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Journal and News Scan
July 4, 2014
Submitted by: Mark Ferguson
The PARTNER trial reported reduced mortality in pts with prior CABG who underwent surgical AVR compared to TAVR. This study further explores the 288 pts in these two groups. The groups were similar in their clinical presentation and had similar instances of procedure-related mortality, stroke, and MI. The TAVR pts had more paravalvular leak, at 2 years trended towards higher all-cause mortality, experienced more rehospitalizations, and had higher rates of mortality associated with death/rehospitalization and death/stroke. Outcomes in pts with prior CABG were better after surgical AVR than after TAVR, the causes for which are not completely understood.
July 3, 2014
Submitted by: Mark Ferguson
Good news for lovers of dark chocolate. In this randomized study of 20 pts with peripheral arterial disease, walking distance and maximal walking time were evaluated 2 hr after ingestion of either dark chocolate or milk chocolate in a cross-over design. Dark chocolate ingestion was associated with an 11% increase in distance and a 15% increase in time, likely related to NOX2 regulation. No such changes were evident in subjects ingesting milk chocolate.
July 1, 2014
Submitted by: Joel Dunning
Destruction of the intervalvular fibrosa (IVF) in infective endocarditis makes radical debridement followed by reconstruction of the IVF as the best treatment available for these patients. Authors describe their techniques in dealing with these extremely challenging cases, and show their results. At Cleveland Clinic, operations requiring reconstruction of the IVF are referred to as ‘Commando operations’, an indicator of the procedure's challenges.
July 1, 2014
Submitted by: Mark Ferguson
This single institution retrospective study compared outcomes for lobectomy and segmentectomy using propensity score matching. For 312 pts in each group, there was no difference in logoregional or overall recurrence rates. Operative mortality rates were similar for segmentectomy and lobectomy (1.2% vs 2.5%). 5-year surival rates were also similar (54% vs 60%).
July 1, 2014
Submitted by: Mark Ferguson
This randomized trial of high risk patients with small clinial stage I cancers randomized pts to sublobar resection with or without adjuvant brachytherapy. The median follow-up for 222 pts was 4.4 years. 3 year survival was identical (71%) between the groups. There was no difference in time to local recurrence. Brachytherapy did not significantly reduce the incidence of local recurrence, even in patients with close or involved margins.
July 1, 2014
Submitted by: Mark Ferguson
In this randomized trial involving195 pts from 30 centers, pts underwent chemoradiotherapy followed by surgery or surgery alone for stage I or II esophageal cancer. The median follow-up was 94 months. 80% of pts had clinical stage II disease. R0 resection rate and 3-year survival were similar between the groups. Induction therapy was associated with an increase in operative mortality (11.1% vs 3.4%, p=0.049).
June 30, 2014
Submitted by: J. Rafael Sadaba
The incidence of coronary artery disease among patients with severe aortic stenosis and candidates for TAVI ranges from 40 to 75%. In the absence of randomized trials, the management of these patients remains to be established. In this paper, the authors offer a good overview of the subject and propose an algorithm for treatment.
June 29, 2014
Submitted by: Joel Dunning
This article looks at the availability of cardiac surgery in africa using a survey to calculate the availability of surgeons around this continent and also looks at the models of care employed.
June 29, 2014
Submitted by: Joel Dunning
A great use for google glasses is demonstrated here. The glasses can be used to film the operative field and communicate with others online in real time.
Thus real time expert opinions from around the world would potentially be possible with their use. They are used here for the first time.
June 28, 2014
Submitted by: Joel Dunning
Two-patch, single-patch, and modified single-patch repairs are accepted techniques for repair of complete atrioventricular (AV) canal defects. We propose a novel, alternative technique: the central patch technique.
The central patch technique is applicable to all forms of complete AV canal defect. Subjectively, it offers technical advantages compared to standard techniques and may result in a shorter learning curve for junior congenital heart surgeons. Results are preliminary but are consistent with standard techniques.