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Journal and News Scan
October 13, 2016
Submitted by: Arie Blitz
This single-center study explored the relationship between spontaneous echo contrast (SEC) and the incidence of thromboembolism and CVA in 98 patients undergoing peripheral VA ECMO. Twenty-two percent of patients had SEC while they were on ECMO. Those exhibiting SEC had significantly higher rates of intracardiac thrombus (46% v. 13%, p = 0.002) and CVA (36% v. 7.9%, p = 0.002). The patients who showed SEC had a lower EF and less frequent aortic valve opening. Comment: Should we be venting the LV more frequently in VA ECMO? If so, how should we vent the LV? Alternatively, should we maintain a baseline level of inotropic support on these patients to discourage stasis in the LV?
October 13, 2016
Submitted by: Arie Blitz
This single center retrospective study analyzed the incidence of permanent pacemaker requirement in 108 consecutive patients undergoing sutureless aortic valve replacement with the Perceval S bioprosthesis. In-hospital postoperative pacemakers were required in 23% of patients, 3 times the rate reported in earlier studies and approximately 6 times the historical rate following a standard surgical AVR.
October 12, 2016
Submitted by: Stuart Head
In the FREEDOM trial, 1900 diabetic patients were randomized between coronary bypass surgery and percutaneous coronary intervention (PCI). Of these, 451 patients had chronic kidney disease (CKD) with a GFR 30-60 mL/min/1.73m2, and the remaining patients were categorized as having no CKD. In both groups, bypass surgery performed better over 5-year follow-up than PCI in patients with CKD (26.0% versus 35.6%; HR=0.73, 95% CI 0.50-1.05) and no CKD (16.2% verus 23.6%; HR=0.76, 95% CI 0.58-1.00). Therefore, independent of chronic kidney disease, diabetic patients with multivessel disease should undergo CABG.
In this single institution retrospective study of postoperative cardiac surgery patients, serum potassium and magnesium levels at times when postoperative atrial fibrillation (POAF) occured were compared with levels in patients who did not experience POAF. The incidence of POAF was 37%, and was associated with increasing magnesium levels. Prophylactic potassium administration had no effect on POAF, whereas prophylactic magnesium administration was associated with an increase in POAF risk.
This retrospective study evaluated whether a systemic-PA shunt in infants with TOF facilitated enlargement of the pulmonary valve annulus (PVA). Placement of a shunt was the only factor associated with PVA growth. This knowledge may affect how repair is staged with an eye towards avoiding a transannular patch.
Semiautomated CT volumetric measurements of tumor volume in patients with malignant pleural mesothelioma were compared to stage and overall survival. CT volumes correlated well with stage and survival.
This analysis of PARTNER data evaluated the impact of chronic kidney disease (CKD) on outcomes after TAVR. Patients were grouped according to GFR as none/mild, moderate, and severe renal disease. Severe disease was most common among women with diabetes. Severe disease was associated with a 50% increase in 30-day mortality and 1-year cominbed mortality and all-cause rehospitalization. Assessment of renal function may help risk stratify patients who are candidates for TAVR.
The authors conducted a meta-analysis of propensity-scored matched patients in published studies to assess outcomes of right internal mammary artery (RIMA) and radial artery (RA) as second conduits for CABG. Eight studies included nearly 3000 matched pairs. RITA was associated with better long-term survival and freedom from reoperation, but also was associated with an increased risk of sternal wound infection when pedicled harvest was conducted. See also: http://www.jtcvsonline.org/article/S0022-5223(16)30538-4/fulltext
This single institution retrospective review assessed outcomes of AVR in patients with concomitant aortic root disease using a composite graft. Early mortality was 5.3% and was related to advanced age, poor NYHA status, urgent operation, and associated MVR or CABG. Late death was related to CRI, COPD, aortic dissection, CABG, and use of the Cabrol technique. 10-year survival was 66%. See also: http://www.jtcvsonline.org/article/S0022-5223(16)30703-6/fulltext
The success of training techniques including dividing robotic lobectomy into graduated steps, reviewing video peformances of trainees, and coaching through challenging technical maneuvers were tracked during a 5-year experience. Performance of individual steps among general surgery and cardiothoracic surgery trainees increased over time, while metrics of outcomes remained the same or improved. See also: http://www.jtcvsonline.org/article/S0022-5223(16)30833-9/pdf