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Journal and News Scan
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%).
January 10, 2015
Submitted by: Mark Ferguson
This study randomized 100 patients with AS to full sternotomy AVR with a conventional prothesis or hemisternotomy with a rapid deployment prosthesis. CPB times were similar, but Ao crossclamp times were 24% shorter in the rapid deployment group. Acute outcomes were similar. The rapid deployment group had a lower transvalvular gradient and a lower prevalence of prosthesis mismatch at 3 months.
January 8, 2015
Submitted by: Joel Dunning
Read this amusing article that documents a series of names of genuine doctors on the UK GMC registar such as psychiatrists called Dr Bhatti, Dr Moodie, a Genitourinary doctor called Dr Hussey and general surgeons called Mr Gore and Mr butcher !
Got any of your own ? Post them now in the comments section
January 6, 2015
Submitted by: Ruben Osnabrugge
In 2012 the American College of Cardiology Foundation and the Society of Thoracic Surgeons Collaboration on the Comparative Effectiveness of Revascularization Strategies (ASCERT) compared the 5 year effectiveness of CABG versus PCI. The registry data is now linked with Centeres for Meidcare and Medicaid Services Claims data in order to study the long-term cost-effectiveness of the two strategies. The authors found that the life-time incremental cost-effectiveness ratio of CABG versus PCI was approximately $30,000/QALY gained, a value that is generally considered economically attractive.
January 5, 2015
Submitted by: Joel Dunning
This patient presented with a large distal arch and proximal descending aortic aneurysm (7 cm). He underwent a Total Arch Replacement and Frozen Elephant Trunk Procedure using the Thoraflex Hybrid Graft (Vascutek Terumo). The entire operation was performed via a hemi-sternotomy (half incision size). He had an enhanced recovery and was discharged home on postoperative day 6.