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Journal and News Scan
The FRANCE 2 investigators have developed a scoring system to predict the risk of in-hospital or 30-day mortality for patients undergoing TAVI. There were 3833 TAVIs used for development and validation of the scoring system with the majority of patients receiving an Edwards Sapien prosthesis. Risk factors for early mortality included age greater than or equal to 90, BMI greater than 30, NYHA class IV, pulmonary hypertension, critical haemodynamic state, more than 2 episodes of pulmonary oedema in the first year, respiratory insufficiency, dialysis and implantation route other than subclavian. The developed 21-point scoring system only demonstrated average discriminatory ability.
An interesting case that raises the question of the need for anticoagulation in patients treated with a transcatheter valve in valve in mitral position
The University of Pittsburgh experience with anterior approaches to spinal problems is summarized. Approaches included cervical/sternotomy in 8 pts, thoracotomy in 79, and thoracoabominal in 43 for infection (50), primary neoplasms (22), and metastases (58). 30 and 90 day mortality were 9% and 21%, and the major complication rate was 28%. The procedures appeared to be effective in relieving symptoms.
Results of a 50 year experience with surgery for cortriatriatum sinister were summarized. A mix of infants and adults underwent treatment, consisting of membrane excision on CPB. 10 year survival was 83%, and all patients were in NYHA class I or II at follow-up.
Patients undergoing catheterization and possible PCI have a poor understanding of the procedures and the attendant benefits/risks. This study investigated the use of a standard consent process compared to a web-based audio-visual presentation. Both processes resulted in similar improvements in patient comprehension, but the web-based process resulted in better comprehension of therapeutic alternatives. Considerable misunderstandings persisted after both approaches.
A transitional care program was instituted for CABG patients to improve care continuity after hospital discharge. The composite outcome was a combination of hospital readmission and death. Among 169 pts who entered the program compared to 232 control patients, program participation was the only independent predictor of improved outcome. The incidence of the composite outcome was reduced by two-thirds for patients in the program.
67 patients without a previous history of lung cancer underwent FNA of a GGO with results suspicious for, but not diagnostic of, adenocarcinoma. 47 pts who elected to undergo resection were compared to 16 who opted for observation. 6/16 observed pts developed interval growth or increase in the solid component of the GGO and 5 underwent resection or radiation therapy. The observed group experienced no cancer-related death or distant recurrence of cancer. The resected group experienced metastatic spread (2), development of new cancers (5), and size progression in other GGOs.
Clinical outcomes of patients with lung adenocarcinoma were analyzed with respect to the histologic subtype of adenocarcinoma. Histologic pattern was associated with sex, T status, N status, and stage. Recurrence was higher in patients with micropapillary and solid tumors. These subtypes were associated with extrathoracic-only recurrence. They were also independent predictors of survival.
Outcomes of patients undergoing lung transplant after LVRS were compared to those of patients undergoing LVRS or transplant alone. OR time and LOS were longer in the combined group. Morbidity and mortality were similar among the groups. Post-transplant survival was substantially lower in the combined group. However, if time from LVRS to transplant was added to transplant survival, long-term survival was similar among the 3 groups.
The authors reviewed transfusion practices after cardiac surgery in Australia and New Zealand using a database of nearly 43,000 patients. Transfusion rates for >=1 unit varied 3-fold (22% to 67%), for >=5 units varied 5-fold, >=1 platelet pack varied 3-fold, >=1 FFP varied 4 fold, and >=1 cryoprecipitate varied 20-fold. The differences were not explained by patient, surgical, or hospital characteristics.