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Journal and News Scan
This is an outstanding video on the surgical repair of the pulmonary arteries, which has been published in the MMCTS as a detailed techniques article.
This updated meta-analysis evaluated outcomes in 2687 pts from 8 randomized clinical trials assessing the utility of polyunsaturated fatty acids in preventing postoperative atrial fibrillation after cardiac surgery. Treatment reduced the incidence of a-fib overall by 16% to 25%. In patients undergoing isolated CABG the reduction was 34% (p=0.003).
This study reviewed single institutional data to develop a composite risk index for mortality after heart transplantation in patients with congenital heart disease. Results in 46 pts operated 1996-2011 were studied with the primary differentiation being single vs double ventricle morphology. Predictors of mortality were preoperative renal insufficiency and the combination of single ventricle morphology and dialysis.
This derivation and validation study involving 2300 patients who underwent resection for NSCLC explored predictors of local/regional recurrence. Recurrence-free survival was similar between the datasets. Predictors of recurrence were different between the datasets. The derivation dataset identified stage I adeno, stage I squamous/large cell, and stage II-IIIA as predictors. The validation dataset identified lymphovascular invasion and stage as predictors.
Management of a dilated ascending aorta at the time of AVR was investigated in patients undergoing AVR alone (362), AVR plus aortic wrapping (67), or AVR plus aortic replacement (70). Long-term outcomes including death and aortic expansion were similar among the 3 groups.
This is a lovely gem of an operation back from 1998 , by Donald Doty. Really nicely filmed.
The only bit I didn't get was where the surgeons was standing !! isn't he on the left side of the patient ?
Patients with prior coronary artery bypass graft surgery (CABG) who present with an acute coronary syndrome have a high risk for recurrent events. Whether intensive antiplatelet therapy with ticagrelor might be beneficial compared with clopidogrel is unknown. In this substudy of the PLATO trial, the authors studied the effects of randomized treatment dependent on history of CABG. Prior–CABG patients presenting with acute coronary syndrome are a high–risk cohort for death and recurrent cardiovascular events but have a lower risk for major bleeding. Similar to the results in no–prior–CABG patients, ticagrelor was associated with a reduction in ischemic events without an increase in major bleeding. Methods Patients participating in PLATO were classified according to whether they had undergone prior CABG. The trial's primary and secondary end points were compared using Cox proportional hazards regression. Results Of the 18,613 study patients, 1,133 (6.1%) had prior CABG. Prior-CABG patients had more high-risk characteristics at study entry and a 2-fold increase in clinical events during follow-up, but less major bleeding. The primary end point (composite of cardiovascular death, myocardial infarction, and stroke) was reduced to a similar extent by ticagrelor among patients with (19.6% vs 21.4%; adjusted hazard ratio [HR], 0.91 [0.67, 1.24]) and without (9.2% vs 11.0%; adjusted HR, 0.86 [0.77, 0.96]; Pinteraction = .73) prior CABG. Major bleeding was similar with ticagrelor versus clopidogrel among patients with (8.1% vs 8.7%; adjusted HR, 0.89 [0.55, 1.47]) and without (11.8% vs 11.4%; HR, 1.08 [0.98, 1.20]; Pinteraction = .46) prior CABG.
The authors review the rationale for platelet function testing and its application in monitoring patients on antiplatelet therapy. They also review recent clinical trials of newer antiplatelet agents. On the basis of this review, they reach conclusions on the current role of antiplatelet function testing in monitoring modern antiplatelet therapy and the role of the new antiplatelet agents in the treatment of ACS. Recent clinical trials have indicated that newer antiplatelet agents have advantages over clopidogrel in the treatment of ACS. Platelet function testing gives us a guide to the timing, efficacy, and variability of therapy and can correlate with poor patient outcomes; however, the use of antiplatelet function testing to tailor therapy does not seem appropriate.
- The authors reviewed recent publications on platelet function testing and clinical trials of newer antiplatelet therapies compared with clopidogrel.
- Platelet function testing is complex, but there is now a bedside test, VerifyNow.
- High platelet reactivity has been associated with worse cardiovascular outcomes in patients undergoing percutaneous coronary intervention.
- Recent clinical trials have not found any advantage in outcomes in patients who have their therapy adjusted by monitoring their platelet function.
- Newer agents, prasugrel, ticagrelor, and cangrelor, produce more rapid, complete, less variable effects on platelet function than clopidogrel.
- Prasugrel was found to improve outcomes compared with clopidogrel in patients with ACS undergoing percutaneous intervention.
- Ticagrelor is beneficial in all patients with ACS and reduces cardiovascular mortality compared with clopidogrel.
- Cangrelor improves outcomes in patients undergoing stenting.
- Recent studies to assess the role of platelet function monitoring of the effects of clopidogrel and modifying treatments have not been successful.
This paper describes the 1-year results of the CADUCEUS randomized trial on the effect of intracoronary delivery of cardiosphere derived cells (CDC) 1.5 to 3 months after myocardial infarction. Safety endpoints were similar in both groups. Patients treated with CDC had smaller scar size, an increase in viable myocardium and improved regional function of infarcted myocardium than those in the control group. Global ventricular function did not change from baseline to follow up in either group.
In this meta-analysis of five randomized trials comprising 958 patients, the authors study the effect of double versus single antiplatelet therapy on graft occlusion in patients undergoing coronary artery bypass graft surgery. Vein grafts in patients on double antiplatelet therapy were significantly less likely to occlude that those in patients on single therapy at up to 1-year follow up. This effect was not seen in arterial grafts. Safety data on bleeding was inconsistent.