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Journal and News Scan
October 13, 2017
Submitted by: Mark Ferguson
This study examined risk estimates for complex major surgery by trainees in internal medicine and in general surgery using seven clinical scenarios. Surgery residents expressed more confidence in their estimates, but were less likely to use published risk models. Most trainees in both specialties significantly overestimated every type of risk, averaging a quarter to a third higher than risk model predictions.
October 13, 2017
Submitted by: Arie Blitz
The authors report on the design and use of a growth-accommodating device that may have a variety of pediatric applications, including valve annuloplasty. The device consists of a biodegradable core and a tubular braided sleeve (woven much like a 'finger trap' toy). After implantation, the core—which constrains the length of the device—degrades so as to allow the annuloplasty to enlarge gradually over time. Thus, the device 'grows' with the child. The authors further present validation of the device in a swine model.
The free full text is available.
October 13, 2017
Submitted by: Joel Dunning
What is already known on this topic:
Female and male physicians differ in their practice of medicine in ways that might substantially affect patient outcomes. Outcomes after surgery depend on the technical and cognitive skills of treating physicians, so findings from medical specialties might not apply to surgical specialties.
What this study adds:
This large, population-based, matched cohort analysis found small differences in surgical outcomes between patients treated by female and male surgeons, with the former having a small but statistically significant decreased risk of short-term postoperative death.
October 12, 2017
Submitted by: Mark Ferguson
In this retrospective study, the long-term survival benefits of multiple arterial coronary grafting were evaluated among over 20,000 patients in British Columbia by comparing outcomes to those of L IMA + SVG. Multiple arterial grafting was associated with decreased mortality (HR 0.79) and decreased revascularization rates (HR 0.74). The incidences of MI and heart failure were also reduced (HR 0.63 and 0.79, respectively).
October 12, 2017
Submitted by: Mark Ferguson
The Impella RP device was approved by the FDA for use as a temporary percutaneous assist for the right ventricle, as announced by Abiomed. Use is approved for up to 14 days for a variety of indications including post MI, heart transplant, open heart surgery, or right heart failure after LVAD implant.
October 12, 2017
Submitted by: Arie Blitz
The authors, using a decision analysis model, compared the cost-effectiveness (over one year) of three different strategies for preventing Staphylococcus aureus infections in patients undergoing CABG in the U.S. The three strategies were as follows:
- Universal decolonization with mupirocin, chlorhexidine, and vancomycin in all patients undergoing CABG
- Targeted decolonization with mupirocin, chlorhexidine, and vancomycin only in patients who are S aureus carriers
- No decolonization in any patients
Findings: Universal decolonization is the most cost-effective strategy in >91% of simulations in this model. Annually in the US, universal decolonization is predicted to lead to $102 million in cost savings, while targeted decolonization is predicted to lead to $45 million in cost savings.
October 11, 2017
Submitted by: Claire Vernon
Beckmann and colleagues present data from over 100,000 heart surgery procedures performed at 78 German centers in 2016. Registry data, divided by procedure type and compared over the last decade, show increases in the proportion of elderly patients, the usage of transcatheter procedures, and the implantation of left ventricular assist devices. The analysis also indicates consistently excellent patient survival rates and nationwide provision of cardiac surgical care.
October 10, 2017
Submitted by: Claire Vernon
Allen and colleagues reviewed the Food and Drug Administration Medical Device Reporting database for reports of nontuberculous mycobacterium (NTM) infections following extracorporeal circulation usage during surgery. This review of a US database found that reported infections were attributable to several device manufacturers, perhaps indicating that design features of these devices make them susceptible to NTM contamination. Infections associated with aerosolized NTM during surgery represent an epidemiologic departure from the usual transmission route of inhalation, and such infections are aggressive despite being slow to develop. The authors conclude that NTM infection secondary to cardiothoracic surgery, despite being uncommon, is an emerging public health concern that merits attention and awareness.
October 8, 2017
Submitted by: Joel Dunning
Right anterior thoracotomy is a technique for aortic valve replacement. Minimal extracorporeal circulation (MECC) is known to reduce the deleterious effects of cardiopulmonary bypass. The authors present a sutureless aortic valve replacement via right anterior thoracotomy by using MECC in an 84-year-old patient with severe aortic stenosis.
Preoperative tomographic angiography showed a right sided aorta. A 4 cm transverse incision was made through the right second intercostal space. Rib resection was not used. A femoral arterial and venous cannulation was used. The main advantage of MECC is less inflammatory response and less hemodilution. By using standard surgical instruments a transverse aortotomy was made from the fat pad. Calcified leaflets are resected and small size. Perceval sutureless valve is inserted. Aortotomy was then closed.Postoperative TEE showed no leak and excellent hemodynamics. Patient recovery was uneventfull.
Sutureless aortic valve replacement with mini cardiopulmonary bypass through the right anterior thoracotomy is a safe and feasible technique and provides an excellent result.
Surgical Management of Esophageal Epiphrenic Diverticula: A Transthoracic Approach Over Four Decades
October 6, 2017
Submitted by: Claire Vernon
Tapias and colleagues find that the surgical management of epiphrenic diverticula can provide good results, with symptoms being resolved in 21 of 31 patients. The authors’ retrospective review confirmed the rarity of this condition, with fewer than one case per year over 40 years. Acute presentation with either ruptured diverticula or hematemesis was associated with poorer outcomes. The authors conclude that a diverticulectomy and myotomy should always be performed but that an antireflux procedure might not influence patient outcomes.