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Journal and News Scan
The authors compare 3 groups of patients undergoing aortic root replacement for ascending aorta aneurysm: valve-sparing root replacement (VSRR, n = 178), Bentall procedure with biological conduit (n = 91) or mechanical conduit (n = 101). Patients with VSRR had the best 5-year survival and low incidence of bleeding complications. The authors suggest the VSRR procedure as first choice for patients with ascending aortic aneurysms.
This exiting paper describes current achievements and open questions on the way to the manufacturing of heart valves using 3D printing.
Fifty years after the first coronary artery bypass grafting, the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) issued together guidelines for myocardial revascularization. In this document ESC and EACTS provide recommendations for revascularization of stable coronary artery disease, non-ST-segment elevation acute coronary syndrome, ST-segment elevation myocardial infarction and revascularization in patients with different risk factors. The authors underline the importance of interaction between cardiologists, cardiac surgeons and referring physicians for choosing the best possible revascularization approach.
A well done video describing radial artery line placement aided by US.
This randomized trial investigated two different thresholds for triggering transfusion in patients with septic shock: 9 g/dL or 7 g/dL. The lower threshold group received a median of 1 unit of blood compared to 4 in the higher threshold group. 90 day mortality rates and other morbidity were similar between the groups.
This study utilised data form the UK National Adult Cardiac Surgery Audit to compare re-intervention free survival between porcine and bovine pericardial aortic valves. All elective or urgent aortic valve replacements with or without coronary artery surgery between 2003 and 2013 were included with a median follow-up time of 3.6 years. There was no difference in in-hospital mortality, survival (10-year survival of 49.0% and 50.3% in the bovine pericardial and porcine groups respectively) or re-intervention free survival between the groups. After adjustment there was a trend towards improved re-intervention free survival in younger patients (<60) who received porcine valves.
This multicenter prospective trial evaluated the impact of induction therapy on anastomotic leak (AL) and other complications after esophagectomy. Of 2944 included pts, 593 had induction chemoradiotherapy. AL occurred in 8.8% of induction therapy pts compared to 10.6% of surgery only patients. 90 day postoperative morbidity and mortality rates were similar between the groups. Chylothorax, cardiovascular complications, and VTE events were more common after induction therapy.
The authors investigated the impact of new onset a-fib after esophagectomy in 437 pts. Risk factors included age, diabetes, induction therapy, and cardiac history. A-fib was associated with postoperative pneumonia, symptomatic pleural effusions, and an increase in C-reactive protein. It was not associated with anastomotic leak or mortality. 92% of affected pts were discharged in sinus rhythm. Long-term survival was not related to the development of a-fib.
The histologic response to induction therapy is usually a binary function. In the current study, the authors explored methods of refining the histologic response classification to improve prediction of prognosis for patients with esophageal adenocarcinoma. They identified 3 unique groups: major response in the primary tumor with ypN0; either major response with ypN+ or minor response with ypN0; minor response and ypN+. The 5-yr survivals were 64%, 42%, and 18%, respectively.
It has recently been reported that the number of lymph nodes resected during esophagectomy is related to long-term survival, leading to recommendations for the proper extent of nodal dissection. The current study used data from the CROSS trial to investigate this relationship in groups of esophagectomy patients with and without induction chemoradiotherapy. The median number of resected nodes in those without and with induction therapy was 18 and 14. Involved nodes had a much greater negative impact on survival in those undergoing induction therapy than in those who had surgery alone. The total number of resected nodes was related to survival in the surgery only group, but had no relationship to survival in the multimodality group.