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Journal and News Scan
April 12, 2016
Submitted by: Mark Ferguson
The association of acute kidney injury (AKI) with adverse outcomes after cardiac surgery is well known. This study compared the association of AKI and the elevation of cystatin C, another filtration marker, with long-term survival after cardiac surgery. 30% of patients experienced an abnormal increase in creatinine postop compared to 15% who had an abnormal rise in cystatin C. A rise in cystatin C was better predictive of decreased long-term survival than was creatinine.
April 12, 2016
Submitted by: Mark Ferguson
The authors used a single institution data base to assess very long-term outcomes after AVR to determine the effects of prosthesis-patient mismatch. Among 673 pts, 24% had mismatch. Mean follow-up was nearly 18 years. On multivariable analysis, mismatch was not a significant determinant of long-term survival.
April 12, 2016
Submitted by: Mark Ferguson
Whether adding radiotherapy to induction chemotherapy prior to esophagectomy adds a survival benefit is uncertain. The authors assessed outcomes of 214 patients with T3N1M0 adenocarcinoma among three institutions who underwent induction therapy followed by esophagectomy. 114 patients had chemotherapy and 100 patients had chemoradiotherapy. 90-day mortality did not differ between the groups (5.3% vs 4.0%), and median survival between the groups was similar (31.2 vs 39.2 months). The role of radiotherapy as part of induction therapy for management of adenocarcinoma of the esophagus requires further exploration.
April 8, 2016
Submitted by: Joseph Basha
ECMO is widely used for cardiogenic shock treatment. Since peripheral V-A ECMO will increase LV afterload and IABP therapy can counterbalance it, will IABP combined with ECMO improve the outcomes? A total of 529 patients (227 ECMO alone and 302 combined IABP plus ECMO) were included. Compared with ECMO alone, combined IABP and ECMO treatment did not improve outcomes. Limitation: this is an observational cohort study, large scale randomized controlled standardized trial is needed.
April 5, 2016
Submitted by: J. Rafael Sadaba
In this manuscript the authors report on their findings in a systematic review and meta-analysis of 18 studies looking into the effect on outcomes of balloon predilatation in patients undergoing transcatheter aortic valve implantation (TAVI). Patients in whom balloon predilatation was performed were more likely to require permanent pacemaker implantation, to have grade 2 or more aortic regurgitation, to suffer stroke, and had a higher 30-day mortality than those patients in whom balloon predilatation was not carried out. Interestingly, the subgroup analysis revealed that patients receiving the Medtronic CoreValve prosthesis appear to benefit more from the no predilatation strategy than those receiving an Edwards Sapien prosthesis.
April 3, 2016
Submitted by: Aristotle Protopapas
Neil Moat, one of the busiest British surgeons involved directly and consistently in TAVR, discusses PARTNER 2 and SURTAVI, paying particular attention to the health economics of low-risk TAVR and the implication of reduced profile devices.
April 3, 2016
Submitted by: Stuart Head
The PARTNER 2A trial randomized 2032 patients at intermediate operative risk (mean STS score of 6) to undergo either transcatheter or surgical aortic valve replacement. The primary endpoint of all-cause death or disabling stroke at 2 years was comparable for the two treatments: TAVR 19.3% versus SAVR 21.1%. A subgroup analysis of patients eligible for transfemoral aortic valve replacement even suggested superior outcomes for TAVR as compared to surgery (HR 0.79, 95% CI 0.62-1.00, P=0.05).
April 3, 2016
Submitted by: Stuart Head
In a propensity-matched analysis, Rosenblum and colleagues found that hybrid revascularization as compared with coronary artery bypass grafting with either single or bilateral internal mammary artery grafts was superior in terms of secondary short-term outcomes (e.g. renal failure, prolonged mechanical ventilation, blood transfusions) and postoperative length-of-stay. After a median of 2.8 years of follow-up, there were no differences in all-cause mortality between any of the groups. It should be noted that groups were small (n=306 each) and that randomized data is imperative before the more widespread adoption of hybrid revascularization.
March 31, 2016
Submitted by: Aristotle Protopapas
The fourth (re- )classification of cardiopericardial tumours came from the World Health Organisation last year, 11 years after the third. In particular, the malignant fibrous histiocytomas are re classified as undifferentiated pleomorphic sarcomas.
March 31, 2016
Submitted by: Aristotle Protopapas
A commentary and follow-up comment on last year's ERICCA and RIPHeart- related publications in the NEJM. The Kansas colleagues re iterate the negative findings on the utility of ischemic preconditioning in these two European RCT's performed in 'everyday polymorbid' patients. They also lament the trials and tribulations of translational research using ischemic preconditioning as an example.