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Journal and News Scan

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 

Source: Journal of the American Medical Association
Author(s): Michael J. Mack, J. Matthew Brennan, Ralph Brindis, John Carroll, Fred Edwards, Fred Grover, David Shahian, E. Murat Tuzcu, Eric D. Peterson, John S. Rumsfeld, Kathleen Hewitt, Cynthia Shewan, Joan Michaels, Barb Christensen, Alexander Christian, Sean O’Brien, David Holmes, for the STS/ACC TVT Registry

This important article describes the initial US commercial experience of transcatheter aortic valve replacement (TAVR) since this therapy was approved by the FDA in 2011. It reports the results of 7710 eligible patients that underwent TAVR for high-risk or inoperable status in 250 centers and were included in the STS/ACC TVT Registry. The median age of the patients was 84 years; 20% were defined as inoperable for standard aortic valve replacement and 80% were considered high operative risk. Of all procedures, 64% were transfemoral, 29% transapical, and the rest performed using other approches. The device was successfully implanted in 92% of cases. In-hospital mortality was 5.5% with risk of stroke being 2%. Conversion to open heart surgery (1%) was associated with very high in-hospital mortality (49%). The authors conclude that US outcomes in the commercial TAVR era are similar to the previously published outcomes from the PARTNER trial and from European trials. Long-term follow-up is needed.

Source: New England Journal of Medicine
Author(s): M Pirmohamed and others for the EU-PACT Group

455 patients with a-fib or VTE were randomized to pharmacogenetic-directed warfarin therapy for the first 5 days or a 3-day loading regimen.  Genotype-based dosing resulted in a 10% higher rate of being in the therapeutic range, a shorter time to reach a therapeutic INR, and fewer instances of excessive anticoagulation. 

Source: New England Journal of Medicine
Author(s): MA Acker and others for the CTSN

251 pts with severe ischemic MR were randomized to MV repair or chordal-sparing MV replacement.  The end point was LVESVI at 12 mos.  LVESVI and mortality were similar between the groups at follow-up.  Recurrent MR was more common in the repair group (32.6% vs 2.3%).  Other outcomes including major adverse events and QOL were similar between the groups.

Source: Lancet
Author(s): H Thiele, U Zeymer, F-J Neumann, M Ferenc, H-G Olbrich, J Hausleiter, A de Waha, G Richardt, M Hennersdorf, K Empen, G Fuernau, S Desch, I Eitel, R Hambrecht, B Lauer, M Bohm, H Ebelt, S Schneider, K Werdan, G Schuler

Pts with acute MI complicated by shock who were being treated with optimal medical therapy and for whom early revascularization was planned were assigned to IABP vs control.  600 patients were randomized.  Death rates at 12 mos in the IABP and control groups were 52% vs 51%.  Reinfarction, recurrent revascularization, stroke, and quality of life did not differ between the groups. 

Source: Lancet
Author(s): C Bullen, C Howe, M Laugesen, H McRobbie, V Parag, J Williman, N Walker

This 2 year trial randomizing pts between e-cigarettes, placebo e-cigarettes, and nicotine patches was conducted in 657 people.  Abstinence from smoking was achieved in 7.3% for e-cigarettes, 5.8% for patches, and 4.1% for placebo.  Abstinence rates were strikingly low, and aids to smoking cessation offered no important advantage in this small study.