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Journal and News Scan
This multicenter prospective study evaluated indications for and outcomes of ICU admission for 449 patients with lung cancer. Most patients had a newly diagnosed lung cancer, and the most common indication for ICU admission was airway compromise. Hospital and 6-month mortality rates were 39% and 55%. Determinants of mortality were severity of organ system dysfunction, recurrent or progressive cancer, poor performance status, and cancer-related complications. Mortality was lower in high volume centers.
This single-centre propensity matched study aimed to compare the outcomes between patients undergoing transapical TAVI or surgical aortic valve replacement in patients who have previously undergone cardiac surgery. Patients who underwent procedures between 2005 and 2012 were included with 40 patients in each group following propensity matching. The majority of patients in both the redo TAVI and redo surgical AVR group had previously undergone CABG. Post-operative permanent neurological defect was more common in the redo surgical AVR group with a trend towards lower 30-day mortality in the redo TAVI group. At four years follow up there was no difference in overall survival between the groups but there was a statistically significant difference in major adverse events which was driven by the rate of permanent neurological deficit in the redo surgical AVR group. The incidence of mild/moderate paravalvular leak in the redo TAVI group was 33%.
This registry study which links Society of Thoracic Surgeons (STS) data with Medicare data examined the rates and predictors of readmission within 30-days of coronary artery surgery. The median readmission rate across 846 hospitals was 16.8%. Predictors of readmission within 30-days of surgery were dialysis, chronic lung disease, creatinine, insulin-dependent diabetes, obesity in women, female gender, immunosupression, pre-operative atrial fibrillation, age, recent MI and low body surface area in men. The c-index for the developed model was 0.648 with 6.1% of hospitals having statistcially worse or better readmission rates than expected.
The retrospective study compared 143 patients who underwent open aortic repair and 50 patients with hybrid thoracic endovascular aortic repair (TEVAR) for non-dissecting aortic arch aneurysms. Patients with hybrid TEVAR recovered earlier from surgery, however, 3-year rates of freedom from reintervention were 80% in this group compared to 99% in the open group and (P < 0.001).
Bilobectomy and right lobectomy were compared in a retrospective case-control study with 117 matched pairs. Space-mismatch related complications were not more frequent following bilobectomy, however, the rate of cardiovascular events was higher after lower and middle lobectomy compared with lower lobectomy.
Author presents a detailed step-by-step approach to Systemic-AP shunt construction in infants via median sternotomy, which offers advantages of preservation of subclavian artery, ease of construction and, perhaps more importantly, ease of takedown. In spite of decreasing annual incidence of this procedure as a result of a change of towards definitive repair whenever possible, it should be still regarded as a very useful procedure in patients who need a reliable source of pulmonary blood flow until such a time when definitive repair may be safely done.
This well documented report analyses different techniques for Bentall procedures performed using biological valved conduit, which have dramatically expanded mainly due to the increased incidence of aortic disease in the aging population, many patients not being amenable to aortic valve repair. Authors offer detailed, well documented description of techniques to be used when performing this procedure with Medtronic Freestyle Root Vascutek BioValsalva graft, Sorin Mitroflow Valsalva graft, and so-called hand-sewn biological composite graft.
Coronary artery bypass grafting versus drug-eluting stents in patients with severe coronary artery disease and diabetes mellitus: a systematic review and meta-analysis
Journal of Diabetes, 06/11/2014 Evidence Based Medicine Review Article
The authors performed a comprehensive meta–analysis to evaluate the comparative benefits of coronary artery bypass grafting versus drug–eluting stents in patients with diabetes mellitus and severe coronary artery disease. For patients with diabetes mellitus and severe coronary artery disease, CABG was superior to DES in that it significantly improve overall and MACCE–free survival rate and reduce incidences of myocardial infarction and repeat revascularization in the long–term follow–up, although it was associated with more perioperative risks and a higher incidence of stroke. Therefore, CABG should remain the gold standard for these patients.
- A comprehensive literature search of PubMed, Embase, and ScienceDirect was carried out.
- References and cited papers of relevant articles were also checked.
- A total of 4 randomized controlled trials, 2 prospective registries and 11 retrospective studies were identified for this review.
- Pooled analysis demonstrated that DES was associated with lower all-cause mortality at 30-day.
- However, there was no significant difference between CABG and DES in mortality at 12-month and at maximum follow-up, DES was associated with lower overall and MACCE-free survival rate, higher incidences of myocardial infarction and repeat revascularization.
- CABG was associated with an increased risk of stroke.
Using data from the Australian Cardiac Surgical Database, the authors provide further information regarding acute kidney damage after cardiac surgery. This study has added to the evidence that preoperative impairment, IABP use, red cell transfusion and infective endocarditis are predictive factors. It remains to be determined what therapies can be instituted to reduce changes in renal function in future clinical trials.
The rate of cerebral embolism in patients with acute infective endocarditis (AIE) was about one quarter on CT scanning, with about one third having silent emboli. This had an adverse impact on survival. Haemorrhagic transformation was low. The authors indicate CT scanning should be routine for all patients with AIE.