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Journal and News Scan

Source: JACC
Author(s): Kuan Ken Lee, Amy V. Ferry, Atul Anand, Fiona E. Strachan, Andrew R. Chapman, Dorien M. Kimenai, Steven J.R. Meex, Colin Berry, Iain Findlay, Alan Reid, Anne Cruickshank, Alasdair Gray, Paul O. Collinson, Fred S. Apple, David A. McAllister, Donogh Maguire, Keith A.A. Fox, David E. Newby, Chris Tuck, Catriona Keerie, Christopher J. Weir, Anoop S.V. Shah, Nicholas L. Mills and on behalf of the High-STEACS Investigators

Using gender specific thresholds for abnormalities in cardiac troponin I, the rate of injury among women increased by 42%. This did not translate into improved management of women, who remained about half as likely to undergo revascularization, receive dual antiplatet therapy, or undergo other interventions.  

Source: Journal of Cardiothoracic and Vascular Anesthesia
Author(s): Meenal Rana, Hakeem Yusuff, Vasileios Zochios

A narrative review offering an intensivists' viewpoint  on specific cardiovascular sequela of double-lumen anaesthesia for pulmonary resections (and by extension, implantation of donor lungs) and other cardiothoracic and vascular operations.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Philip J. McCall, Alex Arthur, Adam Glass, David S. Corcoran, Alan Kirk, Alistair Macfie, John Payne, Martin Johnson, John Kinsella, Benjamin G. Shelle

An extremely interesting  research question abutting cardiac physiology, and a manuscript that may generate future additional clinical research.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Siva Raja, Sudish C. Murthy, Andrew Tang, Hafiz Umair Siddiqui, Malav P. Parikh, Usman Ahmad, Scott Gabbard, Prashanthi Thota, Monica N. Ray, Neha Wadhwa, Madhu R. Sanaka

Interesting sizeable series, and a commentary that follows, on what is effectively a thoracic example of Natural Orifice Transluminal Endoscopic Surgery (NOTES).

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Sebron Harrison, Tiany Sun, Mohamed K Kamel, Corbin Cleary, Brendon M Stiles, Nasser K Altorki, Art Sedrakyan

These incredible findings are the result of an analysis of the New York State Department of Health Statewide Planning and Research Cooperative database. These represent operations from 1995 to 2014 and represent over 99,000 major lung resections. Surgeons performing more than 30 lobectomies per year have a mortality of 1% and surgeons performing less than 12 per year have a mortality of 2.8%. But the most surprising fact is that the low volume surgeons performed 90% of the lobectomies. Do you agree with the results of this very large study and if you do, what do you think should happen about this? 

Source: JAMA Network Open
Author(s): Alan Rozanski, Chirag Bavishi, Laura D. Kubzansky, Randy Cohen

The association of cardiovascular events and all-cause mortality with optimism was assessed in this metaanalysis. Optimism was associated with a decreased risk of cardiovascular events (ROR 0.65) and a decrease in all-cause mortality (RR 0.86). Mechansims have yet to be identified.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Andras P. Durko, Stuart J. Head, Philippe Pibarot, Pavan Atluri, Vinayak Bapat, Duke E. Cameron, Filip P.A. Casselman, Edward P. Chen, Gry Dahle, Tjark Ebels, John A. Elefteriades, Patrizio Lancellotti, Richard L. Prager, Raphael Rosenhek, Alan Speir, Marco Stijnen, Giordano Tasca, Ajit Yoganathan, Thomas Walther, Ruggero De Paulis, EACTS–STS–AATS Valve Labelling Task Force

Excellent document from the EACTS, STS, and AATS emphasizing the importance of standardization of prosthetic heart valve labeling.

Source: The British Medical Journal
Author(s): Karla Solo, Shahar Lavi, Conrad Kabali, Glenn N Levine, Alexander Kulik, Ava A John-Baptiste, Stephen E Fremes, Janet Martin, John W Eikelboom, Marc Ruel, Ashlay A Huitema, Tawfiq Choudhury, Deepak L Bhatt, Nikolaos Tzemos, Mamas A Mamas, Rodrigo Bagur

This timely review examines the use of single and mutiple agents to decrease saphenous graft failure after CABG. These are difficult and expensive studies to perform, requiring repeat imaging after surgery, a procedure patients are often reluctant to undergo. In this analysis, the use of aspirin remains the lynchpin, with ticagrelor and clopidigrel as second agents improving outcomes, albeit at an increased in risk of bleeding.

Source: JAMA Internal Medicine
Author(s): Lily Meier, Elizabeth Y. Wang, Madris Tomes, Rita F. Redberg

Reporting of postmarket outcomes for the Sapien 3 and Mitraclip devices frequently misclassified patient deaths as device malfunction or other outcomes. Misclassification for Sapien 3 involved 17.5% of patient deaths, and involved 24.7% of patient deaths for Mitraclip. These outcomes are important for the public and physicians to understand when discussing risks and benefits of such devices. 

Source: TCTMD
Author(s): Michael O'Riordan

David Taggart, MD, PhD (University of Oxford, England), the chairman of the EXCEL surgical committee during the design and recruitment phase of the trial, believes the investigators downplayed the increased risk of all-cause mortality with PCI and oversold the reduced risk of the study’s primary composite endpoint of death, stroke, and MI, particularly since the benefit was largely driven by a higher risk of periprocedural MIs in the CABG arm. 

“I found it worrying that there seemed to be a strong signal here and I don’t think that was accurately reflected in the New England Journal of Medicine paper,” Taggart told TCTMD. “We’re not talking about two tablets for a headache. We’re talking about people dying. The data are the data, and that’s what the data show.

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