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Journal and News Scan

Source: Innovations
Author(s): Dunning, Joel ; Elsaegh, Mohamed ; Nardini, Marco ; Gillaspie, Erin A. ; Petersen, Rene Horsleben ; Hansen, Henrik Jessen ; Helsel, Bryan ; Naase, Hatam ; Kornaszewska, Malgorzata ; Will, Malcolm B.; Walker, William S. ; Wigle, Dennis; Blackmon, Shanda Haley

Microlobectomy is a novel form of VATS lobectomy.

This paper documents the experience of its use in England, at the Mayo clinic, in Copenhagen, in Edinburgh, Wales and in Texas.

The rules of microlobectomy are that you must perform no incisions greater than 5mm in the intercostal spaces, but the ports mirror your usual multiport approach. You use a subxiphoid incision to remove the lobe and perform the stapling, and there are hints and tips to make this easier at www.microlobectomy.com.

Let us know what you think ? Something new or just a mix of well tried and tested approaches ?

22% of patients went home day 1 and 42% day 2 so if nothing else it shows that well performed minimally invasive lobectomy results in very early discharges with good short term outcomes.

 

 

 

 

 

Source: Journal of the American Heart Association
Author(s): Zakeih Chaker, Vinay Badhwar, Fahad Alqahtani, Sami Aljohani, Chad J. Zack, David R. Holmes, Charanjit S. Rihal, Mohamad Alkhouli

The Nationwide Inpatient Sample (NIS) was queried for aortic valve replacements conducted between 2003 and 2014.  The data on a total of 166,809 patients (37% female) were analyzed with respect to outcomes in men vs. women.   Hospital mortality was 40% higher in women than men (5.6% v. 4%, p<0.001).   When isolated AVRs were analyzed and propensity-matched, hospital mortality was 14% higher in women than men (3.3% v. 2.9%, p=0.001).    The differential outcomes appear to be driven by a distinct risk profile.  

Source: The Daily Mail
Author(s): Helen Weather

NHS surgeon, 52, who earned £125,000 a year is sacked after blowing the whistle on shocking hospital malpractice - and now works as an Uber driver

  • Peter O'Keefe was sacked in 2015 by the Cardiff & Vale University Health Board
  • It came three years after he raised questions about patient safety at the hospital
  • The Health Board said he was fired after complaints that he bullied colleagues 
  • O'Keefe became an Uber driver and to his surprise - he's loving the new job

 

Source: Anaesthesia
Author(s): L. Lei, R. Katznelson, L. Fedorko, J. Carroll, H. Poonawala, M. Machina, R. Styra, V. Rao, G. Djaia

The authors conducted a double-blinded prospective, randomized clinical trial in 249 patients >60 years of age who underwent cardiac surgery with cardiopulmonary bypass to assess whether interventions based on cerebral oximetry would decrease the incidence of postoperative delirium.  Two groups were compared:  The control group, in which the results of cerebral oximetry were blinded, and the intervention group, in which an algorithm was instituted for oximetry values below 75% of baseline.  

Results:  Postop delirium occurred in 24.4%  and 24.6% of the intervention and control groups, respectively (p=0.97).  Thus, interventions based on cerebral oximetry data do not appear to alter the incidence of postop delirium.  Incidentally, a higher baseline cerebral oximetry value was associated with a lower incidence of postoperative delirium.

Source: News from around the web.
Author(s): Claire Vernon

Patient Care

Updated guidelines on dual antiplatelet therapy in coronary artery disease have been published by the European Association for Cardio-Thoracic Surgery and the European Society of Cardiology.

Heart patients at Mongkutwattana General Hospital in Bangkok, Thailand, will continue receiving percutaneous coronary interventions under the universal healthcare scheme, despite the hospital having a part-time rather than a full-time cardiothoracic surgeon.

Children’s Health in Dallas, Texas, joins hospitals in Washington, DC, and London, UK, in conducting radiation-free cardiac catheterization procedures.

 

Drugs and Devices

Medtronic has launched a post-market clinical study of its CoreValve Evolut Pro implant across 35 European centers.

 

Research, Trials, and Funding

Engineers and clinicians in Rochester, New York, were awarded a grant to develop a noninvasive medical technology for mobile devices that would detect atrial fibrillation.

