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Journal and News Scan
January 23, 2014
Submitted by: Benjamin Bidstrup
In this single centre retrospective review, the authors in a multivariable analysis determined the surgeon was a predictor of blood loss after cardiac surgery. Despite much research, bleeding and blood use remains an issue after cardiac surgery. Each surgeon should examine their own techniques to minimise bleeding risk. IMA use and CPB time were other factors that were significant.
January 19, 2014
Submitted by: J. Rafael Sadaba
Significant carotid artery disease is not uncommon in patients undergoing open heart surgery (OHS). Whether to treat both conditions in a staged or combined procedure remains an unresolved matter. In this retrospective study, the authors compared outcomes in three groups of patients according to treatment strategies: staged carotid endarterectomy (CEA) followed by OHS (CEA-OHS), combined CEA-OHS (i.e. concomitant CEA and OHS under a single anesthesia), and staged carotid stenting (CAS) followed by OHS (CAS-OHS) No significant difference in the primary composit endpoint(all-cause death, stroke, and myocardial infarction) was found between staged CAS-OHS and combined CEA-OHS in the short term. However, beyond 12 months, the staged CAS-OHS option appears to be a better choice. Staged CEA-OHS has the highest risk during both early and late phases. These findings were consistent regardless of multiple adjustments using propensity score and propensity matching.
January 18, 2014
Submitted by:
This 5-year follow-up of the first tissue engineered airway using decellularized human trachea demonstrated that the graft became well vascularized, had normal ciliary function and mucous clearance, and maintained a normal diameter. no anti-donor antibodies developed. The graft replaced the left main bronchus that was affected by tracheomalacia. The proximal anastomosis developed stenosis requiring stenting.
January 18, 2014
Submitted by:
The FDA approved the CoreValve TAVI device for use in the US. The approval was originally expected to occur in April 2014, but the panel decided that an independent review of data from the clinical study of extreme-risk patients in the CoreValve US Pivotal Trial was not needed at this time.
January 16, 2014
Submitted by:
The authors studied over 5,700 pts undergoing CABG to assess the dynamics of changes in renal function and related such changes to mortality. Perioperative renal dysfunction was associated with increased long-term mortality. Recovery from renal dysfunction was associated with some improvement in long-term mortality risk. Alternative methods of classifying renal dysfunction may be more useful than creatinine in assessing long-term risk.
January 16, 2014
Submitted by:
The authors compared outcomes for VATS lobectomy by experienced VATS surgeons to those for robotic lobectomies performed by the same surgeons who were learning robotic surgery. 69 pts were evenly divided between the approaches. Other than longer time required for robotic upper lobectomy, there were no differences between the groups in OR time, LOS, nodal harvest, morbidity, or mortality.
January 16, 2014
Submitted by:
The use of mechanical circulatory support (MCS) for pediatric patients undergoing heart surgery was analyzed. Of over 96,000 operations, 2.4% were associated with MCS use. MCS use was associated with younger patients, a greater number of preoperative risk factors, and certain operations (Norwood, complex biventricular repair). Mortality associated with MCS was over 50%. MCS rates differed substantially across participating institutions.
January 16, 2014
Submitted by:
37 pairs of matched patients were analyzed for short-term postoperative outcomes. Neurologic complications and pacemaker implant rates were similiar between the groups. Paravalvular leak rate was higher in the TAVI group (13.5% vs 0%). Survival at a mean f/u of 19 mos was better in the sutureless valve group (97% vs 87%). Better survival was associated with the absence of a paravalvular leak.
January 16, 2014
Submitted by:
Outcomes of the Ross procedure in 55 children and adolescents performed over a 20 year period were reviewed. Median f/u was 5.5 years. Hospital mortality was 13%, and long-term survival was 85%. Freedom from reoperation for autograft failure at 10 years was 74%, and was 56% for RV outflow tract replacement.
January 16, 2014
Submitted by:
This meta-analysis included over 5,000 pts in 28 studies and evaluated mortality and neurologic outcomes after aortic arch surgery. Unilateral and bilateral antegrade cerebral perfusion were associated with similar rate of mortality, temporary neurologic deficit, and permanent neurologic dysfunction.