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Journal and News Scan
The authors examined characteristics of patients undergoing initial palliation for hypoplastic left heart syndrome (HLHS) who remained hospitalized and who required superior cavopulmonary anastomosis (SCPA) during the same hospitalization. 6% of nearly 5400 infants required SCPA during the same admission. A number of conditions/complications were identified as being associated with the need for SCPA. Patients who underwent an initial RV to PA shunt were less likely to require hospitalization until stage 2.
The type and extent of mitral valve remodeling in response to ischemic mitral regurgitation may predict success/recurrence after mitral valve repair. The authors collected 3-dimensional data from patients with ischemic MR and from patients with normal valves and analyzed the data geometrically. Remodeling was identified by lengthening of the middle portion of A2, an increased nonplanarity angle, and an increased tenting angle of P3.
Cardiac surgery patients with ICU stays of more than 7 days were evaluated for the incidence of healthcare-associated infections (HAI) over a 3-year period. 15% of over 2,500 pts had ICU stays of more than 7 days, of whom more than 48% had at least 1 HAI. Mortality in those with HAI was more than twice as high as for those without (29% vs13%). HAI was associated with RBC transfusion. Mortality was associated with HAI and with central line infection.
In a retrospective review of patients undergoing esophagectomy at two high volume centers, the incidence of hiatal hernia was 5% - 10%. The incidence did not differ between open and MIE approaches. Two-thirds of the hernias were discovered incidentally, although half of those patients were symptomatic. Mortality in patients undergoing urgent correction was almost 20%.
The authors write a provocative response to the recent ACGME revisions to duty hours which extend the work hour limitation for first-year residents from 16 to 24hours. The authors also summarize data in favor of and against duty hour restrictions and emphasize the importance of relying on science when making education policy decisions.
Congenitally corrected transposition of the great arteries (CC-TGA) is a complex form of congenital heart disease that may require left ventricular re-training prior to a double switch procedure. This study reviewed experience in 24 patients with CC-TGA who were enrolled in a left ventricular re-training program. Eighteen of the 24 patients underwent successful double switch, and 5 additional candidates are considered good candidates for a double switch. These results demonstrate that left ventricular re-training offers a reliable strategy in CC-TGA
The esteemed authors are to be commended on the detailed but readable desciption of their technique under the heading 'Indication and Surgical Technique of Extracorporeal Membrane Oxygenation and CentriMag Device' (page 753)
A succinct editorial advancing the case for aortic super-centres
Vasoplegia was analysed in 225 patients undergoing heart failure surgery (left ventricular restoration, CorCap implantation or LVAD implantation). The complication was observed in 29% of patients. A higher risk was observed in patients with anaemia and higher thyroxine levels, whereas higher creatinine clearance and beta-blocker medication were associated with a lower risk.
Blood of septic or healthy pigs was used in a 12-h ECMO mock loop experiment. No higher activation of coagulation or inflammatory response or increased problems with the oxygenator was found with septic compared to control blood.