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Journal and News Scan
November 15, 2018
Submitted by: Aristotle Protopapas
An interesting randomized controlled trial asserting robustly that endoscopic harvesting of saphenous vein is: (1) better for leg dehiscence and (2) at least noninferior for MACE compared to the conventional open "full touch" method. Somewhat puzzling are the high mortalities and revascularization rates in both arms, across a median follow up less than three years. The requisite hour or more to harvest the vein(s) openly also seems a bit long for experienced operators, even if we include closure of the incision.
November 14, 2018
Submitted by: Claire Vernon
In this randomized controlled trial, Padmanabhan and colleagues focused on the ability of iron given intravenously to increase hemoglobin levels before elective cardiac surgery, comparing this with iron given orally. The study included 50 anemic patients who were scheduled for cardiac surgery. Ferritin levels increased significantly in patients with intravenous iron administration. Iron administration did not influence hemoglobin level, regardless of the method of administration.
November 14, 2018
Submitted by: Claire Vernon
Thornblade and colleagues endeavored to develop and validate a model that would predict the 2-year risk of recurrence in patients with completely resected node-negative non-small cell lung cancer (NSCLC). Improved recurrence prediction could direct selective use of adjuvant therapy and surveillance imaging in these patients. The authors’ models performed similar to chance, despite using clinical risk factors for recurrence and biomarkers associated with poor survival. They discuss potential reasons for the difficulty in predicting recurrence in this patient group.
November 13, 2018
Submitted by: Wei-Guo Ma
In this paper, Dr Svensson covers his technique of leaflet repair during aortic root reimplantation. The core technical points are described as well as the long-term clinical outcomes. The author's experience has shown that for patients having leaflet repair, bracing the root with a reimplantation operation appears to reduce the risk of late regurgitation and reoperation.
November 9, 2018
Submitted by: Emily Robinson
A multidisciplinary team led by Bob Kiaii at the London Health Sciences Centre in Ontario, Canada, has reportedly completed the world's first robotic performance of a specific aortic valve replacement procedure in a patient with aortic stenosis.
The charity Tiny Tickers is launching a campaign with the goal of ensuring that all maternity wards across the United Kingdom have access to machines for detecting heart defects in newborns.
A woman with cystic fibrosis living in Holbrook, Massachusetts, USA, recently completed her first 5K race after receiving a double-lung transplant.
After reports of several patient injuries, the U.S. Food and Drug Administration has announced a Class I recall for a batch of warfarin test strips used with point-of-care or in-home devices to adjust warfarin dosing.
Research published in The Journal of Nuclear Medicine suggests that a new nuclear medicine tracer could improve the diagnosis and treatment of non-small cell lung cancer.
November 9, 2018
Submitted by: Aristotle Protopapas
Interesting small randomized controlled trial that will definitely be widely discussed.
November 8, 2018
Submitted by: Emily Robinson
This is a randomized controlled trial evaluating the impact of adjunct atrial fibrillation surgical treatment in patients undergoing cardiac surgery. Included are 352 patients. Sinus rhythm was restored two times more frequently in those who underwent atrial fibrillation surgery. There was no difference in survival and quality of life up to two years.
November 7, 2018
Submitted by: Wei-Guo Ma
Watanabe and associates studied the association between false lumen remodeling late after type A dissection repair and the shape of the true lumen in the early postoperative period. They found that the true lumen shape in the early postoperative period predicts false lumen remodeling late after surgery. The methodology of computed tomography angiography measurements used in this work serves as a good example of quantitative image analysis for patients with aortic disease.
November 7, 2018
Submitted by: Ruben Osnabrugge
Why this study – the rationale/objective
This study compared the volumes of transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) since the approval of TAVR in the United States. The Medicare Provider Analysis and Review (MEDPAR) database was used to extract volumes for 2011-2014. The volume of SAVR decreased in hospitals with the largest number of TAVR procedures. At the same time, 30-day and 1-year mortality after SAVR declined in the hospitals with the largest TAVR volumes. Patients who underwent SAVR showed a decrease in comorbidities over time. The study provides some interesting insights. First, the large number of excluded centers highlight the large amount of centers in the US that perform very few aortic valve procedures. Second, the lower mortality after SAVR and low risk profile of SAVR patients was likely the result of high risk patients getting TAVR. Third, the current study does not include data from recent years. It will be very interesting to learn whether the increasing TAVR volume leads to a decrease in SAVR volume, especially since results of TAVR vs. SAVR in low risk patients are expected shortly.
November 7, 2018
Submitted by: Ruben Osnabrugge
The authors of this study analyzed neurological events and quality-of-life in the Surgical Replacement and Transcatheter Aortic Valve Implantation (SURTAVI) trial. A total of 1746 patients with aortic stenosis and intermediate surgical risk were randomized to either TAVI or SAVR. Neurological events and quality of life were analyzed at 30 days, six months, and 12 months. In this group of elderly (approximately 80 years old) patients with an intermediate risk profile (STS-PROM 4.5), the event rates at 30 days were higher for SAVR as compared with TAVI for both stroke and encephalopathy (5.4% vs. 3.3%, p=0.031 and 7.8% vs. 1.6%; p<0.0001, respectively). There were no differences in the incidence of late strokes (TAVI 2.0% vs. SAVR 1.5%). Neurological events were associated with increased mortality at one year. Quality of life after an early stroke in TAVI patients was higher than in SAVR patients who suffered from a stroke. The thoroughness and consistency in stroke assessment in this trial is a major strength. Whereas the early PARTNER IA trial showed a higher stroke rate with TAVI than with SAVR (4.7% vs. 2.4% respectively), these results show a more favorable outcome for strokes after TAVI. Interestingly, no embolic protection devices were used in the trial. Application of these devices is now more and more common and might further reduce stroke rate after TAVI. The results of this study provide further evidence supporting TAVI in intermediate risk patients.