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Journal and News Scan
Within 34 years, 129 patients with a median age of 2 years underwent PCTR. Eighteen revision operations were necessary. Decannulation and satisfactory respiratory and swallowing function were achieved in over 80%, a good voice, however, in only about two third.
In this manuscript the authors describe a systematic review of 71 cases of transcatheter heart valve embolization. In 72% of the patients, the prosthesis used was a balloon expandable one. In most cases valve embolization occurred soon after implantation and it happened in the aortic direction. Interestingly, when the access was transapical, the prosthesis more often embolized into the left ventricle. Early embolization was most commonly secondary to device malposition and pacing error. Late embolization was reportedly due to chest compression during cardiopulmonary resuscitation, asymmetric calcification, and low prosthesis implantation. Suggestions are made on how to prevent this complication and how to proceed when it happens.
The authors reviewed patients with small resected stage I lung adenocarcinoma to determine the frequency of tumor cells spreading through airway spaces (STAS) and their relationship to recurrent cancer. Nearly 40% of patients had tumor cells in the airways beyond the edge of the main tumor. In patients undergoing parenchymal-sparing operations, the recurrence rate was much higher in patients with tumor STAS (43% vs 11%). This relationship was not identified in patients undergoing lobectomy. Tumor STAS should be recognized as a pattern of invasive spread among patients with lung adenocarcinoma.
The Mayo Clinic reviewed its series using VA ECMO for postcardiotomy support in patients older than the age of 70 years. Not surprisingly, only a quarter of patients were able to be discharged alive. Preop atrial fibrillation, chronic kidney disease, lactic acidosis on support, and persistent coagulopathy were each associated with a higher mortality.
The authors retrospectively analyzed the causes of death and their temporal relationship to surgery for close to 500 patients undergoing LVAD implantation at their institutions. The most common causes by time period were as follows: (1) early→cardiac (62%) and neurologic (21%); (2) between hospital dismissal and 6 months→neurologic (31%), cardiac (17%), and device-related (11%); (3) between 6 months and 1 year→neurologic (43%) and cardiac (22%); and (4) later than 1 year→neurologic (35%), cardiac (20%), and infection (15%). Identifying the predominant causes during each time interval may allow better honing of strategies to further improve outcomes.
This feature length documentary takes an in-depth look at uniportal VATS, the relatively new procedure created by Diego Gonzalez Rivas. The film chronicles the development of the procedure, and follows Dr. Gonzalez Rivas as he introduces the minimally invasive technique to hospitals from the UK to China. Patients who have undergone the uniportal procedure also share their stories.
Propensity score-matched analysis of surgical ligation versus medical management of clinically significant patent ductus arteriosus in premature (<37 weeks), extremely low birth weight infants (<1000 g). Infants undergoing surgical ligation had lower mortality (15% vs 26%) and a higher rate of routine disposition from the hospital (48% vs 41%) as opposed to transferring care or requiring home health services. However, in the surgical ligation group, the length of stay was longer (88.5 days vs 65.6 days) and total cost was higher ($209,829 vs $139,446). Necrotizing enterocolitis and sepsis were independent predictors of mortality in both groups of infants.
This retrospective case-control study involving 1852 Hodgkin lymphoma 5-year survivors found that radiation to the heart valves tend to increase the risk for clinically significant valvular heart disease. The rate increased 3.1-fold in patients receiving 31-35 Gy and 11.8-fold in those who received > 40 Gy.
In this manuscript the authors describe their findings in a meta-analysis of 12 randomized placebo-controlled clinical trials involving 2,980 patients undergoing isolated CABG. They found that statin therapy, particularly atorvastatin, initiated before CABG, was associated with a 58% reduction in the risk of postoperative AF. Unfortunately, the optimal dose of statin therapy to achieve this effect was not addressed in the study. Other interesting findings were that the length of hospital stay was lower, and there was a lower number of strokes with preoperative statin therapy. The risk of postoperative MI and renal failure were not significantly decreased with statins.
The authors analysed 621 reliefs, sculptures and paintings from Ancient Egypt looking for anatomical defects of the chest. They found a relief dated back to 2400 BC, depicting a man with an abnormal shape of the chest similar to a pectus excavatum. The authors opened the debate on the occurrence of this deformity in ancient times.