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Journal and News Scan
Active Rehabilitation During Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation
Nine patients from a single institution underwent ECMO support as a bridge to transplantation with 100% post-transplant one year survival. Five patients underwent a rehabilitation program and had minimal sedation. Four patients underwent standard sedation and were immobilized in bed during the ECMO bridge. Rehabilitation could be conducted only in those patients who were cannulated with a two stage single cannula either in the internal jugular or subclavian vein as those with femoral vein cannula could not be mobilized. Rehabilitation started with active and passive exercises in bed, progressed to sitting, then standing and finally ambulation. This required a multi-person team including one strictly responsible for the ECMO cannula and lines. Those who underwent rehabilitation had shorter: post-transplant mechanical ventilation (4 d vs. 34 d), ICU stay (11 d vs. 45 d) and hospital stay (26 d vs. 80 d). This paper underscores two points: ECMO can be successfully used as a bridge to lung transplantation and pre-transplant deconditioning has a negative impact on the post-transplant outcome.
Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
The newest set of guidelines for managing early and regionally advanced NSCLC from the ESMO focuses on screening, staging algorithms, risk assessment, and treatment options.
Safety and Efficacy of Stereotactic Body Radiotherapy for Stage I Non-Small-Cell Lung Cancer in Routine Clinical Practice: A Patterns-of-Care and Outcome Analysis
A retrospective analysis of SBRT in 13 institutions over a 10 year interval was conducted on outcomes in 582 pts with Stage I NSCLC. At 3 years, freedom from local recurrence was 80% and overall survival was 47%. The biological dose was the most important determinant of outcomes. With higher effective dosing, freedom from local recurrence was 92% and overall survival was 62%.
The next generation of fenestrated endografts: results of a clinical trial to support an expanded indication for aortic arch aneurysm treatment
The authors review their shot- and mid-term experience with a new precurved fenestrated aortic endograft in the treatment of aortic arch aneurysms. This multicenter study included 393 patients (2010-2011). 94% of patients had landing zone <20 mm and in 62% the landing zone was less than 15 mm. The authors report technical success of 99.2%. The procedures were complicated by endoleak in 17 patients, stroke in 7, and six deaths. Type I endoleak was related to the maximum length of the aneurysm and in cases with proximal lending zone <15 mm.
Should aortic arch replacement be performed during initial surgery for aortic root aneurysm in patients with Marfan syndrome?
The authors reviewed their 16 year experience with Marfan syndrome patients (94) requiring surgical intervention, presenting with acute aortic dissection in 35% of patients (76% Type A and 24% Type B) and aneurysmal disease in 65%. Total arch replacement was performed initially in 8% of patients for acute aortic dissection. Reoperative total arch replacement had to be performed in 33% of patients with initial presentation of acute aortic dissection and in 3% of patients without aortic dissection. Operative and 30-day mortality for secondary total arch replacement was 0. The authors recommend limiting surgery to the aortic root, ascending aorta and proximal aortic arch in Marfan syndrome patients presenting with acute aortic dissection.
This prospective observational study compared outcomes in children undergoing cardiac surgery and requiring continuous renal replacement therapy (CRRT) to other critically ill children also requiring CRRT. Of 1650 patients undergoing cardiac surgery, 5% required CRRT and 80% of those patients had multiorgan failure. 43% of those requiring CRRT after cardiac surgery died compared to 29% of other children requiring CRRT. In multivariable analysis, the only factor related to an increased risk of mortality on CRRT was hypotension at the time of instituting CRRT.
Oncologic outcomes of segmentectomy compared with lobectomy for clinical stage IA lung adenocarcinoma: Propensity score–matched analysis in a multicenter study
Both overall outcomes and propensity score matched outcomes were compared in patients undergoing either lobectomy or segmentectomy for clinical stage IA adenocarcinoma of the lung. In the overall cohort, 3-year recurrence-free and overall survival were similar between the groups. Among the matched patients, RFS (92.9% vs 90.9%) and OS (93.2% vs 95.7%) were also similar between the lobectomy and segementectomy groups at 3 years.
Short- and intermediate-term survival after extracorporeal membrane oxygenation in children with cardiac disease
A retrospective review was performed of outcomes of ECMO used in pediatric patients with cardiac disease. Among 95 patients, hospital survival was 73%. The most favorable indication was failure to wean from bypass. Risk factors for poor outcomes included chromosomal abnormalities, single venticle, multiple ECMO runs, higher ECMO flows, poor lung compliance, and need for plasma exchange. Almost 90% of survivors had normal or slightly impaired neurologic function at 2 years.
Angiographic outcomes of radial artery versus saphenous vein in coronary artery bypass graft surgery: A meta-analysis of randomized controlled trials
5 RCTs were evalauted to assess outcomes of RA compared to SVG in CABG. RA had significantly better patency at 4 years and beyond, but was also more likely to be associated with string sign at 1 year.
Long-term results of electrical stimulation of the lower esophageal sphincter for the treatment of gastroesophageal reflux disease
In this prospective study of patients with GERD moderately responsive to proton pump inhibitors (PPIs), an electrical device to stimulate the lower esophageal sphincter was implanted and results were assessed at 1 year. GERD health related QOL scores were reduced to 2 compared to 9 on PPIs and 23 off PPIs prior to implant. Acid exposure was reduced from 10% to 3.3%. 96% of patients required no PPIs at 1 year.