Percutaneous left atrial appendage occlusion using different technologies in the United Kingdom: A multicenter registry.

Objectives: This study aimed at assessing the feasibility and long-term efficacy of left atrial appendage occlusion (LAAO) in a "real world" setting.

Background: Although LAAO has recently emerged as an alternative to oral anticoagulants in patients with atrial fibrillation for the prevention of thromboembolic stroke, "real world" data about the procedure with different devices are lacking.

Methods: Eight centers in the United Kingdom contributed to a retrospective registry for LAAO procedures undertaken between July 2009 and November 2014.

WHO cares? Safety checklists in echocardiography.

The number of potentially preventable medical errors that occur has been steadily increasing. These are a significant cause of patient morbidity, can lead to life-threatening complications and may result in a significant financial burden on health care. Effective communication and team working reduce errors and serious incidents.

Magnetic resonance imaging of pulmonary nodules: accuracy in a granulomatous disease-endemic region.

Objective: To estimate the diagnostic accuracy of signal intensity of the lesion-to-spinal cord ratio (LSR) and apparent diffusion coefficient (ADC) in diffusion-weighted (DW) magnetic resonance imaging of pulmonary nodules suspicious for lung cancer in granulomatous lung disease-endemic regions.

Methods: Forty-nine patients with indeterminate solitary pulmonary nodules detected by chest computed tomography and histopathologically confirmed diagnoses were included in the study. DW images were analysed semiquantitatively by focusing regions of interest on the lesion and spinal cord at the same level (for LSR calculation).

Multidetector Computed Tomography Findings in Pulmonary Hamartomas: A New Fat Detection Threshold.

Purpose: The aim of the study was to determine the accuracy of multidetector computed tomography in the evaluation of histologically confirmed pulmonary hamartomas (PHs), with a special focus on fat detection.

Materials And Methods: Data from 55 patients who had received a histologically confirmed diagnosis of PH and had undergone 64-slice thoracic MDCT were retrospectively evaluated.

Results: PHs manifested predominantly as peripheral pulmonary nodules with lobulated margins.

Adverse events following percutaneous and surgical coronary revascularisation: Analysis of non-MACE outcomes in the Stent or Surgery (SoS) Trial.

Objectives: To analyse adverse events requiring or prolonging hospitalisation in the Stent or Surgery (SoS) trial.

Background: Many adverse events following coronary revascularisation are non-major adverse cardiovascular events (non-MACE). Trials comparing percutaneous coronary intervention (PCI) and coronary artery bypass surgery (CABG) have reported rates of mortality and MACE only.

Superior Vena Cava Lipoma in an Asymptomatic Man.

A 58-year-old asymptomatic male smoker, underwent computed tomography of the chest for lung cancer screening. Unenhanced CT showed a hypodense elongated lesion with fat density within the superior vena cava (SVC). Magnetic resonance imaging was performed and confirmed the fatty nature of the lesion.

A Single-Center Randomized Trial of Intraoperative Zero-Balanced Ultrafiltration During Cardiopulmonary Bypass for Patients With Impaired Kidney Function Undergoing Cardiac Surgery.

Objectives: The authors investigated whether zero-balance ultrafiltration (Z-BUF) during bypass significantly improves clinical and cost outcomes or biomarkers of kidney injury for patients with preoperative kidney impairment (estimated glomerular filtration rate [eGFR]<60 mL/minute) undergoing cardiac surgery.

Design: A single-center randomized controlled trial recruited, patients between 2010 and 2013, with a 12-months follow-up.

Setting: Hospital.

Relationship between contact force sensing technology and medium-term outcome of atrial fibrillation ablation: a multicenter study of 600 patients.

Introduction: Contact force sensing (CFS) technology improves acute pulmonary vein isolation durability; however, its impact on the clinical outcome of ablating atrial fibrillation (AF) is unknown.

Methods And Results: First time AF ablation procedures employing CFS from 4 centers were matched retrospectively to those without CFS in a 1:2 manner by type of AF. Freedom from atrial tachyarrhythmia was defined as the primary outcome measure, and fluoroscopy time the secondary outcome measure.

A comparison of fibrinogen measurement using TEG(®) functional fibrinogen and Clauss in cardiac surgery patients.

Introduction: Viscoelastic methods of estimating fibrinogen measure clot formation under platelet inhibition; these methods are gaining in popularity because of their convenience and speed. The aim of this study was to compare the results of the TEG(®) functional fibrinogen (FF) assay with the Clauss fibrinogen method in a group of patients presenting for cardiac surgery and to assess whether they gave equivalent results.

Methods: As part of a larger study evaluation a transfusion algorithm for use in cardiac surgery, 320 paired samples of TEG(®) FF and Clauss fibrinogen were compared.

Unfractionated heparin versus bivalirudin in primary percutaneous coronary intervention (HEAT-PPCI): an open-label, single centre, randomised controlled trial.

Background: Bivalirudin, with selective use of glycoprotein (GP) IIb/IIIa inhibitor agents, is an accepted standard of care in primary percutaneous coronary intervention (PPCI). We aimed to compare antithrombotic therapy with bivalirudin or unfractionated heparin during this procedure.

