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Journal and News Scan

Source: Journal of Cardiac Surgery
Author(s): Christopher Andrew Efthymiou, Rosalind Jane Mills, David John O'Regan
Recommendations for anticoagulation for patients after bioprosthetic AVR are in flux. Current algorithms are based on historical studies. This study summarizes a review of current literature on the topic.
Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Puskas J, et al.
the Prospective Randomized On–X Anticoagulation Clinical Trial (PROACT) tests the safety of less aggressive anticoagulation than is recommended by ACC/AHA guidelines after implantation of an approved bileaflet mechanical valve. INR may be safely maintained between 1.5–2.0 after AVR with this approved bileaflet mechanical prosthesis. With low–dose aspirin, this resulted in significantly lower risk of bleeding, without significant increase in TE.
Author(s): Redmond Burke MD,
Redmond Burke MD, Chief of Pediatric Cardiovascular Surgery at Miami Children's Hospital demonstrates the operative repair and postoperative recovery for a child with VSD.
Source: Aorta
Author(s): Adam El-Gamel,
Transcatheter aortic valve replacement (TAVR) has, without a doubt, brought an unprecedented excitement to the field of interventional cardiology. The avoidance of a sternotomy by transfemoral or transapical aortic-valve implantation appears to come at the price of some serious complications, including an increased risk of embolic stroke and paravalvular leakage. The technical challenges of the procedure and the complex nature of the high-risk patient cohort make the learning curve for this procedure a steep one, with the potential for unexpected complications always looming.
Source: European Journal of Cardio-Thoracic Surgery
Author(s): Karimov JH, Gillinov AM, Schenck L, Cook M, Kosty Sweeney D, Boyle EM, Fukamachi K.
Chest drainage following cardiac surgery is used to avoid complications related to the accumulation of blood and serous fluid in the chest. We aimed to determine the incidence of chest tube clogging and the role of bedside assessment in identifying the potential for failure to drain. CONCLUSIONS: The chest tubes can become clogged at any time after their placement. The status of urgency, reoperations and use of blood products can be contributing factors increasing the incidence of chest tube clogging. Clinicians likely underestimate the prevalence of this failure to drain, as most clogging occurs in the internal portion of the tube.
Source: Journal of Cardiac Surgery
Author(s): Milan Lisy M.D. Mahmut Kahlil M.D. Ulrich A. Stock M.D., Ph.D., Stephen M. Wildhirt M.D.
The use of glues to repair disrupted tissue during acute type-A aortic dissection (TAD) surgery may be discontinuous, and cause embolization and cell necrosis. We report a method of fibrin sealant patch (FSP) to reinforce dissected aortic tissue with a collagen double layer coated with fibrinogen/thrombin on either side
Source: New England Journal of Medicine
Author(s): Michael C. Reade and Simon Finfer
This review outlines causes of delirium and oversedation in ICU patients. Methods of managing these problems are outlined.
Source: Annals of Thoracic Surgery
Author(s): Aimee S. Parnell, Justine Shults, J. William Gaynor, Mary B. Leonard,Dingwei Dai, Chris Feudtner
The accuracy of the diagnosis in patients undergoing congenital heart surgery in a large administrative database was examined in over 14,000 patients aged 0 to 5. Patients admitted on day 1 of life and those undergoing ECMO had a much higher chance of being assigned non-cardiac diagnoses. Pts so misclassified had a substantially higher risk of mortality. This systematic misclassification may lead to inaccurate determination of case volumes and outcomes.
Source: Annals of Thoracic Surgery
Author(s): Sajjad Raza, Joseph F. Sabik, Stephen G. Ellis, Penny L. Houghtaling, Kerry C. Rodgers, Aleck Stockins, Bruce W. Lytle, Eugene H. Blackstone
Because the optimal management of CAD is unclear for many patients, the authors developed a decision support model for CABG and PCI with bare metal or drug eluting stents. Overall survival rates were similar for the different interventions. For PCI with drug eluting stents, optimal outcomes were observed for pts undergoing emergency revascularization for acute MI. Optimal outcomes for CABG were observed in pts with multivessel disease and with many comorbidities.
Source: Annals of Thoracic Surgery
Author(s): Hector Rodriguez Cetina Biefer, Simon H. Sündermann, Maximilian Y. Emmert, Frank Enseleit, Burkhardt Seifert, Frank Ruschitzka, Stephan Jacobs, Mario L. Lachat, Volkmar Falk, Markus J. Wilhelm
The authors report outcomes for recipients of heart transplants performed more than 20 years prior. Overall 20 year survival was 56%. Causes of mortality were similarly distributed among rejection, malignancy, infection, and allograft vasculopathy. Only 2 patients underwent retransplantation.