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Journal and News Scan

Source: Annals of Thoracic Surgery
Author(s): Jaimin R. Trivedi, Allen Cheng, Ramesh Singh, Matthew L. Williams, Mark S. Slaughter

The impact of continuous flow VAD on survival among patients awaiting heart transplant is not well known.  Pts on the UNOS list were propensity score matched 1:2 (HeartMate II vs no VAD). Wait list mortality was 10% during the 7.5 year study.  Use of a VAD improved survival to transplant at 1 (91% vs 77%) and 2 years (85% vs 68%).  Use of VAD as a bridge to transplant may improve survival and improve organ allocation.

Source: Annals of Thoracic Surgery
Author(s): Edward B. Savage, Paramita Saha-Chaudhuri, Craig R. Asher, J. Matthew Brennan, James S. Gammie

This study summarized data regarding valve use in over 1l,000 pts in the STS database who underwent aortic valve replacement for active endocarditis.  Nearly 75% of pts had no prior cardiac surgery.  Prior cardiac surgery was associated with a higher risk of root replacement (29.9% vs 7.2%), a higher rate of complications (68% vs 61%), and a substantially higher rate of operative mortality (21.1% vs 9.8%, unadjusted).  The use of biological valves increased over time. 

Source: Heart
Author(s): Khawaja MZ, Williams R, Hung J, Arri S, Asrress KN, Bolter K, Wilson K, Young CP, Bapat V, Hancock J, Thomas M, Redwood S.

In this retrospective study, the authors evaluate the effect of preprocedural significant mitral regurgitation (MR) on outcomes of patients undergoing transcatheter aortic valve implantation (TAVI) for sever aortic stenosis. In an overall series of 316 patients, 60 had been diagnosed with significant MR prior to the procedure. In multivariate Cox proportional hazards modelling, significant preprocedural MR was independently associated with 12-month and cumulative mortality. Following the procedure, 52.9% of the patients had less than grade 3 MR. Patients in whom MR improved had a better outcome than those with a worsening in MR.

Source: New England Journal of Medicine
Author(s): Otto CM, Prendergast B .

The authors of this review article provide an extensive overview of the curent state of play in the field of Aortic Stenosis. They discuss risk scores,treatment decisions, and up-to-date evidence of Transcatheter Aortic Valve Replacement.

Source: Journal of the National Cancer Institute
Author(s): Ryan P. Merkow, Karl Y. Bilimoria, Rajesh N. Keswani, Jeanette Chung, Karen L. Sherman, Lawrence M. Knab, Mitchell C. Posner and David J. Bentrem

In this retrospective study based on a database of 5390 patients with early-stage esophageal cancer, T1a and T1b lesions were treated by endoscopic (26.5%) or surgical resection (73.5%). For patients undergoing surgery, the incidence of lymph node metastasis was 5.0% for T1a and 16.6% for T1b lesions. Size > 2 cm and intermediate-/high-grade lesions were the best predictors of nodal involvement. The risk of nodal metastases should be considered when counseling patients.

Source: Annals of Thoracic Surgery
Author(s): Damien J. LaPar, Alan M. Speir, Ivan K. Crosby, Edwin Fonner Jr., Michael Brown, Jeffrey B. Rich, Mohammed Quader, John A. Kern, Irving L. Kron, Gorav Ailawadi, MDemail, Investigators for the Virginia Cardiac Surgery Quality Initiative

The study provides a risk-adjusted impact of postoperative atrial fibrillation on hospital mortality, resouces utlization, and costs.  49,264 patients from the STS database who underwent cardiac surgery were extracted from 2001-2012.  AF increased operative mortality 2% vs 1%), morbidity, readmission rates, ICU stay, postoperative length of stay, and costs. 

Source: MedPage Today
Author(s): John P Higgins

This interesting overview points out the negative effects of adrenaline on outcomes in a number of observational and randomized studies of patients experiencing cardiac arrest.  The author recommends using Vasopressin after the first dose of adrenaline during resuscitation from cardiac arrest. 

Source: MMCTS
Author(s): Tomaso Bottio*, Jonida Bejko, Michele Gallo, Giacomo Bortolussi and Gino Gerosa

Authors describe an LVAD implantation technique, applying the concept of less invasive cardiac surgery, consisting in the association of reduced surgical approaches, off-pump implantation and reduced administration of heparin dose, in order to achieve rapid extubation and rehabilitation of the patient, preserving low morbidity, and still meeting all the goals of the standard procedure. To reduce the invasiveness, authors combine an anterior left minithoracotomy with T-upper reversed ministernotomy.


Source: MMCTS
Author(s): Sahin Senaya, Ahmet Umit Gullua, Muharrem Kocyigitb, Aleks Degirmenciogluc, Hasan Karabuluta and Cem Alhan

This study demonstrates the basic concepts and technique of totally endoscopic robotic ASD closure. The operation can be performed for secundum or sinus venosus type ASDs and can be combined with right-sided robotic operations including mitral or tricuspid valve pathologies. In the short video clips, authors describe the step-step approach to ASD closure. They applied this technique, using Da Vinci system, in 20 patients without mortality or  complications.

Source: New York Daily news

Five years ago, the Oscar-winning actor underwent surgery at the Cleveland Clinic to replace his aortic valve, fix his mitral valve and correct an irregular heartbeat.

Depression is one side effect of cardiac surgery.

It's unknown exactly when Williams' battle with depression began, but his rep issued a statement after the star's death on Monday at 63, noting he had "been battling severe depression of late."

"Open-heart surgery has historically been known to affect a person's cognitive functioning following recovery," Dr. Jeffrey Lieberman, chief of psychiatry at New York-Presbyterian Hospital Columbia, told the Daily News.

"The valve replacement involves stopping the heart while you're replacing it, and having that kind of procedure with general anesthesia, there is an increased frequency of depression occurring in the aftermath," he said.

A number of factors could contribute to this post-operative depression, said Dr. Tara Narula, associate director of the cardiac care unit at Lenox Hill Hospital and a spokeswoman for the American Heart Association and American Stroke Association.

During open-heart surgery, emboli — little pieces of plaque in the aorta — may break off and travel up to the brain, which could result in changes to the brain's structure and abilities, Narula said. Open-heart surgery also makes use of hypothermia — lowering the body's temperature — which may affect brain chemistry, as could general anesthesia.

"It's multifactorial but certainly it is something that we know exists," Narula said of cardiac depression, adding that it affects 20-40% of heart surgery patients. She said patients and doctors need to educate themselves more about the link.

"There are so many things we can do to help people with depression, but if you don't recognize you have it, you're never going to be able to get treatment," she said.

The stress of Williams' open-heart surgery could have also led to "a reactive depression," said Dr. Alan Rozanski, chief of cardiology at Mount Sinai St. Luke’s and Mount Sinai Roosevelt. He noted that up to 10% of people can develop post-traumatic stress symptoms in the wake of a major medical procedure.

"We need to be increasingly aware of that link," he said.



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