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Journal and News Scan
October 31, 2014
Submitted by: Ruben Osnabrugge
In this review, the authors describe alternative treatments for hypertrophic cardiomyopathy (HCM). The most important evidence comparing alcohol septal ablation (ASA) and surgical myectomy is discussed. The authors conclude that surgery is most consistent in achieving optimal hemodynamic results, quality of life and longevity. ASA however is a good alternative in older patients with more comorbidities.
October 28, 2014
Submitted by: Joel Dunning
The Heart and Lung Transplant team of St. Vincent’s hospital (Sydney, Australia) have successfully transplanted “dead” hearts into three patients. The donor hearts had stopped beating for 20 minutes, but were kept viable by being immersed in a preservation solution. The hearts were then restarted and kept beating in a specially developed circuit, called a “heart in a box.”
October 28, 2014
Submitted by: J. Rafael Sadaba
Retrospective study on 102 consecutive asymptomatic or mildly symptomatic patients with no left ventricular dysfunction and with degenerative mitral regurgitation (MR) who underwent mitral valve surgery in three centers. The authors looked into the usefulness of exercise stress echocardiography in this group of patients to predict postoperative cardiovascular events. The findings show that the development of exercise-induced pulmonary hypertension (PHT) is a major risk factor for cardiovascular events following mitral valve surgery, regardless of symptom onset during the preoperative course. The results of this study suggest that asymptomatic patients with exercise-induced PHT may benefit from early elective surgical intervention.
October 25, 2014
Submitted by: Ruben Osnabrugge
The authors of this piece summarize how surgery has changed over the past decades. They do this using the mnemonic: TWO POEMS:
Teamwork, Work hours,Outcomes, Patient-centered care, Outpatient, Expense, Minimally invasive, Simulation and education.
October 22, 2014
Submitted by: J. Rafael Sadaba
In this study the authors evaluate the prevalence of significant aortic stenosis (diagnosed with echocardiography and computed tomography) in the elderly, in a cohort representative of the general population of Iceland. Based on their findings, the authors conclude that the number of elderly patients with severe AS will greatly increase in the coming decades. The current study shows that the largest increase will be in the population of 70 years of age and older, both in men and in women.
October 22, 2014
Submitted by: Mark Ferguson
This survey of publicly available information on LVAD for patients considering such therapy identified numerous flaws in the materials. All discussed benefits, few discussed surgical issues, quality of life, and complications. Some had outdated statistics, some were written above a 3rd grade level, and most did not meet international standards. The perception among patients was that the materials were strongly biased towards LVAD therapy.
October 20, 2014
Submitted by: Ruben Osnabrugge
In this paper, the authors aim to further understand the factors associated with vein graft failure (VGF) after CABG. They used data on 1828 participants in the PREVENT IV trial to identify patient and surgical factors associated with VGF. They found that longer surgical duration, endoscopic vein harvesting, poor target artery quality and postoperative clopidogrel use were independently associated with VGF. These findings will help identifying patients at high risk of VGF, as well as helping to develop interventions with lower rates of VGF.
October 19, 2014
Submitted by: J. Rafael Sadaba
In this manuscript, the authors use meta-analysis techniques to evaluate the relationship between measured coronary fractional flow reserve (FFR) and patients’ outcomes. They demonstrate that FFR provides a continuous and independent marker of subsequent MACE as modulated by treatment (medical therapy vs revascularization) in a broad range of clinical scenarios. Lesions with lower FFR values receive larger absolute benefits from PCI or CABG. When FFR values are high, we can do harm by proceeding with revascularization. The cut-point for determining revascularization strategy using this statistical analysis remains in the 0.75-0.80 range, which is in keeping with previous reports on this subject. According to the findings, the authors conclude that an FFR-guided revascularization strategy significantly reduces MACE and increases freedom from angina with less PCI or CABG than an anatomy-based strategy.
October 16, 2014
Submitted by: Joel Dunning
In a retrospective cohort study of patients less than 18 years old who underwent cardiopulmonary bypass, intraoperative hemodynamics and vasopressor use were compared between patients who received preoperative ACE inhibitor/ARB therapy and those who did not. Use of preoperative ACE inhibitors and ARBs in pediatric patients undergoing cardiac surgery did not increase the incidence of hypotension after induction of anesthesia and did not increase vasoconstrictor requirements upon weaning from cardiopulmonary bypass.
October 16, 2014
Submitted by: Mark Ferguson
Because of the observation that already debilitated pts who undergo lung resection become even more debilitated afterwards, the authors conducted a randomized trial of endurance and strength training for 20 wks after major lung resection. Training significantly improved peak VO2, DLCO, strength, endurance, and muscle mass compared to controls. Quality of life, both physical and mental, was also improved with the training compared to controls.