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Journal and News Scan
January 9, 2014
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According to this systematic review, preoperative statin therapy reduces early all-cause mortality, postoperative atrial fibrillation and stay on intensive care unit and in hospital. No effect on myocardial infarction or renal failure was found.
January 8, 2014
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The authors studied the effects of implementing a multidisciplinary thoracic aortic surgery program (TASP) on the outcomes after acute type A aortic dissection (ATAAD) repair. They used data of 128 patients who underwent ATAAD at a single institution during the 6 years before (n=56) and 6 years after (n=72) implementation of the TASP. They found that both short and long-term mortality improved after implementation of the multidisciplinary program and conclude that centralization of ATAAD patients is warranted.
January 8, 2014
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Meta-analysis study involving 228,465 patients suggesting a dose response decrease in atrial fibrillation in those that consume caffeine.
January 7, 2014
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In this propensity matched analysis, Hlatky et al, investigate the adoption patterns of IMA grafting in the United States and study the association with clinical outcomes. They matched 60,896 Medicare patients with and without IMA grafts. The investigators found that IMA use was associated with lower rates of death (HR=0.77), death/MI (HR=0.77) and repeat revascularizations over a 5-year timeframe (8% vs. 9%, p<0.001). Also, IMA adoption grew between 1988 and 2008, and showed considerable geographic variation.
January 7, 2014
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The authors of this multicenter trial performed a post-hoc analysis of a randomized trial comparing open and endovascular abdominal aortic aneurysm repair. 351 patients were randomly assigned to undergo either open abdominal aortic aneurysm repair or endovascular repair. Patients who were on lipid-lowering medication at registration in the trial (n = 135) were compared with those who were not (n = 216). During 6 years of follow-up, statin therapy at registration in the trial was independently associated with better overall survival after open or endovascular aneurysm.
January 7, 2014
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The authors reviewed their experience with the stainless steel-based graft - Zenith Pro-Form TX2 stent grafts (Cook Medical, Bloomington) - in treating aoertic pathology involving the distal arch.
They compared 19 patients so grafted to 19 patints treated with Zenith Z-Trak stent grafts.
CTA scans were analyzed at baseline, and then at 1, 6, and 12 months postoperatively. Arch angulation and bird-beak configuration were evaluated according to sealing zones of attachment.
The treated diseases included chronic type B dissections and degenerative aneurysmal disease.
The authors conclude that aortic remodeling after stainless steel stent grafting of aortic pathology is a continuous process with significant aortic arch transformation over zone 2 and left subclavian artery.
In the Pro-Form platform, a preoperative zone 2 angle <151.1° was a better estimation of the presence of a postoperative bird-beak configuration
January 7, 2014
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Unilateral diaphragm dysfunction can result from phrenic nerve injury and often results in respiratory symptoms. This study evaluated 92 pts for the presence of residual nerve activity and assigned them to phrenic nerve restorative surgery (PS) or no intervention, while a set of patients who underwent diaphragm plication (DP) was culled from the literature for comparison. Improvements in spirometry were similar in the PS and DP groups (13-14% vs 16-17%). Nerve conduction and signal strength were substantially improved by PS. There was a 28% improvement in function in the PS group based on SF-36.
Transfusion of 1 and 2 Units of Red Blood Cells Is Associated With Increased Morbidity and Mortality
January 7, 2014
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The effect of blood transfusion (Tx; 1-2 units only) on mortality after isolated CABG was evaluated in nearly 17,000 pts in Michigan. Operative mortality was 0.5% for no Tx and 1.3% for Tx (p<0.0001). Nine other adverse postoperative outcomes were significantly increased in pts receiving Tx. Aggressive attempts at reducing even small Tx amounts may result in substantial outcomes improvement.
January 7, 2014
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The outcomes of failed mitral clipping were evaluated in 19 pts. Surgical risk score increased significantly between the time of clipping and subsequent remedial surgery. Severe valve tissue damage as a result of clip application was evident in most patients. Valve repair was possible in 83% of pts who had a single clip, whereas only 23% of patients with more than one clip could have valve repair. One year survival was 68%.
January 7, 2014
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A multivariable analysis was performed on data from 4 European centers for outcomes comparing trans-apical (TA; 10%) and transfemoral (TF; 90%) AVI. TA-AVI pts had higher predicted risk and more comorbidities. TA-AVI was associated with increased complications, hospital stay, 30 day mortality, and all cause long-term mortality.