This site is not optimized for Internet Explorer 8 (or older).
Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.
Journal and News Scan
Dr Preventza and associates performed a meta-analysis of 3,154 patients who underwent frozen elephant trunk procedure to determine the incidence of neurologic complications. The incidences were 4.7% for spinal cord injury and 7.6% for stroke. Operative mortality was 8.8%. Stent longer than 15 cm or coverage of T8 and beyond was assoicated with a higher incidence of spinal cord injury compared to stent length of 10 cm.
Compliance with American College of Chest Physicians guidelines for physiologic evaluation of lung resection patients was 50% or better for only half the physicians. The frequency of individualizing risk thresholds based on surgical approach increased according to the number of years in practice. Cardiothoracic surgeons more frequently referred all patients for cardiovascular risk assessment by a cardiologist than did thoracic surgeons (17.6% vs 2.4%).
A balanced appraisal of last year's manuscript from the Lancet Group on a relatively novel portable Organ Care System for donor lungs. The analysis of the technical complications, especially organ damage from overenthusiastic revving of the pump, is particularly sobering.
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.