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Bariatric surgery reduces incidence of atrial fibrillation: a propensity score –matched analysis
Atrial fibrillation (AF) affects 33.5 million individuals worldwide [1] and it is estimated that the prevalence of AF in the United States will increase 2- to 3-fold over the next 50 years [2]. Patients with AF are more likely to experience a variety of negative health outcomes, including myocardial infarction, heart failure, and stroke [3,4]. In addition to these major health risks, there is a significant economic burden associated with AF, amounting to as much as $26 billion in annual healthcare expenditures in the United States alone [5].
Source: Surgery for Obesity and Related Diseases - November 24, 2018 Category: Surgery Authors: Kevin T. Lynch, J. Hunter Mehaffey, Robert B. Hawkins, Taryn E. Hassinger, Peter T. Hallowell, Jennifer L. Kirby Tags: Original article Source Type: research

Reply
I am pleased Ross Naylor is of the opinion that I have built a convincing case with respect to the implications of increasing stenosis severity in asymptomatic patients with carotid stenosis. Furthermore, it is difficult to refute the statement that carotid interventions are not undertaken to prevent transient ischemic attack (TIA). Virtually all natural history studies (Asymptomatic Carotid Stenosis and Risk of Stroke [ACSRS], North American Symptomatic Carotid Endarterectomy Trial [NASCET]) including ours (see Conrad, reference 3) have indicated that the index neurologic event in previously asymptomatic patients is as li...
Source: Journal of Vascular Surgery - July 20, 2018 Category: Surgery Authors: Richard P. Cambria Tags: Letter to the Editor Source Type: research

PC052. The Effects of Stroke Unit Centralization for Patients With a Symptomatic Carotid Stenosis in the Carotid Endarterectomy Pathway
Carotid endarterectomy (CEA) should be performed on symptomatic, surgically suitable patients who present a stenosis greater than 50% North American Symptomatic Carotid Endarterectomy Trial stenosis of the internal carotid artery within 14 days of their symptoms. Aim of this study was to evaluate the effects of Stroke Uni centralization for patients with symptomatic carotid stenosis undergoing CEA.
Source: Journal of Vascular Surgery - May 22, 2018 Category: Surgery Authors: Emiliano Chisci, Lorenzo Nenci, Giulia Zaccagnini, Alberto Fortini, Gabriele Nenci, Luciana Tramacere, Massimo Cincotta, Stefano Michelagnoli Source Type: research

Best medical treatment alone may not be adequate for all patients with asymptomatic carotid artery stenosis
Stroke is the fifth leading cause of death in the United States, with>130,000 deaths/y.1 Every year, about 795,000 people in the United States sustain a stroke.1 About 610,000 of these are first strokes and 185,000 are recurrent strokes.1 Three landmark randomized controlled trials (RCTs) demonstrated that in patients with 60% to 99% asymptomatic carotid stenosis (ACS), carotid endarterectomy (CEA) conferred a 50% relative risk reduction in the 5-year stroke risk compared with medical treatment (MT) alone (absolute risk reduction of ≈1%/y).
Source: Journal of Vascular Surgery - May 14, 2018 Category: Surgery Authors: Kosmas I. Paraskevas, Frank J. Veith, Jean-Baptiste Ricco Tags: Special Communication Source Type: research

Invited commentary
Although carotid endarterectomy and stenting for symptomatic significant carotid artery stenosis are widely accepted for stroke prevention, their use for asymptomatic stenosis is more controversial. With the advances in medical therapy, particularly the use of statins, and with an annual stroke risk of 1% to 2% for asymptomatic disease, justifying these interventions in these patients is more difficult. What is more disturbing is that ∼90% of all carotid endarterectomy and stenting procedures in the United States are performed on asymptomatic patients and that many were felt to be unnecessary, resulting in a cost of>$2 billion annually.
Source: Journal of Vascular Surgery - April 26, 2018 Category: Surgery Authors: Ali F. AbuRahma Tags: From bench to bedside Source Type: research

Laparoscopic Sleeve Gastrectomy in Patients with Heart Failure and Left Ventricular Assist Devices as a Bridge to Transplant
Obesity is an epidemic that is progressive, costly, and closely associated with cardiac disease and death. Obesity causes structural and functional changes in the heart due to increases in metabolic demand, total blood volume, and stroke volume, all of which cause left ventricular dilation, cardiac muscle hypertrophy, and atrial enlargement [1,2]. Heart failure is a deadly condition, affecting up to 5.8 million people in the United States with associated health care costs exceeding 30 billion dollars per year [3,4].
Source: Surgery for Obesity and Related Diseases - April 18, 2018 Category: Surgery Authors: Russell B Hawkins, Kristina Go, Steven L Raymond, Alexander Ayzengart, Jeffrey Friedman Source Type: research

Invited commentary
The North American Symptomatic Carotid Endarterectomy Trial (NASCET) concluded that carotid surgery for symptomatic stenosis is better than medical therapy, and the conferred benefit of surgery is proportional to the degree of stenosis.1 The European Carotid Surgery Trial (ECST) came to a similar conclusion and that “on average, the immediate risk of surgery was worth trading off against the long-term risk of stroke without surgery when the stenosis was greater than 80% diameter.”2 The preceding and other studies leave little room for doubt that endarterectomy is beneficial to symptomatic patients; what is still being ...
Source: Journal of Vascular Surgery - November 20, 2017 Category: Surgery Authors: M. Ashraf Mansour Tags: Clinical research study Source Type: research

Adolescent bariatric surgery is on the Rise: An analysis of utilization and procedure trends in New York State
Obesity constitutes a major public health issue affecting an increasing number of families. In the United States the percentage of adolescents aged 12-19 years with obesity has reached an alarming level of 21%.  Childhood obesity could lead to long term development of heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis. The bariatric surgical interventions have emerged as successful alternative to the behavioral and psychological interventions in weight loss for adolescents .
Source: Surgery for Obesity and Related Diseases - October 1, 2017 Category: Surgery Authors: Shabana Humayon, Maria Altieri, Jie Yang, Kristie Price, Konstantinos Spaniolas, Aurora Pryor Tags: Bariatric Surgery in Adolescents Source Type: research

The Use of Branched Endografts for the Aortic Arch in the Endovascular Era.
Authors: Tadros RO, Safir SR, Faries PL, Han DK, Chander RK, Abraham CZ, Marin ML, Stewart AS Abstract The endovascular realm has steadily increased its footing in the treatment of the aorta and all of its territories since the foundational case in 1990 by Parodi. The aortic arch, however, continues to be one of the last bastions for treatment via open surgery, which remains the gold standard. Significant comorbidity and prior cardiac surgery prevent open surgery from being the only preferred option, allowing novel endovascular procedures to be considered. Since 1999, more advanced endovascular systems have been cr...
Source: Surgical Technology International - July 13, 2017 Category: Surgery Tags: Surg Technol Int Source Type: research

The effects of centralisation of vascular surgical services in the Bath, Bristol and Weston area on the carotid endarterectomy pathway.
Conclusion Centralisation has not significantly impacted the overall efficiency of the carotid endarterectomy pathway. This study highlights areas where improvement across the vascular network is required. This includes addressing the 35% patients that are not currently meeting the 14-day target and standardising the provision of care to outlying communities. Further follow-up is required to assess the longer term effects of centralisation. PMID: 28682128 [PubMed - as supplied by publisher]
Source: Annals of the Royal College of Surgeons of England - July 6, 2017 Category: Surgery Authors: Partridge E, Brooks M, Curd C, Davis V, Oates C, McGeeney D Tags: Ann R Coll Surg Engl Source Type: research

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