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Journal and News Scan

Source: Annals of Thoracic Surgery
Author(s): Ming Liu, Charlotte M. Druschel, Edward L. Hannan

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.

Source: Annals of Thoracic Surgery
Author(s): Fred H. Edwards, David M. Shahian, Maria V. Grau-Sepulveda, Frederick L. Grover, John E. Mayer, Sean M. O'Brien, Elizabeth DeLong, Eric D. Peterson, Charles McKay, Richard E. Shaw, Kirk N. Garratt, George D. Dangas, John Messenger, Lloyd W. Klein, Jeffrey J. Popma, William S. Weintraub

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.

Source: Annals of Thoracic Surgery
Author(s): Shady M. Eldaif, Richard Lee, Kumari N. Adams, Patrick D. Kilgo, Mark A. Gruszynski, Seth D. Force, Allan Pickens, Felix G. Fernandez, Theresa D. Luu, Daniel L. Miller

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. 

Source: Annals of Thoracic Surgery
Author(s): Lorenzo Spaggiari, Giuseppe Marulli, Pietro Bovolato, Marco Alloisio, Vittore Pagan, Alberto Oliaro, Giovanni Battista Ratto, Francesco Facciolo, Rocco Sacco, Daniela Brambilla, Patrick Maisonneuve, Felice Mucilli, Gabriele Alessandrini, Giacomo Leoncini, Enrico Ruffini, Paolo Fontana, Maurizio Infante, Gian Luca Pariscenti, Monica Casiraghi, Federico Rea

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. 

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Viktorija Petraitiene, Dainius H. Pauza and Rimantas Benetis

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.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Philippe Nafteux, Toni Lerut, Gert De Hertogh, Johnny Moons, Willy Coosemans, Georges Decker, Hans Van Veer and Paul De Leyn

 

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.  

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Paula Moreno, Antonio Alvarez, Francisco Santos, José Manuel Vaquero, Carlos Baamonde, Javier Redel, Francisco Cerezo, Francisco Javier Algar and Angel Salvatierra

 

365 Lung transplantions were reviewed and classified for optimal and extended both donors and recipients. Extended recipients were characterized by pulmonary fibrosis or pulmonary hypertension, pretransplant intubation, age >60 years and bypass >2 h. They experience early graft failure more frequently and had a poorer survival than optimal donors without an influence of donor quality or length of ischemic time. 

Source: The American Journal of Cardiology
Author(s): Laura Fusini et al

The aims of this study were, in patients with MVP undergoing MV repair, to describe the prevalence and characteristics of MAC, to correlate MAC with clinical risk factors, coronary involvement, and aortic valve disease, and to describe prevalence, site, and extension of MAC in fibroelastic deficiency (FED) versus Barlow's disease (BD) and correlate MAC to surgical outcomes. Despite very high percentage of repairability, MAC influences surgical outcomes and very detailed echo evaluation is advocated.

Source: EMCrit Blog
Author(s): Joe Novak

Joe Novak, MD was an F-15 Combat Pilot and now is an Emergency Physician. In this fantastic lecture, he brings the concepts of Combat Aviation to the art of Resuscitation.

The Boldface

aka the no-shitters things that must be absolutely incorporated into your memory and available for immediate execution. You should not need to think about what to do in these situations.

Checklists

Cognitive unloading and guarantee of the performance of critical actions. Use after addressing the boldface

Prioritization of Attention and Tasks

In combat aviation:

  1. Aviate
  2. Navigate
  3. Communicate

In EM & Critical Care:

  1. Resuscitate
  2. Differentiate
  3. Communicate

The Cross-Check

Keep coming back to the global patient picture before diving into any minutiae

Efficient and Unambiguous Communication

  • Directive
  • Descriptive
  • Informative

Click on the vimeo video near the end to hear his full lecture 

 

Source: Journal of Gastrointestinal Surgery
Author(s): P Schollaert, R Crott, C Bertrand, L D'Hondt, T Vander Borght, B Krug

This metanalysis identified 26 eligible studies that assess the predictive value of PET for survival after induction therapy.  Complete metabolic response was associated with a 50% decrease in mortality and in tumor recurrence compared to no response.   

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