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.
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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.
Interesting viewpoint of a cardiologist on low-SYNTAX subjects.
Gershengorn and colleagues evaluated the incidence and safety of overnight extubation following coronary artery bypass grafting (CABG), using retrospective data from The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Between 2014 and 2017, 42% of patients undergoing elective CABG had an overnight extubation, a rate that the authors report is similar to patients undergoing other cardiac procedures.
An interesting meta-analysis discouraging perhaps the use of this KATP modulator, especially after surgical revascularization where optimization of serum potassium is generally sought.
Excellent and brief summary of the debate on functional mitral regurgitation on mechanical support.
A robust RCT that denies association of nuclear CT-defined myocardial viability and long-term benefit from surgical coronary revascularisation. It is worth following the discussion this manuscript is certain to generate..
It's never too late to quit. Among heavy smokers, smoking cessation resulted in a significantly lower risk of cardiovascular disease within five years of quitting (hazard ratio 0.61), although their risk remained elevated compared to never smokers.
A most educative cross-Atlantic retrospective study on an always important question. The short accompanying video is also valuable!
Ljungqvist O, Batchelor T, Coates J. ERAS in Cardiothoracic Surgery and Digital Chest Drains. August 2019. doi:10.25373/ctsnet.9172451.
Enhanced Recovery After Surgery (ERAS) is a perioperative protocol that places the patient at the center of all medical decisions. It is designed to reduce stress for the patient, alleviate the amount of pain they experience, and crucially, speed up the recovery and mobilization process, where removing invasive lines and drains as soon as possible is essential.
During the Seventh ERAS World Congress, held in Liverpool, UK, in early May 2019, the myriad benefits of the protocol for both patients and the perioperative care team were discussed by three experts: Olle Ljungqvist, Professor of Surgery at Örebro University, Sweden, and co-founder and current president of the ERAS® Society; Tim Batchelor, a thoracic surgeon from Bristol in the UK and lead author of the recently published ERAS® Society/ESTS guidelines for lung surgery; and Jim Coates, clinical research fellow in cardiothoracic anesthesia and principal investigator of ERAS for heart patients at the James Cook University Hospital in Middlesbrough, UK. The group discusses the implementation of ERAS protocols, how patients benefit from ERAS approaches, and how digital chest drains fit into the ERAS philosophy.
Jim Coates directed a feasibility study for using digital chest drains during an ERAS program in Middelsbrough, UK, work that was supported by a grant from Medela. Additionally, the filming of this roundtable was organized and paid for by Medela; the panelists were not reimbursed for their participation.