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Journal and News Scan
A batch of staplers manufactured in July-August 2019 and distributed during August-September 2019 has been recalled. Seven serious injuries and one death are reported to have been associated with failure of this device.
In this multicenter study, the authors report on outcomes in 156 patients who underwent surgery for anomalous aortic origin of the coronary arteries. Unroofing and reimplantation were the most common procedures. There was no perioperative mortality. The authors concluded that surgery for anomalous aortic origin of the coronary arteries is safe and effective and most patients can return to normal life.
Commonly, a jejunostomy is placed during esophagectomy. In this report including 188 patients, the impact of jejunostomy on outcomes after esophagectomy was examined. Jejunostomy lead frequently (7%) to jejunostomy-related complications and did not reduce the risk of postoperative weight loss. The authors concluded that the routine use of intraoperative jejunostomy appears to be an unnecessary step.
Dr Preventza and associates performed a meta-analysis of 3,154 patients who underwent frozen elephant trunk procedure to determine the incidence of neurologic complications. The incidences were 4.7% for spinal cord injury and 7.6% for stroke. Operative mortality was 8.8%. Stent longer than 15 cm or coverage of T8 and beyond was assoicated with a higher incidence of spinal cord injury compared to stent length of 10 cm.
Compliance with American College of Chest Physicians guidelines for physiologic evaluation of lung resection patients was 50% or better for only half the physicians. The frequency of individualizing risk thresholds based on surgical approach increased according to the number of years in practice. Cardiothoracic surgeons more frequently referred all patients for cardiovascular risk assessment by a cardiologist than did thoracic surgeons (17.6% vs 2.4%).
A balanced appraisal of last year's manuscript from the Lancet Group on a relatively novel portable Organ Care System for donor lungs. The analysis of the technical complications, especially organ damage from overenthusiastic revving of the pump, is particularly sobering.
This article reviews real-life outcomes of 42,714 patients undergoing coronary bypass grafting from 2005 to 2012. After adjusting for the differences in the populations, the patients who received multiple arterial grafts had lower long-term mortality, myocardial infarction, and re-intervention rates than patients who received a single arterial graft. More telling, however, is the fact that only 15% of patients in the study group received more than one arterial graft.
Interesting clinicolaboratory experiment: Any translational value for the coronary surgeon and the cardiologist remains to be seen, especially regarding the risk stratification and prioritization for urgent (inpatient) revascularisation. Also, the value of the observation for the cardiovascular anesthetist may be important with regards to induction of anesthesia for CABG.
A must-read position paper.
The authors analyzed the effectiveness of left atrial appendage closure with AtriClip in 43 patients. In all patients, the absence of blood flow in the excluded appendage was confirmed. In 31 patients, no residual stump was observed. In only one patient, there was a significant (>10 mm) stump. In 11 patients, the residual stump was less than 10 mm. The authors concluded that the left atrial appendage closure with AtriClip is effective and the definition of clinical significant left atrial appendage stump should be further evaluated.