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Journal and News Scan
Anemic off-pump CABG (n=361) versus on-pump CABG (n=578) patients were compared. In anemic patients, off-pump CABG was associated with lower early morbitidy and mortality. 1 to 6 month follow-up mortality, however, was higher in the off-pump CABG cohort.
The authors perform a meta-analysis of the limited studies available on the utility of tricuspid valve surgery in patients with significant TR at the time of LVAD implantation. No RCTs are available on this issue; however, six observational studies were analyzed by the group. The analysis reveals that, although the addition of TV surgery clearly increases the cardiopulmonary bypass time, no conclusions are warranted regarding the efficacy or safety of TV surgery in these patients. The jury remains out on this controversial issue.
Guidelines advocate changes in fatty acid consumption to promote cardiovascular health.
This papers summarizes evidence about associations between fatty acids and coronary disease.
They conclude that Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.
Transcatheter aortic valve implantation has also evolved as a suitable treatment option for degenerative surgical heart valve disease, with considerable experience in the aortic and mitral positions. Success of a valve-in-valve (VIV) procedure depends on four main concepts. These include the following:
- Understanding transcatheter heart valve design.
- A detailed understanding of the design or anatomy, in particular fluoroscopic appearances of the failing SHV.
- Correct sizing of the chosen transcatheter heart valve prosthesis for the existing SHV.
- The ideal implantation position for the transcatheter heart valve.
The aim of this article is to emphasize the impact of the anatomy and design features of surgical heart valve disease (SHV) to provide an understanding of VIV procedures and ensure their success, with focus on VIV in the failing aortic SHV.
Dr. Asai and colleagues from Japan report on their midterm results using the "butterfly" technique of leaflet resection for posterior leaflet prolapse. In this procedure, the shape of the resected specimen of prolapsed leaflet resembles the shape of a butterfly as opposed to the conventional quadrangular shape. The authors argue that the procedure allows an adjustable height reduction of the posterior leaflet with minimal tissue resection and no annular plication. This may minimize the risk of SAM following mitral repair. Both early and midterm outcomes following the butterfly resection were excellent, with superb durability of the repair.
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.