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Journal and News Scan

Source: Journal of Cardiac Surgery
Author(s): Tomasz Plonek

17 manuscripts were included in the final analysis and postoperative data of 722 patients were studied. The mean age of patients was 58 years and mean follow-up was 62 months. Hospital mortality was 1.5% (11 deaths). During the follow-up late aortic related mortality was noted in two patients (0.3%), there were 12 (1.7%) cases of significant redilatation of the ascending aorta, and 13 (1.8%) patients had to have their ascending aorta reoperated. All of the aortic complications were noted in patients who either did not have their external wrapping sutured to the aorta or who underwent concomitant aortoplasty.

The results of the metaanalysis suggest that external aortic wrapping may be considered as a safe operative technique. In patients with a moderately dilated aorta it offers good mid-term and long-term outcome compared to replacement of the ascending aorta.


Source: Journal of Cardiac Surgery
Author(s): Diana Reser M.D., Mathias van Hemelrijck, Jovana Pavicevic M.D., Anna Platzmann M.D., Etem Caliskan M.D. , Volkmar Falk M.D. and Stephan Jacobs M.D.

This article shows that MIMVS is a safe approach with low morbidity and mortality that allows a high and durable repair rate with low reoperation rates and favorable short-term event-free survival

Source: Annals of Thoracic Surgery
Author(s): Colleen G. Koch, Edmunds Z. Reineks, Anne S. Tang, Eric D. Hixson, Shannon Phillips, Joseph F. Sabik III, J. Michael Henderson, Eugene H. Blackstone

The CCF group conducted a study of their phlebotomy practices during a 6-month period in 2012.  Phlebotomy volumes on each patient were estimated and calculated.  Surprisingly, the group found that, on average, cardiac surgery patients lose ~10% of their blood volume due to postoperative phlebotomy alone.  Clearly, further efforts are indicated to minimize such blood loss.  These efforts will include using smaller volume tubes, assessing the necessity of some of the blood tests, and developing a suitable means of minimizing discard volumes when blood is drawn from a patient line.

Source: MedPage Today
Author(s): Crystal Phend

The FDA recently approved the fourth new oral anticoagulant, Savaysa for use in non-valvular afib, DVT, and PE.  It is another factor Xa inhibitor.  Use in non-valvular afib requires renal function assessment prior to prescribing, as the drug is renally excreted.  Paradoxically, efficacy may be reduced in patients with better-than-normal renal function.

Source: Annals of Surgery
Author(s): Watson, David I.; Thompson, Sarah K.; Devitt, Peter G.; Smith, Lorelle; Woods, Simon D.; Aly, Ahmad; Gan, Susan; Game, Philip A.; Jamieson, Glyn G.

This study investigated repair methods for large hiatal hernias randomized to suture only vs absorbable mesh vs nonabsorbable mesh.  The design was randomized, double blind.  At 12 mos the recurrence rate was 21%, with no difference among the groups.  Postoperative symptoms were different among the groups, but these differences were judged to be of small clinical importance. 

Source: Annals of Thoracic Surgery
Author(s): Talha Shaikh, Karen Ruth, Walter J. Scott, Barbara A. Burtness, Steven J. Cohen, Andre A. Konski, Harry S. Cooper, Igor Astsaturov, Joshua E. Meyer

The authors retrospectively analyzed pathologic response rates and their relation to the interval between completion of induction therapy and esophagectomy for esophageal cancer in 88 patients.  Complete response rates increased from 12.5% to 40.9% among quartiles as the interval increased from <45 days to >63 days.  There was no increase in morbidity associated with longer intervals to surgery.

Source: Annals of Thoracic Surgery
Author(s): Maria Restrepo, Elaine Tang, Christopher M. Haggerty, Reza H. Khiabani, Lucia Mirabella, James Bethel, Anne Marie Valente, Kevin K. Whitehead, Doff B. McElhinney, Mark A. Fogel, Ajit P. Yoganathan

Patients who underwent a Fontan procedure for single ventricle physiology were evaluated with serial cardiac MR over time to identify changes in vessel characteristics and their relationship to flow.  Although vessel diameter increased over time, normalized diameters decreased.  This was not associated with changes in flow, but hemodynamic efficiency declined over time. 

Source: Annals of Thoracic Surgery
Author(s): Vinod H. Thourani, Rakesh M. Suri, Rebecca L. Gunter, Shubin Sheng, Sean M. O’Brien, Gorav Ailawadi, Wilson Y. Szeto, Todd M. Dewey, Robert A. Guyton, Joseph E. Bavaria, Vasilis Babaliaros, James S. Gammie, Lars Svensson, Mathew Williams, Vinay Badhwar, Michael J. Mack

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%). 

Source: Annals of Thoracic Surgery
Author(s): Michael A. Borger, Vadim Moustafine, Lenard Conradi, Christoph Knosalla, Markus Richter, Denis R. Merk, Torsten Doenst, Robert Hammerschmidt, Hendrik Treede, Pascal Dohmen, Justus T. Strauch

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. 

Source: Royal College of surgeons of England Bulletin
Author(s): C Limb, D Limb, R Limb - Consultant orthopaedic surgeons

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