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Journal and News Scan
Jennifer Nelson, the former STS Resident Director, discusses the past, present, and future of cardiothoracic surgery training. Changes that have occurred in the recent past include removal of the requirement for general surgery certification, the establishment of specialty tracks, and the development of integrated programs. This has resulted in a large number of applicants for integrated programs and a recent increase in applicants for traditional programs. The future of our field is bright.
The authors reviewed their experience between May 2008 and May 2011 with 107 patients who underwent surgical repair for acute Type I aortic dissection. They report favorable results of more effective end-organ protection with the use of intermittent lower body perfusion and moderate hypothermic circulatory arrest.
Acute myocardial infarction (AMI) may safely be ruled out by testing a single blood sample at patient presentation. In a recently-completed intervention study, using a Copeptin-based diagnostic algorithm enabled immediate discharge of 2/3 of patients with suspected acute coronary syndrome (ACS) from the emergency department. At 30 days, patients managed using Copeptin had 100% survival and a comparably low major cardiovascular event rate (MACE) to that in patients undergoing conventional multiple laboratory testing and hours-long observation. Based on these results, the Thermo Scientific™ B•R•A•H•M•S™ Copeptin biomarker assays improve patient care and clinical resource allocation - without compromising safety.
This is a review article of the diagnosis and treatment of the various forms of shock. The treatment of septic shock is well expounded as this makes up 62% of cases of shock in the ICU. Norepinephrine is the first choice of vasopressor agents and dopamine is discouraged due to its arrhythmogenicity. Dobutamine is the first choice of inotropic agents for increasing CO. Low dose of vasopressin in distributive shock is safe and has a survival benefit. Adequacy of circulation is measured by mixed venous saturation with a target of at least 70%. A decrease in blood lactate level signifies effective therapy. The conclusion discusses the four phases of treatment of shock: salvage, optimization, stabilization and deescalation.
In this multicenter study, a frailty scale was administered to 183 pts with ACS and the degree of frailty was correlated with outcomes. Increased frailty was associated with older age, increased comorbidities, great LOS, and decreased procedure use. After adjusting for baseline differences between the populations, frail patients' HR for mortality was 3.49 relative to fit patients.
This review/synthesis covers atrial fibrillation, the physiology of the atrial appendage, and indications/outcomes for mechanical closure of the appendage. The author, recognized as the originator of surgical treatments for atrial fibrillation, encourages a more aggressive approach to atrial appendage closure in an expanded pool of patients.
The authors reviewed outcomes of refractory septic shock requiring veno-arterial ECMO for circulatory support in a single institution study 2005-2010. Of the 52 pts, 75% had failure of 3 or more organ systems and 40% experienced cardiac arrest at the time of ECMO implant. Only 15% of patients survived to hospital discharge, and survival was related primarily to patient age.
The authors review a 6-year experience with use of cryopreserved grafts for pulmonary artery reconstruction after sleeve pulmonary resection. Of 32 PA reconstructions performed, 10 were done with cryopreserved vessels. Graft patency was 90%. Overall 5-year survival was 67%.
3-D virtual bronchoscopy was used to develop two modes of virtual bronchoscopic ultrasound to assist in determining the ideal location and angle for needle insertion for TBNA. The simple method required standard computation methods, the involved method required advanced computation methods, the latter was more intuitive to use. Both methods obviated the need for EBUS for identifying puncture sites for performing TBNA, and might serve as a complement for current techniques.
In the second session from the TAVI Round Table Discussion, the assembled panel of internationally-recognised opinion leaders discuss planning the procedure.
Designed to support the continuous education of practicing physicians, this second session shares leading opinion and addresses the following questions and key educational objectives:
Assessment: Imaging and investigations
Should trans-femoral be the default access route?
General anaesthetic or sedation; TOE or ICE?
Closure device or surgical cut down?
The panel for this session comprises:
Simon Kennon (Chair), London Chest Hospital, UK
Jonathan Byrne, King's College Hospital, London, UK
Enrico Ferrari, Cardiovascular Surgery Department, University Hospital of Lausanne, Switzerland
Carlos Ruiz, Lenox Hill Heart and Vascular Institute of New York, US
Lars Søndergaard, Rigshospitalet Copenhagen University Hospital, Denmark
Corrado Tamburino, University of Catania, Catania, Italy
Radcliffe Cardiology and Interventional Cardiology Review extend their thanks to all panel members.