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Journal and News Scan
The readmission rate after mitral valve surgery was 17% among over 75,000 patients in the National Readmissions Database. Predictors included extended initial LOS, chronic lung or renal disease, and low hospital procedural volume for mitral surgery. The mean cost of readmission was over $15,000.
Following the withdrawal of the support of EACTS for the left main stem chapter of the EACTS/ESC Chapter of the revascularisation guidelines following the BBC Newsnight documentary of this, and the withdrawal of Professor David Taggart as an author of the EXCEL trial published in the NEJM, the EXCEL trial authors have published a very robust defence of their trial that was ten years in the creation and conduct.
Find the EACTS statement here:
Go straight to the response document from the EXCEL trial here:
Donor lungs undergoing EVLP were more injured, but long-term outcomes of transplant were similar between EVLP and non-EVLP lungs, including the incidence of graft dysfunction and survival.
A medium-size RCT on the growing research question of efficacy of peroral myotomy for achalasia, with a 17% failure to improve symptoms in the peroral endoscopic myotomy (POEM) arm, is discussed in this article. It recognizes a quite sobering incidence of endoscopically-evidenced reflux esophagitis in both arms, bafflingly improving between 3 and 24 months in the POEM group and increasing in the controls (Dor), while the incidence in the POEM arm was double!
The PulMiCC is a randomized clinical trial that tried to build more evidence for performing pulmonary metastasectomy in patients affected by advanced colorectal cancer and previously treated with curative intent. Unfortunately, the trial was stopped earlier becasue of poor recruitment and high drop out rate. The resuts are now published, and the authors question the relevance of performing pulmonary metastasectomy in order to prolong survival.
This is a report on outcomes after thoracic endovascular aortic repair (TEVAR) for uncomplicated type B dissection in 751 patients. Ten-year survival was 83% and the 10-year reintervention rate was 10%. The authors concluded that TEVAR may be considered a first choice for patients with uncomplicated type B dissection.
This review demonstrates that preoperative anemia is associated with increased mortality, AKI, CVA, and infection after cardiac surgery. Preoperative anemia appears to be a modifiable risk factor.
Performance of curative surgery for early stage cancer varied considerably among counties in the US, and was related to socioeconomic factors, availability of surgeons, and non-metropolitan status.
Medicare claims data were reviewed for patients in Michigan who underwent inpatient surgery. Some patients were enrolled in prehabilitation programs consisting of home-based walking exercise, nutrition, smoking cessation, and stress reduction. Patients undergoing prehabilitation were compared to similar patients undergoing surgery at the same hospitals but who did not enroll in the program. Patients undergoing prehabilitation had shorter LOS, lower costs of care, and were more likely to be discharged to home.
The authors analyzed the outcomes of the continuous-flow left ventricular assist devices. The study includes 105 patients supported with HM2 (N=54), HM3 (N=25), and HW (N-26). Eighteen-month data suggested that HM3 had a better prognostic and adverse-event profile over other devices.