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Journal and News Scan
Using gender specific thresholds for abnormalities in cardiac troponin I, the rate of injury among women increased by 42%. This did not translate into improved management of women, who remained about half as likely to undergo revascularization, receive dual antiplatet therapy, or undergo other interventions.
A narrative review offering an intensivists' viewpoint on specific cardiovascular sequela of double-lumen anaesthesia for pulmonary resections (and by extension, implantation of donor lungs) and other cardiothoracic and vascular operations.
An extremely interesting research question abutting cardiac physiology, and a manuscript that may generate future additional clinical research.
Interesting sizeable series, and a commentary that follows, on what is effectively a thoracic example of Natural Orifice Transluminal Endoscopic Surgery (NOTES).
These incredible findings are the result of an analysis of the New York State Department of Health Statewide Planning and Research Cooperative database. These represent operations from 1995 to 2014 and represent over 99,000 major lung resections. Surgeons performing more than 30 lobectomies per year have a mortality of 1% and surgeons performing less than 12 per year have a mortality of 2.8%. But the most surprising fact is that the low volume surgeons performed 90% of the lobectomies. Do you agree with the results of this very large study and if you do, what do you think should happen about this?
The association of cardiovascular events and all-cause mortality with optimism was assessed in this metaanalysis. Optimism was associated with a decreased risk of cardiovascular events (ROR 0.65) and a decrease in all-cause mortality (RR 0.86). Mechansims have yet to be identified.
Excellent document from the EACTS, STS, and AATS emphasizing the importance of standardization of prosthetic heart valve labeling.
This timely review examines the use of single and mutiple agents to decrease saphenous graft failure after CABG. These are difficult and expensive studies to perform, requiring repeat imaging after surgery, a procedure patients are often reluctant to undergo. In this analysis, the use of aspirin remains the lynchpin, with ticagrelor and clopidigrel as second agents improving outcomes, albeit at an increased in risk of bleeding.
Reporting of postmarket outcomes for the Sapien 3 and Mitraclip devices frequently misclassified patient deaths as device malfunction or other outcomes. Misclassification for Sapien 3 involved 17.5% of patient deaths, and involved 24.7% of patient deaths for Mitraclip. These outcomes are important for the public and physicians to understand when discussing risks and benefits of such devices.
David Taggart, MD, PhD (University of Oxford, England), the chairman of the EXCEL surgical committee during the design and recruitment phase of the trial, believes the investigators downplayed the increased risk of all-cause mortality with PCI and oversold the reduced risk of the study’s primary composite endpoint of death, stroke, and MI, particularly since the benefit was largely driven by a higher risk of periprocedural MIs in the CABG arm.
“I found it worrying that there seemed to be a strong signal here and I don’t think that was accurately reflected in the New England Journal of Medicine paper,” Taggart told TCTMD. “We’re not talking about two tablets for a headache. We’re talking about people dying. The data are the data, and that’s what the data show.