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Journal and News Scan

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): ZW Fitch, O Debesa, R Ohkuma, D Duquaine, J Steppan, EB Schneider, GJR Whitman
This study summarizes 3 phases of clinical experience with a protocol for early extubation after CABG: standard practice, multidisciplinary protocol guidance, and multidisciplinary protocol guidance with expanded indications and bedside reminders. Early extubation (<6 hours) rates during the phases were 12%, 24%, and 38%. There were no differences in reintubation rates.
Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): J Puskas, M Gerdisch, D Nichols, R Quinn, C Anderson, B Rhenman, L Fermin, M McGrath, B Kong, C Hughes, G Sethi, M Wait, T Martin, A Graeve
The PROACT trial is evaluating the clinical utility and safety of less aggressive anticoagulation schemes after bileaflet AVR. This arm of the trial compared low dose (INR 1.5-2.0) to standard dose (INR 2.0-3.0)warfarin. At an average follow-up of nearly 4 years, the low dose group experienced significantly fewer bleeding complications but had similar rates of neurologic events and all-cause mortality.
Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): AS Bryant, RJ Cerfolio
This study surveyed outcomes of sympathotomy for hyperhidrosis more than 1 year postoperatively. 77% reported clinically bothersome compensatory sweating, although the incidence decreased over time to 35% at 5 years and thereafter. Predictors of bothersome compensatory sweating included multiple sites of sweating and R2/R3 sympathotomy (rather than R4/R5).
Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): K Bedeir, M Reardon, B Ramlawi
This comprehensive review discusses evolving strategies for managing infective endocarditis and the mechanisms for how the most common and life-threatening complications occur.
Source: MedPage Today
Author(s): C Phend

On March 20, 2014, a panel of the FDA gave unanimous approval for use of an ex-vivo perfusion system for improving the quality of explanted lungs prior to transplantation.  If this recommendation is followed by the FDA, such devices could be used clinically under IRB protocols.

Source: Journal of the American College of Cardiology
Author(s): Lindman BR, Pibarot P, Arnold SV, Suri RM, McAndrew TC, Maniar HS, Zajarias A, Kodali S, Kirtane AJ, Thourani VH, Tuzcu EM, Svensson LG, Waksman R, Smith CR, Leon MB
In this manuscript, the authors compare outcomes among patients from the PARTNER trial with diabetes who underwent surgical or transcatheter treatment. Among these patients with diabetes, 6-month and 1-year all cause mortality was lower in the transcatheter group compared with the surgical group. At 2 years this survival benefit was lost. Stroke rates were similar between surgical and transcatheter treated patients at 30 days and 1 year.
Source: MedPage Today
Author(s): C Phend
On March 20, 2014, a panel of the FDA gave unanimous approval for use of an ex-vivo perfusion system for improving the quality of explanted lungs prior to transplantation. If this recommendation is followed by the FDA, such devices could be used clinically under IRB protocols.
Source: Annals of Internal Medicine
Author(s): Rajiv Chowdhury, MD, PhD; Samantha Warnakula, MPhil*; Setor Kunutsor, MD, MSt*; Francesca Crowe, PhD; Heather A. Ward, PhD; Laura Johnson, PhD; Oscar H. Franco, MD, PhD; Adam S. Butterworth, PhD; Nita G. Forouhi, MRCP, PhD; Simon G. Thompson, FMedSci; Kay-Tee Khaw, FMedSci; Dariush Mozaffarian, MD, DrPH; John Danesh, FRCP*; and Emanuele Di Angelantonio, MD, PhD*

The effects of different kinds of fats and food oils on health may have been exaggerated, researchers warned last night.

The latest analysis casts doubt on advice to avoid the saturated fats found in dairy foods.

And it casts further doubt on the benefits of oils extracted from plants, finding some limited evidence for the benefits of fish oils.

Researchers at Cambridge University, UK, set out to compare saturated fats with the polyunsaturated fats, such as omega 3 and omega 6, found in plant oils and fish.

Their analysis of more than 72 pieces of research involving studying the diets of more than 600,000 people concluded there was no link between total levels of saturated fat in the diet and risk of heart disease.

There was even evidence that one dairy fat, margaric acid, was linked to a reduced risk of heart disease.

Reporting in the Annals of Internal Medicine, the researchers say there is "weak" evidence linking animal fats to increased risk of heart disease.

There was also "some" evidence that the two omega-3 oils found in fish, eicosapentaenoic and docosahexaenoic acids, are linked to reduce heart disease risk.

Researcher Dr Rajiv Chowdhury said: "In 2008, more than 17 million people died from a cardiovascular cause globally. With so many affected by this illness, it is critical to have appropriate prevention guidelines which are informed by the best available scientific evidence."

Professor Jeremy Pearson, associate medical director of the British Heart Foundation, called for "large-scale" clinical studies to come to give conclusive answers to the link between fat in the diet and heart disease.

He said: "This analysis of existing data suggests there isn't enough evidence to say that a diet rich in polyunsaturated fats but low in saturated fats reduces the risk of cardiovascular disease.

"Alongside taking any necessary medication, the best way to stay heart healthy is to stop smoking, stay active, and ensure our whole diet is healthy – and this means considering not only the fats in our diet but also our intake of salt, sugar and fruit and vegetables."

Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk. Annals of Internal Medicine 18 March 2014

Source: New England Journal of Medicine
Author(s): P Caironi and others for the ALBIOS Study Investigators

This study randomized severely septic patients to either 20% albumin or crystalloid for resuscitation, with a primary outcome of mortality at 28 days.  During the first week the albumin pts had a higher MAP and lower net fluid balance.  Total administered fluids did not differ between the groups.  Morality was similar at 28 and 90 days, and the rate of organ dysfunction did not differ between the groups.

Source: New England Journal of Medicine
Author(s): P Asfar and others for the SEPSISPAM Investigators

This randomized trial assigned septic pts to resuscitation with a MAP goal of 80-85 mm Hg or 65-70 mm Hg.  There was no difference in mortality at 30 or 90 days.  Afib was more common in the high goal pts, and high goal pts with chronic hypertension required less renal replacement therapy.

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