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Journal and News Scan
This article reviews real-life outcomes of 42,714 patients undergoing coronary bypass grafting from 2005 to 2012. After adjusting for the differences in the populations, the patients who received multiple arterial grafts had lower long-term mortality, myocardial infarction, and re-intervention rates than patients who received a single arterial graft. More telling, however, is the fact that only 15% of patients in the study group received more than one arterial graft.
Interesting clinicolaboratory experiment: Any translational value for the coronary surgeon and the cardiologist remains to be seen, especially regarding the risk stratification and prioritization for urgent (inpatient) revascularisation. Also, the value of the observation for the cardiovascular anesthetist may be important with regards to induction of anesthesia for CABG.
A must-read position paper.
The authors analyzed the effectiveness of left atrial appendage closure with AtriClip in 43 patients. In all patients, the absence of blood flow in the excluded appendage was confirmed. In 31 patients, no residual stump was observed. In only one patient, there was a significant (>10 mm) stump. In 11 patients, the residual stump was less than 10 mm. The authors concluded that the left atrial appendage closure with AtriClip is effective and the definition of clinical significant left atrial appendage stump should be further evaluated.
Persistent opioid use (>90 days postoperatively) in this Medicare database study identified modifiable factors, including prescription size and preoperative prescription refills, among other features, that could be targeted in order to reduce opioid dependency.
The authors review the growing suspicion that fluoroquinolone antibiotic (FQ) use may be related to the occurrence of thoracic aortic aneurysms and acute aortic dissection. The proposed mechanism is through an increase in matrix metalloproteinases (MMPs), which degrade collagen, a precursor to aortic injury. At least one international agency has recommended modifying the product package insert to warn users of this risk.
Identification of Anonymous MRI Research Participants with Face-Recognition Software: The authors demonstrated the ability to use facial recognition software to identify individuals undergoing head MR, highlighting the risk of loss of anonymity when seemingly de-identified data are available to others.
The National Cancer Database was queried regarding esophageal squamous cancer cases from 2004-2013, and over 11,000 patients were identified. Definitive chemoradiotherapy was used in 79%, whereas resection was employed in 21% at some phase of therapy. Resection alone and definitive chemoradiotherapy were associated with increased mortality compared to neoadjuvant therapy followed by resection. Higher volume centers (>20/year) had better survival than other centers regardless of therapy.
This multiinstitutional study including advocates of robotic lung resection identified a 1.9% incidence of intraoperative castrophes, most commonly pulmonary arterial bleeding. Patients at risk had lower FEV1%, higher clinical stage, and more frequent preoperative radiation therapy. Interestingly, they were also undergoing a different surgical approach than what the authors normally used. The hospital mortality in these patients was 10-fold higher than among patients who did not suffer catastrophes.
This analysis of data from the JCOG0201 trial identified factors that place patients at increased risk for recurrence after lobectomy for stage I adenocarcinoma. They include visceral pleural invasion, vascular invasion, or an invasive component measuring >2 cm.