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Journal and News Scan
The authors of this piece summarize how surgery has changed over the past decades. They do this using the mnemonic: TWO POEMS:
Teamwork, Work hours,Outcomes, Patient-centered care, Outpatient, Expense, Minimally invasive, Simulation and education.
In this study the authors evaluate the prevalence of significant aortic stenosis (diagnosed with echocardiography and computed tomography) in the elderly, in a cohort representative of the general population of Iceland. Based on their findings, the authors conclude that the number of elderly patients with severe AS will greatly increase in the coming decades. The current study shows that the largest increase will be in the population of 70 years of age and older, both in men and in women.
This survey of publicly available information on LVAD for patients considering such therapy identified numerous flaws in the materials. All discussed benefits, few discussed surgical issues, quality of life, and complications. Some had outdated statistics, some were written above a 3rd grade level, and most did not meet international standards. The perception among patients was that the materials were strongly biased towards LVAD therapy.
In this paper, the authors aim to further understand the factors associated with vein graft failure (VGF) after CABG. They used data on 1828 participants in the PREVENT IV trial to identify patient and surgical factors associated with VGF. They found that longer surgical duration, endoscopic vein harvesting, poor target artery quality and postoperative clopidogrel use were independently associated with VGF. These findings will help identifying patients at high risk of VGF, as well as helping to develop interventions with lower rates of VGF.
In this manuscript, the authors use meta-analysis techniques to evaluate the relationship between measured coronary fractional flow reserve (FFR) and patients’ outcomes. They demonstrate that FFR provides a continuous and independent marker of subsequent MACE as modulated by treatment (medical therapy vs revascularization) in a broad range of clinical scenarios. Lesions with lower FFR values receive larger absolute benefits from PCI or CABG. When FFR values are high, we can do harm by proceeding with revascularization. The cut-point for determining revascularization strategy using this statistical analysis remains in the 0.75-0.80 range, which is in keeping with previous reports on this subject. According to the findings, the authors conclude that an FFR-guided revascularization strategy significantly reduces MACE and increases freedom from angina with less PCI or CABG than an anatomy-based strategy.
In a retrospective cohort study of patients less than 18 years old who underwent cardiopulmonary bypass, intraoperative hemodynamics and vasopressor use were compared between patients who received preoperative ACE inhibitor/ARB therapy and those who did not. Use of preoperative ACE inhibitors and ARBs in pediatric patients undergoing cardiac surgery did not increase the incidence of hypotension after induction of anesthesia and did not increase vasoconstrictor requirements upon weaning from cardiopulmonary bypass.
Because of the observation that already debilitated pts who undergo lung resection become even more debilitated afterwards, the authors conducted a randomized trial of endurance and strength training for 20 wks after major lung resection. Training significantly improved peak VO2, DLCO, strength, endurance, and muscle mass compared to controls. Quality of life, both physical and mental, was also improved with the training compared to controls.
In the last EACTS meeting celebrated in Milan, presented by A. Kerr nee Bradley and colleagues from Birmingham Heartlands Hospital, are the first data in humans showing the improvement in chest wall motion in both operated and contralateral sides following diaphragmatic plication for unilateral paralysis.
It seems that patients with lung or colorectal cancer have poor enrollment in clinical trials, according to the recent multiregional survey carried out by the authors in a cohort of 8778 patients three to six months after diagnosis. Only 14% of patients have discussed their participation in clinical trials.
Using a data set of over 76,000 women from the Women's Health Initiative Observational Study, the effects of active and passive smoking on cancer were evaluated. Lung cancer incidence was highest among active smokers (HR 13.44) and was also high among prior smokers (HR 4.20). A prolonged exposure (>30 yr) to passive smoking in the household also increased the risk of lung cancer (HR 1.61).