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Journal and News Scan
Outcomes of surgical AVR were summarized from the STS Cardiac Surgery Database 2002-2010 to establish contemporary data for different surgical risk groups (low <4% risk, intermediate 4%-8% risk, high >8% risk). 80% were low risk, 6% were high risk. Hospital mortality was lower than predicted by STS PROM for all groups (low: 1.4$ vs 1.7%; intermediate 5.1% vs 5.5%; high 11.8% vs 13.7%).
This study randomized 100 patients with AS to full sternotomy AVR with a conventional prothesis or hemisternotomy with a rapid deployment prosthesis. CPB times were similar, but Ao crossclamp times were 24% shorter in the rapid deployment group. Acute outcomes were similar. The rapid deployment group had a lower transvalvular gradient and a lower prevalence of prosthesis mismatch at 3 months.
Read this amusing article that documents a series of names of genuine doctors on the UK GMC registar such as psychiatrists called Dr Bhatti, Dr Moodie, a Genitourinary doctor called Dr Hussey and general surgeons called Mr Gore and Mr butcher !
Got any of your own ? Post them now in the comments section
In 2012 the American College of Cardiology Foundation and the Society of Thoracic Surgeons Collaboration on the Comparative Effectiveness of Revascularization Strategies (ASCERT) compared the 5 year effectiveness of CABG versus PCI. The registry data is now linked with Centeres for Meidcare and Medicaid Services Claims data in order to study the long-term cost-effectiveness of the two strategies. The authors found that the life-time incremental cost-effectiveness ratio of CABG versus PCI was approximately $30,000/QALY gained, a value that is generally considered economically attractive.
This patient presented with a large distal arch and proximal descending aortic aneurysm (7 cm). He underwent a Total Arch Replacement and Frozen Elephant Trunk Procedure using the Thoraflex Hybrid Graft (Vascutek Terumo). The entire operation was performed via a hemi-sternotomy (half incision size). He had an enhanced recovery and was discharged home on postoperative day 6.
Overall, 13.4% of single ventricle patients received ECMO support following the Norwood operation. Although there were no preoperative or operative predictors of the requirement of ECMO support following the Norwood operation, unplanned reoperation for shunt problems or technical complications was associated with an increased need for ECMO use. Although hospital death was high at 58% in patients who required
postoperative ECMO support, those who survived to hospital discharge had interstage mortality, progression through consecutive palliation stages, freedom from heart transplantation, and late survival that were comparable to those in patients who did not require ECMO following their Norwood operation.
This is a retrospective review of 260 patients undergoing TAVI, looking at the relationship between aortic valve calcium score and post procedural paravalvular leakage. The results suggest that the amount of calcification significantly impacts the occurrence, the degree and localization of paravalvular leakage after TAVI.
This is a retrospective study comparing outcomes in 25 octogenarian patients undergoing percutaneous mitral valve intervention with the Mitraclip device and 35 octogenarian patients undergoing surgical mitral valve repair or replacement for isolated mitral regurgitation. Mitraclip patients were older, had higher calculated risk scores, and had worse NYHA functional status. At 30 days, there was a non significant difference in mortality but there were significantly less complications among Mitraclip patients. Patients in the surgical mitral valve repair or replacement group showed better 2-year survival and freedom from more than grade II mitral regurgitation.
This is a retrospective study looking at 2,768,007 Medicare beneficiaries in the US undergoing myocardial revascularization between 2008 and 2012. From a surgical point of view it is interesting to see that the proportion of CABG among all revascularization procedures declined from 24.8% in 2008 to 23.2% in 2012. The number of centers performing less than 100 CABG procedures per year increased from 23.4% of the total number of centers performing CABG in 2008 to 29.5% in 2012, and the proportion of centers performing more than 500 CABG procedures per year declined from 5.1% in 2008 to 3.2% in 2012. In hospital mortality for isolated CABG varied between 2.27 and 2.56%.
The authors translated 10 common medical phrases into 26 foreign languages and had native speakers of those languages translate those phrases back to English. 42% of the translations were wrong, with the worst accuracy among African and Asian languages.