Journal and News Scan

Social media offers enormous potential benefits for both care providers and patients, because the platform allows for the dissemination and gathering of information and has the innate ability to network globally. The Cardiothoracic (CT) Ethics Forum functions as the ethics educational arm for the CT surgical community, producing ethics-related programs at major CT surgery meetings and subsequently publishing articles on those proceedings as well as ethical topics in CT surgical and other medical specialty journals. The Forum has constructed a very important and useful set of recommendations for CT surgeons as they engage with social media.

This is a cohort study from the Pediatric Cardiac Care Consortium based on data from 616 patients with pulmonary atresia with intact ventricular septum (PA/IVS) treated between 1982 and 2003. Median follow-up was 16.7 years (IQR 12.6-22.7).

Initial interventions included aortopulmonary shunt in 247, right ventricular decompression in 96, and both in 273. Risk factors for death at initial intervention included earlier birth era (1982-1992), chromosomal abnormality, and atresia of one or both coronary ostia. Among 494 survivors of neonatal hospitalization, there were 99 deaths (4 posttransplant) and 10 transplants (median age of death or transplant 0.7 years, IQR, 0.3-1.8). Definite repair or last-stage palliation was achieved in the form of completed 2-ventricle repair (n=201), one-and-a-half ventricle (n=39), or Fontan (n=96). Overall 20-year survival was 66%, but for patients discharged alive after definitive repair, it reached 97.6% for single-ventricle patients, 90.9% for those with one-and-a-half ventricle, and 98.0% for those with complete 2-ventricle repair (log-rank p=0.052).

The authors conclude that transplant-free survival in PA/IVS is poor due to significant infantile and interstage mortality. Survival into early adulthood is excellent for patients reaching completion of their intended treatment path, independent of type of repair.

Migally and colleagues retrospectively evaluated data from the Pediatric Heart Network Single Ventricle Reconstruction trial to determine whether regional cerebral perfusion (RCP) affected outcomes for neonates undergoing the Norwood operation. A total of 549 patients were included in the analysis, with 45.9% of them receiving RCP during their procedure. The authors found that RCP use was not associated with mortality and/or need for heart transplant, prolonged mechanical ventilation, or prolonged length of hospital stay. It was associated with longer cardiopulmonary bypass times, increased use of ultrafiltration, and a higher probability of open chest after the procedure, however the authors also noted a strong association between lower procedural volume and use of RCP.

Verdial and colleagues prospectively characterized the performance of a guideline-recommended invasive mediastinal staging (IMS) strategy in detecting nodal disease among 123 patients with non–small cell lung cancer (NSCLC). While the guideline-recommended approach identified all patients with true nodal disease, it also selected 65% of patients without nodal disease to undergo IMS. Toward the goal of reducing the usage of invasive procedures in patients with node-negative NSCLC, the authors developed a prediction model composed of five radiographic factors. They found that their prediction model maintained the sensitivity of the guideline-recommended IMS strategy (within a margin of error) while selecting fewer patients without nodal disease to undergo invasive staging. The authors note the need for the model to be independently validated in other cohorts.