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Journal and News Scan
October 18, 2015
Submitted by: J. Rafael Sadaba
In this manuscript the authors report on the results of a retrospective propensity score analysis in 102 matched pairs of patients, considered to be in a “grey zone” of surgical risk for either TAVI (Edwards Sapiens, Medtronic CoreValve or Symetis Acurate TA prosthesis) or aortic valve replacement (AVR) with a sutureless prosthesis (Sorin Perceal). There were no significant differences in intra-procedural complications, postoperative renal, neurological or respiratory complications and the need for pacemaker between the patients undergoing TAVI and sutureless AVR. Patients receiving TAVI had shorter ICU and hospital stay, and required less blood transfusion, but suffered vascular complications significantly more frequently than patients receiving a sutureless prosthesis. There was no significant difference in hospital mortality. At follow up, paravalvular leak was more frequent in the TAVI group. Survival rate was significantly better in the sutureless AVR group. Outcomes regarding the cost associated to the two procedures showed than when the cost of the device was included, sutureless AVR resulted as a cost-saving treatment compared with TAVI.
October 16, 2015
Submitted by: Mark Ferguson
Using an anonymous survey, surgeons at a single institution were asked to rate the impact of 9 stressors on performance and outcomes. Complex cases, rarely performed cases, and lack of adequate assistance were assocated with the most stress. A stress-related intraoperative complication occurrence was reported by 40%. More than 80% indicated that training in stress management would be useful.
October 14, 2015
Submitted by: Arie Blitz
During the 2013 In-Training Exam for cardiothoracic surgery residents, 312 residents were surveyed regarding their training. Residents self-reported that only 70-75% of the cases they claimed 'surgeon' credit met the ABTS definition for 'surgeon'--i.e., the resident performs "those technical manipulations that constituted the essential parts of the procedure itself" and has substantial involvement in preoperative and postoperative care. What are the reasons that residents feel they need to 'over-report' their cases? What are the implications of this study?
October 14, 2015
Submitted by: Arie Blitz
The authors retrospectively reviewed the postoperative TEEs on patients undergoing DCCV within 30 days after cardiac surgery that included LAA closure (n=93 patients). The presence of a residual communication between the LAA and the left atrium was 37% overall. The LAA patency rates according to LAA technique were as follows: amputation, 0%; suture closure, 51%; staple exclusion, 29%. These results beg the question: should the appendage always be amputated?
October 13, 2015
Submitted by: Joel Dunning
This is an anterior approach to the station 7 lymph node after a left upper lobectomy. I have certainly never seen the lymph node from this direction. very interesting
October 12, 2015
Submitted by: Mark Ferguson
This single institution study evaluated compliance with NCCN guidelines in the management of stage II-III esophageal cancer. Overall compliance was 81%, and was related to younger age, white race, and higher education level. Compliance was associated with improved survival.
October 10, 2015
Submitted by: Mark Ferguson
Chinese men smoke one-third of the world's cigarettes; two-thirds of adult Chinese men are smokers. In contrast, the percentage of women smokers is low and is decreasing (<3%). It is estimated that by 2030 2 million annual deaths in China will be attributable to smoking.
October 8, 2015
Submitted by: Mark Ferguson
The authors evaluated ventricular function after AR or MR in young patients with regurgitation and preoperative signs of ventricular dysfunction. Results at 18 mos were compared to a normal population. Persistent LV dysfunction was present in 85% after AR+MR and was more common than after either operation alone. Preoperative end-systolic volume predicted postop LV dysfunction in pts undergoing isolated MR or AR.
October 8, 2015
Submitted by: Mark Ferguson
The authors sought to risk stratify pts with secondary TR and then analyze outcomes of different treatment options for TR in conjunction with repair of left-sided valve disease. Low risk patients did well without TR intervention, intermediate risk patients did well with De Vega annuloplasty, and high risk patients fitted with an undersized annuloplasty ring had good outcomes.
October 8, 2015
Submitted by: Mark Ferguson
The effects of renal failure on outcomes of AVR were examined using CMS data. TAVR pts on dialysis, TAVR pts not on dialysis, and surgical AVR pts on dialysis were compared after propensity score matching. In TAVR patients, dialysis was associated with increased 30 day mortality and survival, and was an independent predictor of worse survival. TAVR and SAVR patients on dialysis had similar outcomes, although length of hospitalization was shorter among TAVR pts.