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Journal and News Scan
January 12, 2015
Submitted by: Joel Dunning
Results from the European REdo Cardiac Operation Research Database (RECORD) indicate that outcome of redo aortic valve replacement is influenced by baseline risk factors and perioperative complications. Hospital mortality was seen in 5.1% of 711 evaluated cases.
January 12, 2015
Submitted by: Joel Dunning
The incidence of bacterial endocarditis has significantly increased in the UK and this coincides with a 90% reduction of antibiotic prophylaxis for dental work according to the 2008 NICE guidance which recommended against its use.
This video from the AHA describes the study and implications for the future.
January 12, 2015
Submitted by: Joel Dunning
17 manuscripts were included in the final analysis and postoperative data of 722 patients were studied. The mean age of patients was 58 years and mean follow-up was 62 months. Hospital mortality was 1.5% (11 deaths). During the follow-up late aortic related mortality was noted in two patients (0.3%), there were 12 (1.7%) cases of significant redilatation of the ascending aorta, and 13 (1.8%) patients had to have their ascending aorta reoperated. All of the aortic complications were noted in patients who either did not have their external wrapping sutured to the aorta or who underwent concomitant aortoplasty.
The results of the metaanalysis suggest that external aortic wrapping may be considered as a safe operative technique. In patients with a moderately dilated aorta it offers good mid-term and long-term outcome compared to replacement of the ascending aorta.
January 12, 2015
Submitted by: Joel Dunning
This article shows that MIMVS is a safe approach with low morbidity and mortality that allows a high and durable repair rate with low reoperation rates and favorable short-term event-free survival
January 11, 2015
Submitted by: Arie Blitz
The CCF group conducted a study of their phlebotomy practices during a 6-month period in 2012. Phlebotomy volumes on each patient were estimated and calculated. Surprisingly, the group found that, on average, cardiac surgery patients lose ~10% of their blood volume due to postoperative phlebotomy alone. Clearly, further efforts are indicated to minimize such blood loss. These efforts will include using smaller volume tubes, assessing the necessity of some of the blood tests, and developing a suitable means of minimizing discard volumes when blood is drawn from a patient line.
January 10, 2015
Submitted by: Mark Ferguson
The FDA recently approved the fourth new oral anticoagulant, Savaysa for use in non-valvular afib, DVT, and PE. It is another factor Xa inhibitor. Use in non-valvular afib requires renal function assessment prior to prescribing, as the drug is renally excreted. Paradoxically, efficacy may be reduced in patients with better-than-normal renal function.
January 10, 2015
Submitted by: Mark Ferguson
This study investigated repair methods for large hiatal hernias randomized to suture only vs absorbable mesh vs nonabsorbable mesh. The design was randomized, double blind. At 12 mos the recurrence rate was 21%, with no difference among the groups. Postoperative symptoms were different among the groups, but these differences were judged to be of small clinical importance.
January 10, 2015
Submitted by: Mark Ferguson
The authors retrospectively analyzed pathologic response rates and their relation to the interval between completion of induction therapy and esophagectomy for esophageal cancer in 88 patients. Complete response rates increased from 12.5% to 40.9% among quartiles as the interval increased from <45 days to >63 days. There was no increase in morbidity associated with longer intervals to surgery.
January 10, 2015
Submitted by: Mark Ferguson
Patients who underwent a Fontan procedure for single ventricle physiology were evaluated with serial cardiac MR over time to identify changes in vessel characteristics and their relationship to flow. Although vessel diameter increased over time, normalized diameters decreased. This was not associated with changes in flow, but hemodynamic efficiency declined over time.
January 10, 2015
Submitted by: Mark Ferguson
Outcomes of surgical AVR were summarized from the STS Cardiac Surgery Database 2002-2010 to establish contemporary data for different surgical risk groups (low <4% risk, intermediate 4%-8% risk, high >8% risk). 80% were low risk, 6% were high risk. Hospital mortality was lower than predicted by STS PROM for all groups (low: 1.4$ vs 1.7%; intermediate 5.1% vs 5.5%; high 11.8% vs 13.7%).