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Journal and News Scan
Prospective observational cohort study of 106 patients undergoing repair of giant paraesphageal hernia (GPEH) with near complete follow-up at 1 year. Outcomes measured at the first postoperative visit and at one year were radiographic recurrence, patient satisfaction and GERD-HRQL score. Importantly, this study compared patients with small radiographic recurrence (<2cm) to those with a commonly used definition of radiographic recurrence (classified as large recurrence for this cohort): >2cm or 10% of the stomach above the diaphragm. Most patients underwent laparoscopic repair (80.2%) and 66% had an esophageal lengthening procedure. The overall recurrence rate at one year was 32.7% versus 18.8% using the commonly used definition (>2cm or 10% of the stomach above the diaphragm). Patient satisfaction increased from 2.9% preoperatively to 85% at 1 month and 71.4% at one year. There was no difference in patient satisfaction between those with small and large recurrences (57.1% versus 52.6%). The median GERD-HRQL score was 22.5 preoperative, 3.0 at one month, and 7.0 at one year. There was no difference in GERD-HRQL scores between patients with small and large recurrences (12.0 versus 14.0). The authors concluded that any recurrence, whether small or large, has a negative effect on patient satisfaction and control of symptoms and that there is a need for further investigation of patients with small recurrences to determine their clinical importance.
The authors have examined impedance aggregometry on patients undergoing CABG on DAPT. They examined the impact of cessation on beeding and transfusion and showed a higher level of platelet function led to lower transfusions.
A succinct review of cardiac amyloidosis, particularly relevant to transplant surgeons that are expected to see more patients with the condition
Dozens of recent clinical trials contain suspicious statistical patterns that could indicate incorrect or falsified data, according to a review of thousands of papers published in leading medical journals.
The analysis was carried out by John Carlisle, a consultant anaesthetist at Torbay Hospital, who previously used similar statistical tools to expose one of the most egregious cases of scientific fraud on record, involving a Japanese anaesthesiologist who was found to have fabricated data in many of his 183 retracted scientific papers.
The latest study identified 90 trials that had skewed baseline statistics, 43 of which with measurements that had about a one in a quadrillion probability of occurring by chance.
This study is published in Anaesthesia and it names the papers concerned - go here to read the paper
This special issue of the ACS is focused on Tricuspid Valve Surgery. With Guest Editors Dr Bettina Pfannmuller and the late Dr Lawrence Cohn, topics of interest include non-functional tricuspid valve disease, innovative solutions for tricuspid leaflet repair, management of Ebstein’s Anomaly, minimal access surgery and much more. Contributors include Dale Adler, Jamahal Luxford, Rebecca Hahn, Gosta Pettersson, Irving Kron, Marisa Cevasco and many more.
Outcomes of surgery for congenital heart defects in children with trisomy 13 or 18 were evaluated in 98 pts the Pediatric Cardiac Care Consortium 1982-2008. Hospital mortality was 28% and 13%, respectively. Median survival was 15 years and 16 years, primarily related to cardiac and respiratory causes.
A statewide quality initiative database that included over 11,500 pts undergoing surgical AVR (SAVR) who were assessed for outcomes based on pre-TAVR and post-TAVR time periods (divided into early TAVR and commercial TAVR). SAVR rates increased with each time period, wheres predicted mortality rates decreased, observed mortality was lowest during the commercial era, and major morbidity decreased throughout the time periods. SAVR outcomes are improving, possibly because the highest risk patients are undergoing TAVR.
Data from the Centers for Medicare and Medicaid Services related to patients aged 65 and older who underwent TAVR during a 2 year period were evaluated, stratified into older (age 90 or greater; 19.3%) and younger cohorts. Nonagenarians had fewer comorbidities. Mortality was higher in nonagenarians (8.4% vs 5.9%) as was morbidity (25.4% vs 21.5%). Among nonagenarians, the transfemoral approach was associated with lower mortality, higher rates of discharge to home, and lower readmission rates.
In this single site retrospective review, outcomes of repair of giant paraesophageal hiatal hernia were reviewed with respect to the effects of patient age. Patients aged 80 or greater had greater comorbidity at the time of surgery, more often had Type IV hernias, and underwent emergency intervention more often. The incidence of postoperative complications was higher in this group. Recurrence rates were similar between the older and younger groups.