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Journal and News Scan
September 26, 2015
Submitted by: Mark Ferguson
In this RCT, patients at increased risk for cardiac surgery requiring CPB were assigned to steroids at the time of anesthetic induction and again at the time of CPB induction or no steroids. Primary outcomes were 30-day mortality and major morbidity. Steriods had no effect on the primary outcomes. There was no evidence that steroids increased the risk of other complications, particularly infection, surgical site infection, and delirium.
September 24, 2015
Submitted by: Ruben Osnabrugge
The investigators of this study compared survival of bare metal stent percutaneous coronary intervention (BMS-PCI) versus drug-eluting stent PCI (DES-PCI) versus single artery CABG (SA-CABG) versus multiarterial CABG (MA-CABG) in patients with multivessel coronary artery disease. They used propensity-matching and Cox regression techniques in more than 8000 patients from 1 institution. The authors found that survival after DES-PCI was higher than after BMS-PCI. Long-term survival after DES-PCI was similar to SA-CABG. However, when compared to MA-CABG, the DES-PCI group showed worse survival at 5 years (86.3% versus 95.6%) and at 9 years (82.8% versus 89.8%; HR 0.45, p<0.001). The authors conclude that MA-CABG should be adopted as the optimal therapy for multivessel coronary heart disease.
September 23, 2015
Submitted by: Joel Dunning
This is a fabulous grand round presentation from Tom D'Amico documenting the history and the future of thoracoscopic lobectomy. A Must see for thoracic surgeons
September 23, 2015
Submitted by: Arie Blitz
The authors conducted a propensity-matched analysis of outcomes and costs associated with TAVR vs. SAVR procedures in patients considered either intermediate risk (STS PROM 4-8%) or high risk (STS PROM >8%) within the Commonwealth of Virginia. Although the incidence of major morbidity was higher and the length of stay was longer with SAVR, the mortality was higher for TAVR (10% vs. 6%, p<0.047). Importantly, the median total costs of the implant hospitalization were more than double for the TAVR group in comparison to the SAVR group ($69,921 vs. $33,598). Not surprisingly, the dominant cost driver for TAVR was the cost of the device, which accounted for 40% of the cost of the implant hospitalization.
September 20, 2015
Submitted by: Philip McElnay
A large retrospective study comparing 117618 patients from the National Cancer Database with Stage I NSCLC. 111731 received surgery, 5887 received SBRT. In a propensity managed comparison, those undergoing surgery had increased overall survival.
September 18, 2015
Submitted by: Arie Blitz
This sub-study of the Randomized On/Off Bypass (ROOBY) trial compared clinical outcomes and 1-year graft patency between CABG cases where residents vs. attending surgeons were the primary operator. Graft patency rates were similar between resident- vs. attending-completed distal anastomoses for on-pump (83.0% vs. 82.4%) and off-pump (77.2% vs. 76.6%) procedures.
September 18, 2015
Submitted by: Stuart Grant
This study describes activity and outcomes for both standard aortic valve implantation and transcatheter aortic valve implantation (TAVI) in England and Wales in the TAVI era. The study demonstrates that both standard aortic valve implantation and TAVI acitivity have increased since TAVI was first performed in the United Kingdom. The proportion of all aortic valve implantations performed by TAVI has increased from 0.8% in 2007 to 10.9% in 2012. Procedural outcomes have improved for both standard AVR and TAVI over time.
September 17, 2015
Submitted by: CTSNet Staff
Authors report on visceral malperfusion in a series of 121 patients with acute type A aortic dissection. They postulate that in case of severe visceral ischaemia, abdominal surgery should be performed first to avoid irreversible ischaemic damage caused by circulatory arrest required for aortic repair.
September 17, 2015
Submitted by: CTSNet Staff
The paper evaluates de novo development of aortic insufficiency (AI) following implantation of continuous flow left ventricular assist (84 HeartMate II, 13 HeartWare, 2 VentrAssist). Preoperatively, 17 patients had mild AI, which did not change later. Fourty-three of the other 82 patients developed new AI, with no influence on survival. Rate of freedom from de novo AI at 1 year after VAD implantation was 35.9%. Smaller body surface area, larger aortic root diameter and higher pulmonary artery systolic pressure were identified as the independent preoperative risk factors.
September 17, 2015
Submitted by: CTSNet Staff
This single-center study analyses outcomes of living-donor lobar lung transplantations. Eight out of 38 patients who survived more than three months developed chronic lung allograft dysfunction (CLAD). Six of these eight patients had undergone bilateral transplantation. Unilateral CLAD was observed in three and bilateral CLAD developed in the other three patients.