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Journal and News Scan
In this article authors describe their technique to manage complex mitral reoperations using a minimally invasive approach, moderate hypothermia and avoiding aortic cross-clamping. Minimally invasive procedures with an unclamped aorta have the potential to combine the benefits of less invasive access and continuous myocardial perfusion. The advantage of a right mini-thoracotomy is the avoidance of sternal re-entry and limited dissection of adhesions, reducing the risk of cardiac structures or patent graft injury.
This study demonstrates the basic concepts and technique of robotic mitral valve replacement for valve pathologies that are not suitable for repair. Among this group of patients, robotic surgery is still feasible with some technical differences from a standard robotic mitral valve repair procedure.
This paper presents an update on diagnostic and prognostic biomarkers in malignant pleural mesothelioma considering also recent molecular biologic achievements as microRNA and genomic sequencing.
This prospective observational study compares patients with coronary artery bypass grafting on aspirin and ticagrelor (n = 173) or on aspirin and clopidogrel (n = 232). Major bleeding complications occurred in 14.5% with ticagrelor and 13.8% with clopidogrel (p=0.89).
No significant differences were observed, too, when the drugs were discontinued ≥5 or 2-4 days before surgery. A strong tendency to more bleeding complications in the ticagrelor group was found, however, when the drugs were given until 0–1 day before surgery.
The authors compare 3 groups of patients undergoing aortic root replacement for ascending aorta aneurysm: valve-sparing root replacement (VSRR, n = 178), Bentall procedure with biological conduit (n = 91) or mechanical conduit (n = 101). Patients with VSRR had the best 5-year survival and low incidence of bleeding complications. The authors suggest the VSRR procedure as first choice for patients with ascending aortic aneurysms.
This exiting paper describes current achievements and open questions on the way to the manufacturing of heart valves using 3D printing.
Fifty years after the first coronary artery bypass grafting, the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) issued together guidelines for myocardial revascularization. In this document ESC and EACTS provide recommendations for revascularization of stable coronary artery disease, non-ST-segment elevation acute coronary syndrome, ST-segment elevation myocardial infarction and revascularization in patients with different risk factors. The authors underline the importance of interaction between cardiologists, cardiac surgeons and referring physicians for choosing the best possible revascularization approach.
A well done video describing radial artery line placement aided by US.
This randomized trial investigated two different thresholds for triggering transfusion in patients with septic shock: 9 g/dL or 7 g/dL. The lower threshold group received a median of 1 unit of blood compared to 4 in the higher threshold group. 90 day mortality rates and other morbidity were similar between the groups.
This study utilised data form the UK National Adult Cardiac Surgery Audit to compare re-intervention free survival between porcine and bovine pericardial aortic valves. All elective or urgent aortic valve replacements with or without coronary artery surgery between 2003 and 2013 were included with a median follow-up time of 3.6 years. There was no difference in in-hospital mortality, survival (10-year survival of 49.0% and 50.3% in the bovine pericardial and porcine groups respectively) or re-intervention free survival between the groups. After adjustment there was a trend towards improved re-intervention free survival in younger patients (<60) who received porcine valves.