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Journal and News Scan
September 29, 2014
Submitted by: Mark Ferguson
This randomized double-blind multicenter study involving 667 pts evaluated the utility of IV fenoldopam in reducing the rate of renal replacement therapy for patients undergoing cardiac surgery who exhibit postoperative acute kidney injury. Fenoldopam did not importantly reduce the need for renal replacement therapy or 30 day mortality. Its use was asssociated with an increase in postoperative hypotension.
September 29, 2014
Submitted by: Joel Dunning
WASHINGTON D.C. -- September 16, 2014 -- Use of a dual-filter cerebral protection system reduces the number and volume of cerebral lesions in patients with severe aortic stenosis undergoing transaortic valve replacement (TAVR), according to prospective research presented at the 2014 Transcatheter Cardiovascular Therapeutics meeting (TCT).
“In patients with severe aortic stenosis who are at increased surgical risk, the use of [a] dual-filter cerebral protection system during TAVR significantly reduces the number and volume of cerebral lesions as determined by DW-MRI [diffusion-weighted magnetic resonance imaging] subtraction at 2 and 7 days after TAVR,” explained presenter Axel Linke, MD, University of Leipzig Heart Center, Leipzig, Germany, speaking here at a plenary session on September 13.
“Although results with TAVR have improved considerably over the last decade, stroke remains a major issue, and increases mortality by threefold,” Dr. Linke noted. He said also that neuro-imaging studies are revealing ischaemic brain lesions in more than two-thirds of these patients. “We know that those lesions are associated with a poorer neurocognitive outcome,” he added.
September 25, 2014
Submitted by: Mark Ferguson
Costs of lung cancer screening were determined for individuals with a 2% or greater risk of lung cancer over 3 years for 2059 subjects participating in the Pan-Canadian Early Detection of Lung Cancer Study. During the first 18 mos of screening the per-person cost was $453. Surgical therapy cost $33,344 over 2 years compared to costs of treating advanced stage cancers of $47,792.
September 25, 2014
Submitted by: Mark Ferguson
This phase II trial evaluated outcomes of isolated lung perfusion with Melphalan and complete surgical resection for pulmonary metastases from colorectal cancer or sarcoma in 50 pts. Surgical mortality was 0%, but morbidity (primarily grade 3 or 4 pulmonary morbidity) was 44%. 30 patients suffered local recurrence. 3-year survival was 57% and recurrence-free survival was 36%.
September 25, 2014
Submitted by: Mark Ferguson
A model for predicting lung cancer in patients with suspicious lung nodules (TREAT) was developed using single institutional data (Vanderbilt), validated using data from another institution, and compared to the Mayo Clinic predictive model. The model accuracy was 87% in the development cohort and 89% in the validation cohort, compared to 80% in the Mayo Clinic model.
September 25, 2014
Submitted by: Mark Ferguson
This randomized controlled trial compared VATS partial pleurectomy (VAT-PP) to talc pleurodesis in patients with malignant mesothelioma and a pleural effusion, evaluating overall survival. VAT-PP was associated with significantly greater surgical complications, a higher rate of respiratory complications and prolonged air leak, and a significantly longer median hospital length of stay. Survival at 1 year was similar to the talc pleurodesis group (52% vs 57%). VAT-PP is not recommended for improving survival in patients with malignant mesothelioma and a pleural effusion.
September 25, 2014
Submitted by: Mark Ferguson
This retrospective review evaluated the relationship of pretreatment vs post-induction therapy stage to survival in patients undergoing surgery for esophageal adenocarcinoma in 2 centers in London. Among 584 pts, 400 underwent induction therapy. Downstaging predicted improved survival (HR 0.43). Downstaging was associated with decreased rates of local and distant recurrence. Survival was more closely associated with stage after induction therapy than initial stage.
September 25, 2014
Submitted by: Mark Ferguson
This meta-analysis of 70 studies evaluated the utility of PET in assessing over 8,511 lung nodules, comparing regions in which infectious lung disease is endemic to other regions. Specificity was lower in regions with endemic infectious diseases, 61% vs 77%. Overall, the accuracy of PET was extremely heterogeneous.
September 18, 2014
Submitted by: J. Rafael Sadaba
In this manuscript, the authors describe their findings of a cohort analysis of 66 453 Medicare beneficiaries over the age of 65, who underwent aortic valve replacement (AVR) ± CABG and compare date of surgery, 30-day and one-year mortality between those receiving biological and mechanical prosthesis.
The mortality rate for the date of surgery and the first 30 days after the date of surgery was statistically higher among mechanical valve recipients than biological valve recipients. The unadjusted OR for death between recipients of mechanical and biological prosthesis was highest on the date of surgery. The difference in mortality rate between both groups was not statistically significant for the first 30 days after the date of hospital discharge and within 31 to 365 days after the date of surgery. Subgroup analyses suggest that the mortality difference between recipients of biological and mechanical valves in the overall population is primarily driven by high-risk patients who underwent concurrent CABG. Patients undergoing isolated AVR may have little or no increased risk for early death after mechanical AVR when
compared with bioprosthetic AVR.
September 18, 2014
Submitted by: J. Rafael Sadaba
In this retrospective review, the authors evaluate the long-term outcome of 61 patients undergoing edge-to-edge mitral valve repair without annuloplasty ring for degenerative mitral regurgitation (MR). The reasons for not performing annuloplasty were either severe annular calcification or absence of significant annular dilatation. Follow up was 100%. Overall survival at 12 years was 51±7%, and freedom from MR ≥3+ was 43±7.6%. Twenty-one patients required reoperation during the follow up period. These findings lead the authors to conclude that in degenerative MR, the overall long-term results of the surgical edge-to edge technique without annuloplasty are not satisfactory. The authors underscore the relevance this may have in transcatheter mitral valve repair procedures.