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Journal and News Scan
Outcomes of stented bovine pericardial aortic valvular prostheses were evaluated over a 30 year experience. 48% had concomitant CABG and 26% had additional valve procedures at the time of implant. Explants were required in 1.9% at 10 years and in 15% by 20 years. Explant rates were 3-fold higher in patients younger than 60 years. Patient-prosthesis mismatch and high gradients were associated with a higher risk of explant.
250 children with tuberculosis causing central airway narrowing were evaluated. 34% needed transthoracic nodal dissection for relief of obstruction, nearely one-third of those as an urgent procedure. Success was more common in those with bronchus intermedius or left main bronchial obstruction. The success rate was 98%.
The authors retrospectively reviewed their institutional database to assess outcomes for VATS lobectomy vs SBRT for stage I NSCLC, comparing propensity score-matched groups (41 pairs). Survival, cancer-specific survival, local recurrence, and distant recurrence were significantly better in the surgical group.
This video demonstrates aortic valve bypass surgery on an 83-year-old male patient. This surgery was offered to the patient as an alternative to conventional aortic valve replacement.
This article takes an in-depth look at robotic-assisted thymectomy. The technique is described and data from over 100 centers is analyzed.
The authors describe a kinetic modeling tool to safely regulate the osmotic changes that can occur when treating severe metabolic alkalosis and concurent hypernatremia. The authors discuss disequilibrium syndrome and brain edema, a potential occurence when intermittant dialisis is used versus a longer, slower, and potentially more easily regulable therapy such as CRRT.
The authors of this article compared CABG and PCI with second generation drug eluting stents (DES-PCI) in patients with multivessel coronary artery disease. They used data from a large observational registry and applied propensity score matching to create groups with similar baseline characteristics. They found that, at a mean follow-up of almost 3 years, DES-PCI and CABG had a similar risk of all-cause death (3.1% per year versus 2.9% per year, p=0.50), but a higher risk of myocardial infarction (1.9% per year vs. 1.1% per year; p<0.001) and repeat revascularization (7.2% per year vs. 3.1% per year, p<0.001). The risk of stroke was lower with DES-PCI (0.7% per year vs. 1.0% per year, p<0.001). The higher risk of myocardial infarction seemed to be restricted to those DES-PCI patients in whom there was incomplete revascularization. The authors conclude that the 3-year mortality risk between second generation DES-PCI and CABG was similar. DES-PCI was associatied with higher risk of myocadial infarction and repeat revascularization, but had a lower risk of stroke.
Benedetto and co-authors analyzed propensity-matched groups of patients who underwent CABG or PCI (n= 1097 pairs) for multivessel disease, and found that outcomes were comparable at 1-year follow-up, while CABG did significantly better during follow-up to 5 years and Kaplan-Meier curves continued to diverge even further after 5 years.
In a prospective study using MRI before and within 14 days after AVR and TAVI, Crouch and co-authors demonstrated that postoperative aortic regurgitation that was higher in the TAVI group had a significant impact on increasing left atrial size and declining right ventricular function.
The authors evaluated a simple scoring system for assessing sternal healing after sternotomy. Observers had close agreement as to how CT findings matched the scoring system. There was no attempt at correlating CT findings with clinical results. Healing scores increased over time, indicating some correlation with biologic behavior.