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Journal and News Scan

Source: New England Journal of Medicine
Author(s): M Pirmohamed and others for the EU-PACT Group

455 patients with a-fib or VTE were randomized to pharmacogenetic-directed warfarin therapy for the first 5 days or a 3-day loading regimen.  Genotype-based dosing resulted in a 10% higher rate of being in the therapeutic range, a shorter time to reach a therapeutic INR, and fewer instances of excessive anticoagulation. 

Source: New England Journal of Medicine
Author(s): MA Acker and others for the CTSN

251 pts with severe ischemic MR were randomized to MV repair or chordal-sparing MV replacement.  The end point was LVESVI at 12 mos.  LVESVI and mortality were similar between the groups at follow-up.  Recurrent MR was more common in the repair group (32.6% vs 2.3%).  Other outcomes including major adverse events and QOL were similar between the groups.

Source: Lancet
Author(s): H Thiele, U Zeymer, F-J Neumann, M Ferenc, H-G Olbrich, J Hausleiter, A de Waha, G Richardt, M Hennersdorf, K Empen, G Fuernau, S Desch, I Eitel, R Hambrecht, B Lauer, M Bohm, H Ebelt, S Schneider, K Werdan, G Schuler

Pts with acute MI complicated by shock who were being treated with optimal medical therapy and for whom early revascularization was planned were assigned to IABP vs control.  600 patients were randomized.  Death rates at 12 mos in the IABP and control groups were 52% vs 51%.  Reinfarction, recurrent revascularization, stroke, and quality of life did not differ between the groups. 

Source: Lancet
Author(s): C Bullen, C Howe, M Laugesen, H McRobbie, V Parag, J Williman, N Walker

This 2 year trial randomizing pts between e-cigarettes, placebo e-cigarettes, and nicotine patches was conducted in 657 people.  Abstinence from smoking was achieved in 7.3% for e-cigarettes, 5.8% for patches, and 4.1% for placebo.  Abstinence rates were strikingly low, and aids to smoking cessation offered no important advantage in this small study. 

Source: JAMA
Author(s): F Kim, G Nichol, C MAynard, A Hallstrom, PJ Kudenchuk, T Rea, MK Copass, D Carlbom, S Deem, WR Longstreth Jr, M Olsufka, LA Cobb.

This trial of hypothermia for unconsious survivors of out-of-hospital cardiac arrest randomized 1359 patients to prehospital cooling and hospital cooling.  Prehospital cooling achieved a 1.2º - 1.3º C. decrease in core temperature by the time of arrival to the hospital and reduced time to adequate cooling by 1 hour, but was associated with an increased risk of rearrest prior to hospital arrival.  Survival to hospital discharge (62.7% vs 64.3%) and neurologic status at the time of discharge were similar between the 2 groups.   

Source: New England Journal of Medicine
Author(s): N Nielsen and others for the TTM Trial Investigators

Hypothermia is recommended for unconscious survivors of out-of-hospital cardiac arrest to preserve heart and neurologic function.  This study randomized 950 pts to determine whether 33º C or 36º C is the most appropriate target temperature.  Mortality was similar (50% vs 48%) and outcomes at 180 days for mortality and poor neurologic function were also similar (54% vs 52%). 

Source: Surgery
Author(s): Michael B. Ujiki, Amy K. Yetasook, Matthew Zapf, John G. Linn, Joann M. Carbray, Woody Denham

This study presents a comparison between PerOral Endoscopic Myotomy (POEM) and Standard Laparoscopic Approach in the treatment of achalasia. The authors report satisfactory results of the postoperative course and for grade of patients satisfaction with POEM. The complication incidence was similar for both procedures.

Source: Journal of Heart and Lung Transplantation
Author(s): Wiebke Sommer, Christian Kühn, Igor Tudorache, Murat Avsar, Jens Gottlieb, Dietmar Boethig, Axel Haverich, Gregor Warnecke

The scarcity of lung donors is a worldwide concern. This paper reports a single center experience on use of lungs of marginal donors with a rescue offer system. The results are satisfactory in terms of patients outcome and lung allocation.

Source: Annals of Thoracic Surgery
Author(s): Jennifer Nelson

Jennifer Nelson, the former STS Resident Director, discusses the past, present, and future of cardiothoracic surgery training.  Changes that have occurred in the recent past include removal of the requirement for general surgery certification, the establishment of specialty tracks, and the development of integrated programs.  This has resulted in a large number of applicants for integrated programs and a recent increase in applicants for traditional programs.  The future of our field is bright.

Source: European Journal of Cardiothoracic Surgery
Author(s): Suk-Won Song, Kyung-Jong Yoo, Yoo Rim Shin, Sun-Hee Lim, and Bum-Koo Cho

The authors reviewed their experience between May 2008 and May 2011 with 107 patients who underwent surgical repair for acute Type I aortic dissection. They report favorable results of more effective end-organ protection with the use of intermittent lower body perfusion and moderate hypothermic circulatory arrest.