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Journal and News Scan
A new cohort analysis looks at the use of functional imaging, in addition to coronary angiography, in preoperative planning for surgical revascularization.
In this manuscript the authors describe their finding after a systematic review and meta-analysis to explore the safety and efficacy of the Mitraclip procedure for patients with functional mitral regurgitation (FMR). Overall, 875 patients were included. Every patient underwent a follow-up of at least 6 months. The primary safety end point was a composite of all-cause death, rehospitalization for heart failure, and reinterventions during follow-up. The primary efficacy end point was the change in 6-minute walk test (6MWT). Secondary efficacy end points were change in left ventricle ejection fraction (EF), left ventricle volumes, pulmonary arterial pressure, and left atrial volumes, whereas the secondary safety end points were the single components of the primary composite one, cardiac death, and acute kidney injury during index hospitalization. The main findings were a net improvement in 6MWT, in NYHA functional class, and in reverse remodeling; a negative impact of AF diagnosis on positive effect in terms of remodeling; and low rates of procedural cardiac deaths. The authors conclude that Mitraclip is an effective treatment strategy for patients with heart failure and significant mitral regurgitation.
The paper reviews the anatomy of spinal cord perfusion, strategies to shorten the intraoperative duration of ischemia of the spinal cord, to increase its ischemic tolerance, to detect ischemia and to improve its perfusion.
The procedure of transcatheter aortic valve implantation (TAVI) was analyzed in 2287 patients. About 11% needed surgical interventions, about 2% were converted to full sternotomy and about 1% required use of the heart lung machine. The authors advocate the presence of a cardiac surgeon at each TAVI and building experienced teams within specialized centres.
This post hoc analysis of the Arterial Revascularization Trial (ART) on 3102 patients compares intraoperative parameters and 1-year outcome for on-pump and off-pump surgery. Both techniques show excellent results with differences only in a small number of secondary endpoints.
In this retrospective review of 336 patients treated surgically for early stage NSCLC, the prognostic value of PET SUV was evaluated. Risks of recurrence and death increased steadily as SUV increased.
This interesting article summarizes the potential benefits of exercise in patients with lung cancer, including improved exercise capacity and quality of life, and reduced postoperative complications and length of postoperative stay. This modality is safe, and is likely underutilized in this patient population.
This prospective observational study followed 111 patients for 3 years after laparoscopic repair of a type III paraesophageal hernia. QOL improved at all postoperative time intervals from 28.5 preop to about 10. The radiographic recurrence rate was 27% at 1 year. Hernias involving most of the stomach were more likely to recur than smaller hernias.
A pooled analysis of outcomes from two randomized trials involving SBRT or surgery for operable patients with clinical early stage NSCLC was performed. The number of patients was small (58 total) and the follow-up was a median of 35-40 mos. Overall 3-year survival was better in the SBRT group (95% vs 79%; p=0.037) whereas recurrence free survival did not differ between the groups. Grade 4 complications or death occurred in 48% of surgical patients (1 mortality) and in none of the SBRT patients.
This retrospective review compared outcomes for re-do minimally invasive mitral valve operations vs re-do sternotomy in mitral valve operations. The authors demonstrate a similar MV-repair rate in the two groups but a significantly lower bypass and cross-clamp time in the minimally invasive group. Working within the confines of a retrospective study the authors have produced a very interesting paper.