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Journal and News Scan
This meta-analysis evaluated 6 published studies involving over 71,000 cancer patients who experienced 2002 instances of cancer mortality. Compared to patients with low fitness, those with high levels of cardiorespiratory fitness had a 50% reduction in their cancer mortality risk.
The author recounts the posttraumatic distress that Captain Scully and other crewmembers experienced after the emergency landing of US Airways Flight 1549 on the Hudson River in New York City. She describes the counseling this team required after executing a nearly perfect recovery from a potentially disastrous aviation event. The author wonders why, when physicians experience similarly traumatic experiences with their patients (especially those with fatal outcomes), they are expected to resume work immediately, without counseling and without regard for any potential disability.
Coronary Subclavian Steal Syndrome Detected During Coronary Bypass Surgery in a Hemodialysis Patient
Coronary subclavian steal syndrome is a concern in hemodialysis patients with an upper extremity arteriovenous fistula (AVF) who are undergoing ipsilateral IMA harvest for revascularization. In this case report, the authors describe the intraoperative documentation of reversal of flow in the LIMA to LAD graft that improved with occlusion of the AVF. This finding prompted taking the LIMA off the Aorta as a free graft, which led to improvement of flow characteristics.
In this retrospective study of 173 lung transplants performed at Loyola University, investigators found a correlation between heavy alcohol use in lung transplant donors and risk of developing severe primary graft dysfunction. Those recipients had an 8.7 times higher risk than patients who received lungs from donors who did not drink.
This manuscript offers a comprehensive and easy to read review of annular rupture during TAVI. The authors explain the pathophysiology of this complication and classify it according to the anatomical location. They also discuss the management options in terms of diagnosis and treatment.
Dear Colleagues,
I am heartbroken to inform you that Dr. Michael J. Davidson, director of Endovascular Cardiac Surgery at Brigham and Women’s Hospital, has tragically died this evening after sustaining gunshot wounds this morning during the shooting event at the Shapiro Cardiovascular Center.
Dr. Davidson was a wonderful and inspiring bright light and an outstanding cardiac surgeon who devoted his career to saving lives and improving the quality of life of every patient he cared for. It is truly devastating that his own life was taken in this horrible manner.
Dr. Davidson was kind, compassionate and beloved by his colleagues and his patients. He was deeply dedicated to the Brigham. In 2010, he ran the Boston Marathon with Team Brigham to celebrate his 40th birthday. He stated at the time, “There is no better way to commemorate a birthday, run the marathon to achieve a personal goal and, in the process, support Team Brigham and its mission to help so many people.”
He was part of the remarkable team that performed the hospital’s first tricuspid “valve-in-valve” procedure and was involved in establishing the hybrid OR at BWH, once of the most advanced operating rooms in the country. Dr. Davidson graduated from Yale University School of Medicine and then trained at Duke University and Brigham and Women’s Hospital, joining our Brigham family in 2006.
The world is a better place because of Dr. Davidson. Let us honor our dear colleague’s memory and legacy by treating each other with kindness and providing the best possible care to those who come to us in need. If you need support, the Employee Assistance Program staff are available for any employees who wish to contact them. The telephone number is 617-732-6017.
Our thoughts and prayers are with his family at this time. More information on a memorial service will be forthcoming.
This study from the University of Texas Southwestern sought to analyze the effects of mechanical unloading during prolonged LVAD support on mitochondrial mass, DNA damage response (DDR), and cardiomyocyte proliferation. Ten matched human samples of LV myocardium were analyzed before and after mechanical circulatory support. Among its interesting findings, the study found that prolonged mechanical unloading induces adult human cardiomyocyte proliferation, hypothesized to occur through prevention of mitochondria-mediated activation of DDR. How do we optimize LVAD myocardial recovery regimens to leverage this important finding?
This systematic review and meta-analysis explores the literature to determine the relative advantages and disadvantages of using bilateral IMAs over single IMAs on outcomes after CABG in diabetic patients. In their analysis, the group found that patients who underwent bilateral IMA grafting using skeletonized IMAs had no greater incidence of sternal wound infection than those undergoing unilateral IMA harvesting; however, if the mammaries were harvested on a pedicle, an increased incidence of sternal wound infection was noted in the bilateral harvest group. In addition, the meta-analysis demonstrated better long-term survival in the bilateral IMA group, regardless of harvesting method, over the unilateral IMA group. Is it time to reconsider bilateral IMA usage in diabetics? If bilateral IMAs are indeed used, should they be harvested only in skeletonized fashion?
The Columbia group performed a retrospective analysis of 46 balloon atrial septostomies in 32 patients with severe and medically refractory PAH from 2002-2013. There were no procedural deaths or complications. BAS was safely used as a bridge to lung transplantation or to alleviate right heart failure symptoms and/or syncope.
In this comprehensive article the author describes the potential harmful effects of peri-operative allogeneic transfusions during cardaic surgery employing the CPB circuit. The author also describes potenital risks of low hematocrits during CPB as would be seen when employing Acute Normovolemic Hemodilution technique for blood conservation. Patient conditions that may provide an early warning of "at risk" patients are outlined. Some insights on potential ways of mitigating the complication of renal failure post cardiac surgery are offered, however, the article left me with a few unanswered questions. Would the use of continuous ultrafiltration during the CPB phase help to remove the neprotoxic PFH? Shoud use of CVVH post operativly in "at risk" patients be a routine standard? Would it help? Should any banked RBC transfusion be first washed in an autotransfusion system before infusion and would this be of potential benefit?