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Journal and News Scan

Source: New England Journal of Medicine
Author(s): RP Giugliano and others for ENGAGE AF-TIMI 48 Investigators

The efficacy of high dose and low dose Edoxaban, an oral factor Xa inhibitor, was compared to Warfarin in patients with high risk a-fib. The efficacy endpoint was stroke or systemic embolus, the safety endpoint was bleeding. Edoxaban was non-inferior to Warfarin for both doses in terms of efficacy, and was associated with reduced risks of bleeding and cardiovascular death.

Source: New England Journal of Medicine
Author(s): Randall C. Starling, Nader Moazami, Scott C. Silvestry, Gregory Ewald, Joseph G. Rogers, Carmelo A. Milano, J. Eduardo Rame, Michael A. Acker, Eugene H. Blackstone, John Ehrlinger, Lucy Thuita, Maria M. Mountis, Edward G. Soltesz, Bruce W. Lytle, and Nicholas G. Smedira

The incidence of device thrombosis in HeartMate II VAD devices in 3 centers was investigated. 895 devices were implanted 2004-present. The incidence of device thrombosis increased from 2.2% in the earlier period to 8.4% in the past 2 years. During the same interval the time to thrombosis decreased from 18.6 mos to 2.7 mos. Elevated LDH levels presaged thrombosis. In patients who did not undergo device replacement or transplant after thrombosis, the mortality at 6 mos was 48%.

Source: European Heart Journal
Author(s): Lauten A, Hamadanchi A, Doenst T, Figulla HR

Short article describing the autopsy findings in the first patient to have a transcatheter valve implantation in the inferior vena cava for tricuspid insufficiency. Three months following implantation, the prosthesis remained in place and with normal appearances. Some interesting autopsy pictures can be found in the manuscript.

Source: Journal of the American Medical Association
Author(s): Deb S, Wijeysundera HC, Ko DT, Tsubota H, Hill S, Fremes SE.

Systematic review article comparing surgical versus percutaneous revascularization for ischaemic heart disease in patients with unprotected left main disease (ULMD), diabetes, multivessel CAD or left ventricular dysfunction. The authors reinforce the idea that patients suffering with diabetes appear to do better with surgery. In patients with ULMD, multivessel disease, or left ventricular dysfunction, the type of therapy should be determined by the complexity of the lesions. Patients with SYNTAX score above 22 are better served with coronary artery bypass graft surgery, whereas in patients with a SYTAX score equal or below 22, percutaneous revascularization should be the first choice.

Source: Journal of the American Medical Association
Author(s): Traverse JH, Henry TD, Pepine CJ, Willerson JT, Ellis SG.

This paper reports on the 1-year follow up of the Timing In Myocardial Infarction Evaluation (TIME) trial, in which patients with moderate to large anterior ST elevation myocardial infarction received treatment with intracoronary delivery of 150 million autologous bone marrow mononuclear cells 3 or 7 days following the event. At 1-year, there continued to be no evidence of improvement in the primary end-points of LVEF and regional (infarct and border zone) LV function in the treatment groups compared with the control group, irrespective of cell delivery at 3 or 7 days.

Source: Journal of Cardiothoracic and Vascular Anesthesia
Author(s): Oliver et al

The goal of this study was to assess the postoperative safety of ketorolac, an intravenously administered nonsteroidal anti–inflammatory drugs (NSAIDs), after cardiac surgery. Ketorolac appears to be well–tolerated for use when administered selectively after cardiac surgery. Although a black box warning exists, the data highlights the need for further research regarding its perioperative administration. Methods A total of 1,309 cardiac surgical patients (78.1% coronary bypass, 28.0% valve) treated between 2006 and 2012. A total of 488 of these patients received ketorolac for postoperative analgesia within 72hours of surgery. Results Ketorolac–treated patients were younger, had better preoperative renal function, and underwent less complex operations compared with non–ketorolac patients. Ketorolac was administered, on average, 8.7hours after surgery (mean doses: 3.1). Postoperative outcomes for ketorolac–treated patients were similar to those expected using Society of Thoracic Surgery database risk–adjusted outcomes. In unadjusted analysis, patients who received ketorolac had similar or better postoperative outcomes compared with patients who did not receive ketorolac, including gastrointestinal bleeding (1.2% v 1.3%; p=1.0), renal failure requiring dialysis (0.4% v 3.0%; p=0.001), perioperative myocardial infarction (1.0% v 0.6%; p=0.51), stroke or transient ischemic attack (1.0% v 1.7%; p=0.47), and death (0.4% v 5.8%; p<0.0001). With adjustment in a multivariate model, treatment with ketorolac was not a predictor for adverse outcome in this cohort (odds ratio: 0.72; p=0.23).

Source: Surgery
Author(s): Kevin W. Southerland, Anthony W. Castleberry, Judson B. Williams, Mani A. Daneshmand, Ayyaz A. Ali and Carmelo A. Milano

The authors present an analysis of outcome of heart transplantations performed with donors who experienced cardiac arrest during the assessment, comparing them to transplantation with standard donors. No differences were reported in short and long term survivals.

Source: EACTS
Author(s): Chaired by Dr Francesco Maisano

This is an EACTS video debate session held at EACTS 2013 in Vienna. 
Drs Maisano, Dr Robert Klautz, Dr Rafaele Rosenhek and Dr Yolanda Kluin 

They discuss a range of aspects of minimal access Mitral surgery 

Source: EACTS
Author(s): Chaired by Michael Mack

An Interview with Michael Mack, Patrick Surrys, Fredrick Mohr,  and Dr van Miegham over the options of revascularization and the debate between PCI and CABG. 
This was recorded at EACTS 2013 in Vienna

Source: Youtube
Author(s): James Cook University Hospital, Middlesbrough

This is a video of VATS diaphragmatic Plication  using CO2, and 3 10mm ports. It also features the endostitch to create the plication sutures and these sutures are pledgeted during the procedure. 
Finally we also use the SILS clinch device that can grasp tissue at any angle and together this all make the procedure very straightforward indeed. 
The patient had an NG tube during surgery and was discharged on day 4