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Journal and News Scan

Source: Cardiovascular Business
Author(s): Michael Walter

Transcatheter aortic valve replacement (TAVR) is not inferior to surgical aortic valve replacement (SAVR) when it comes to all-cause mortality after one year. This is among moderate-risk patients with severe, symptomatic aortic stenosis (AS). According to a new analysis published in JAMA,  a close comparison revealed that each treatment option is associated with certain benefits over the other.

Source: Medscape
Author(s): Patrice Wendling

A recent ISCHEMIA trial substudy is under scrutiny from surgeons for a discrepancy in data. This has rekindled concerns about reliance on the landmark trial data in the newest coronary revascularization guidelines. CTSNet recently recently published a webinar on this topic featuring leading CT surgeons around the globe.

Source: The New England Journal of Medicine
Author(s): Edward C. Traver, Nina J. Gao

Gripping vignette of a fatal case of renocardiac pathologies. The stills from the (sadly non-contrast) CTA are most interesting.

Source: Journal of Cardiac Surgery
Author(s): Adam Eqbal, Saurabh Gupta, Ameen Basha, Yuan Qiu, Nicole Wu, Filip Rega, Fan Victor Chu, Emilie P Belley-Cote, Richard Whitlock

Meta-analysis of 119 studies (approx 38,000 patients) evaluating outcomes of minimally invasive mitral valve surgery with conventional sternotomy approach.
MMVS was associated with fewer days in hospital (RCT: MD: -2.2 days, 95% CI, [-3.7 to -0.8]; observational: MD: -2.4 days, 95% CI, [-2.7 to -2.1]). Observational studies suggested that MMVS reduced transfusion requirements with fewer units transfused per patient (MD: -1.2; 95% CI, [-1.6 to -0.9]) and fewer patients transfused (RR, 0.7; 95% CI, [0.6-0.7]). Observational data also suggested lower mortality with MMVS (RR, 0.6; 95% CI, [0.5-0.7], p < .001, I2 = 0%), but this was not corroborated by RCT data. The risk of postoperative mitral regurgitation (≥2+ or requiring re-intervention) did not differ between the two groups.

Source: Annals of Thoracic Surgery
Author(s): Marlena E. Sabatino, BA Matthew L. Williams, MD Ike S. Okwuosa, MD Ehimare Akhabue, MD Jung Hyun Kim, PhD, MPH Mark J. Russo, MD

Data from Scientific Registry of Transplant Recipients was modeled over 30 years to evaluate temporal trends, as well as graft survival.
Among 56,488 primary adult heart recipients, we observed 5529 (9.8%) all-cause deaths and 1933 (3.4%) graft failure events within 6 months posttransplant. Prevalence of known recipient risk factors increased over time. Unadjusted modeling demonstrated a significant 30-year improvement in graft survival, averaging 2.6% per year (95% confidence interval, 2.4-2.9; P for trend < .001). After adjusting for population changes the 30-year trend remained significant and graft survival improved on average 3.0% per year (95% confidence interval, 2.6-3.3). Regression modeling identified multiple predictors of graft survival. Modeling 2 additional outcomes of 6-month mortality and 6-month graft failure produced similar results.

Source: JTCVS
Author(s): Nirav C. Patel, MD Jonathan M. Hemli, MD Karthik Seetharam, MD Varinder P. Singh, MD S. Jacob Scheinerman, MD Luigi Pirelli, MD

Retrospective review (propensity-matched) comparing patients undergoing PCI vs minimally invasive CABG for complex LAD lesions.
Overall 9-year survival was not significantly different between patient groups both before and after propensity matching. Midterm mortality in the matched minimally invasive direct coronary artery bypass group was low, irrespective of patient risk profile. By contrast, advanced age (hazard ratio, 1.10; P = .012) and obesity (hazard ratio, 1.09; P = .044) predicted increased late death after drug-eluting stent percutaneous coronary intervention among matched patients. Patients who underwent minimally invasive direct coronary artery bypass were significantly less likely to require repeat left anterior descending revascularization than those who had percutaneous coronary intervention, both before and after propensity matching. Smaller stent diameter in drug-eluting stent percutaneous coronary intervention was associated with increased left anterior descending reintervention (hazard ratio, 3.53; P = .005).

Source: tctMD
Author(s): Yael L. Maxwell
A new “aspirational” document delivers some goals for multidisciplinary discussions, but its relevance on the global stage is unclear.
Source: The Annals of Thoracic Surgery
Author(s): Aaron R. Dezube, MD Emanuele Mazzola, PhD Ashley Deeb, MD Daniel C. Wiener, MD M. Blair Marshall, MD Mathew W. Rochefort, MD Michael T. Jaklitsch, MD

Recommendations for intraoperative lymph node evaluation are uniform regardless of whether a primary tumor is clinical T1a or T2a according to TNM 8th edition for stage I non-small cell lung cancer (NSCLC). We quantified nodal disease risk in patients with T1a disease (≤1 cm).

Source: Surgery in Practice and Science
Author(s): Lin Y, Gergen A, Sperry A, Pal, J, Downs E, Han J.

Lack of prioritization of simulation activities is commonly reported by trainees for a variety of reasons, including time constraints and perceived translational benefit. These barriers become even more pronounced in low-income countries with limited healthcare resources, as the current era of simulation-based training often requires substantial investments of time, money, and teaching personnel [4,5]. 

A low-fidelity compact simulator with all necessary instruments and materials contained within a 12.5-inch toolbox was utilized by thirty general surgery residents from an academic medical center with instruction  on how to perform two different vascular anastomoses. Participants were then sent an anonymized survey evaluating its practicality and helpfulness. 

Further, as a global health equity initiative, current efforts include implementing a “make one locally, give one globally” approach, whereby training programs can assist in creating additional simulators and distributing them to partner surgical training programs in low- and middle-income countries.

 

 

Source: The Annals of Thoracic Surgery
Author(s): Emily Shih, MD John J. Squiers, MD J. Michael DiMaio, MD Timothy George, MD Jasjit Banwait, PhD Kara Monday, MD Britton Blough, MD Dan Meyer, MD Gary S. Schwartz, MD

Extracorporeal membrane oxygenation (ECMO) can be effective for refractory acute respiratory distress syndrome (ARDS) in patients with influenza, but its utility in patients with coronavirus disease 2019 (COVID-19) is uncertain. We compared outcomes of patients with refractory ARDS from COVID-19 and influenza placed on ECMO.

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