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Journal and News Scan

Source: The New England Journal of Medicine
Author(s): Jean-Louis Vincent and Daniel De Backer

This is a review article of the diagnosis and treatment of the various forms of shock. The treatment of septic shock is well expounded as this makes up 62% of cases of shock in the ICU. Norepinephrine is the first choice of vasopressor agents and dopamine is discouraged due to its arrhythmogenicity. Dobutamine is the first choice of inotropic agents for increasing CO. Low dose of vasopressin in distributive shock is safe and has a survival benefit. Adequacy of circulation is measured by mixed venous saturation with a target of at least 70%. A decrease in blood lactate level signifies effective therapy. The conclusion discusses the four phases of treatment of shock: salvage, optimization, stabilization and deescalation.

Source: Canadian Journal of Cardiology
Author(s): MM Graham, PD Galbraith, D O'Neill, DB Rolfson, C Dando, CM Norris

In this multicenter study, a frailty scale was administered to 183 pts with ACS and the degree of frailty was correlated with outcomes.   Increased frailty was associated with older age, increased comorbidities, great LOS, and decreased procedure use.  After adjusting for baseline differences between the populations, frail patients' HR for mortality was 3.49 relative to fit patients.   

Source: journal of Thoracic and Cardiovascular Surgery
Author(s): JL Cox

This review/synthesis covers atrial fibrillation, the physiology of the atrial appendage, and indications/outcomes for mechanical closure of the appendage. The author, recognized as the originator of surgical treatments for atrial fibrillation, encourages a more aggressive approach to atrial appendage closure in an expanded pool of patients.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): C-T Huang, Y-J Tsai, P-R Tsai, W-J Ko

The authors reviewed outcomes of refractory septic shock requiring veno-arterial ECMO for circulatory support in a single institution study 2005-2010. Of the 52 pts, 75% had failure of 3 or more organ systems and 40% experienced cardiac arrest at the time of ECMO implant. Only 15% of patients survived to hospital discharge, and survival was related primarily to patient age.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): J-P Berthet, M Boada, M Paradela, L Molins, S Matecki, C-H Marty-Ane, A Gomez-Caro.

The authors review a 6-year experience with use of cryopreserved grafts for pulmonary artery reconstruction after sleeve pulmonary resection. Of 32 PA reconstructions performed, 10 were done with cryopreserved vessels. Graft patency was 90%. Overall 5-year survival was 67%.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): M Sato, F Chen, A Aoyama, T Yamada, M Ikeda, T Bando, H Date

3-D virtual bronchoscopy was used to develop two modes of virtual bronchoscopic ultrasound to assist in determining the ideal location and angle for needle insertion for TBNA. The simple method required standard computation methods, the involved method required advanced computation methods, the latter was more intuitive to use. Both methods obviated the need for EBUS for identifying puncture sites for performing TBNA, and might serve as a complement for current techniques.

Source: Radcliffe Infirmary in Oxford
Author(s): Simon Kennon

In the second session from the TAVI Round Table Discussion, the assembled panel of internationally-recognised opinion leaders discuss planning the procedure.

Designed to support the continuous education of practicing physicians, this second session shares leading opinion and addresses the following questions and key educational objectives:

Assessment: Imaging and investigations
Should trans-femoral be the default access route?
General anaesthetic or sedation; TOE or ICE?
Closure device or surgical cut down?
The panel for this session comprises:

Simon Kennon (Chair), London Chest Hospital, UK
Jonathan Byrne, King's College Hospital, London, UK
Enrico Ferrari, Cardiovascular Surgery Department, University Hospital of Lausanne, Switzerland
Carlos Ruiz, Lenox Hill Heart and Vascular Institute of New York, US
Lars Søndergaard, Rigshospitalet Copenhagen University Hospital, Denmark
Corrado Tamburino, University of Catania, Catania, Italy
Radcliffe Cardiology and Interventional Cardiology Review extend their thanks to all panel members.

Source: Interactive Journal of Cardiovascular and Thoracic Surgery
Author(s): Stefan C. Sandker, Gianclaudio Mecozzi, Azuwerus van Buiten, Massimo A. Mariani, Hendrik Buikema, and Jan G. Grandjean

The authors showed in an ex vivo model, that the adventitial dissected radial artery is less susceptible to vasoconstriction and more prone to vasorelaxation. Adventitial dissection of the radial artery graft might reduce vasospasm for arterial revascularization in CABG.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Kristian Bartnes, Stig E. Hermansen, Øystein Dahl-Eriksen, Ramez Bahar, Rolf Busund, Dag G. Sørlie, and Truls Myrmel

This long-term follow up on 290 grafted vessels did not find a disadvantage of vein grafts compared to IMA or radial artery. Native occlusion correlated with serum-cholesterol and was predicted by right coronary artery territory, patent corresponding graft, the corresponding graft being an IMA and end-to-side anastomosis.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Phil Botha, Ruth Solana, Jane Cassidy, Gareth Parry, Richard Kirk, Asif Hasan, and Massimo Griselli

The proportion of pediatric patients with mechanical circulatory support (MCS) prior to heart transplantation has increased from 27% to 51% in the recent years. These patients have a higher 30-day post-transplant mortality and suffer more neurological and respiratory sequelae. However, more transplantations were possible due to the use of MCS.

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