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Journal and News Scan

Source: Cochrane review
Author(s): Massel DR et al

. – Patients with prosthetic heart valves are at increased risk for valve thrombosis and arterial thromboembolism. Oral anticoagulation alone, or the addition of antiplatelet drugs, has been used to minimise this risk. An important issue is the effectiveness and safety of the latter strategy. This is an update of our previous review; the goal was to create a valid synthesis of all available, methodologically sound data to further assess the safety and efficacy of combined oral anticoagulant and antiplatelet therapy versus oral anticoagulant monotherapy in patients with prosthetic heart valves. Adding antiplatelet therapy, either dipyridamole or low–dose aspirin, to oral anticoagulation decreases the risk of systemic embolism or death among patients with prosthetic heart valves. The risk of major bleeding is increased with antiplatelet therapy. These results apply to patients with mechanical prosthetic valves or those with biological valves and indicators of high risk such as atrial fibrillation or prior thromboembolic events. The effectiveness and safety of low–dose aspirin (100 mg daily) appears to be similar to higher–dose aspirin and dipyridamole. In general, the quality of the included trials tended to be low, possibly reflecting the era when the majority of the trials were conducted (1970s and 1980s when trial methodology was less advanced).

Source: Heart
Author(s): Raina macintyre

Middle-aged people with hidden heart disease may gain protection from flu vaccination, researchers reveal today.

A study has found that receiving vaccination halves the risk of heart attacks in people over the age of 50 with narrowed arteries.

Australian researchers say their findings may show that flu is a clinically important factor in the risk of heart attack.

Researchers compared 275 patients who suffered a heart attack with another 284 who had not.

The study found no link between suffering flu and having a heart attack - but they did find that being vaccinated was linked to a 45% reduced risk of suffering a heart attack.

Writing in the journal Heart, the researchers call for flu vaccination programmes to be extended to people over the age of 50.

Researcher Professor Raina Macintyre, of the University of New South Wales, Sydney, Australia, writes: "As such, even a small effect of influenza vaccination in preventing heart attacks may have significant population health gains."

Source: The Lancet
Author(s): M Thielmann, E Kottenberg, P Kleinbongard, D Wendt, N Gedik, S Pasa, V Price, K Tsagakis, M Neuhauser, J Peters, H Jakob, G Heusch

Patients undergoing first time CABG using CPB were randomized to remote ischemic preconditioning (left upper arm) or control after induction of anesthetic.  The metric was myocardial injury measured by troponin levels during the first 3 postop days.  Preconditioning resulted in lower troponin levels and in lower operative mortality. 

Source: American Journal of Cardiology
Author(s): Ribichini F, Pesarini G, Feola M, Agostini M, Molinari G, Rossi A, Faggian G, Vassanelli C.

Interesting case report of a patient with previous triple valve replacement who underwent a transfemoral implantation of a 29-mm Edwards SAPIEN XT percutaneous valve into a failing tricuspid valve bioprosthesis.

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.