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Journal and News Scan
March 21, 2015
Submitted by: J. Rafael Sadaba
The authors describe the one-year results of a randomized trial comparing outcomes between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) among an all-comers cohort of 280 patients. Patients 70 years of age or older with severe degenerative aortic valve stenosis referred for SAVR but also a candidate for TAVR were eligible for inclusion regardless of their predicted risk of death after surgery. The primary hypothesis was that the rate of the composite outcome of death from any cause, stroke, or myocardial infarction after 1 year would be lower for patients receiving TAVR versus SAVR. In the intent-to-treat analysis, the primary outcome was similar in the two groups (13.1% vs.16.3% for TAVR and SAVR). The need for permanent pacemaker implantation was higher in TAVR patients (38.0% vs. 2.4%), while the rate of new-onset or worsening atrial fibrillation was lower (21.2% vs. 59.4%). After 1 year, patients undergoing TAVR had more dyspnea compared to SAVR patients (29.5% vs. 15.0%; P=0.01). There was more improvement in effective orifice area relative to baseline in SAVR patients, but TAVR patients experienced a higher rate of significant aortic valve regurgitation. The authors conclude that based on their findings, they are not able to recommend one procedure over the other in lower risk patients.
March 17, 2015
Submitted by: Mark Ferguson
The authors sought to validate the definition of the systemic inflammatory response syndrome (SIRS), which requires the presence of 2 or more clinical criteria, and determined whether meeting the definition was associated with an increased risk of death. Over 109,000 ICU patients in Australia and New Zealand who had infection and organ failure were studied. 88% had SIRS positive sepsis, the others did not meet the SIRS criteria (SIRS negative sepsis). Mortality in the two groups decreased similarly over the 14 year study. There was a linear increase in mortality associated with each additional SIRS criterion, indicating that the threshold of 2 criteria did not represent a transition in risk level.
March 17, 2015
Submitted by: Mark Ferguson
The study investigated management of atrial fibrillation existing at the time of mitral valve surgery, randomizing 260 pts to ablation or observation. The end point was freedom from afib at both 6 and 12 mos. Ablation yielded success in 63% compared to 29% of controls, but was associated with a higher risk of pacemaker implant (21% vs 8%).
March 16, 2015
Submitted by: Mark Ferguson
This Netherlands population-based study followed causes of death in patients with NSCLC diagnosed 1989-2008, including more than 72,000 patients. For those with localized disease, lung cancer was the cause of death in 80-85% for years 0-3, 60-75% for years 4-6, and remained the cause of death for more than 30% thereafter. After 6 years CAD and COPD became the primary causes of death.
March 16, 2015
Submitted by: Mark Ferguson
The authors describe results of initial bronchoscopy therapy (IBT) for endobronchial carcinoids aimed at relieving obstruction, accurate subtyping, and potentially complete eradication. After a minimum follow-up of 5 years, 42% of patients were spared surgical therapy, having had no evidence of local or distant recurrence (42/83 with typical histology, 5/29 with atypical histology).
March 16, 2015
Submitted by: J. Rafael Sadaba
In this manuscript the authors present a post-hoc study of the SYNTAX trial. They compare outcomes between those patients on optimal medical therapy (OMT) and non-optimal medical therapy following revascularization for complex coronary artery disease (CAD). OMT was defined as combination of at least one antiplatelet drug, statin, beta-blocker and angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACE-I/ARB). Only one third of the patients were found to be on OMT at 5-year follow up. Lack of OMT was associated with a higher mortality and combined endpoint of death, MI and stroke. These findings reinforce the the importance of OMT use for patients with complex CAD undergoing revascularization.
March 16, 2015
Submitted by: Mark Ferguson
Using STS/ACC registry data, the authors updated 30-day outcomes and present 1 year outcomes for TAVR pts. Over 12,000 pts were in the registry; median age was 84, and STS predicted operative mortality risk was 7.1%. 30-day mortality was 7.0%, 1-year mortality was 23.7%. 1-year mortality was associated with advanced age, male sex, end-stage renal disease, COPD, non-transfemoral access, high predicted risk, and preoperative afib.
March 16, 2015
Submitted by: Mark Ferguson
With the increase in solitary pulmonary nodule identification anticipated with increased CT screening, the authors devised a novel method of bronchoscopically biopsying nodules not adjacent to airways. Using endoscopic instruments, a transparenchymal tunnel was created between a bronchial entry point to the nodule, and biopsies were obtained. The procedure was successful in 10/12 pts and the histologic results were well correlated with surgical findings. No complications occurred.
March 14, 2015
Submitted by: Arie Blitz
This is a very provocative British study that examined whether a more liberal (Hgb < 9 g/dL) versus a more restrictive (Hgb < 7.5 g/dL) transfusion threshold after cardiac surgery is associated with higher morbidity and costs. The authors conducted a multicenter, prospective randomized trail by randomizing patients who had a Hgb < 9 g/dL after heart surgery to one of the two groups. Over 2,000 patients were enrolled in the study. Interestingly, the group with the more liberal transfusion protocol had no worse outcomes and no higher costs than the restrictive group. Moreover - even more provocatively - the secondary outcome of 90-day all-cause mortality was 64% more likely to occur in the restrictive transfusion threshold group.
March 12, 2015
Submitted by: Marcelo Jimenez
Samples from tissue microarrays of 552 NSCLC patients were analyzed to measure the levels of 3 different tumor-infiltrating lymphocytes (TILs): CD3, CD8, and CD20. An elevated level of CD3 or CD8 was associated with longer survival. This finding might be useful to evaluate response or assess the local immune effect of anticancer immune inhibitors.