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Journal and News Scan
June 17, 2015
Submitted by: Mark Ferguson
Using propensity score matching techniques, outcomes and costs for robotic cardiac surgery were compared to open cardiac surgery using data from the Nationwide Inpatient Sample. Robotic surgery was more expensive ($39,030 vs $36,340) but was associated with a shorter length of stay (5 vs 6 days), lower mortality (1.0% vs 1.9%), and lower overall complication rates (27.2% vs 30.3%).
June 16, 2015
Submitted by: Mark Ferguson
The good news continues regarding chocolate consumption! A study involving nearly 21,000 individuals with a median follow-up of nearly 12 years correlated cardiovascular disease with quintiles of chocolate consumption. The lowest quintile was associated with a 50% higher risk of coronary heart disease and a similar increase in stroke incidence.
June 16, 2015
Submitted by: Mark Ferguson
Data from a variety of US sources were used to estimate the contribution of smoking to mortality for 12 common malignancies (colorectal, esophagus, kidney, larynx, liver, lung, leukemia, head/neck, pancreas, stomach, bladder, cervix. The contribution of smoking to mortality ranged from 10% (colorectal) to 77% (larynx). The overall contribution was 49%.
June 16, 2015
Submitted by: Mark Ferguson
The British Thoracic Society developed guidelines for evaluation and management of solitary pulmonary nodules based on a literature review and expert opinion. New features include the use of a malignancy risk algorithm, use of a higher threshold for follow-up (5mm), and a reduction in the follow-up interval to 1 year for solid nodules. Management of part solid nodules is assigned a separate algorithm.
June 14, 2015
Submitted by: Philip McElnay
Trials evaluating the use of surgery in stage IIIB NSCLC are lacking. This study goes some way to address that and demonstrates that surgery as part of multi-modality therapy may result in a survival benefit.
June 14, 2015
Submitted by: Arie Blitz
This Swedish study was a retrospective review over a 20-year time period that compared survival after out-of-hospital cardiac arrest between those receiving bystander CPR prior to EMS arrival and those not receiving such. CPR before the arrival of EMS was associated with an increased 30-d survival rate (odds ratio 2.15; 95% CI 1.88-2.45).
June 14, 2015
Submitted by: J. Rafael Sadaba
In this manuscript the authors report on data from the German Aortic Valve Registry (GARY) comprising 15964 transcatheter aortic valve replacement (TAVR) procedures performed from 2011 to 2013 evaluating severe vital complications (SVCs), technical complications of the procedures (TCOs), other complications, conversion to sternotomy and in-hospital death. Patients’ mean age was 80.9 years. A balloon expandable prosthesis was used in 52.6% of the cases. An average 5% of the patients experienced SVCs, with a significant decrease in SVCs from 6.8% (in 2011) to 4.9% (in 2012) and 3.9% (in 2013). Residual aortic regurgitation was detected in 5.8% of patients. Need for pacemaker implantation occurred in 17.5% of patients. Stroke was diagnosed in 1.5%. Technical complications occurred in 748 patients (4.7%). Conversion to sternotomy was required in 201 patients (1.3%). Major vascular complications occurred in 4.1%. All these complications showed a significant decline in prevalence during the study period.
Logistic Euroscore and STS score were 18.3 and 5.0 respectively. A total of 828 patients (5.2%) died during the procedures or during the hospital stay. Interestingly, multivariate analysis showed that the transapical approach was not an independent predictor of death. The authors conclude that TAVR therapy is safe with acceptable complication rates (decreasing over time) in an all-comers and high-risk patient population.
June 13, 2015
Submitted by: J. Rafael Sadaba
In this open-access article, the authors describe their findings in a systematic review of transcatheter heart valve (THV) failures, comprising 70 articles and 87 individual cases. Unusual complications such as late embolization (mostly into the left ventricle) and prosthetic compression (exclusively in balloon expandable THVs) are described. Structural valve deterioration is reported in 13 cases, the most common cause being severe leaflet calcification. THV thrombosis has been documented in 10 publications comprising 15 patients (14 balloon expandable THV). The authors conclude that THV appear to be susceptible to failure modes both similar to those of surgical bioprosthetic valves and unique to the specific design features of THVs.
June 12, 2015
Submitted by: Mark Ferguson
This meta-analysis of published studies evaluated outcomes of multimodality therapy including resection for superior sulcus NSCLC invading the spine. 134 articles were evaluated, which included 135 patients. 63% had induction therapy, and all underwent en bloc resection. 52% had adjuvant therapy. Survival at 3,5, and 10 years was 57%, 42%, and 27%. R0 resection was a predictor of survival.
June 12, 2015
Submitted by: Mark Ferguson
Outcomes of esophagectomy, including in-hospital mortality and length of stay (LOS), were compared between England (centralized care) and the US (no centralized care). Data for 2005-2010 included 7433 esophagectomies performed in 66 hospitals in England and 5858 esophagectomies performed in 775 hospitals in the US. Morality was greater in the US (5.5% vs 4.2%; p=0.001). Predictors of mortality included age, comorbidities, hospital volume, and surgery in the US. Interestingly, in high volume hospitals mortality was lower in the US (2.1% vs 3.5%; p=0.02). LOS overall was greater in England; LOS decreased with increasing hospital volume in the US but not in England.