Methods: In our open-label, randomised controlled trial, we enrolled consecutive adults scheduled for angiography in the context of a PPCI presentation at Liverpool Heart and Chest Hospital (Liverpool, UK) with a strategy of delayed consent.

Shadowing: a central component of patient and family-centred care.

Patient and family-centred care (PFCC), as distinct from patient-centred, or patient-focused, care, enables healthcare organisations to work collaboratively with patients and their families to enhance and improve their care experiences. Liverpool Heart and Chest Hospital NHS Foundation Trust has implemented a PFCC model that is supported by a number of strategies including 'shadowing', which involves closely following patients and their families throughout their care experiences. This article briefly describes PFCC and discusses how shadowing works and the benefits of the process.

Intra- and inter-centre standardisation of thromboelastography (TEG®).

Thromboelastography is used for assessment of coagulation and to guide administration of blood products peri-operatively. There is currently no method of standardisation in the UK, nor an approved method of proving quality. We investigated the reproducibility of thromboelastography by testing whole blood with no coagulation abnormality in three phases.

Interobserver agreement between radiologists and radiology residents and emergency physicians in the detection of PE using CTPA.

Objective: To assess interobserver agreement between thoracic radiologists, radiology residents, and emergency physicians in diagnosing pulmonary embolism (PE).

Materials And Methods: Emergency physicians, radiology residents, and thoracic radiologists evaluated 123 computed tomography pulmonary angiography images. Interobserver agreement was analysed using kappa statistics.

Systematic review of the dry powder inhalers colistimethate sodium and tobramycin in cystic fibrosis.

This systematic review evaluated evidence for two dry powder formulations, colistimethate sodium and tobramycin, for the treatment of chronic Pseudomonas aeruginosa in cystic fibrosis, as part of the UK national recommendation process for new technologies. Electronic bibliographic databases were searched in May 2012 (MEDLINE, MEDLINE in-Process, EMBASE, Cochrane Library databases, CINAHL, Web of Science, Conference Proceedings Citation Index and BIOSIS Previews). Relevant outcomes included rate and extent of microbial response (e.

The impact of continuous haemofiltration with high-volume fluid exchange during cardiopulmonary bypass surgery on the recovery of patients with impaired renal function: a pilot randomised trial.

Background: There is widespread variability in clinical practice within cardiac surgery units worldwide on the use of haemofiltration. The clinical impact and safety of this modality is, however, unknown.

Objectives: The primary pilot trial objectives were as follows: to assess the feasibility of randomising 60 patients with impaired kidney function undergoing on-pump coronary artery bypass graft (CABG) surgery within 6 months; to assess the suitability and reliability of our chosen outcome measures; to explore issues that may impact on recruitment into a definitive trial; and to undertake an exploratory economic evaluation.

The impact of systemic fungal infection in patients with perforated oesophagus.

Introduction: Perforated oesophagus is a surgical emergency with significant morbidity and mortality. Systemic fungal infection represents a poor response to the magnitude of the insult, which adds significantly to the risk of morbidity and mortality in these patients. We reviewed our experience with this group of patients over a six-year period in a tertiary referral centre.

A pilot randomised controlled trial in intensive care patients comparing 7 days' treatment with empirical antibiotics with 2 days' treatment for hospital-acquired infection of unknown origin.

Background: Management of cardiac intensive care unit (ICU) sepsis is complicated by the high incidence of systemic inflammatory response syndrome, which mimics sepsis but without an infective cause. This pilot randomised trial investigated whether or not, in the ICU, 48 hours of broad-spectrum antibiotic treatment was adequate to safely treat suspected sepsis of unknown and unproven origin and also the predictive power of newer biomarkers of sepsis.

Objective: The main objective of this pilot study was to provide preliminary data on the likely safety and efficacy of a reduced course of antibiotics for the treatment of ICU infections of unknown origin.

Air leaks following pulmonary resection for lung cancer: is it a patient or surgeon related problem?

Introduction: Prolonged air leak (PAL) is the most common complication after partial lung resection and the most important determinant of length of hospital stay for patients post-operatively. The aim of this study was to determine the risk factors involved in developing air leaks and the consequences of PAL.

Methods: All patients undergoing lung resection between January 2002 and December 2007 in our hospital were studied retrospectively.

Cannulating a dissecting aorta using ultrasound-epiaortic and transesophageal guidance.

Management of acute Stanford type A aortic dissection remains a major surgical challenge. Directly cannulating the ascending aorta provides a rapid establishment of cardiopulmonary bypass but consists of risks such as complete rupture of the aorta, false lumen cannulation, subsequent malperfusion and propagation of the dissection.We describe a technique of cannulating the ascending aorta in patients with acute aortic dissection that can be performed rapidly in hemodynamically unstable patients under ultrasound-epiaortic and transesophageal (TEE) guidance.

Perfusion and aortic surgery: patient directed cardiopulmonary bypass and quality improvement.

Aortic surgery frequently extends the boundaries of perfusion knowledge learned from non aortic cardiac surgery.This is due to the extremes of temperature, prolonged bypass times, hypothermic arrest, and selective organ(s) perfusion. Suboptimal perfusion can potentially affect outcomes even after technically successful aortic surgery.