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Journal and News Scan
February 2, 2015
Submitted by: J. Rafael Sadaba
This manuscript describes the findings of a retrospective analysis of 874 consecutive high risk or inoperable patients undergoing TAVR in three different centres, evaluating outcomes after up to three years of follow up. In-hospital mortality was 5%. Early mortality was strongly associated with the occurrence of procedural complications. The relative incidence of non-cardiovascular death increased with time to become the principal cause of mortality beyond 6 months and outnumbering cardiovascular mortality beyond 24 months. Cumulative mortality at three years was 31.5%. Baseline comorbidities, particularly COPD and renal impairment, had a major detrimental impact on long-term mortality.
January 29, 2015
Submitted by: Mark Ferguson
This meta-analysis of 6 prior publications analyzed factors associated with outcomes after resection of synchronous lung cancers. Favorable predictors of survival were exclusive adenocarcinoma, small T size, bilateral disease, no nodal involvement, young age, and female sex.
January 29, 2015
Submitted by: Mark Ferguson
There is growing recognition of the utility of EBUS in staging NSCLC. In this study EBUS and mediastinoscopy were performed in 127 patients requiring mediastinal staging for clinical N1-3 NSCLC. The authors found that EBUS had superior accuracy (93% vs 89%) and negative predictive value (85% vs 79%).
January 29, 2015
Submitted by: Mark Ferguson
This analysis of nearly 40,000 patients with inoperable early stage lung cancer explored factors associated with delivery of potentially curative conventional radiotherapy (ConvRT) or SBRT. Treatment was less likely in blacks and hispanics. SBRT was more likely than ConvRT in high volume and academic centers. Overall use of SBRT, ConvRT, and no treatment was 68%, 11%, and 21% in academic centers compared to 25%, 28%, and 46% in community centers.
January 29, 2015
Submitted by: Mark Ferguson
There is growing recognition that hospital mortality is not an accurate metric for surgery-related mortality after cancer operations. This article evaluated SEER data for 1-month mortality after cancer surgery in nearly 54,000 patients. 4.8% died within 1 month of surgery. Favorable factors included being married, being insured, having an above-median income, and having an above-median educational status. Eliminating such adverse outcomes in those with socioeconomic disparities provides the opportunity to substantially improve cancer survival.
January 29, 2015
Submitted by: Mark Ferguson
This meta-analysis evaluated 6 published studies involving over 71,000 cancer patients who experienced 2002 instances of cancer mortality. Compared to patients with low fitness, those with high levels of cardiorespiratory fitness had a 50% reduction in their cancer mortality risk.
January 29, 2015
Submitted by: Mark Ferguson
The author recounts the posttraumatic distress that Captain Scully and other crewmembers experienced after the emergency landing of US Airways Flight 1549 on the Hudson River in New York City. She describes the counseling this team required after executing a nearly perfect recovery from a potentially disastrous aviation event. The author wonders why, when physicians experience similarly traumatic experiences with their patients (especially those with fatal outcomes), they are expected to resume work immediately, without counseling and without regard for any potential disability.
Coronary Subclavian Steal Syndrome Detected During Coronary Bypass Surgery in a Hemodialysis Patient
January 28, 2015
Submitted by: Arie Blitz
Coronary subclavian steal syndrome is a concern in hemodialysis patients with an upper extremity arteriovenous fistula (AVF) who are undergoing ipsilateral IMA harvest for revascularization. In this case report, the authors describe the intraoperative documentation of reversal of flow in the LIMA to LAD graft that improved with occlusion of the AVF. This finding prompted taking the LIMA off the Aorta as a free graft, which led to improvement of flow characteristics.
January 26, 2015
Submitted by: Marcelo Jimenez
In this retrospective study of 173 lung transplants performed at Loyola University, investigators found a correlation between heavy alcohol use in lung transplant donors and risk of developing severe primary graft dysfunction. Those recipients had an 8.7 times higher risk than patients who received lungs from donors who did not drink.
January 25, 2015
Submitted by: J. Rafael Sadaba
This manuscript offers a comprehensive and easy to read review of annular rupture during TAVI. The authors explain the pathophysiology of this complication and classify it according to the anatomical location. They also discuss the management options in terms of diagnosis and treatment.