Journal and News Scan

The authors assessed the relationship between second hand smoke exposure in non-smokers and mortality related to lung cancer using serum cotinine levels.  Cotinine levels were associated with survival, death from lung cancer, and death from all cancers after adjustment.  Such levels identify second hand smoke effects.

The authors performed a subgroup analysis of the Papillary Muscle Approximation (PMA) trial, a randomized trial that, while showing superiority of PMA + restrictive annuloplasty (RA) over RA alone in terms of LV remodeling and MR recurrence, failed to show a survival advantage and was plagued by a relatively high incidence of reoperation.  In this study, the authors found that the best outcomes were seen in patients with preop symmetric tethering, asymmetric tethering, or inferior wall dyskinesia.  Patients with primarily anterolateral wall dysfunction did not benefit from the addition of the PMA.

The Johns Hopkins group reviewed their experience with mediastinal exploration for bleeding after cardiac surgery during the period from 2011 through June 2014, and retrospectively reviewed the outcomes of two categories of patients:  (1)  Planned Reexploration, defined as patients left open at the initial operation with a plan for a second-look procedure (n=62), and (2) Unplanned Reexploration, defined as those patients who initially underwent sternal closure but required reexploration for bleeding (n=48).  Propensity matching generated 30 well-matched pairs for comparison.   The primary outcome, operative mortality, was no different between the planned and unplanned reexploration groups, whether propensity-matched (37% v. 37%, p=.47) or not (29% v. 23%, p=.47).  The authors conclude that delayed sternal closure with planned reexploration is a safe alternative to initial sternal closure in patients at increased risk for ongoing bleeding.

Comment:  After reading this study, would you have a lower threshold for leaving a chest open for bleeding upon completion of a cardiac operation?  Why or why not?

Balloon aortic valve dilatation has been assumed by some to provide the same outcomes as surgical aortic valvuloplasty. However, the development of precise modern surgical valvuloplasty techniques may result in better

long-term durability of the aortic valve repair. This review of the recent literature suggests that current surgical aortic valvuloplasty techniques provide a safe and durable repair. Furthermore, primary surgical valvuloplasty appears to have greater freedom from re-intervention and aortic valve replacement as compared to balloon aortic valve dilatation.