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06 Dec 2018
A strong belief in the necessity of medication is associated with better adherence to oral disease-modifying antirheumatic drugs (DMARDs) or prednisone, while higher self-efficacy correlates with poor adherence, in a diverse cohort of patients with rheumatoid arthritis (RA), suggests a study.
Pearl Toh, Yesterday
First-line therapy with the BTK* inhibitor ibrutinib plus the anti-CD20 immunotherapy rituximab confers significant survival advantage over the current gold-standard regimen of fludarabine, cyclophosphamide, and rituximab (FCR) for young, fit patients with treatment-naïve chronic lymphocytic leukaemia (CLL), according to the E1912 trial, a large cooperative group study supported by the US National Cancer Institute.
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Better outcomes with mitral valve repair than replacement

Elaine Soliven
09 Oct 2018

Mitral valve (MV) repair appears to be associated with a lower mortality rate and better clinical outcomes in patients with infective endocarditis compared with MV replacement, according to review of previous studies presented at AFCC 2018.

A previous meta-analysis has shown that patients who underwent MV repair had a lower rate of mortality compared with MV replacement (in-hospital, 2.3 percent vs 14.4 percent and long-term, 7.8 percent vs 40.5 percent). [Ann Thorac Surg 2007;83:564-570]

In addition, patients who had MV repair had lower cerebrovascular events (early, 5 percent vs 11 percent and late, 2 percent vs 24 percent), lower rates of reoperation (2 percent vs 12 percent) and reinfection (2 percent vs 7 percent) vs those who had MV replacement.

In another study, more patients had better outcomes with MV repair than replacement. There were higher rates of reoperation-free survival (96 percent vs 68 percent) and reinfection-free survival (95 percent vs 73 percent). [Ann Thorac Surg 1997;63:1718-1724] “This is a very encouraging [result, which taught us] how to deal with this problem,” said Dr Taweesak Chotivatanapong from the Department of Cardiothoracic Surgery at Central Chest Institute of Thailand in Nonthaburi, Thailand. 

With regard to safety, a previous study showed that no recurrent infection and reoperation for valve incompetency was observed among patients who had a valve repair during their early phase of active endocarditis, “which means that valve repair was good, safe, and a feasible strategy to deal with this infection … we have to hit earlier to get a better result,” said Chotivatanapong. [Ann Thorac Surg 1990;49:706-711]

He added that the optimal timing of surgery in patients with infective endocarditis who had cerebrovascular complications (ie, stroke) has been a subject of debate. Evidence from previous studies suggests that the procedure should not be delayed if the patient is not in coma and has no intracranial haemorrhage (class IIa level B), and after a transient ischaemic attack or a silent cerebral embolism (class I level B). [Interact Cardiovasc Thorac Surg 2012;14:72-80]

However, if intracranial haemorrhage is present, then surgery should be performed within 1 month, and this was corroborated by another study from Japan, said Chotivatanapong. [Eur J Cardiothorac Surg 2016;50:374-382]

“MV repair in [patients with] infective endocarditis is feasible, safe, reproducible, and stable … Resuscitation to improve condition, early surgical intervention, adequate debridement, and proper surgical techniques are important for good outcome,” he said. “Simplified and innovative techniques are now evolving and effective.”

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Most Read Articles
06 Dec 2018
A strong belief in the necessity of medication is associated with better adherence to oral disease-modifying antirheumatic drugs (DMARDs) or prednisone, while higher self-efficacy correlates with poor adherence, in a diverse cohort of patients with rheumatoid arthritis (RA), suggests a study.
Pearl Toh, Yesterday
First-line therapy with the BTK* inhibitor ibrutinib plus the anti-CD20 immunotherapy rituximab confers significant survival advantage over the current gold-standard regimen of fludarabine, cyclophosphamide, and rituximab (FCR) for young, fit patients with treatment-naïve chronic lymphocytic leukaemia (CLL), according to the E1912 trial, a large cooperative group study supported by the US National Cancer Institute.
6 days ago
Low-dose administrations of haloperidol after thoracic surgery does not appear to prevent postoperative delirium, according to a new study.
4 days ago
Percutaneous coronary intervention (PCI) displays comparable rates of mortality and serious composite outcomes but a higher rate of target-vessel revascularization at 10 years relative to coronary artery bypass grafting (CABG) in patients with significant left main coronary artery (LMCA) disease, reports a study. On the other hand, CABG delivers lower mortality and serious composite outcome rates compared with PCI with drug-eluting stents after 5 years.