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Journal and News Scan
The authors describe a "huge" increase in ECMO usage for pulmonay failure with a trend, though not statistically significant, towards improved outcomes. Interestingly, there was not any appreciable increase in hospital costs associated with this significant increase in ECMO utilization. The improved survival was most evident in centers categorized as "medium" size centers doing at least 6 ECMO procedures per year. However, the authors point out that patients transferred to a larger center on ECMO were considered survivors but the outcome of the transferred patients was not available. The authors also contemplate that the improved survival trend is related to improved technology and protocols and that this technological improvement will result in an even greater increase in ECMO usage in the future.
This RCT compared daily 200mg or 300mg of FXI-ASO (an antisense oligonucleotide that reduces levels of factor XI) to daily 40mg of enoxaparin in pts undergoing knee replacement surgery. The end point was thromboembolism. FXI-ASO significantly reduced factor XI levels in a dose-response manner. FXI-ASO 200 mg was equivalent to enoxaparin in frequency of the end point (27% vs 30%) and FXI-ASO was superior (4%). Bleeding was evident in 8% after enoxaparin and in 4% after either dose of FXI-ASO.
A tool for assessing competency in chest tube insertion was developed and validated using mannequins and patients. Scores varied according to participant experience, and interrater consistency in evaluations was high. It is suggested that this assessment tool can be used to judge the development of competence in chest to insertion and to evaluate the effectiveness of teaching.
This multicenter study analyzes the utility of a "Top Gun" competition in promoting simulator use and improving technical skills among 1st-year CT Surgery residents. A coronary anastomosis simulation module was sent to most 1st-year residents in the U.S. Fifteen residents submitted baseline and final videos for evaluation. Most residents improved their technical skills as rated by faculty. The highest 5 scores were invited to participate in a live "Top Gun" competition at the AATS meeting. Clearly, simulator use will be a useful adjunct for training CT surgery residents. Unfortunately, resident engagement has not always met expectations. Will the introduction of a competitive environment--the "Top Gun" battle--serve to engage residents further?
An interdisciplinary expert panel on the treatment of type B intramural haematoma (IMH) and penetrating atherosclerotic ulcer (PAU) evaluated 46 studies on overall 1386 patients. Recommendations for decision making on medical, open surgical or endovascular treatment are given in the paper.
The single-centre study analyses 257 Norwood procedures. Patients older than 20 days were at higher risk for early postoperative mortality, postoperative pulmonary hypertensive and impaired cardiac function.
Results from the European REdo Cardiac Operation Research Database (RECORD) indicate that outcome of redo aortic valve replacement is influenced by baseline risk factors and perioperative complications. Hospital mortality was seen in 5.1% of 711 evaluated cases.
The incidence of bacterial endocarditis has significantly increased in the UK and this coincides with a 90% reduction of antibiotic prophylaxis for dental work according to the 2008 NICE guidance which recommended against its use.
This video from the AHA describes the study and implications for the future.
17 manuscripts were included in the final analysis and postoperative data of 722 patients were studied. The mean age of patients was 58 years and mean follow-up was 62 months. Hospital mortality was 1.5% (11 deaths). During the follow-up late aortic related mortality was noted in two patients (0.3%), there were 12 (1.7%) cases of significant redilatation of the ascending aorta, and 13 (1.8%) patients had to have their ascending aorta reoperated. All of the aortic complications were noted in patients who either did not have their external wrapping sutured to the aorta or who underwent concomitant aortoplasty.
The results of the metaanalysis suggest that external aortic wrapping may be considered as a safe operative technique. In patients with a moderately dilated aorta it offers good mid-term and long-term outcome compared to replacement of the ascending aorta.
This article shows that MIMVS is a safe approach with low morbidity and mortality that allows a high and durable repair rate with low reoperation rates and favorable short-term event-free survival