ALERT!
This site is not optimized for Internet Explorer 8 (or older).
Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.
Journal and News Scan
October 8, 2015
Submitted by: Mark Ferguson
The authors sought to risk stratify pts with secondary TR and then analyze outcomes of different treatment options for TR in conjunction with repair of left-sided valve disease. Low risk patients did well without TR intervention, intermediate risk patients did well with De Vega annuloplasty, and high risk patients fitted with an undersized annuloplasty ring had good outcomes.
October 8, 2015
Submitted by: Mark Ferguson
The effects of renal failure on outcomes of AVR were examined using CMS data. TAVR pts on dialysis, TAVR pts not on dialysis, and surgical AVR pts on dialysis were compared after propensity score matching. In TAVR patients, dialysis was associated with increased 30 day mortality and survival, and was an independent predictor of worse survival. TAVR and SAVR patients on dialysis had similar outcomes, although length of hospitalization was shorter among TAVR pts.
October 8, 2015
Submitted by: Mark Ferguson
The authors evaluated a single year of thoracic surgery operations at their institution and compared outcomes based on data in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), which uses a sampling technique, to the STS General Thoracic Database, a comprehensive data collection system. Globally, NSQIP underestimated postoperative complications. When specific procedures were evaluated, the number of errors in NSQIP increased. The authors concluded that a comprehensive database provide more accurate outcomes information.
October 7, 2015
Submitted by: Joel Dunning
Check out this amazing free resource on everything you every wanted to know about anatomy. It also has radiology, suturing skills and several other videos and tips.
A fabulous resource
October 6, 2015
Submitted by: Joel Dunning
Dr. Michael Mack. Patient Background: 49 year old male, Sever Aortic Stenosis with BicuspidAortic Valve, Normal LV with 60 mmhg peak gradient, Valve area- 0.79 cm2, Moderate Aortic Insufficiency, Minimally Invasive Aortic Valve Replacement with a 25 mm Edwards Magna Tissue Valve.
October 5, 2015
Submitted by: Mark Ferguson
Pts undergoing cardiac surgery requiring CPB were randomized to remote ischemic preconditioning of the upper extremity or sham intervention. The end point was combined death, MI, stroke, and acute renal failure during hospitalization, and secondary endpoints were the occurrence of any such event within 90 days. Outcomes were similar between the groups, with no treatment effects evident on multiple sub-analyses.
October 5, 2015
Submitted by: Mark Ferguson
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.
October 5, 2015
Submitted by: Mark Ferguson
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.
October 1, 2015
Submitted by: Mark Ferguson
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.
September 30, 2015
Submitted by: Joel Dunning
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.