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Journal and News Scan
Hansson and colleagues analyzed the effect of preoperative dual antiplatelet therapy on outcomes for patients undergoing surgery for acute aortic dissection type A. Among 1,141 patients with acute type A dissection, 108 had aspirin and clopidogrel, and 11 had aspirin and ticagrelor. Dual antiplatelet therapy led to more bleeding and more transfusions but not to more deaths. However, major bleeding was associated with higher mortality. The authors conclude that correct diagnosis is important to avoid dual antiplatelet therapy and reduce bleeding complications in patients with type A dissection.
Yanagawa and colleagues review the current understanding of factors that predict the failure of aortic valve repair. They highlight factors that include unaddressed annular dilatation, residual cusp prolapse, commissural orientation, and the use of patch material, and they note that better understanding of these repair elements results in continually refined techniques that can improve patient outcomes.
Using deep learning employing data from over 700,000 patients (6 billion data points), an algorithm for continuous prediction of the risk of acute kidney injury (AKI) was developed. The model correctly predicted over 90% of AKI requiring dialysis with a lead time of up to 48 hours, with 2 false alerts for every true alert.
In this trial involving over 400 patients, accupuncture was compared to two sham groups and an observation group. The intervention group experienced a nearly two-thirds reduction in the frequency of angina attacks during the 20-week treatment period, significantly better than the sham and observation groups.
In this article, Umana-Pizana et al performed a phases-of-care mortality analysis amongst 5141 cardiac surgery cases with a 4.6% crude mortality in a population with a median STS risk score of 5.8%. They demonstrate that triggers for mortality occured primarily preoperatively (49.3%), followed by in the intensive care unit (23.9%), intraoperatively (13.4%), discharge phase (10.4%), and postoperative floor (3.0%). Importantly, their findings demonstrate that the mortality distribution is bimodal, occuring in those at lowest and highest risk, and they provide targets for areas of improvement and elimination of triggers for mortality in the cardiac surgical patient.
Corsini et al examined the results of a single-institution's 5-year experience of cardiothoracic surgery mock oral examinations. They demonstrate that this time- and labor-intensive exercise where trainees verbalize and practice their certification examination in a safe, controlled environment with their faculty can lead to improvement in preparation for the high-stakes real examination, with an impressive 5-year 100% pass rate for trainees involved in this experience.
These results are encouraging for surgical educators and trainees alike in our quest to better prepare tomorrow's cardiothoracic surgeons for their transition to practice.
U.S. News has just released the 2019-2020 best hospitals in the United States based on data from nearly 5,000 medical centers.
In the category for Cardiology & Heart Surgery, Cleveland Clinic in Cleveland, Ohio, Mayo Clinic in Rochester, Minnesota, Cedars-Sinai Medical Center in Los Angeles, California, New York-Presbyterian Hospital-Columbia and Cornell in New York, and Massachusetts General Hospital in Boston make up the top five.
Also published is a roster of the best U.S. hospitals for congestive heart failure, heart bypass surgery, and aortic valve replacement.
Beckers and colleagues evaluated toxicity and outcomes of regional chemotherapeutic treatment with isolated lung perfusion of melphalan combined with metastasectomy for patients with resectable pulmonary metastases. The prospective study included 107 patients with metastases of colorectal carcinoma, osteosarcoma, or soft-tissue sarcoma. The authors report low morbidity and no long-term pulmonary toxicity. The disease-free and progression-free rates at 5 years were 26% and 44% for patients with colorectal carcinoma and 29% and 63% for patients with sarcoma. The authors conclude that isolated lung perfusion with melphalan combined with metastasectomy is both feasible and safe, and that further evaluation of this approach is warranted.
This narrated video highlights an aortic valve repair performed for a 47-year-old man who presented with severe, symptomatic aortic regurgitation on a quadricuspid valve. The repair was performed through a median sternotomy using conventional cannulation for cardiopulmonary bypass, and Mastrobuoni and colleagues extensively outline their technique for “tricuspidization.” Additionally, the authors discuss their experience with 10 quadricuspid valve repairs. No increased perioperative risk is noted by the authors, with excellent long-term results in terms of regurgitation and reoperation on the valve.
Delvin and associates reported the long-term outcomes and quality of life in patients with d-TGA after repair using data from 24 centers of the Congenital Heart Surgeons’ Society (CHSS).
Among 830 neonates operated on between 1985 and 1990, 516 underwent arterial switch, 110 had Mustard operations, 175 Senning procedures, and 29 Rastelli operations. The median duration of follow-up was 24 years, extending to just over 32 years. Survival at 30 years was over 70% for all operations: 86±8% for Rastelli, 81±5% for Mustard, 80±2% for arterial switch, and 70±4% for Senning. The risk of late death was lowest in patients with arterial switch operation. Chest pain and fainting, pacemaker implantation, and unemployment were associated with reduced self-reported health status. Arterial switch patients reported higher functional health status in all domains than did atrial switch patients.