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Journal and News Scan
February 8, 2014
Submitted by: Stuart Head
Di Giammarco and colleagues reported that intraoperative graft verification was significantly improved if a combination of transit-time flow measurement and epicardial echocardiography was used in comparison with transit-time flow measurement alone. The positive predictive value increased from 10% to almost 100% in an analysis of 678 grafts in 333 patients undergoing isolated CABG, reducing the rate of unnecessary graft revisions.
February 8, 2014
Submitted by: Mark Ferguson
The authors performed a population-based study to determine the extent to which mesothelioma occurs absent occupational asbestos exposure. A clear dose-response relationship between degree of exposure and risk of mesothelioma was identified. Occupational exposure to asbestos carried a much higher risk of mesothelioma than did non-occupational exposure, and non-occupational exposure carried a higher risk than did no exposure. Non-occupational exposure to asbestos carried a substantially higher mesothelioma risk in women than it did in men.
February 7, 2014
Submitted by: Joel Dunning
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.
February 7, 2014
Submitted by: Joel Dunning
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
February 7, 2014
Submitted by: Joel Dunning
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.
February 7, 2014
Submitted by: Joel Dunning
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.
February 7, 2014
Submitted by: Joel Dunning
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.
February 7, 2014
Submitted by: Joel Dunning
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.
February 6, 2014
Submitted by: Mark Ferguson
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.
February 6, 2014
Submitted by: Mark Ferguson
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.