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Journal and News Scan
the Prospective Randomized On–X Anticoagulation Clinical Trial (PROACT) tests the safety of less aggressive anticoagulation than is recommended by ACC/AHA guidelines after implantation of an approved bileaflet mechanical valve. INR may be safely maintained between 1.5–2.0 after AVR with this approved bileaflet mechanical prosthesis. With low–dose aspirin, this resulted in significantly lower risk of bleeding, without significant increase in TE.
Redmond Burke MD, Chief of Pediatric Cardiovascular Surgery at Miami Children's Hospital demonstrates the operative repair and postoperative recovery for a child with VSD.
Transcatheter aortic valve replacement (TAVR) has, without a doubt, brought an unprecedented excitement to the field of interventional cardiology. The avoidance of a sternotomy by transfemoral or transapical aortic-valve implantation appears to come at the price of some serious complications, including an increased risk of embolic stroke and paravalvular leakage. The technical challenges of the procedure and the complex nature of the high-risk patient cohort make the learning curve for this procedure a steep one, with the potential for unexpected complications always looming.
The accuracy of the diagnosis in patients undergoing congenital heart surgery in a large administrative database was examined in over 14,000 patients aged 0 to 5. Patients admitted on day 1 of life and those undergoing ECMO had a much higher chance of being assigned non-cardiac diagnoses. Pts so misclassified had a substantially higher risk of mortality. This systematic misclassification may lead to inaccurate determination of case volumes and outcomes.
Because the optimal management of CAD is unclear for many patients, the authors developed a decision support model for CABG and PCI with bare metal or drug eluting stents. Overall survival rates were similar for the different interventions. For PCI with drug eluting stents, optimal outcomes were observed for pts undergoing emergency revascularization for acute MI. Optimal outcomes for CABG were observed in pts with multivessel disease and with many comorbidities.
The authors report outcomes for recipients of heart transplants performed more than 20 years prior. Overall 20 year survival was 56%. Causes of mortality were similarly distributed among rejection, malignancy, infection, and allograft vasculopathy. Only 2 patients underwent retransplantation.
The authors hypothesized that examination of more lymph nodes resulting from lung resection for NSCLC would result in fewer missed nodal metastases and be associated with better survival related to more accurate staging. Based on nearly 25,000 pts from SEER, they found the median number of nodes examined was only 6. Pts who had 18-21 nodes examined had a hazard ratio for mortality of 0.65.
This review outlines causes of delirium and oversedation in ICU patients. Methods of managing these problems are outlined.
February 5, 2014
Submitted by: Ruben Osnabrugge
In this article, the authors investigated the impact of the timing neonatal arterial switch operation on morbidity, mortality and costs. They included 140 patients with transposition of the great arteries and found a mortality and morbidity rate of 2% and 20%, as well as median hospital costs of $60,000. Their multivariable model showed that for every day beyond day 3 that the arterial switch was delayed, the risk of major morbidity increased with 47% and costs by 8%.
January 24, 2014
The most common type of mesothelioma is malignant pleural mesothelioma, a nearly invariably lethal tumour of the pleura. Very seldom diagnosed prior to the advent of widespread asbestos mining in the early to mid twentieth century, this disease has sharply risen in incidence over the last five decades (1). The worldwide consumption of asbestos has peaked in the 1980s consequent to the call for an asbestos ban in several developed countries. However, in recent years the use of this carcinogenic mineral and its products seems to get an unprecedented popularity in Eastern Europe, Asia and South America (2). The tragic consequences of increased asbestos use in these parts of the world are that many more mesothelioma cases will be diagnosed in the future and that a major carcinogenic legacy is left behind for next generations. Asbestos has also been characterized as a time-bomb due to the long latency between first asbestos exposure and occurrence of disease (3). The purpose of these guidelines is clear. They are providing a set of concise evidence-based recommendations for the diagnosis, treatment and care of patients with malignant pleural mesothelioma. Although they were written to be used in an Australian context they will lend themselves also to be translated in health care settings outside of Australia. The team who voluntarily invested a significant amount of time in this project considered it a privilege to focus on better diagnostics, better treatment and care for those unfortunate victims of a hideous man-made disease called malignant pleural mesothelioma.