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Journal and News Scan
July 22, 2015
Submitted by: CTSNet Staff
Mayo Clinic surgeons describe and illustrate the techniques they utilize to relieve obstruction in hypertrophic cardiomyopathy in those circumstances where it is difficult to adequately expose the basal and midventricular septum through the aortic root. In selected patients, either at primary myectomy or at redo myectomy, septal excision can be approached through a left ventricular transapical incision. This important alternative should be considered in cases where successful relief of dynamic basal or midventricular obstruction cannot be accomplished through the aorta.
July 21, 2015
Submitted by: Arie Blitz
The authors analyzed an audited collaborative multicenter database in Australia of over 34,000 consecutive patients who underwent CABG from 2001 to 2012, and they compared outcomes in those undergoing total arterial revascularization (TAR) vs. those that did not. In their propensity-matched cohort, the operative mortality was 0.9% for TAR patients and 1.2% for non-TAR patients (p<.001). Ten-year survival was 85.4% for the TAR patients and 81.2% for the non-TAR patients (p<0.001). The authors conclude that TAR is associated with a low operative mortality and superior long-term survival and should be used more liberally than it is at present.
July 20, 2015
Submitted by: Tom C. Nguyen
This study explores the genetical contribution to lung cancer in non-smoking patients using a state-wide cancer registry for lung cancer (n=5544). This study provides insight into which non-smoking patients are at risk for lung cancer.
July 20, 2015
Submitted by: Ruben Osnabrugge
The authors of this paper investigated the outcomes of percutaneous coronary intervention (PCI) performed in centers with and without cardiac surgical support onsite in a large database in the United Kingdom between 2006 and 2012. They found in multivarate analysis that there was no difference at 30 days, 1 year or 5 years. Therefore they conclude that performing PCI at centers that do not have onsite cardiac surgical backup does not carry a higher risk of mortality, both at short and long-term follow-up
July 17, 2015
Submitted by: Lisa Brown
Retrospective study of 917 patients undergoing esophagectomy for squamous cell carcinoma at a single hospital in China. In the 7th version of the AJCC staging system for esophageal cancer, nodal stage (N stage) is based solely on the number of lymph node (LN) metastases. However, an updated staging system that includes the extent of LN metastases is proposed to determine if patients can be better stratified according to stage and subsequent survival. The authors hypothesized that given the same number of LNs, the prognosis may differ between patients whose metastatic LNs are contained in one station versus multiple stations. The current AJCC staging system used global data from 4,627 patients, but only 40% of these patients had squamous cell carcinoma. All patients in this study underwent transthoracic en-bloc esophagectomy with mediastinal and abdominal two-field lymphadenectomies. Four revised N stages were proposed: r-N0, 0 station, r-N1, 1 station, r-N2, 2 stations, r-N3, 3 stations based on Casson's LN drainage map. There was improvement in discrimination in terms of survival between those with r-N2 versus r-N3 and also between stages IIIB and IIIC using the revised staging system.
July 16, 2015
Submitted by: Arie Blitz
The authors conducted a randomized prospective study comparing 3 methods of SVG harvesting in 156 patients. The 3 methods compared were as follows: Conventional (C)--stripped and distended veins; Intermediate (IM)--stripped but not distended veins; and, No Touch (NT)--neither stripped nor distended but harvested on a pedicle. In comparing the C (n=27) and NT (n=27) groups that were available at a mean of 16 years, crude SVG patency was 64% in C vs. 83% in NT (p=0.03). The latter was comparable to the observed LIMA patency, 88%.
July 16, 2015
Submitted by: Mark Ferguson
In order to improve the diagnostic accuracy of bronchoscopy for lung cancer, epithelial cells were collected from normal appearing mucosa in the mainstem bronchus of patients suspected of having lung cancer during diagnostic bronchoscopy. The samples were evaluated with a gene expression classifier. 43% of the standard examinations were nondiagnostic. The gene expression classifier had an accuracy of 74% to 78%. The combination of gene classifier and standard bronchoscopy had a sensitivity of 96% to 98%. The gene classifier improved the diagnostic accuracy of bronchoscopy in intermediate-risk patients.
July 15, 2015
Submitted by: Arie Blitz
The University of Pennsylvania group, in a porcine model of ischemic mitral regurgitation (IMR), compared echocardiographic surface coaptation in two groups of pigs: Those undergoing MV repair with a flat semirigid annuloplasty ring vs. with a saddle-shaped rigid annuloplasty ring. The group found that the latter ring led to significantly improved leaflet coaptation compared to the former.
July 14, 2015
Submitted by: Mark Ferguson
This important consensus statement on definitions of postoperative complications after esophagectomy was developed by an international group of surgical experts. It should serve as a template for data collection and reporting for clinical reports and trials.
July 14, 2015
Submitted by: Mark Ferguson
This small randomized trial evaluated the potential benefits of ghrelin, an anti-inflammatory agent, in reducing the SIRS response after esophagectomy. The ghrelin group had a reduced SIRS duration, lower CRP levels, and lower IL-6 levels compared to controls. Pulmonary complications were reduced in the ghrelin group, but other complication incidences were similar.