A report finds that, between 2006 and 2014, lung cancer cases in Northern Ireland increased by more than 30%.

Source: The Thoracic and Cardiovascular Surgeon
Author(s): Georg Daniel Duerr, Jan-Malte Sinning, Armin Georg Welz, Fritz Mellert

Duerr and colleagues describe the experimental development of a mitral anuloplasty ring, which should facilitate later transcatheter valve-in-ring implantation. Two accompanying videos demonstrate valve expansion and implantation within the ring. The article illustrates the potential importance these new technologies are expected to gain in the near future.

Source: The Annals of Thoracic Surgery
Author(s): Vladimiro L. Vida, Lorenza Zanotto, Lucia Zanotto, Giovanni Stellin and the European Congenital Heart Surgeons Association (ECHSA) Study Group, Massimo Padalino, Georges Sarris, Eleftherios Protopapas, Carol Prospero, Christian Pizarro, Edward Woodford, Thomas Tlaskal, Hakan Berggren, Martin Kostolny, Ikenna Omeje, Boulos Asfour, Alexander Kadner, Thierry Carrel, Paul H. Schoof, Matej Nosal, Josè Fragata, Michał Kozłowski, Bohdan Maruszewski, Luca A. Vricella, Duke E. Cameron, Vladimir Sojak, Mark Hazekamp, Jukka Salminen, Ilkka P. Mattila, Julie Cleuziou, Patrick O. Myers, Viktor Hraska

Vida and colleagues retrospectively reviewed 111 left-sided reoperations after an arterial switch operation (ASO) across 17 ECHSA centers between 1975 and 2010. The authors found a low reoperation frequency of 1.4% after ASO. Initial diagnosis of D-transposition of the great arteries (D-TGA) was more common among patients who required reoperation than was diagnosis of double-outlet right ventricle TGA-type, however a greater percentage of the latter group encountered postoperative complications (5 of 12, versus 16 of 99). The majority of survivors were asymptomatic at last follow-up, with only 13% in New York Heart Association class II and only 3% in class III.

CME related to this article is available through The Annals' website.

Source: BioMed Central
Author(s): Policlinico University Hospital, University of Catania, Morgani Institute, Policlinico Giaccone, University of Palermo (Italy). Main Contact: Prof. Marcello Migliore.

We urgently need more answers for the patients affected by mesothelioma, a devastating diasese whose prognosis is 6-9 months from the diagnosis. We are now living the era of plateau of the epidemiology due to industrial use of amiantus of the last century. Furthermore, there are other etiology than asbestos in endemic areas, like for example the natural exposure to fluoro-edenite of certain regions of Japan and Sicily. We do need more informatinos to direct the difficult management of all these individuals and there are many ongoing studies where surgery is considered a valid option. This trial will compare the outcome of 2 groups: the first group will have a debulking surgery and hyperthermic intraoperative intrathoracic chemotherapy (HITHOC) with cisplatinum while the second group will receive talc pleurodesis alone. The primary outcomes measured will be length of hospital stay, quality of life, and long-term survival.

Source: World Journal for Pediatric and Congenital Heart Surgery
Author(s): Connor Patrick Callahan, MD, David Saudek, Amanda Shillingford, Sara Creighton, Garick Hill, William K Johnson, PhD, James Tweddell, Michael E. Mitchell, Ronald Woods

This single institution observational study compares clinical outcomes and resource utilization associated with two surgical approaches for single-stage repair of coarctation of the aorta and ventricular septal defect. Authors found that single-stage two-incision repair of both defects in appropriately selected patients may be associated with higher value of care compared to single-stage one incision repair.

Source: Annals of Thoracic Surgery
Author(s): Dhaval Chauhan, MD, Alexis K. Okoh, MD, Setri Fugar, MD, Rivandra Karanam, MD, David Baran, MD, Mark Zucker, MD, Magarita Camacho, MD, Mark J. Russo, MD

The authors queried the UNOS heart transplantation database to determine if LVAD device-related complications (DRCs) were associated with worse postoperative graft survival.  The 5 categories of DRCs were as follows:  device thrombosis, infection, device malfunction, life-threatening arrhythmias, and others.  

Results:  None of the 5 categories of DRCs was associated with worse graft survival on multivariate analysis.

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