The Challenges of Redo Aortic Coarctation Repair in Adults.

PURPOSE OF REVIEW: Aortic coarctation is a common congenital abnormality causing significant morbidity and mortality if not corrected. Re-coarctation or restenosis of the aorta following treatment is a relatively common long-term problem and the optimal therapy has not been elucidated. In this review, we identify the challenges associated with and the optimal management for recurrent aortic coarctation and the most appropriate therapy for different patient cohorts. RECENT FINDINGS: Open surgery provides a durable long-term aortic repair, however, given the complex nature of the procedure, has a somewhat higher rate of serious complications. Endovascular repair, although less invasive and relatively safe, has limitations in treated complex anatomy and is more likely to require repeat intervention. Open surgical repair is more appropriate for infants that have not been intervened on and endovascular therapy should be reserved for older children and adults and those that require repeat intervention.

Intracardiac Extension of Intravenous Leiomyomatosis.

Intravenous leiomyomatosis with intracardiac extension is a rare condition characterized by extensive growth of a benign uterine mass that extends into the venous system through uterine channels and then into the cardiac chambers. A variety of presentations exist; cure relies on complete surgical resection. Extensive abdominal dissection, cardiopulmonary bypass (with or without circulatory arrest), and removal of the intracaval component are required. However, because of the rarity and variety of presentation, exact preferred management has not been well defined. A specific case, followed by a comprehensive literature review, helps delineate the specific decision making necessary for mass removal.

Risk analysis for readmission after coronary artery bypass surgery: developing a strategy to reduce readmissions.

BACKGROUND: Readmission within 30 days of adult cardiac surgery procedures is a frequent contributor to the costs of cardiac surgery hospitalizations, but current data regarding risk factors for readmission are limited. We therefore sought to analyze quality improvement risk factors for readmissions after coronary bypass surgery (CABG). STUDY DESIGN: The records of patients undergoing CABG at our institution from July 2006 to June 2011 were evaluated for variables with potential literature-based associations with readmission, including New York Cardiac Surgery Reporting System (CSRS) risk factors, discharge medications, and laboratory values. RESULTS: The readmission rate was 13% (n = 158 of 1,205); the CSRS predicted rate was 8.7% (observed/expected ratio = 1.5). Median time from CABG discharge to readmission was 6 days (interquartile range [IQ] 3 to 13 days). Median readmission length of stay was 4 days (IQ 2 to 7 days). The most frequent reasons for readmission were cardiac (n = 40 [25% of readmissions]) and pulmonary complications, including pleural effusions (n = 36 [23%]). Beyond CSRS risk factors, only abnormal discharge serum creatinine was associated with increased readmission (p = 0.05). Combining CSRS risk variables for government insurance and unplanned reoperation led to the highest readmission risk (odds ratio [OR] 5.7, 95% CI 1.7 to 18.7). CONCLUSIONS: Coronary bypass surgery readmissions remain a persistent clinical challenge. Given that readmissions often occur within the first week postdischarge and are typically of short duration, post-CABG readmissions may be reduced through careful postoperative surveillance for readmission risk factors (eg, abnormal serum creatinine or unplanned reoperations) and/or for frequent causes of readmission (eg, pleural effusions).

Progress in studies on the RNA world.

The montmorillonite-catalyzed reactions of D, L-ImpA with D, L-ImpU generates RNA-like oligomers. The structures of the dimers to pentamers were investigated and homochiral products were identified in greater amounts than would be expected if theoretical amounts of each were formed. The homochirality increased from 64% to 97% as the chain length increased from dimers to pentamers. Investigation of the effect of pH, occupancy of the interlayer space and the influence of various cations in the reaction provided further insight into physical process in the mechanism of the catalysis. A detailed analysis of dimers was carried out in view of there being key intermediates towards formation of higher oligomers. The study was extended to the synthesis of non-standard dimers including those formed with deoxy-ribonucleotides.