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Journal and News Scan
Cardiac surgery patients with ICU stays of more than 7 days were evaluated for the incidence of healthcare-associated infections (HAI) over a 3-year period. 15% of over 2,500 pts had ICU stays of more than 7 days, of whom more than 48% had at least 1 HAI. Mortality in those with HAI was more than twice as high as for those without (29% vs13%). HAI was associated with RBC transfusion. Mortality was associated with HAI and with central line infection.
In a retrospective review of patients undergoing esophagectomy at two high volume centers, the incidence of hiatal hernia was 5% - 10%. The incidence did not differ between open and MIE approaches. Two-thirds of the hernias were discovered incidentally, although half of those patients were symptomatic. Mortality in patients undergoing urgent correction was almost 20%.
The authors write a provocative response to the recent ACGME revisions to duty hours which extend the work hour limitation for first-year residents from 16 to 24hours. The authors also summarize data in favor of and against duty hour restrictions and emphasize the importance of relying on science when making education policy decisions.
Congenitally corrected transposition of the great arteries (CC-TGA) is a complex form of congenital heart disease that may require left ventricular re-training prior to a double switch procedure. This study reviewed experience in 24 patients with CC-TGA who were enrolled in a left ventricular re-training program. Eighteen of the 24 patients underwent successful double switch, and 5 additional candidates are considered good candidates for a double switch. These results demonstrate that left ventricular re-training offers a reliable strategy in CC-TGA
The esteemed authors are to be commended on the detailed but readable desciption of their technique under the heading 'Indication and Surgical Technique of Extracorporeal Membrane Oxygenation and CentriMag Device' (page 753)
A succinct editorial advancing the case for aortic super-centres
Vasoplegia was analysed in 225 patients undergoing heart failure surgery (left ventricular restoration, CorCap implantation or LVAD implantation). The complication was observed in 29% of patients. A higher risk was observed in patients with anaemia and higher thyroxine levels, whereas higher creatinine clearance and beta-blocker medication were associated with a lower risk.
Blood of septic or healthy pigs was used in a 12-h ECMO mock loop experiment. No higher activation of coagulation or inflammatory response or increased problems with the oxygenator was found with septic compared to control blood.
Christophe Chautems and colleagues shed light on the challenges, strategies and current developments in the field of magnetically driven medical microrobots for intracorporeal use.
The authors report here on the results of the Italian CHEETAH study, a randomized, double-blind, placebo-controlled trial examining whether adding the unique inotrope levosimendan—in low doses—improves 30-day mortality after cardiac surgery in patients with perioperative LV dysfunction. The trial was halted after the first 506 patients were enrolled because of the futility of continuing the trial. There were no significant differences between the levosimendan group and the placebo group in 30-day survival, as well as for any of the measured postoperative secondary outcomes. (Levosimendan is currently not FDA approved for use in the U.S.)