Journal and News Scan

The authors performed a randomized control study of 178 patients with heart failure and systolic dyssynchrony who were accepted for CABG, randomizing the participants into two groups:  CABG alone (n=87) and CABG + concomitant epicardial CRT (n=91).  CRT was activated postoperatively.  At a mean follow-up period of 55 months, the mortality rate of the CABG group was 36% and that of the CABG + CRT group was 15%.  Moreover, all-cause mortality, cardiac death, and hospital readmissions were significantly lower for the CABG + CRT group.

It is known that not all patients with potential indications for CRT undergoing CABG will meet the criteria for CRT postoperatively.  The question is whether performing CRT at the time of CABG in all such patients is a cost-effective strategy.

Are we removing enough pericardial fluid to allow a diagnosis of malignant effusion?  The authors reviewed  480 pericardiocentesis specimens by comparing the percentage of malignant diagnoses ("malignancy fraction") by the volume submitted for analysis.  Using pericardial biopsy as the standard,  the sensitivity for the diagnosis of malignancy was 18.1% vs. 10.6% if more or less than 60 mL was submitted, respectively.  These results beg the following questions:  1.  Did patients with pericardial malignancies tend to have larger effusions and therefore larger aspirations?  2.  Was more fluid aspirated or submitted in patients with a higher index of suspicion for malignancy?

The goal of this study was to present the changes in pulmonary function after SBRT in 127 patients with clinical stage I NSCLC or a single lung metastasis. These patients were either too high risk for an operation or preferred a non-operative treatment approach. PFTs were measured at several time points including within 10 weeks of starting SBRT and then 6 weeks, 3 months, 6 months, 9 months, 1 year and 2 years after treatment (median follow-up was 25 months). At 12 months, there were significant decreases in TLC (-3.6%), FVC (-5.7%), FVC % predicted (-4.6%), FEV1 (-4.1%), and corrected DLCO (-5.2%) compared to baseline. At 24 months, there were significant decreases in FVC (-8.9%), and FEV1 (-7.6%) compared to baseline. When compared to surgical series, the reductions in lung function appear later and are smaller.  

Using CMS CABG data as a denominator, the investigators examined the penetration, completeness, and representativeness of the STS database with respect to the CMS database.  The investigators found that, in 2012--the most recent year analyzed--center-level penetration was 90% and patient-level penetration was 94%.   These penetrations have increased substantially since 2000.  By linking the two databases, a robust synergy may be created that will provide a powerful tool for analyzing long-term outcomes and costs for cardiothoracic surgery.