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Journal and News Scan
The authors review their clinical experience with management of postoperative chylothorax among 97 patients. They favor duct ligation over embolization, and recommend intervention in patients with outputs greater than 1,100/day.
The authors demonstrate that use of an ultrasonic sealing device is safe for pulmonary artery branches 7 mm or less in diameter. This information could substantially reduce costs for lobectomy related to stapler use.
The authors explored the optimal extent of LN resection for T1aN0 carcinoid tumors undergoing lung resection using the National Cancer Data Base. Twenty-five percent of patients had no nodes evaluated. Four percent of patients were upstaged based on node status. Survival was similar comparing lobectomy to sublobar resection.
A good follow up for repair of mitral insufficiency due to excessive leaflet mobility, confirming good results for what appears again to be a not very lethal condition. (Be aware of the somewhat confusing abbreviation "MI" for mitral insufficiency.)
Rahmanian and colleagues retrospectively compared surgical outcomes and hemodynamics between rapid deployment aortic valve replacement (RDAVR) and standard AVR. The authors conclude that RDAVR required shorter aortic cross-clamp times and allowed for larger prostheses, achieving better hemodynamics than standard AVR. The two procedures had similar rates of postoperative complications.
A very brief editorial on frailty as a risk factor. In the time of weighing transcatheter interventions versus variable access surgical options, quantifying this physiological concept is of major importance for the cardiac teams and, importantly, the autonomy of the patient.
A refreshing brief editorial comment on hydrohemodynamics on the occasion of critiquing a manuscript on related echocardiographic computations in neonates. The focus is on the Laplacean principles of compliance/elastance applied to the left ventricle.
This is a meta-analysis of perioperative aspirin use. Preoperative aspirin use increased bleeding risk, but it did not increase the need for reexploration or red cell transfusion if the preoperative dose was lower than 160 mg/d. Aspirin use was associated with decreased mortality, acute kidney injury, and perioperative myocardial infarction.
Bjerregaard and colleagues evaluated methylprednisolone as an analgesic strategy following video-assisted thoracoscopic surgery (VATS) in a randomized controlled trial with 96 patients. Patients received either methylprednisolone or placebo prior to their VATS lobectomy. High-dose methylprednisolone reduced pain at rest and while sitting on the day of the procedure.
A handy free, short, good quality video on an open valve-in valve procedure.