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Journal and News Scan
The authors reviewed their 16 year experience with Marfan syndrome patients (94) requiring surgical intervention, presenting with acute aortic dissection in 35% of patients (76% Type A and 24% Type B) and aneurysmal disease in 65%. Total arch replacement was performed initially in 8% of patients for acute aortic dissection. Reoperative total arch replacement had to be performed in 33% of patients with initial presentation of acute aortic dissection and in 3% of patients without aortic dissection. Operative and 30-day mortality for secondary total arch replacement was 0. The authors recommend limiting surgery to the aortic root, ascending aorta and proximal aortic arch in Marfan syndrome patients presenting with acute aortic dissection.
This prospective observational study compared outcomes in children undergoing cardiac surgery and requiring continuous renal replacement therapy (CRRT) to other critically ill children also requiring CRRT. Of 1650 patients undergoing cardiac surgery, 5% required CRRT and 80% of those patients had multiorgan failure. 43% of those requiring CRRT after cardiac surgery died compared to 29% of other children requiring CRRT. In multivariable analysis, the only factor related to an increased risk of mortality on CRRT was hypotension at the time of instituting CRRT.
Both overall outcomes and propensity score matched outcomes were compared in patients undergoing either lobectomy or segmentectomy for clinical stage IA adenocarcinoma of the lung. In the overall cohort, 3-year recurrence-free and overall survival were similar between the groups. Among the matched patients, RFS (92.9% vs 90.9%) and OS (93.2% vs 95.7%) were also similar between the lobectomy and segementectomy groups at 3 years.
A retrospective review was performed of outcomes of ECMO used in pediatric patients with cardiac disease. Among 95 patients, hospital survival was 73%. The most favorable indication was failure to wean from bypass. Risk factors for poor outcomes included chromosomal abnormalities, single venticle, multiple ECMO runs, higher ECMO flows, poor lung compliance, and need for plasma exchange. Almost 90% of survivors had normal or slightly impaired neurologic function at 2 years.
5 RCTs were evalauted to assess outcomes of RA compared to SVG in CABG. RA had significantly better patency at 4 years and beyond, but was also more likely to be associated with string sign at 1 year.
In this prospective study of patients with GERD moderately responsive to proton pump inhibitors (PPIs), an electrical device to stimulate the lower esophageal sphincter was implanted and results were assessed at 1 year. GERD health related QOL scores were reduced to 2 compared to 9 on PPIs and 23 off PPIs prior to implant. Acid exposure was reduced from 10% to 3.3%. 96% of patients required no PPIs at 1 year.