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Journal and News Scan
The authors reviewed transfusion practices after cardiac surgery in Australia and New Zealand using a database of nearly 43,000 patients. Transfusion rates for >=1 unit varied 3-fold (22% to 67%), for >=5 units varied 5-fold, >=1 platelet pack varied 3-fold, >=1 FFP varied 4 fold, and >=1 cryoprecipitate varied 20-fold. The differences were not explained by patient, surgical, or hospital characteristics.
The authors compared outcomes of surgical management of early stage thymoma in 125 patients undergoing unilateral VATS to 137 patients undergoing transsternal resection. OR time, blood loss, chest tube drainage, chest tube duration, and LOS were less in the VATS group. Complication rates and local recurrence rates were similar.
This study compared early and intermediate biventricular function after early arterial switch in 26 infants and 20 age-matched controls. At 1 year LV performance was similar in ASO and controls, whereas RV systolic and diastolic function remained impaired. This stresses the need for ongoing monitoring of RV function after ASO.
Appropriate management of functional ischemic MR at the time of CABG is unknown. This study randomized 31 patients with moderate functional ischemic MR to CABG alone or in combination with ring annuloplasty. Moderate differences in outcomes were evident at 3 months, but at 12 months the groups were similar in LVEF and MR improvement.
This is a really nice summary article of the new oral antocoagulants which is freely available in full.
It describes the particular complications of the NOAC and cautions in renal failure and recommends safe stopping times before surgery
In this manuscript, the authors describe their findings after reviewing 27 young patients (between 7 and 30 years of age) who had undergone aortic valve replacement with two types of bovine pericardial biological prosthesis: Mitroflow® LXA (15 patients) and PERIMOUNT Magna® and Magna Ease® (12 patients) valves.
Life-threatening aortic bioprosthetic valve stenosis at 1.5 to 3 years after Mitroflow® LXA valve implantation occurred in 5 patients (33%). Freedom from valve failure at 3 years among those with a Mitroflow® LXA valve was 18%, and progression from less than mild to severe aortic stenosis was observed over a median of 6 months. No valve failures were noted in the observation period among 12 patients with a Magna® or Magna Ease® aortic bioprosthesis.
Based on their findings, the authors conclude that children and very young adults who have received a Mitroflow® LXA pericardial aortic bioprosthesis are at elevated risk for rapid prosthetic valve failure.
This systematic review and meta-analysis of individual patient data from 15 RCTs (2385 pts) assessed the utility of preoperative chemotherapy in patients with primarily stages Ib-IIIa NSCLC. Chemotherapy resulted in a 13% reduction in death (HR 0.87, p=0.007), and a 5% survival improvement at 5 years. Improvement was also evident for recurrence free survival and time to distant recurrence. There was no evidence for a difference in effects based on chemo regimens or patient characteristics.
For those of you anticipating the need to perform an emergency cricothyroidotomy outside of a medical setting, this article will guide you to the best pen to use for this purpose. [Spoiler alert: Baron retractable ballpoint and BIC soft feel jumbo]
A panel for the Centers for Medicare and Medicaid determined that annual low-dose CT screening for lung cancer carries too high a risk related to the potential benefits. They expressed concern about high false-positive rates, quality assurance, and gaps in evidence as to how the CT results would be used. Despite the fact that many professional groups have recommended screening, there is now concern that screening will not be approved for coverage at the vote scheduled for November 2014.
Dr. James Cox, DLV 2012 Faculty, gives his explanation of atrial fibrillation with an interesting imagery of a mouse on a yellow umbrella at Dallas-Leipzig Valve 2012.