Journal and News Scan

This retrospective review of pts undergoing complete resection by extrapleural pneumonectomy 1998-2011 for malignant mesothelioma focused on stage predictors of survival.  Surgical mortality was 5%.  Overall survival at 5 years was 14%, and median survival was 18 mos.   Median survival for N1 or N2 disease was 17 and 13 mos, respectively.  Nodal staging is important for estimating prognosis and for patient selection.

This descriptive study presents the peri-operative and 1-year results of on-pump and off-pump surgery performed in patients enrolled in the Arterial Revascularization Trial (ART). Out of the 3102 patients randomised in the ART trial to undergo either single or bilateral mammary artery grafting, 41% had their surgery performed off-pump. The decision to perform on or off-pump surgery was at the discretion of the surgeon. A similar number of grafts were performed in off-pump and on-pump procedures. Both operative time and ventilation time were shorter in patients who had off-pump surgery. Blood loss and platelet transfusion requirements were also lower in the off-pump surgery group. There was no clinically significant difference in 30-day mortality, stroke, peri-operative myocardial infarction, need for repeat revascularization or 1-year mortality between the off-pump and on-pump groups (formal statistical hypothesis testing was not performed due to the study design).

The COPPS-2 trial evaluated the efficacy of oral colchicine in reducing a-fib, post-pericardiotomy syndrome, and pericardial/pleural effusion after cardiac surgery in 360 pts randomized to drug or placebo for 1 month postop.  Colchicine reduced the incidence of post-pericardiotomy syndrome (20% vs 30%) but had no important effect on effusions or a-fib.  Adverse events were more common in the Colchicine group (20% vs 12%).

This controlled randomized trial examined the benefits of targeted PCI vs medical therapy alone for patients with stable CAD and stenosis who were found to have zones of fractional flow reserve of less than 0.8 at angiography.  Patients without regions of FFR <0.8 were entered into a  registry.  The composite outcome was death, nonfatal MI, or urgent revascularization within 2 years.  The PCI group had a lower incidence of the composite outcome, 8.1% vs 19.5%, driven by their lower rate of urgent revascularization.  The registry group had a similar rate of the composite outcome as did the PCI group.