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Journal and News Scan
A refreshing brief editorial comment on hydrohemodynamics on the occasion of critiquing a manuscript on related echocardiographic computations in neonates. The focus is on the Laplacean principles of compliance/elastance applied to the left ventricle.
This is a meta-analysis of perioperative aspirin use. Preoperative aspirin use increased bleeding risk, but it did not increase the need for reexploration or red cell transfusion if the preoperative dose was lower than 160 mg/d. Aspirin use was associated with decreased mortality, acute kidney injury, and perioperative myocardial infarction.
Bjerregaard and colleagues evaluated methylprednisolone as an analgesic strategy following video-assisted thoracoscopic surgery (VATS) in a randomized controlled trial with 96 patients. Patients received either methylprednisolone or placebo prior to their VATS lobectomy. High-dose methylprednisolone reduced pain at rest and while sitting on the day of the procedure.
A handy free, short, good quality video on an open valve-in valve procedure.
A large cadaveric study of the scalloping of normal mitral valve leaflets. As the accompanying editorial points out, it would be useful to correlate the cadaveric observations to imaging and surgical anatomy.
This article from the BBC highlights two different artificial intelligence (AI) diagnostic systems, one that evaluates coronary artery disease (CAD) and another that determines whether a lung nodule is cancerous. The systems are being trialed around the UK, and they show promise for improved accuracy of imaging-based diagnoses. The software that evaluates CAD could be available throughout the UK as early as summer of 2018.
Video and a readable digest of a talk in a Harvard meeting, especially interesting in its scepticism on prevention.
The authors compared mechanically expanded TAVR to self-expanding TAVR in a randomized non-inferiority trial. Major adverse events occurred in 20% and 17% of patients, respectively (safety measure). The one-year rates of mortality, stroke, or paravalvular leak for the valves were 15.4% and 25.5%, respectively (effectiveness measure). Mechanically expanded valves are not inferior to self-expanding valves and broaden the options available for high risk patients.
A sobering editorial, read last May at the AATS, that discusses at length the ethics of ventricular assist as a super expensive therapy seen from the principle of fairness.
A dense but short and readable editorial arguing for the complexity of risk stratification of aortic pathology.