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Journal and News Scan
The authors point out that randomized trials of incentive spirometry have failed to mitigate early postoperative fevers, traditionally attributed to atelectasis. They propose that an immune response triggered by injured cells is responsible for noninfectious postoperative fevers, and that this is a natural, self-limited process that requires no intervention.
Investigators reported, in abstract form, promising results of a single dose of radiotherapy, delivered with electorphysiologic guidance, for managing ventricular tachycardia. Seventy-eight percent of patients had a clinically important reduction in ventricular tachycardia episodes.
Immune checkpoint inhibitors have revolutionized treatment of non-small cell lung cancer. In this study, breath prophiles were collected from 143 patients and a single biomarker profile was created that detected responses to anti-PD-1 treatment with 89% accuracy.
Using coworker reports of unprofessional behavior as a metric, surgeons' complication rates were assessed. Compared to surgeons with no reports, the complication rate for surgeons with 1-3 reports was increased 14.3%, and that for surgeons with 4 or more reports was increased 11.9%.
In this randomized trial, the authors studied the use of cerebral autoregulation monitoring to target mean arterial pressure during CPB. The outcome of interest was postopertive delirium. The incidence of delirium was 53% in the usual care group compared to 38% in the intervention group, with a reduction in the odds of delirium of 45% (p=0.04).
This is a retrospective study in OPCAB patients comparing patients who received skeletonized versus nonskeletonized SIMA and BIMA grafts. They reported patients with any sternal wound complication including redness or minor drainage that healed naturally. There was a lower incidence of complications in the skeletonized group as well as overall lower grade of complications. These effects were more pronounced in subgroup analysis of the BIMA group, including diabetics.
This study reports ten year outcomes of the STICH trial. Comparing CABG to medical therapy groups, the authors note that CABG reduced all cause, cardiovascular, and heart failure hospitalizations. This included time-to-first and recurrent events. This was due to fewer total cardiovascular hospitalizations, the majority due to heart failure.
Using the STS Congenital Heart Surgery Database, investigators identified factors associated with adverse outcomes after repair of anomalous coronary arteries arising from the pulmonary artery. Operative mortality was increased related to preoperative shock and the use of extracorporeal membrane oxygenation.
Concomitant aortic root enlargement at the time of surgical aortic valve replacement is an option to avoid patient-prosthesis mismatch. In this single-center study, 4,210 patients underwent aortic valve replacement, of which 171 had concomitant aortic root enlargement. In analysis of matched patient outcomes, there were similar numbers of postoperative bleeding and pericardial effusion events, and no difference in early deaths. The authors conclude that aortic root enlargement can be performed safely with no increase in early postoperative surgical complications.