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Journal and News Scan

Source: New England Journal of Medicine
Author(s): Derek J. Hausenloy, Luciano Candilio, Richard Evans, Cono Ariti, David P. Jenkins, Shyam Kolvekar, Rosemary Knight, Gudrun Kunst, Christopher Laing, Jennifer Nicholas, John Pepper, Steven Robertson, Maria Xenou, Tim Clayton, and Derek M. Yellon for the ERICCA Trial Investigators

Pts undergoing CABG on-pump were randomized to remote preconditioning (upper arm ischemia) or sham intervention prior to surgical incision.  The primary end point was a combination of cardiovascular death, stroke, MI, and revascularization.  At 1 year there was no difference between the groups in the incidence of the end point, and other important clinical outcomes were also similar.

Source: New England Journal of Medicine
Author(s): Raj R. Makkar, Gregory Fontana, Hasan Jilaihawi, Tarun Chakravarty, Klaus F. Kofoed, Ole de Backer, Federico M. Asch, Carlos E. Ruiz, Niels T. Olsen, Alfredo Trento, John Friedman, Daniel Berman, Wen Cheng, Mohammad Kashif, Vladimir Jelnin, Chad A. Kliger, Hongfei Guo, Augusto D. Pichard, Neil J. Weissman, Samir Kapadia, Eric Manasse, Deepak L. Bhatt, Martin B. Leon, and Lars Søndergaard

Patients entered into a clinical trial of TAVR and patients in two registries were evaluated for possible subclinical leaflet thrombosis in their bioprosthetic valves.  40% of the patients in the TAVR trial and 13% of registry patients were found to have such thrombosis.  The risk was lower in patients anticoagulated with warfarin.  Therpeutic anticoagulation for thrombosis resulted in a high rate of resolution.The risk of TIA and stroke was somewhat increased in patients with thrombosis.

Source: American Journal of Surgery
Author(s): Sarah Majercik, Sathya Vijayakumar, Griffin Olsen, Emily Wilson, Scott Gardner, Steven R. Granger, Don H. Van Boerum, Thomas W. White

This single institution study evaluated patients with traumatic rib fracture treated with rib fixation vs medical management; patients were propensity score matched.  RF pts experienced a lower incidence of re-intervention for retained hemothorax, a lower incidence of empyema, and a lower incidence of readmision.

Source: The Annals of Cardiothoracic Surgery
Author(s): Damian La Par

Ischemic mitral regurgitation (IMR) is a subset of functional mitral regurgitation (MR) that has the potential to impact an increasing number of patients in the future. This is in the context of a worldwide population, which continues to live longer with improved survival after myocardial infarction. Substantial data have accumulated over the past few decades demonstrating the negative effects of IMR. Further, significant research has been done to define the optimal surgical approach and several studies have compared mitral repair versus replacement for patients with severe mitral regurgitation (SMR). Studies supporting performance of mitral repair cite superior operative morbidity and mortality rates, while proponents of mitral replacement cite improved long-term durability and correction of MR. Lack of clinically robust Level I randomized controlled trial data have curtailed attempts to better define appropriate surgical treatment allocation over the past few decades. Recently, however, the Cardiothoracic Surgical Trials Network (CTSN) conducted the first randomized controlled trial, funded by the National Heart, Lung, and Blood Institute, the National Institute for Neurological Diseases and Stroke and the Canadian Institute for Health Research, to compare the performance of mitral repair versus replacement for SMR. Herein, the present review describes the design, results and implications of the CTSN SMR trial and its efforts to identify the most efficacious surgical approach to SMR. This review also describes CTSN investigation to predict the recurrence of MR after mitral repair.

Source: World Journal of Surgery
Author(s): Alexander T. Yahanda, Kelly J. Lafaro, Gaya Spolverato, Timothy M. Pawlik

Given surgery’s inherent risks, a patient should be able to make the most informed decisions possible in selecting surgical treatment. However, there is little information on what factors patients deem important when choosing a surgeon. We performed a systematic review of the literature focused on how patients select surgical care, focusing on identification of factors that influence patient choice as well as important sources of information used by patients.

 

Patients draw upon a myriad of factors when choosing a surgeon and the circumstances surrounding patients’ decisions maybe differ based on sociodemographic, cultural, as well as other factors. Additional information on how patients choose surgeons or hospitals will help providers assist patients in finding their preferred caregivers.

Source: CSIRO
Author(s): Adam Knight

A Spanish cancer patient has received a 3D printed titanium sternum and rib cage designed and manufactured right here in Australia, at our Melbourne-based 3D printing facility in Melbourne.

Suffering from a chest wall sarcoma (a type of cancerous tumour that grows, in this instance, around the rib cage), the 54 year old man needed his sternum and a portion of his rib cage replaced. This part of the chest is notoriously tricky to recreate with prosthetics, due to the complex geometry and design required for each patient. So the patient’s surgical team determined that a fully customisable 3D printed sternum and rib cage was the best option.

Source: YouTube
Author(s): Aresu Giuseppe

Wow. That looks difficult !!. Amazing result at the end though. well done 

Source: Medscape
Author(s): Michael O'Riordan

Researchers from Mount Sinai Beth Israel Medical Center, New York, argue that multiarterial CABG lowers mortality compared with PCI.

Source: Eur J Cardiothorac Surg
Author(s): Bastien Orsini, Jean Marc Baste, Dominique Gossot, Jean Philippe Berthet, Jalal Assouad, Marcel Dahan, Alain Bernard, and Pascal Alexandre Thomas

The IPAL (index of prolonged air leak, PAL) score was published in 2011 for open lung resections. This paper validates the score on approx. 1000 lobectomy and approx. 200 segmentectormy patients who underwent videoassisted thoracic surgery (VATS). The analysis shows a satisfactory predictive value and may be used for the estimation of the predictive risk of PAL after VATS lung resections.  

Source: Eur J Cardiothorac Surg
Author(s): Hyung Gon Je, Deborah J. Shuman, and Niv Ad

This systematic review compares three minimally invasive techniques for surgical treatment of atrial fibrillation: the endocardial Cox-Maze procedure, epicardial surgical ablation and an epicardial surgical and catheter-based endocardial ablation hybrid procedure. According to this analysis, the Cox-Maze procedure is the most effective one and has important safety advantages.

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