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Journal and News Scan
January 9, 2016
Submitted by: Arie Blitz
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.
January 6, 2016
Submitted by: Mark Ferguson
This long-awaited lung cancer staging update serves as the model for the AJCC 8 update that will be published in the near future. The primary changes involve T status and an expansion of M status to include a single distant metastasis as T4c. Stage IA is now subdivided into 3 stages, IIIC has been added, and stage IV has been expanded into IVA and IVB. Overall, the previous 7 TNM stages have been expanded to 11.
January 6, 2016
Submitted by: Arie Blitz
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?
January 4, 2016
Submitted by: Mark Ferguson
This retrospective single-center study evaluated outcomes of patients treated for flail chest using open reduction and fixation (ORIF) or non-operative management (NOM). The 41 ORIF and 45 NOM patients were similar in demographics and injury severity. Hospital and ICU LOS were longer in the ORIF group. The ORIF group also trended towards longer time on the ventilator. Further knowledge regarding appropriate patient selection criteria for ORIF in the management of flail chest is needed.
December 28, 2015
Submitted by: Lisa Brown
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.
December 27, 2015
Submitted by: Arie Blitz
The authors tested a group of 176 patients undergoing cardiac surgery for dysphagia both preoperatively and postoperatively. Preoperatively, 8.5% of patients failed the swallow test. Postoperatively, 21.6% failed the test. All patients who failed preoperatively also failed postoperatively. Thus, approximately 40% fo patients who have postop dysphagia had evidence of dysphagia preoperatively.
These results beg the question: Ought we to be screening at-risk patients for dysphagia preoperatively? If so, how would this change management postop?
December 26, 2015
Submitted by: Arie Blitz
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.
December 24, 2015
Submitted by: Mark Ferguson
Whether postoperative adjuvant therapy for node-positive residual disease after induction therapy and resection for esophageal cancer is unknown. This single institution study identified 101 node positive patients among 764 treated with induction therapy and surgery during 2000-2012. 45 of 101 patients who underwent adjuvant therapy, primarily chemotherapy were compared to the 56 patients who received no additional therapy. Median survival was better in the adjuvant group, 24 vs 18 mos (p=0.033). Determinants of survival were adjuvant therapy, hospital length of stay, and number of affected nodes.
December 24, 2015
Submitted by: Mark Ferguson
The impact of combined mitral stenosis and aortic atresia on outcomes of Norwood procedures for hypoplastic left heart syndrome was examined in a single institution. The incidence among 74 operated patients was 19%. Mortality for affected patients was 29% vs 7% for the other patients. The mechanism of mortality appeared to be myocardial ischemia. Preoperative angiography did not assist in risk-stratifying patients.
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.