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Journal and News Scan
Henmi and colleagues analyzed the results of different reimplantation techniques of segmental arteries during thoracoabdominal aortic aneurysm repair. Among 172 patients, 111 underwent segmental artery reconstruction via graft interposition, 38 via single-cuff anastomosis, and 23 via island reconstruction. The graft interposition technique had a poor patency rate. Island reconstruction and single-cuff anastomosis offered better patency, however island reconstruction required reoperation for patch aneurysm. The authors conclude that single-cuff anastomosis is a more reliable technique in terms of early and long-term outcomes.
The January update of an expert panel from the American College of Chest Physicians on the expanding clinical entity of pulmonary hypertension, especially pertinent to the transplant community.
Remote ischemic preconditioning did not influence 12-month survival or readmission rates in a randomized trial involving more than 5,400 patients undergoing percutaneous coronary intervention after ST-segment elevation MI.
The authors reviewed the New York State database. Patients with single arterial grafts were compared to those with multiple arterial grafts. Propensity matching was performed based on 38 baseline characteristics. Twenty percent had multiple arterial grafting. There was no difference at one year but at seven years the multiple arterial graft group had lower mortality and a lower repeat revascularization rate.
Interesting viewpoint of a cardiologist on low-SYNTAX subjects.
The growth and replication of cardiomyocytes derived from stem cells is insufficient to permit regeneration of functioning heart tissue. In this study, the authors used stem cell-derived epicardial cells to facilitate myocardial regeneration. Tissues from such stem cells enhance the structure and function of heart muscle by improving contractility, calcium handling, and myofibril structure. In a rat heart model, this intervention produced functional improvements for up to three months.
This review details the risks of surgical smoke exposure, which include lung injury and cancer. The level of risk has yet to be determined. Most operating rooms do not require smoke evacuation devices, but their use should be considered.
In this best evidence topic paper, the authors examined outcome and safety of innominate artery cannulation versus axillary artery cannulation in thoracic aortic surgery. There were no significant differences in mortality with innominate artery cannulation compared to axillary artery cannulation. In most studies, a stroke occurred slightly less frequently in patients receiving innominate artery cannulation compared to axillary artery cannulation. The authors conclude that innominate artery cannulation is noninferior to axillary artery cannulation.
Gershengorn and colleagues evaluated the incidence and safety of overnight extubation following coronary artery bypass grafting (CABG), using retrospective data from The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Between 2014 and 2017, 42% of patients undergoing elective CABG had an overnight extubation, a rate that the authors report is similar to patients undergoing other cardiac procedures. For patients who had mechanical ventilation duration of six to eight hours, overnight extubation was associated with increased reintubation and longer intensive care unit stays, but less reintubation and reduced length of stay were observed for patients extubated overnight who had mechanical ventilation durations between nine and 20 hours. No difference in mortality was noted with overnight extubation, and the authors conclude that the practice is prevalent after cardiac surgery and that it is associated with little risk.
Using an approach that minimizes valve depth relative to the membranous septum, the authors reduced the need for permanent pacemaker placement to a reliable and predictable 3% compared to the accepted standard of 10%.