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Journal and News Scan
The new EACTS Guidelines on perioperative medication in adult cardiac surgery address antithrombotic management, atrial ﬁbrillation, renin–angiotensin–aldosterone system inhibitors, beta-blockers, dyslipidaemia, ulcer prevention and steroids, antibiotic prophylaxis, anaesthesia and postoperative analgesia, and blood glucose management.
In this study with 663 TAVI patients, the authors investigated the predictors for next day discharge (NDD). After excluding cases that did not have a minimalist transfemoral approach, 150 patients had NDD and 210 patients had non-NDD.
Predictors of NDD include male sex, lower creatinine, absence of atrial fibrillation and younger age. When compared to uncomplicated cases with longer hospital stay, NDD patients had similar 30-day and even superior one-year clinical outcomes.
In this video-based article, Sarsam and colleagues demonstrate the use of continuous barbed sutures in four robotic procedures, two wedge bronchoplasties and two sleeve bronchoplasties.
Holst and colleagues present their experience with cone repair of the tricuspid valve for Ebstein’s anomaly in 235 patients over eight years. They conclude that cone repair is safe and effectively reduces tricuspid regurgitation, which might allow for right ventricular remodeling. The procedure remains a challenge to master, however, due to the rarity of the disease and the highly variable anatomy.
The authors studied survival in patients with multiple lung cancers and their associated genetic mutations. There was 90% discordance in driver mutations beween cancers in individual patients that was associated with favorable survival. The two patients in whom condordance was present suffered recurrent cancer.
Using a group of nearly 23,000 individuals in four community-based longitudinal cohorts, the authors studied those who developed heart failure (HF) with either preserved (633) or reduced (841) ejection fraction (EF). HF with reduced EF was more strongly associated with natriuretic peptide, troponin, and C-reactive protein than was HF with preserved EF.
Interesting research/opinion piece about how the introduction of robots has forced a change in surgical training, with some residents gaining skill through a process of "shadow learning."
Portugal’s first Eurovision winner, Salvador Sobral, has made a good recovery after undergoing a heart transplant in December.
Canada’s first Inuk cardiac surgeon talks about choosing to become a surgeon and the pride she takes in serving her patients.
Surgeons perform the first pneumonectomy at the Cleveland Clinic Abu Dhabi, UAE, for a patient with respiratory failure secondary to a multi-drug resistant infection.
Drugs and Devices
The US Food and Drug Administration (FDA) has pushed back approval of AndexXa, which is designed to reverse the anticoagulant effect of Factor Xa inhibitors, as they review additional data.
Research, Trials, and Funding
An international group of researchers have developed a robot that pulls on the esophagus to induce cell growth in awake pigs, a technology that could be applied to large-gap esophageal atresia in infants.
Two studies published in the Annals of Internal Medicine come to slightly different conclusions on the benefits of risk-based screening for lung cancer outcomes.
Researchers in Finland look at how 30 minutes in a sauna affects one’s cardiovascular function.
Veterinary researchers in Ontario, Canada, found that atrial fibrillation appears to be a heritable trait in Standardbred racehorses.
The authors summarizes a personal experience with 529 patients undergoing VATS operations under local anesthesia and sedation. No nerve block, epidural, laryngeal mask airway, or endotracheal intubation was used. Indications were lung nodule, hemothorax, empyema, pleural effusion, pericardial effusion, chylothorax, etc. There was one unsuccessful attempt using this technique.
De Beaufort and colleagues assessed the outcomes of acute aortic dissections in 258 consecutive patients with Marfan syndrome in the International Registry of Acute Aortic Dissection (IRAD) database, comparing these with the dissection outcomes in the general population. Patients with Marfan syndrome were younger and had fewer comorbidities. In-hospital mortality rates were lower for patients with Marfan syndrome than for the general population (10.9% versus 16.9%, p = 0.01). There was lower mortality after open surgical repair of type B aortic dissection when compared to the general population (0% versus 17.6%, p = 0.011). As expected, the freedom from reintervention in the cohort of patients with Marfan syndrome was significantly less than in the general population (44.7% versus 81.5%, p<0.001).