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Journal and News Scan
December 24, 2015
Submitted by: Mark Ferguson
Patients undergoing surgical ablation for afib were evaluated for recurrence using either intermittent monitoring using traditional methods or continuous monitoring using an implantable loop recorder (ILR). Compliance with ILR use was higher than with traditional monitoring methods (93% vs about 80%). Detection of afib was similar between ILR and traditional methods. Few symptomatic events actually represented afib.
December 24, 2015
Submitted by: Mark Ferguson
With the successful linking of the STS Adult Cardiac Surgery Database and the Centers for Medicare and Medicaid (CMS) database, the authors studied the extent to which the STS database represents national activity in CABG. The number of centers represented increased from 45% in 2000 to 90% in 2012. The number of CABG patients represented increased from 51% to 94% during the same period. The number of CABG patients operated on at STS sites and registered in the STS database increased from 88% to 98%.
December 23, 2015
Submitted by: Mark Ferguson
Intermediate term results of a single institution experience with POEM for management of achalasia are reported for the first 100 cases. Most patients were women (59%) and the overall mean age was 48 years. POEM was successfully completed in 94 pts and without complications. Clinical success was declared in 94.5%, although pH studies documented abnormal esophageal acid exposure in 53% of patients postoperatively and 24% of patients complained of heartburn.
December 23, 2015
Submitted by: Mark Ferguson
This longitudinal review of single institution experience with GEJ adenocarcinomas identified time-related trends. The proportion of GEJ tumors compared to all esophageal cancers increased from 22% to 36%. GERD increased from 7% to 11%. An increased in GERD was associated with an increased in the prevalance of Seiwert I tumors. There was a significant increase in the use of total gastrectomy to treat these cancers (20% vs 42%).
December 16, 2015
Submitted by: Arie Blitz
PREVENT IV trial participants who had undergone either a RIMA or LIMA to LAD anastomosis and underwent an angiogram at 1 to 1.5 years (n=1539) were analyzed for mammary graft failure (defined as >75% stenosis). Mammary graft failure occurred in 8.6% of patients, and independent predictors of graft failure were an LAD stenosis < 75% and the presence of a graft to the diagonal. These associations suggest competitive flow may play an important role in mammary graft failure and raise the question of whether LAD stenoses < 75% without evidence of ischemia should be bypassed and whether diagonal grafts should be more selectively performed.
December 13, 2015
Submitted by: J. Rafael Sadaba
In this prospective study on 377 patients, the authors evaluate the effect of the application of a patient-specific transcatheter heart valve (THV) selection algorithm, which suggests the use of a specific THV (CoreValve or SAPIEN XT) for specific anatomical subsets, on procedural outcomes. Among the 377 patients, 184 consecutive patients underwent TAVR with the THV selection algorithm (study group) and 193 consecutive patients without the algorithm (control group). The main finding of the study is that the application of the algorithm resulted in a reduction of the incidence of moderate/severe paravalvular regurgitation and the composite of aortic annular rupture, coronary occlusion and THV embolization after TAVR and provided higher device success.
December 10, 2015
Submitted by: Tom C. Nguyen
A growing body of evidence demonstrates improved short, mid, and long term outcomes with the use of arterial conduits for coronary revascularization. Despite this, less than 10% of patients receive more than 2 arterial grafts. This is the first set of guidelines by the STS focused on arterial revascularization with supporting levels of evidence.
December 10, 2015
Submitted by: J. Rafael Sadaba
The study was a single-arm, multicentre, prospective study enrolling 31 high-risk adult individuals with symptomatic mitral regurgitation despite optimal medical therapy from five institutions in Europe. The primary efficacy endpoints included: (a) Technical success rate of the device implantation; (b) Technical feasibility of Cardioband adjustment; and (c) Cardioband ability to reduce the annular septolateral dimension and MR. The technical success rate of implantation was 93.6%. Cardioband adjustment was successful in 29 of 31 subjects. At 30 days, 22 of 25 patients had MR ≤2+. Procedural mortality was zero and in-hospital mortality was 6.5%. The authors conclude that the initial experience with the Cardioband system shows that transfemoral implantation of a surgical-like direct annuloplasty device is feasible, safe, and effective.
December 8, 2015
Submitted by: Joel Dunning
This is an edition of the annals of Cardiothoracic Surgery dedicated to minimally invasive cardiothoracic surgery. It contains many approaches for thymectomy and mediastinal masses including VATS, uniportal VATS, subxiphoid approaches and robotic approaches.
December 3, 2015
Submitted by: Aamir Shah
Patients with bicuspid aortic valves have a significantly increased incidence of aortic complications including type A aortic dissection. The authors studied 1181 patients with bicuspid aortic valves and sinus of valsalva or ascending aortic aneurysms with diameter greater than or equal to 4.7 cm on CT scan or MRI. The prevalence of type A dissection identified by initial imaging or detected at operation or during surveillance follow up was 5.3%. The probability of surgical intervention for aortic expansion or dissection among patients undergoing surveillance was 16% at 1 year and 50% at 6 years follow up. The authors found the cross-sectional area of the ascending aorta or sinuses of Valsalva to height ratio to be the best predictor of type A dissection, and recommend aortic replacement in patients with bicuspid aortic valves and aortic diameter greater than 5 cm or cross sectional area to height ratio greater than 10 cm2/m.