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Journal and News Scan
February 7, 2014
Recommendations for anticoagulation for patients after bioprosthetic AVR are in flux. Current algorithms are based on historical studies. This study summarizes a review of current literature on the topic.
February 7, 2014
the Prospective Randomized On–X Anticoagulation Clinical Trial (PROACT) tests the safety of less aggressive anticoagulation than is recommended by ACC/AHA guidelines after implantation of an approved bileaflet mechanical valve. INR may be safely maintained between 1.5–2.0 after AVR with this approved bileaflet mechanical prosthesis. With low–dose aspirin, this resulted in significantly lower risk of bleeding, without significant increase in TE.
This review outlines causes of delirium and oversedation in ICU patients. Methods of managing these problems are outlined.
The accuracy of the diagnosis in patients undergoing congenital heart surgery in a large administrative database was examined in over 14,000 patients aged 0 to 5. Patients admitted on day 1 of life and those undergoing ECMO had a much higher chance of being assigned non-cardiac diagnoses. Pts so misclassified had a substantially higher risk of mortality. This systematic misclassification may lead to inaccurate determination of case volumes and outcomes.
Because the optimal management of CAD is unclear for many patients, the authors developed a decision support model for CABG and PCI with bare metal or drug eluting stents. Overall survival rates were similar for the different interventions. For PCI with drug eluting stents, optimal outcomes were observed for pts undergoing emergency revascularization for acute MI. Optimal outcomes for CABG were observed in pts with multivessel disease and with many comorbidities.
The authors report outcomes for recipients of heart transplants performed more than 20 years prior. Overall 20 year survival was 56%. Causes of mortality were similarly distributed among rejection, malignancy, infection, and allograft vasculopathy. Only 2 patients underwent retransplantation.
The authors hypothesized that examination of more lymph nodes resulting from lung resection for NSCLC would result in fewer missed nodal metastases and be associated with better survival related to more accurate staging. Based on nearly 25,000 pts from SEER, they found the median number of nodes examined was only 6. Pts who had 18-21 nodes examined had a hazard ratio for mortality of 0.65.
February 5, 2014
Submitted by: Ruben Osnabrugge
In this article, the authors investigated the impact of the timing neonatal arterial switch operation on morbidity, mortality and costs. They included 140 patients with transposition of the great arteries and found a mortality and morbidity rate of 2% and 20%, as well as median hospital costs of $60,000. Their multivariable model showed that for every day beyond day 3 that the arterial switch was delayed, the risk of major morbidity increased with 47% and costs by 8%.
January 24, 2014
ISLAMABAD: Pakistan's former military ruler Pervez Musharraf wants to travel abroad for heart surgery requiring special equipment not available at home, legal sources said Friday quoting from a new medical report. Musharraf faces treason charges dating back to his 1999-2008 rule. But has not shown up for any hearings of a special tribunal due to security fears and lately a heart complaint. The 70-year-old former army chief has been in a military hospital since falling ill while travelling to the tribunal on January 2. An earlier diagnosis from the Armed Forces Institute of Cardiology, where Musharraf is being treated, said he was suffering coronary artery disease and his lawyers have suggested he should be treated abroad. The full report was not released but a legal source who has read it shared some of its contents with reporters. The source said that in the report, Musharraf said he needed "special equipment for his heart surgery which is only available abroad".
January 24, 2014
This is a video from the EACTS/STS AORTIC SESSION Martin Czerny, Joseph Coselli, Bill Brinkman, and Martin Grabenwöger discuss the differences and common issues between the US and Europe in current practice in aortic surgery.