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Journal and News Scan
Anomalous Aortic Origin of a Coronary Artery (AAOCA) is a common congenital heart lesion that may rarely be associated with myocardial ischemia and sudden death in the young. Evidence-based criteria for management are lacking. As of June 2012, 198 patients were enrolled in the CHSS Registry of young patients with AAOCA. Analysis of demographic, clinical and morphologic data suggests that management decisions, including surgical referral, are associated with patient symptoms and coronary morphology.
Interesting paper evaluating the usage of IMA for coronary artery bypass graft surgery in the USA from 1988 to 2008 among Medicare users. The study looks into the adoption of IMA grafting over this period of time and the variation in its use among different states which goes from less than 87.5% to over 95%. Differences in outcomes in those patients with and without an IMA graft were also analyzed.
Nice operative video of an anterior approach to resection of a pan coast tumour
This study of 6,220 patients with resected lung adenocarcinoma shows that bronchioloalveolar carcinoma (BAC) had a significantly better prognosis than other types of adenocarcinoma. In contrary to the current definition, pure bronchioloalveolar growth pattern without invasion, stage II-IV was observed in 8% of patients and 9% had recurrences.
Eleven pairs of donor lungs with inferior PaO2/FiO2 ratio, bilateral infiltrate on chest X-ray or ongoing extra corporeal membrane oxygenation were successfully reconditioned by ex vivo lung perfusion and transplanted. The early postoperative course was acceptable when compared to originally suitable donor lungs.
According to this systematic review, preoperative statin therapy reduces early all-cause mortality, postoperative atrial fibrillation and stay on intensive care unit and in hospital. No effect on myocardial infarction or renal failure was found.
The authors studied the effects of implementing a multidisciplinary thoracic aortic surgery program (TASP) on the outcomes after acute type A aortic dissection (ATAAD) repair. They used data of 128 patients who underwent ATAAD at a single institution during the 6 years before (n=56) and 6 years after (n=72) implementation of the TASP. They found that both short and long-term mortality improved after implementation of the multidisciplinary program and conclude that centralization of ATAAD patients is warranted.
Meta-analysis study involving 228,465 patients suggesting a dose response decrease in atrial fibrillation in those that consume caffeine.
In this propensity matched analysis, Hlatky et al, investigate the adoption patterns of IMA grafting in the United States and study the association with clinical outcomes. They matched 60,896 Medicare patients with and without IMA grafts. The investigators found that IMA use was associated with lower rates of death (HR=0.77), death/MI (HR=0.77) and repeat revascularizations over a 5-year timeframe (8% vs. 9%, p<0.001). Also, IMA adoption grew between 1988 and 2008, and showed considerable geographic variation.
The authors of this multicenter trial performed a post-hoc analysis of a randomized trial comparing open and endovascular abdominal aortic aneurysm repair. 351 patients were randomly assigned to undergo either open abdominal aortic aneurysm repair or endovascular repair. Patients who were on lipid-lowering medication at registration in the trial (n = 135) were compared with those who were not (n = 216). During 6 years of follow-up, statin therapy at registration in the trial was independently associated with better overall survival after open or endovascular aneurysm.