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Journal and News Scan
Patients requiring readmission after cardiac surgery were compared to time-matched patients who did not require readmission to evaluate factors associated with this adverse event. Predictors of readmission included COPD, decreased EF, prolonged length of stay, and lower educational level. Failure to see a physician early after discharge increased the risk of readmission by 6-fold.
Pts undergoing aortic root replacement who moderate MR preoperatively were evaluated for outcomes after mitral repair vs no repair. Mitral repair was associated with longer crossclamp times, and postoperative renal failure. Root replacement improved MR without mitral repair, but mitral repair further improved the degree of regurgitation. There was no difference in long-term survival.
Pts surviving esophagectomy longer than 10 years were queried as to QOL. Alimentary comfort rating was 9 out of 10. 33% experienced diarrhea, dumping, or regurgitation. 15% had aspiration requiring hospital care. Mean weight loss was 26 lbs. Median GI QOL score was 2.9 out of 4.
February 10, 2014
The CROSS trials randomized pts with esophageal cancer or GEJ cancer to surgery vs induction chemoradiotherapy (CRT) followed by surgery. Prior studies reported a significant improvement in survival and freedom from recurrence associated with induction therapy. In this report, CRT reduced locoregional recurrence from 34% to 14% and reduced peritoneal carcinomatosis from 14% to 4%. Local recurrence within the RT field occurred in only 5% of patients.
February 8, 2014
Submitted by: Stuart Head
Di Giammarco and colleagues reported that intraoperative graft verification was significantly improved if a combination of transit-time flow measurement and epicardial echocardiography was used in comparison with transit-time flow measurement alone. The positive predictive value increased from 10% to almost 100% in an analysis of 678 grafts in 333 patients undergoing isolated CABG, reducing the rate of unnecessary graft revisions.
February 8, 2014
The authors performed a population-based study to determine the extent to which mesothelioma occurs absent occupational asbestos exposure. A clear dose-response relationship between degree of exposure and risk of mesothelioma was identified. Occupational exposure to asbestos carried a much higher risk of mesothelioma than did non-occupational exposure, and non-occupational exposure carried a higher risk than did no exposure. Non-occupational exposure to asbestos carried a substantially higher mesothelioma risk in women than it did in men.
Chest drainage following cardiac surgery is used to avoid complications related to the accumulation of blood and serous fluid in the chest. We aimed to determine the incidence of chest tube clogging and the role of bedside assessment in identifying the potential for failure to drain. CONCLUSIONS: The chest tubes can become clogged at any time after their placement. The status of urgency, reoperations and use of blood products can be contributing factors increasing the incidence of chest tube clogging. Clinicians likely underestimate the prevalence of this failure to drain, as most clogging occurs in the internal portion of the tube.
The use of glues to repair disrupted tissue during acute type-A aortic dissection (TAD) surgery may be discontinuous, and cause embolization and cell necrosis. We report a method of fibrin sealant patch (FSP) to reinforce dissected aortic tissue with a collagen double layer coated with fibrinogen/thrombin on either side
Recommendations for anticoagulation for patients after bioprosthetic AVR are in flux. Current algorithms are based on historical studies. This study summarizes a review of current literature on the topic.
the Prospective Randomized On–X Anticoagulation Clinical Trial (PROACT) tests the safety of less aggressive anticoagulation than is recommended by ACC/AHA guidelines after implantation of an approved bileaflet mechanical valve. INR may be safely maintained between 1.5–2.0 after AVR with this approved bileaflet mechanical prosthesis. With low–dose aspirin, this resulted in significantly lower risk of bleeding, without significant increase in TE.