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Journal and News Scan
September 19, 2019
Submitted by: Mark Ferguson
In this randomized trial, the authors studied the use of cerebral autoregulation monitoring to target mean arterial pressure during CPB. The outcome of interest was postopertive delirium. The incidence of delirium was 53% in the usual care group compared to 38% in the intervention group, with a reduction in the odds of delirium of 45% (p=0.04).
September 18, 2019
Submitted by: Edward Savage
This is a retrospective study in OPCAB patients comparing patients who received skeletonized versus nonskeletonized SIMA and BIMA grafts. They reported patients with any sternal wound complication including redness or minor drainage that healed naturally. There was a lower incidence of complications in the skeletonized group as well as overall lower grade of complications. These effects were more pronounced in subgroup analysis of the BIMA group, including diabetics.
September 14, 2019
Submitted by: Edward Savage
This study reports ten year outcomes of the STICH trial. Comparing CABG to medical therapy groups, the authors note that CABG reduced all cause, cardiovascular, and heart failure hospitalizations. This included time-to-first and recurrent events. This was due to fewer total cardiovascular hospitalizations, the majority due to heart failure.
September 13, 2019
Submitted by: Emily Robinson
Using the STS Congenital Heart Surgery Database, investigators identified factors associated with adverse outcomes after repair of anomalous coronary arteries arising from the pulmonary artery. Operative mortality was increased related to preoperative shock and the use of extracorporeal membrane oxygenation.
September 12, 2019
Submitted by: Emily Robinson
Concomitant aortic root enlargement at the time of surgical aortic valve replacement is an option to avoid patient-prosthesis mismatch. In this single-center study, 4,210 patients underwent aortic valve replacement, of which 171 had concomitant aortic root enlargement. In analysis of matched patient outcomes, there were similar numbers of postoperative bleeding and pericardial effusion events, and no difference in early deaths. The authors conclude that aortic root enlargement can be performed safely with no increase in early postoperative surgical complications.
September 7, 2019
Submitted by: Mark Ferguson
Posting of a still-relevant TED video regarding the high number of suicides among physicians, a world-wide problem that relates in part to training and working conditions.
September 6, 2019
Submitted by: Emily Robinson
Henmi and colleagues analyzed the results of different reimplantation techniques of segmental arteries during thoracoabdominal aortic aneurysm repair. Among 172 patients, 111 underwent segmental artery reconstruction via graft interposition, 38 via single-cuff anastomosis, and 23 via island reconstruction. The graft interposition technique had a poor patency rate. Island reconstruction and single-cuff anastomosis offered better patency, however island reconstruction required reoperation for patch aneurysm. The authors conclude that single-cuff anastomosis is a more reliable technique in terms of early and long-term outcomes.
September 5, 2019
Submitted by: Aristotle Protopapas
The January update of an expert panel from the American College of Chest Physicians on the expanding clinical entity of pulmonary hypertension, especially pertinent to the transplant community.
September 3, 2019
Submitted by: Mark Ferguson
Remote ischemic preconditioning did not influence 12-month survival or readmission rates in a randomized trial involving more than 5,400 patients undergoing percutaneous coronary intervention after ST-segment elevation MI.
September 2, 2019
Submitted by: Edward Savage
The authors reviewed the New York State database. Patients with single arterial grafts were compared to those with multiple arterial grafts. Propensity matching was performed based on 38 baseline characteristics. Twenty percent had multiple arterial grafting. There was no difference at one year but at seven years the multiple arterial graft group had lower mortality and a lower repeat revascularization rate.