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Journal and News Scan

Source: ASAIO Journal
Submitted by: Arie Blitz
November 27, 2014
Author(s): Abrams, Darryl; Bacchetta, Matthew; Brodie, Daniel
Abrams and colleagues provide a comprehensive review of the topic of recirculation during VV ECMO.  Specifically, the authors discuss the factors contributing to recirculation, how to calculate the extent of recirculation, and what interventions can be applied to correct the issue.  Recirculation can be a significant challenge during VV ECMO, particularly in patients that have worse underlying pulmonary function.  For ECMO programs, this article is a "must-have" to distribute to fellows, residents, and other health care providers managing these patients.
Source: Seminars in Thoracic and Cardiovascular Surgery
Submitted by: Arie Blitz
November 26, 2014
Author(s): Joshua B. Goldberg, Joon Bum Kim, Thoralf M. Sundt
Goldberg and colleagues provide an excellent review on a complex topic:  intramural hematomas.  The article has several take-home messages:  one must be very careful in how one defines IMH; its pathogenesis remains unclear; IMH tends to involve a more outer location of the aortic media than aortic dissections (AD) do;  IMH is more likely to rupture externally than AD; risk factors for progression from IMH to AD include aortic diameter and aortic wall thickness; the liberal use of stent grafting for type B IMH is probably unwarranted.  It remains to be proven whether IMH should be treated any differently from AD.  Until then, except under unusual circumstances, the same treatment approach is likely warranted.
Source: YOUTUBE
Submitted by: Joel Dunning
November 25, 2014
Author(s): Shanda Blackmon
Simply fabulous !!   Well done Shanda Blackmon. We are all proud to be Cardiothoracic surgeon too !
Source: ASAIO Journal
Submitted by: Arie Blitz
November 25, 2014
Author(s): Lee, Yeon Joo; Kim, Dong Jung; Kim, Jun Sung; Lee, Jae-Ho; Lee, Choon-Taek; Jheon, Sanghoon; Cho, Young-Jae
In a retrospective review of 45 cases where patients were placed on VV ECMO, investigators from Seoul performed a multivariate analysis of pre-ECMO risk factors  that might be predictive of  an unsuccessful ECMO wean.  Notably, successful weaning from ECMO was only 46%, and overall survival was only 18%.   Importantly, higher platelet counts at ICU admission and the day prior to initiating ECMO were predictive of successful weaning.  Specifically, patients with a platelet count > 70K had an 11X greater likelihood of a successful wean.  Why?  Is the low platelet count a surrogate for the severity of illness?
Source: Journal of the National Cancer Institute
Submitted by: Mark Ferguson
November 24, 2014
Author(s): Aaron P. Thrift, Nicholas J. Shaheen, Marilie D. Gammon, Leslie Bernstein, Brian J. Reid, Lynn Onstad, Harvey A. Risch, Geoffrey Liu, Nigel C. Bird, Anna H. Wu, Douglas A. Corley, Yvonne Romero, Stephen J. Chanock, Wong-Ho Chow, Alan G. Casson, David M. Levine, Rui Zhang, Weronica E. Ek, Stuart MacGregor, Weimin Ye, Laura J. Hardie, Thomas L. Vaughan and David C. Whiteman
Data from the Barrett's and Esophageal Adenocarcinoma Genetic Susceptibility Study were used to determine the relationship of a genetic risk score associated with obesity to cancer risk.  The risk score was not associated with GERD or smoking.  Cancer and Barrett's were strongly associated with increasing BMI.  The authors conlude that those with a genetic makeup associated with obesity have increased risk of cancer and Barrett's.   
Source: Journal of the National Cancer Institute
Submitted by: Mark Ferguson
November 24, 2014
Author(s): David S. Gierada, Paul Pinsky, Hrudaya Nath, Caroline Chiles, Fenghai Duan and Denise R. Aberle
Data from the National Lung Screening Trial (NLST) were examined by exploring different size thresholds for classifying CT screening scans as positive.  In the NLST, nearly two-thirds of nodules were 7mm in diameter or less.  Using a threshold of 5mm, the percentage of missed/delayed diagnosis and the likelihood of avoiding false positive findings were 1% and 16%.  Using a threshold of 8mm increased those rates to 11% and 66%.  Increasing size thresholds reduced follow-up CTs and invasive procedures.  Interestingly, differences in thresholds did not affect survival or mortality.
Source: YOUTUBE
Submitted by: Joel Dunning
November 22, 2014
Author(s): Henrick Hansen
You have to check out this amazing VATS lobectomy surgery simulator. It is unbelievably realistic and comes in a LAP surgery simulator: staplers, slings, the works!!  Henrik Hansen was key in designing this, so it uses his anterior approach to do the lobectomy.     
Source: New England Journal of Medicine
Submitted by: Mark Ferguson
November 20, 2014
Author(s): Peter K. Smith, John D. Puskas, Deborah D. Ascheim, Pierre Voisine, Annetine C. Gelijns, Alan J. Moskowitz, Judy W. Hung, Michael K. Parides, Gorav Ailawadi, Louis P. Perrault, Michael A. Acker, Michael Argenziano, Vinod Thourani, James S. Gammie, Marissa A. Miller, Pierre Pagé, Jessica R. Overbey, Emilia Bagiella, François Dagenais, Eugene H. Blackstone, Irving L. Kron, Daniel J. Goldstein, Eric A. Rose, Ellen G. Moquete, Neal Jeffries, Timothy J. Gardner, Patrick T. O'Gara, John H. Alexander, and Robert E. Michler
301 pts with CAD required revascularization and moderate MR were randomly assigned to CABG or CABG with MV repair.  The outcome was LV end-systolic index at 1 year.  MV repair contributed to longer pump times, longer hospitalization, and more neurologic events.  MV repair did not result in an improved primary outcome at 1 year, but was associated with reduced rates of moderate to severe MR.  The potential benefit of this latter finding is unclear.
Source: Annals of Oncology
Submitted by: Mark Ferguson
November 20, 2014
Author(s): C. Handforth, A. Clegg, C. Young, S. Simpkins, M.T. Seymour, P.J. Selby, and J. Young
Data from 20 observational studies including nearly 3000 pts were reviewed to assess the prevalence of pre-frailty/frailty and clinical outcomes in older cancer patients.  Frailty was identified in 42% and pre-frailty in 43% of patients.  Combined frailty was associated with increased all cause mortality (5-yr HR 1.57), postoperative mortality, and postoperative complications.
Source: Annals of Thoracic Surgery
Submitted by: Arie Blitz
November 20, 2014
Author(s): Michael A. Borger, Vadim Moustafine, Lenard Conradi, Christoph Knosalla, Markus Richter, Denis R. Merk, Torsten Doenst, Robert Hammerschmidt, Hendrik Treede, Pascal Dohmen, Justus T. Strauch
A prospective, randomized multi-center trial explored the clinical outcomes in 100 patients undergoing either conventional AVR or minimally invasive rapid deployment AVR (RDAVR). RDAVR consists of positioning the valve with a precrimped subannular skirt frame into the annulus, and then balloon deploying the frame. Implanted valve sizes were similar.  RDAVR was associated with shorter X-clamp times. Early outcomes were similar. RDAVR patients had less patient-prosthesis mismatch at 3 months post-op.  

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