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Journal and News Scan
March 28, 2016
Submitted by: Aristotle Protopapas
A refreshing , adequately supported by pragmatic imaging, 22 minute presentation from an Arizona meeting that many surgeons would find quite informative and educating. Dr. Gellert offers the view of the anaesthetist performing the intraoperative TEE (TOE) addressing his interventional cardiologist colleagues, yet I find he covers what the mitral surgeon needs to learn in order to communicate with both anaasthetists and cardiologists before, during and after an operation. I found particularly germane to our surgical practice the balanced analysis of SAM post-TAVR and the pitfalls of 2-D echo.
March 27, 2016
Submitted by: Joseph Basha
Norepinephrine is often used to maintain the mean pressure during open heart surgery but it is said that it could constrict cerebral arteries, reducing cerebral blood flow. Is it true? The authors explored the association of Norepi doses and rSO2 measured using near-infrared spectroscopy. The results showed that no statistically significant association was found. Therefore, the investigators concluded that Norepi is safe to be used during CPB to increase the mean pressures without reducing rSO2.
March 27, 2016
Submitted by: Lisa Brown
The authors provide a comprehensive and exhaustive review of the literature comparing lobectomy to sublobar resection for treatment of early stage NSCLC. The focus of the study was to highlight the methodological differences used and determine if comparisons between studies can be made. Twenty-three studies met the inclusion criteria for this review, 4 showing no difference in survival between lobectomy and sublobar resection, 13 favoring lobectomy, and 6 favoring sublobar resection. The authors point out that selection bias likely occurred as these studies were all observational. Given the heterogeneity in study design and data analysis among these 23 studies, the authors were unable to provide a metaestimate comparing the two resection strategies and suggest that standardizing study design, analysis, and reporting of outcomes may allow for better comparison.
March 27, 2016
Submitted by: J. Rafael Sadaba
Therapy with b-blockers has shown a beneficial effect in reducing aortic dilation progression and has been proposed as the standard treatment for Marfan´s syndrome (MFS). However, angiotensin II-receptor blockers are emerging as potential alternatives to b-blockers. In this manuscript the authors describe the results of a phase IIIb randomized, parallel, double-blind study of 140 MFS patients comparing the effect of losartan and atenolol. Primary end-points were changes in aortic root and ascending aorta diameter indexed by body surface area (BSA) on MRI after 36 months of treatment. Results showed no differences in the effects of losartan and atenolol on changes in aortic root and ascending aorta diameters in MFS patients.
March 24, 2016
Submitted by: Mark Ferguson
For you chocolate lovers out there, hard evidence that dark chocolate can boost endurance performance.
March 23, 2016
Submitted by: Arie Blitz
Guidelines recommend that ICDs should not be implanted until after 90 days following revascularization in patients with an EF<35% and an MI. Studies have shown that no clinical benefit or detriment was derived by implantation prior to 90 days. In the PREDICTS study, the results of which are reported in this publication, patients who had sustained an AMI and had an EF<35% around the time of the MI were evaluated for ICD implantation after the 90-day mark. Of 231 enrolled patients, 84% of patients underwent PCI and 16% underwent medical management. In the PCI cohort, 94/166 (57%) patients had an EF>35% at follow-up.
Although revascularization in this trial was accomplished by PCI, at least under these circumstances, more than half of patients who initially would have qualified for an ICD by EF criteria alone no longer qualified after 90 days.
March 22, 2016
Submitted by: Ruben Osnabrugge
In this study the STS/ACC Transcatheter Valve Therapy registry was used to compare TAVI in nonogenarians versus TAVI in patients <90 years old. In total 3,773 (15.7%) of the patients were >90 years old. Mortality at 30 days and 1-year was significantly higher for nonogenarians (8.8% vs. 5.9%, p<0.001 and 24.8% vs. 22.0%, p=0.001, respectively). With regard to quality of life, nonogenarians did worse at 30 days than the younger patients, while at 1 year there was no significant difference. Although the study had to exclude 35% of the long-term follow-up and there were many missing quality of life data, the authors conclude that this large study confirms the safety and efficacy of TAVR in nonogenarians.
March 22, 2016
Submitted by: Arie Blitz
This retrospective study evaluated the relationship between the timing betweenLHC and CABG and its effect on renal function in a cohort of 2371 patients at a single center. Findings included:
A shorter interval between LHC and CABG was independently associated with postop kidney injury in patients undergoing on-pump CABG, but not in those undergoing OPCAB.
Question: Should the findings of this study influence whether you perform off-pump vs. on-pump CABG if CABG is performed within a week of LHC, independent of other considerations?
March 21, 2016
Submitted by: CTSNet Staff
The new AHA/ACC Scientific Statement represents significant progress regarding the management of anomalous aortic origin of a coronary artery (AAOCA) by liberalizing the exercise restrictions on those asymptomatic patients with anomalous aortic origin of the right coronary artery. More data regarding the risk of and risk factors for sudden cardiac death (SCD) from AAOCA are needed and can only be obtained with collaboration between multiple centers. Future statements or guidelines should focus on a more detailed definition of ‘‘asymptomatic’’ as well as on additional provocative screening evaluations for risk of SCD prior to allowing these children to return to competitive sport.
March 21, 2016
Submitted by: Arie Blitz
This French group retrospectively compared their experience with tricuspid valve replacements (n=188) using either tissue (82%) or mechanical (18%) valves during a >30-year period. Findings from the study included:
- Almost half the cases were reoperative surgeries, and concomitant procedures were performed in 71%.
- Overall operative mortality was 28%, but decreased down to 10% in the most recent decade.
- Freedom from structural valve deterioration trended higher for mechanical valves but did not reach statistical significance.
- Freedom from thromboembolic events and any valve-related adverse events were significantly higher for tissue valves.
- Eleven patients required repeat tricuspid valve replacements for structural valve disease at a mean interval of 16 years (range 4 to 33 years). None of these valves were mechanical at the original implantation.