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Journal and News Scan
January 31, 2017
Submitted by: Rakesh Arora
The authors of this review article offer an approach to the utilization of a contempory mechanical circulatory support devices. They further provide insights of the key role that well-functioning interdisciplinary teams contribute to the success of a MCS program and future directions to consider as this field continues to rapidly evolve.
January 31, 2017
Submitted by: Rakesh Arora
Appropriate perioperative fluid management is of increasing interest for the team caring for the critically ill cardiac patient as fluid overload has been shown to have negative effects on organ function. The Authors provide the reader with practical ultrasonographic techniques to examine patients for signs of extracardiac fluid overload and how to use this information to tailor management for the patient in a cardiac ICU.
January 31, 2017
Submitted by: Rakesh Arora
In this is review article the authors have proposed a "3-strike" model of risk that increases the likelihood of experiencing postoperative delirium in older adults undergoing cardiac surgery. The 3 strikes consists of a baseline vulnerability (such as frailty), the intraoperative surgical stressor and the postoperative hemodynamic perturbations (and other process of care factors) that can contribute to the occurance of postoperative delirium. Pratical tips on how cardiac team can begin to address this important issue are provided in this review.
January 28, 2017
Submitted by: Mark Ferguson
The authors assessed the influence of patch material type on the incidence of recoarctation in infants undergoing Norwood I repair for hypoplastic left heart syndrome. Among 145 patients, recoarctation developed in 18% at a median of 4.3 months. At 2 years, freedom from recoarctation was about 85% for homograft and autologous pericardium, whereas it was 30% for equine pericardium; use of the latter was the only risk factor for recoarctation in multivariable analysis.
January 28, 2017
Submitted by: Mark Ferguson
The authors investigated the efficacy of vancomycin paste applied to the sternal edges during cardiac surgery in reducing the risk of deep sternal wound infection among nearly 14,500 cardiac surgical patients. The incidence of such infections was 09.%. In a multivariable analysis, BMI, NYHA class, and the STS DSWI risk index were significantly associated with deep sternal wound infection. Vancomycin paste did not reduce the incidence of infection.
January 28, 2017
Submitted by: Mark Ferguson
Mitral valve surgery complicated by atrioventricular groove disruption has a high mortality rate. The authors describe results of an external repair for this injury, directly suturing the atrioventricular groove. In a 20-year experience involving over 3,000 mitral valve operations, 13 such injuries occurred. 30-day and hospital mortality were 15% and 23%. 1-year survival was 73%. The external repair approach appears to offer favorable results after this devastating complication.
January 28, 2017
Submitted by: Mark Ferguson
Using pigs as an experimental model, the authors demonstrated incorporation of bioengineered tracheal grafts in large tracheal defects. The grafts were constructed of acellular bovine dermis extracellular matrix and human mesenchymal stem cells incubated with chondogenic factors. The authors demonstrated that the use of stem cells resulted in chondrogenesis, and that the grafts developed neovascularization and epithelialization, all of which are important in supporting tracheal healing and growth.
January 27, 2017
Submitted by: J. Rafael Sadaba
Results are reported of a global feasibility study in which 30 patients at high risk for mitral valve surgery were enrolled at 8 study sites. Patients underwent transapical mitral valve replacement with a Tendyne transcatheter mitral valve. A mitral prosthesis was successfully implanted in 93%. In these 28 patients, the residual MR (valvular or paravalvular) was grade 0 in all but 1 patient and there was no LVOT obstruction. There was no device embolization or cardiac perforation. At 30 days, there was only one death (3.3%). Repeat echocardiography showed no evidence of prosthesis dysfunction. There were no strokes, no myocardial infarctions, and no additional device-related complications during hospitalization. The authors conclude that transcatheter mitral valve replacement using a prosthesis specifically designed for the mitral valve is feasible and can be performed safely.
January 26, 2017
Submitted by: Joel Dunning
This New STS Expert Consensus Statement is now available to download.
For the first time this protocol gives units who look after patients after cardiac surgery a complete guide for the management for patients who arrest.
Most notably there is a recommendation that patients should undergo an emergency resternotomy within 5 minutes if quickly reversible factors are not found, in order to save those patients who have arrested due to tamponade, for whom external CPR is ineffective.
There are recommendations for the organisation of the team, recommendations against the use of epinephrine, recommendations on how to identify rapidly reversible causes for the arrest and importantly there is advice as to how to implement this guidance into your unit and how to get trained.
The APACVS have also set up a training arm to help with the implementation of the protocol that can be found at www.csu-als.com
January 25, 2017
Submitted by: Joel Dunning
In a bold and very challenging move, thoracic surgeons at Toronto General Hospital (TGH) removed severely infected lungs from a dying mom, keeping her alive without them for six days, so that she could recover enough to receive a life-saving lung transplant.