To what extent this is a problem is unclear. But the paper illustrates the issue with an anecdote involving a woman named Jeri Burtchell. She was enrolled in a trial for an experimental multiple sclerosis drug and convinced she was getting the new medicine, which was not the standard therapy that some patients were randomly assigned to receive.
August 2, 2014
Submitted by: Tom C. Nguyen
2014 consensus guidelines on the perioperative evaluation and management of patients undergoing NONCARDIAC surgery.
July 31, 2014
Submitted by: Mark Ferguson
Using a retrospective analysis of pts undergoing VATS for suspected pleural malignancy, the authors assessed the utility of CT in diagnosing pleural malignancy. Of 370 pts studied, 211 had a pleural malignancy diagnosis established by biopsy. The sensitivity of CT for detecting malignancy was 68%, and the negative predictive value was 65%. CT alone is not highly effective in determining which patients should have invasive pleural biopsies.
July 29, 2014
Submitted by: Mark Ferguson
Records of nearly 24,000 Australian patients with NSCLC were evaluated to determine the relationship between distance to the nearest speciality hospital (NASH) and survival. Increasing distance from a NASH was associated with decreasing likelihood of admission to a NASH and decreasing likelihood of lung cancer resection, resulting in an increasing hazard of lung cancer death. Lung cancer outcomes are best when patients are treated in a specialty hospital.
July 29, 2014
Submitted by: Mark Ferguson
Using data from 2 centers in London, outcomes after induction therapy and resection for esophageal cancer were analyzed according to the pathological response to induction therapy. Downstaging was the strongest predictor of survival (HR 0.43). Downstaging was also associated with a lower rate of local recurrence (6% vs 13%) and systemic recurrence (19% vs 29%). Pathologic stage after induction therapy was a stronger predictor of survival that was pretreatment clinical stage.