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Journal and News Scan
This Stanford group retrospectively reviewed their experience over a 10-year period with 293 patients who underwent either limited aortic root repair or root replacement.
- No significant difference in weighted perioperative mortality.
- No significant difference in weighted survival.
- However, there was a significantly higher rate of later reoperation in the limited root repair group (11% versus 0%, p<0.001).
The authors present a thorough expert consensus review on the prevention—preoperative, intraoperative, and postoperative—and the postoperative management of sternal wound infections. The authors conclude with a guideline with class recommendations and levels of evidence.
This article should be in every cardiac surgeon's armamentarium.
This single-center group retrospectively reviewed their experience (2004-2014) with at least two arterial conduits for triple-vessel coronary artery disease to assess the benefit of adding a third arterial conduit versus a venous conduit to the right-sided circulation. A total of 167 propensity-matched pairs were compared. In this small study comparing intermediate survival, no benefit of adding a third arterial conduit was appreciated (HR 0.72, p = 0.411).
The EJCTS and ICVTS are publishing a series of Statistical Primers to help clinicians perform and interpret research. In the first series of primers, Buccheri and coauthors provide a conceptual framework for conducting, interpreting, and critically evaluating meta-analyses. With an increasing number of meta-analyses being performed, it is crucial for surgeons to increase their understanding of the methodology.
A retrospective Mount Sinai small series on selective emergent implantation of long-term ventricular assist devices in cardiogenic shock. It challenges the traditional concept of short-term stabilisation with ECMO or short-term support, and is likely to generate criticism and discussions.
The Mayo Clinic team retrospectively reviewed their experience with isolated CABG for multivessel coronary artery disease over a 15-year period to assess usage of bilateral internal mammary arteries (BIMA) and selected outcomes. The population included a total of 6468 isolated CABG procedures.
Some of the salient findings from their study are:
- The use of BIMA doubled over the most recent 4-year period (13% to 27%).
- Propensity-matched patients exhibited a survival advantage for BIMA patients, with a hazard ratio of 0.81.
- Sternal infection was not significantly higher in the BIMA group.
The authors conclude that BIMA use should be encouraged and expanded.
The authors retrospectively examined the mid-term outcomes in 34 patients who required stabilization of the sternum with the Synthes Titanium Sternal Fixation System for either established sternal dehiscence or high risk for sternal dehiscence. Reported outcomes (at a median follow-up period of 1.4 years) were as follows:
- All patients had stable sternums on physical exam.
- Bone consolidation assessment by CT scans on follow-up showed: complete consolidation of bone in 26% of patients, near-complete in 39%, partial in 10%, and missing in 26%.
- 13 patients (38%) required plate removal for either pain or infection.
While thoracic stabilization was thus achievable, the authors caution that the non-negligible complication rate should reserve plating for patients at high risk for dehiscence and who are unsuitable for standard closure.
Weder and colleagues present a debate addressing surgery versus stereotactic body radiotherapy as the primary treatment of early-stage lung cancer. Arguments relating to outcome and the impact on further therapy are given by both surgeons and radiation oncologists.
A succinct, readable, and well-referenced editorial on extending criteria for surgery on bicuspid aortopathy below the threshold of 4.5 cm diameter. It is even more interesting in the era of increasing industry pressure for transcatheter aortic valve replacement.