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Journal and News Scan
The researchers performed a systematic review to look at outcomes and complications associated with transcatheter closure of ventricular septal defects (VSD). This analysis suggests that transcatheter device closure of VSD is safe and yields good results. The limitations of this study are difficulties in analyzing different devices individually, and segregating the different VSD types, Further stratification by type of VSD, age of patients, and prevention of complications is needed before this can be recommended for routine treatment.
- A PubMed search for series in English on device closure of VSD from 2003 to June 2012 was performed.
- They excluded small series that were included in multicenter studies and patients who had acquired VSD following myocardial infarction.
- The random effects model was used to obtain pooled estimates of success and complications.
- A total of 37 publications comprising 4,406 patients with VSD (perimembranous=3,758, muscular=419, intracristal=47, doubly committed subarterial=36, multiple=16, postsurgical=123, unclassified=7) were included in this analysis.
- The age of patients ranged from 3 days to 84 years.
- The pooled estimate of successful device implantation was 96.6% (95% CI: 95.7-97.5).
- The most common complication is residual shunt (pooled estimated 25.5%; 95% CI: 18.9-32.1).
- Others included valvular defects (pooled estimate 4.9%; 95% CI: 3.4–6.4) and arrhythmias (pooled estimate 10.6%; 95% CI: 8.4-12.7).
We are all dissapointed to see that a study that looked at 783 patients from the chianti region over 10 years that looked at resveratrol metabolites showed no health benefits for high intake of this mtabolite of chocolate and wine
Using the Nationwide Inpatient Sample, the authors evaluated outcomes and costs of VATS (37,595) vs robotic (2,498) lobectomy 2008-2011. Robotic lobectomy was associated with higher rates of complications, particularly cardiovascular and iatrogenic bleeding, and higher costs ($22,582 vs $17,874).
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.