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Journal and News Scan
LVR using endobronchial therapies remains experimental. This multicenter study tested LVR coils in 60 pts for safety and efficacy. There were a total of 18 serious adverse events. At 6 and 12 mos, dyspnea scores decreased 11%, 6 min walk increased 30-50 m, and FEV1 increased 0.11 L. Pts with either heterogeneous or homogeneous emphysema appeared to improve.
This is a nice video that demonstrates what items are required to safely perform an emergency resternotomy.
Might be a nice video to show to your ICU nurses or those who might be required to assist in an emergency resternotomy.
There is further information on emergency resternotomy at www.csu-als.com
This study assessed whether the application of a poly based hydrogel containing amioderone applied to the epicardium at the time of surgery reduced the incidence of post-operative atrial fibrillation. The study randomised 100 patients undergoing cardiac surgery to either receive the amioderone spray at the time of surgery or no intervention. Patients in who received epicardial amioderone had a significantly reduced incidence of post-operative AF (4/50, 8%) compared to the control group (13/50, 26%) up to 14 days post-surgery. Plasma amioderone levels remained below the detection limit for the duration of the study.
This multi-centre registry study assessed peri-operative and long-term outcomes in patients who underwent isolated surgical aortic valve replacement (AVR) who had previous undergone coronary artery bypass graft surgery (CABG). The study included 113 patients who underwent AVR after previous CABG across seven centres between 2000-2013. Clamping of a patent IMA graft was performed in the majority of cases. The in-hospital mortality rate was 4.4% with a predicted risk of in-hospital mortality according to EuroSCORE II of 10.3%. The post-operative stroke rate was 8.0% with just under 20% of patients requiring a prolonged ITU stay. Five-year survival was 88.4%.
The authors studied outcomes after congenital operations in 12 programs in New York state (4,776 operations) to assess whether prolonged length of stay (PLOS) can be used as a quality measure. PLOS incidence ranged from 7.5% to 36.5.5. PLOS was strongly correlated with mortality rates. The authors conclude that PLOS is a reasonable quality metric, especially in low volume centers.
This study assessed nonfatal outcomes comparing CABG to PCI for pts with multivessel CAD identified in national registries. The outcome was the composite of death, MI, or stroke. Registry data were linked to Medicare data to obtain outcomes and pts were propensity score matched. The authors identified a total of 86,244 CABG and 103,549 PCI pts. At 4 yrs in matched cohorts, MI incidence was 3.2% after CABG and 6.6% after PCI. Stroke incidence was 4.5% in CABG and 3.1% in PCI pts; the difference was primarily due to the 30-day stroke rate after CABG. The composite index incidence was 21.6% for CABG and 26.7 % for PCI.
This retrospective review included 322 pts undergoing open esophagectomy 2005-2010. Gastric empyting procedures included Botox (78), pyloroplasty (199), and pyloromyotomy (45). Botox was associated with more postop reflux symptoms and required more prokinetic agents. Botox pts experienced no difference in gastric emptying, and the incidence of dumping was not reduced.
This multicenter retrospective review included 518 pts from 9 centers who underwent EPP from 2000 to 2010. Half the pts received induction chemotherapy, and nearly three-quarters of the patients received postoperative adjuvant therapy, primarily chemotherapy. The major surgical complication rate was 26% and 90 day mortality was 6.9%. 3-year survival was 27%. Factors negatively influencing survival were male sex and non-epithelial histology. Trimodality treatment with induction therapy was favorably associated with survival.
The distribution of sympathetic and parasympathetic nerve fibres of the epicardial subplexuses at the heart hilum was elucidated. The results may help to explain mechanisms of the initiation of supraventricular arrhythmias and to determine effective treatment options.
Extracapsular spread of cancer cells is associated with poorer outcome compared to intracapsular limitation in positive lymphnodes in patients with adenocarcinoma of the oesophagus and gastro-oesophageal junction. This finding is not reflected by the current tumour staging system.