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Journal and News Scan
November 26, 2014
Submitted by: Arie Blitz
Goldberg and colleagues provide an excellent review on a complex topic: intramural hematomas. The article has several take-home messages: one must be very careful in how one defines IMH; its pathogenesis remains unclear; IMH tends to involve a more outer location of the aortic media than aortic dissections (AD) do; IMH is more likely to rupture externally than AD; risk factors for progression from IMH to AD include aortic diameter and aortic wall thickness; the liberal use of stent grafting for type B IMH is probably unwarranted. It remains to be proven whether IMH should be treated any differently from AD. Until then, except under unusual circumstances, the same treatment approach is likely warranted.
November 25, 2014
Submitted by: Joel Dunning
Simply fabulous !!
Well done Shanda Blackmon. We are all proud to be Cardiothoracic surgeon too !
November 25, 2014
Submitted by: Arie Blitz
In a retrospective review of 45 cases where patients were placed on VV ECMO, investigators from Seoul performed a multivariate analysis of pre-ECMO risk factors that might be predictive of an unsuccessful ECMO wean. Notably, successful weaning from ECMO was only 46%, and overall survival was only 18%. Importantly, higher platelet counts at ICU admission and the day prior to initiating ECMO were predictive of successful weaning. Specifically, patients with a platelet count > 70K had an 11X greater likelihood of a successful wean. Why? Is the low platelet count a surrogate for the severity of illness?
November 24, 2014
Submitted by: Mark Ferguson
Data from the Barrett's and Esophageal Adenocarcinoma Genetic Susceptibility Study were used to determine the relationship of a genetic risk score associated with obesity to cancer risk. The risk score was not associated with GERD or smoking. Cancer and Barrett's were strongly associated with increasing BMI. The authors conlude that those with a genetic makeup associated with obesity have increased risk of cancer and Barrett's.
November 24, 2014
Submitted by: Mark Ferguson
Data from the National Lung Screening Trial (NLST) were examined by exploring different size thresholds for classifying CT screening scans as positive. In the NLST, nearly two-thirds of nodules were 7mm in diameter or less. Using a threshold of 5mm, the percentage of missed/delayed diagnosis and the likelihood of avoiding false positive findings were 1% and 16%. Using a threshold of 8mm increased those rates to 11% and 66%. Increasing size thresholds reduced follow-up CTs and invasive procedures. Interestingly, differences in thresholds did not affect survival or mortality.
November 22, 2014
Submitted by: Joel Dunning
You have to check out this amazing VATS lobectomy surgery simulator. It is unbelievably realistic and comes in a LAP surgery simulator: staplers, slings, the works!!
Henrik Hansen was key in designing this, so it uses his anterior approach to do the lobectomy.
November 20, 2014
Submitted by: Mark Ferguson
301 pts with CAD required revascularization and moderate MR were randomly assigned to CABG or CABG with MV repair. The outcome was LV end-systolic index at 1 year. MV repair contributed to longer pump times, longer hospitalization, and more neurologic events. MV repair did not result in an improved primary outcome at 1 year, but was associated with reduced rates of moderate to severe MR. The potential benefit of this latter finding is unclear.
November 20, 2014
Submitted by: Mark Ferguson
Data from 20 observational studies including nearly 3000 pts were reviewed to assess the prevalence of pre-frailty/frailty and clinical outcomes in older cancer patients. Frailty was identified in 42% and pre-frailty in 43% of patients. Combined frailty was associated with increased all cause mortality (5-yr HR 1.57), postoperative mortality, and postoperative complications.
November 17, 2014
Submitted by: Mark Ferguson
This trial randomized 900 pts with type 1 or 2 diabetes to screening with coronary computed tomography angiography (CCTA) or standard care and evaluated death and non-fatal coronary outcomes. The major outcome was a composite of death, MI, and admission for management of unstable angina. The secondary outcome was a composite of CAD-associated death, MI, or unstable angina. CCTA screening did not influence the rate of major or secondary outcomes.
November 17, 2014
Submitted by: J. Rafael Sadaba
This is a matched case controlled study of 27 consecutive patients with severe symptomatic aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) with the SAPIEN 3 (SV3)device in 2 centers. These patients were matched with patients who had undergone TAVI with the 26-mm SAPIEN XT (SXTV) who were drawn from a prospective database of 270 consecutive patients.
The rate of balloon postdilation after valve implantation was higher in the SXTV group compared with the S3V group (p = 0.047). In the S3V group, only 2 patients (7%) had a paravalvular leak graded as mild or greater, compared with 42% of the patients in the SXTV group (p = 0.002). In the univariate analysis, the implantation of the S3V was the only factor associated with no/trace paravalvular leaks after TAVI.