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Journal and News Scan
This remarkable dog served tours in Iraq and Afghanistan sniffing out bomb threats, and it is estimated he saved thousands of lives. When he was diagnosed with a cardiac tumor, his handler decided to offer him heart surgery, and is raising money for this purpose.
The impact of center and surgeon volume on outcomes after arterial switch for TGV was investigated using data from the STS database. Median center and surgeon annual volumes were 4 and 2. Both center and surgeon volume were important determinants of the composite outcome (death or major complication), with surgeon volume having the most important effect.
The impact of continuous flow VAD on survival among patients awaiting heart transplant is not well known. Pts on the UNOS list were propensity score matched 1:2 (HeartMate II vs no VAD). Wait list mortality was 10% during the 7.5 year study. Use of a VAD improved survival to transplant at 1 (91% vs 77%) and 2 years (85% vs 68%). Use of VAD as a bridge to transplant may improve survival and improve organ allocation.
This study summarized data regarding valve use in over 1l,000 pts in the STS database who underwent aortic valve replacement for active endocarditis. Nearly 75% of pts had no prior cardiac surgery. Prior cardiac surgery was associated with a higher risk of root replacement (29.9% vs 7.2%), a higher rate of complications (68% vs 61%), and a substantially higher rate of operative mortality (21.1% vs 9.8%, unadjusted). The use of biological valves increased over time.
In this retrospective study, the authors evaluate the effect of preprocedural significant mitral regurgitation (MR) on outcomes of patients undergoing transcatheter aortic valve implantation (TAVI) for sever aortic stenosis. In an overall series of 316 patients, 60 had been diagnosed with significant MR prior to the procedure. In multivariate Cox proportional hazards modelling, significant preprocedural MR was independently associated with 12-month and cumulative mortality. Following the procedure, 52.9% of the patients had less than grade 3 MR. Patients in whom MR improved had a better outcome than those with a worsening in MR.
The authors of this review article provide an extensive overview of the curent state of play in the field of Aortic Stenosis. They discuss risk scores,treatment decisions, and up-to-date evidence of Transcatheter Aortic Valve Replacement.
In this retrospective study based on a database of 5390 patients with early-stage esophageal cancer, T1a and T1b lesions were treated by endoscopic (26.5%) or surgical resection (73.5%). For patients undergoing surgery, the incidence of lymph node metastasis was 5.0% for T1a and 16.6% for T1b lesions. Size > 2 cm and intermediate-/high-grade lesions were the best predictors of nodal involvement. The risk of nodal metastases should be considered when counseling patients.
The study provides a risk-adjusted impact of postoperative atrial fibrillation on hospital mortality, resouces utlization, and costs. 49,264 patients from the STS database who underwent cardiac surgery were extracted from 2001-2012. AF increased operative mortality 2% vs 1%), morbidity, readmission rates, ICU stay, postoperative length of stay, and costs.
This interesting overview points out the negative effects of adrenaline on outcomes in a number of observational and randomized studies of patients experiencing cardiac arrest. The author recommends using Vasopressin after the first dose of adrenaline during resuscitation from cardiac arrest.
Authors describe an LVAD implantation technique, applying the concept of less invasive cardiac surgery, consisting in the association of reduced surgical approaches, off-pump implantation and reduced administration of heparin dose, in order to achieve rapid extubation and rehabilitation of the patient, preserving low morbidity, and still meeting all the goals of the standard procedure. To reduce the invasiveness, authors combine an anterior left minithoracotomy with T-upper reversed ministernotomy.