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Journal and News Scan
November 16, 2015
Submitted by: Mark Ferguson
Using the STS Database, a mortality risk score was developed for adult patients undergoing congenital heart surgery. Procedure-specific outcomes differed by age category. The age-specific mortality risk score was more accurate than a score for all age categories (81% vs 78%).
Multidisciplinary Treatment for Stage IIIA Non-Small Cell Lung Cancer: Does Institution Type Matter?
November 16, 2015
Submitted by: Mark Ferguson
The relationship to institution type and survival after multimodality therapy for IIIA NSCLC was investigated using the NCDB (National Cancer Database). Academic medical centers had a higher incidence of induction therapy, lower postoperative mortality, and improved overall survival.
November 16, 2015
Submitted by: Mark Ferguson
Data from a large multicenter registry were evaluated to determine whether there is a sex difference in susceptibility to acute kidney injury after CBP related to nadir hematocrit levels. Based on a 21% hematocrit threshold, 9.5% of men and 31.9% of women were affected. Rates of AKI were similar between the sexes. There was a strong interaction betwen sex and nadir Hct level; men were significantly more susceptible to AKI related to nadir Hct.
November 16, 2015
Submitted by: Mark Ferguson
The report of FDA-mandated prospective evaluation of outcomes after Cox Maze-IV for atrial fibrillation during cardiac surgery for other problems. It utilized the Synergy ablation system and focused on absence of AF off antiarrhythmics at 6 months and the absence of major adverse events at 30 days. 76% were AF free, and 9.1% experienced major complications. Results were comparable to the cut-and-sew technique of the Cox Maze-III procedure.
November 15, 2015
Submitted by: Lisa Brown
The goal of this study was to detemine whether adjuvant chemotherapy leads to a survival benefit in patients with positive LNs who have undergone induction chemoradiation therapy followed by esophagectomy. This is a retrospective study of 764 patients undergoing esophagectomy at a single institution from 2000-2013. There were 212 patients with postive LNs on the final pathology report and 101 of these had undergone induction chemoradiation therapy. Of those 101, 45 received adjuvant chemotherapy and 56 did not. There was no difference in two-year freedom from recurrence between the two groups, but patients who did not receive adjuvant had earlier recurrence (6.2 versus 9.4 months). For those who received adjuvant therapy, 5-year survival was significantly longer at 41% (versus 25%). When patients who died within the first 90 days were excluded (1 in the adjuvant group and 5 in the no adjuvant group) the 5-year survival was 42% (adjuvant group) versus 27% (no adjuvant group), but was no longer statistically significant. The authors stated that the survival difference between the two groups may be partially due to sicker patients in the no adjuvant group. The 5-year survival for patients with <=3 (+) LNs was 37% versus 17% for those with >=4 (+) LNs. Independent predictors of survival were age, total number of (+) LNs resected, and pathologic T stage.
November 11, 2015
Submitted by: Mark Ferguson
2 year outcomes of a randomized trial of MV repair vs MV replacement for severe ischemic MR are reported. LVESVI was similar between the two groups. Recurrent moderate or severe MR was higher in the repair group (59% vs 4%). The repair group suffered higher rates of heart failure and hospital readmission. Mortality rates were not different.
November 11, 2015
Submitted by: Mark Ferguson
Results of a multicenter trial of a leadless transcatheter pacing system were reviewed in 300 pts at 6 mos. Implantation was successful in 99%. Safety was assessed as freedom from system-related or procedure related complications, and was 96%. Efficacy was assessed as stable pacing capture at low voltage and was 98%. 25 pts suffered major complications, which is less than for typical systems with leads.
November 11, 2015
Submitted by: Mark Ferguson
The timing and dosage of preoperative ASA administration was evaluated with regard to CABG outcomes in a series of 3018 pts. Dosing within 24 hrs of surgery was associated with a 50% lower mortality rate and an 81mg dose was associated with a 50% or greater reduction in mortality compared to a 325mg dose or no ASA.
November 11, 2015
Submitted by: Mark Ferguson
A prospective evaluation of patients suffering minor thoracic injuries was performed to assess functional impact at 90 days. One-third had at least 1 rib fracture and 12% had a delayed hemothorax. 23% had severe or moderate disabilities at 90 days, which was more common among those with more severe injuries. Outcomes were unrelated to age.
November 11, 2015
Submitted by: Mark Ferguson
A French multicenter database was used to assess the relationship between severe anastomotic leak on outcomes after esophagectomy. Among 2439 pts, 8.5% developed a severe leak. This was associated with lower median overall survival (36 mos vs 55 mos) and disease-free survival (34 mos vs 48 mos), a 28% increased likelihood of death, and a significant increase in recurrence.