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Journal and News Scan

Source: Journal of the American College of Cardiology
Author(s): Henrique B. Ribiero, 41 others

A multicenter TAVI registry that included nearly 6,700 patients identified 44 who suffered coronary obstruction following TAVI.  This complication was associated with older age, female sex, no prior CABG, and use of a balloon-expandable valve.  30-day mortality was 41%.  The left coronary artery was most commonly affected, and patients were at increased risk who had lower mean ostial height and smaller sinus diameters.

Source: Annals of Oncology
Author(s): A Trimborn, B Senf, K Muenstedt, J Buentzel, O Micke, R Muecke, FJ Prott, S Wicker, J Huebner

This survey of healthcare workers at a German university clinic explored attitudes towards complementary and alternative medicine (CAM).  Women were more interested than men (80% vs 20%) and nurses were more interested than physicians (72% vs 57%).  Physicians had more concern than nurses about possible adverse effects (52% vs 12%).  Almost 3 out of 4 did not feel adequately informed about CAM.

Source: AHA
Author(s): AHA guidelines committee
  • Recommendations for implementing professionalism and quality policies
  • Opportunities to translate current communication and teamwork knowledge into clinical practice
  • Recommendations for future action and research opportunities in the physical and safety culture of the OR
Source: ABC News
Author(s): Abbey Phillip

Unfortunately , there are lots of stories like this around at the moment. He didn't undergo surgery, he had a stent.

Source: Journal of the National Cancer Institute
Author(s): Jun-ichi Nitadori, Adam J. Bograd, Kyuichi Kadota, Camelia S. Sima, Nabil P. Rizk, Eduardo A. Morales, Valerie W. Rusch, William D. Travis and Prasad S. Adusumilli

This retrospective study assessed the prognostic significance of the new lung adenocarcinoma classification in patients undergoing resection for small tumors (≤2cm) comparing limited vs lobectomy resections. Histologic subtype with micropapillary component >5% was associated with an increased risk of recurrence in patients operated with limited resections but not lobectomy.  This increased risk disappeared when the surgical margin was >1 cm.

Source: Circulation
Author(s): Joyce A. Wahr; Richard L. Prager; J.H. Abernathy III; Elizabeth A. Martinez; Eduardo Salas;Patricia C. Seifert; Robert C. Groom; Bruce D. Spiess; Bruce E. Searles; Thoralf M. Sundt III; Juan A. Sanchez; Scott A. Shappell; Michael H. Culig; Elizabeth H. Lazzara; David C. Fitzgerald; Vinod H. Thourani; Pirooz Eghtesady; John S. Ikonomidis; Michael R. England; Frank W. Sellke; Nancy A. Nussmeier; on behalf of the American Heart Association Council on Cardiovascular Surgery and Anesthesia, Council on Cardiovascular and Stroke Nursing, and Council on Quality of Care and Outcomes Research

This joint statement regarding patient safety advocates a variety of systems to improve outcomes, including checklists, preoperative briefings, postoperative debriefings, and training in communication skills.  Nontechnical skills are the key to improvements in safety.  Anonymous event reporting and regular training in rare but significant events are also recommended. 

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Loor, Gabriel.

The surgical team at Cleveland Clinic have established a checklist, designed to become second nature to residents in training, for checking haemostasis after cardiac surgery. They have tested  their process both in a trial mode and then in a service-wide implementation. This is an important part of establishing a plan for reduction of blood use and of re-opening for bleeding.

Source: Heart
Author(s): Sonia Bouri, Matthew James Shun-Shin, Graham D Cole, Jamil Mayet, Darrel P Francis

Bouri and collegues have analysed data from multiple trials of beta blockade prior to non-cardiac surgery. Guidelines for management have been based on these findings. However, exclusion of one report, now discredited, suggests an increase in morbidity rather than a protective effect. They note the increase in the risk of mortality, the primary end-point at 30 days of 27%. These findings indicate the need for further well controlled studies into the use of beta blockers.

Source: British Medical Journal
Author(s): Hawkes, Nigel

In an editorial relating to a published meta-analysis ( Heart doi:10.1136/heartjnl-2013-304262), Hawkes raises the thorny but all too often repeated issue of research fraud. He estimates that in the UK, many deaths may be related to the recommendations regarding the use of β blockers during surgery, based mainly on a study by a now discredited researcher from Holland. There have been many recent and highly publicised instances of research fraud, leading to retractions of multiple peer reviewed papers, potentially impacting on our day to day clinical practice.

Source: Annals of Cardiothoracic Surgery
Author(s): Aaron J. Weiss, Shan Zhao, David H. Tian, David P. Taggart, Tristan D. Yan

This updated meta-analysis comparing bilateral internal mammary artery (BIMA) versus left internal mammary artery (LIMA) for coronary artery bypass grafting includes 27 observational studies and over 79,000 patients and demonstrates an increased long-term survival in patients receiving a BIMA operation versus a LIMA operation.