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Journal and News Scan
For those of you anticipating the need to perform an emergency cricothyroidotomy outside of a medical setting, this article will guide you to the best pen to use for this purpose. [Spoiler alert: Baron retractable ballpoint and BIC soft feel jumbo]
A panel for the Centers for Medicare and Medicaid determined that annual low-dose CT screening for lung cancer carries too high a risk related to the potential benefits. They expressed concern about high false-positive rates, quality assurance, and gaps in evidence as to how the CT results would be used. Despite the fact that many professional groups have recommended screening, there is now concern that screening will not be approved for coverage at the vote scheduled for November 2014.
Dr. James Cox, DLV 2012 Faculty, gives his explanation of atrial fibrillation with an interesting imagery of a mouse on a yellow umbrella at Dallas-Leipzig Valve 2012.
Dr. Thomas Walther discusses the transapical TAVR Access technique at Dallas-Leipzig Valve 2012.
A Consensus Statement issued by the International Aortic Arch Surgery Study Group, on the standardization of clinical endpoints for aortic arch surgery. This guideline recommends a list important secondary outcomes that should be reported to enable comprehensive analysis of patient outcomes. It also defines the severity of various postoperative complications classified using a management-based grading system.
The new expert opinion paper by the ESC working on the optimal strategy for antiplateletet therapy in patients undergoing CABG
This article compares clinical adverse events after percutaneous intervention with drug‐eluting stents (DESs) and coronary artery bypass grafting (CABG) in patients with ESRD. Early mortality is lower with DESs compared with coronary artery bypass in patients with ESRD. Rate of reintervention is significantly higher in the DES cohort. At a mean pooled follow‐up of two years, both mortality and MACCE are comparable in both cohorts.
Long-term survival following coronary artery bypass grafting: off-pump versus on-pump strategies
JACC - Journal of the American College of Cardiology, 04/18/2014 Evidence Based Medicine Clinical Article
Although several large–scale clinical trials have compared the surgical outcomes between off–pump and on–pump CABG, the long–term survival has not been compared between the two surgical strategies in a reasonably sized cohort. To compare long–term survival after off–pump and on–pump coronary artery bypass grafting (CABG). In patients undergoing elective isolated CABG, on–pump strategy conferred a long–term survival advantage compared with off–pump strategy.
- Authors evaluated long–term survival data in 5203 patients (aged 62.9±9.1 years, 1340 females) who underwent elective isolated CABG (off–pump, n=2333; on–pump, n=2870) from 1989 through 2012.
- Vital statuses were validated from Korean National Registry of Vital Statistics.
- Long–term survival was compared with the use of propensity scores and inverse–probability–weighting to adjust selection bias.
- Patients undergoing on–pump CABG had higher number of distal anastomoses than those undergoing off–pump CABG (3.7±1.2 vs. 3.0±1.1, P<0.001).
- Survival data were complete in 5167 patients (99.3%) with a median follow–up duration of 6.4 years (inter–quartile range, 3.7–10.5 years; maximum 23.1 years).
- During follow–up, 1181 patients (22.7%) died.
- After adjustment, both groups of patients showed a similar risk of death at 30–day (odds ratio, 0.70; 95% CI, 0.35–1.40; P=0.31) and up to one year (HR, 1.11; 95% CI, 0.74–1.65; P=0.62).
- For overall mortality, however, patients undergoing off–pump CABG were at a significantly higher risk of death (HR, 1.43; 95% CI 1.19–1.71; P<0.0001) compared with those undergoing on–pump CABG.
- In subgroup analyses, on–pump CABG conferred survival benefits in most demographic, clinical and anatomic subgroups compared with off–pump CABG
The authors, well-known experts in critical care medicine, provide a detailed and usedful overview of critical illness polyneuropathy. This affects 25% to 100% of ICU patients and is associated with impaired recovery after cricial illness.
A brief case presentation is followed by an operative video detailing the technique for performing an aortic valve replacement in the setting of endocarditis. In this particular video, a pericardial patch is used to reconstruct the area of the commissure between the right and left coronary sinuses. A prosthetic tissue valve is then implanted. (Please see the companion video as well showing the operative technique for aortic root replacement in the setting of endocarditis: http://www.youtube.com/watch?v=5vPzaX... )