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Journal and News Scan
January 12, 2018
Submitted by: Mark Ferguson
The authors summarizes a personal experience with 529 patients undergoing VATS operations under local anesthesia and sedation. No nerve block, epidural, laryngeal mask airway, or endotracheal intubation was used. Indications were lung nodule, hemothorax, empyema, pleural effusion, pericardial effusion, chylothorax, etc. There was one unsuccessful attempt using this technique.
January 11, 2018
Submitted by: Claire Vernon
De Beaufort and colleagues assessed the outcomes of acute aortic dissections in 258 consecutive patients with Marfan syndrome in the International Registry of Acute Aortic Dissection (IRAD) database, comparing these with the dissection outcomes in the general population. Patients with Marfan syndrome were younger and had fewer comorbidities. In-hospital mortality rates were lower for patients with Marfan syndrome than for the general population (10.9% versus 16.9%, p = 0.01). There was lower mortality after open surgical repair of type B aortic dissection when compared to the general population (0% versus 17.6%, p = 0.011). As expected, the freedom from reintervention in the cohort of patients with Marfan syndrome was significantly less than in the general population (44.7% versus 81.5%, p<0.001).
January 10, 2018
Submitted by: Claire Vernon
Folliguet and colleagues report on 145 patients from three French centers who underwent transcarotid aortic valve implantation. The procedures were successful in all. Eight patients suffered a stroke, and one patient had a localized carotid dissection. There were no intraoperative conversions and no postoperative respiratory complications were observed.
Office-Based Spirometry: A New Model of Care in Preoperative Assessment for Low-Risk Lung Resections
January 10, 2018
Submitted by: Mark Ferguson
The authors compared low risk patients undergoing office spirometry only (FEV1 of >60%) to those undergoing laboratory spirometry followed by lung resection. Outcomes for propensity score matched patients were similar for complications, length of stay, and readmission. Use of office-based spirometry was estimated to save their insitution $38,000 annually.
January 10, 2018
Submitted by: Mark Ferguson
Among patients aged 65 and older undergoing lung resection for NSCLC, long-term survival was related to cancer stage and patient age. Lobectomy patients fared better than those undergoing parenchymal-sparing resections or pneumonectomy. VATS approaches provided better long-term survival.
January 10, 2018
Submitted by: Mark Ferguson
The authors review their clinical experience with management of postoperative chylothorax among 97 patients. They favor duct ligation over embolization, and recommend intervention in patients with outputs greater than 1,100/day.
Phase 1 Trial Evaluating Safety of Pulmonary Artery Sealing With Ultrasonic Energy in VATS Lobectomy
January 10, 2018
Submitted by: Mark Ferguson
The authors demonstrate that use of an ultrasonic sealing device is safe for pulmonary artery branches 7 mm or less in diameter. This information could substantially reduce costs for lobectomy related to stapler use.
January 10, 2018
Submitted by: Mark Ferguson
The authors explored the optimal extent of LN resection for T1aN0 carcinoid tumors undergoing lung resection using the National Cancer Data Base. Twenty-five percent of patients had no nodes evaluated. Four percent of patients were upstaged based on node status. Survival was similar comparing lobectomy to sublobar resection.
January 10, 2018
Submitted by: Aristotle Protopapas
A good follow up for repair of mitral insufficiency due to excessive leaflet mobility, confirming good results for what appears again to be a not very lethal condition. (Be aware of the somewhat confusing abbreviation "MI" for mitral insufficiency.)
January 8, 2018
Submitted by: Claire Vernon
Rahmanian and colleagues retrospectively compared surgical outcomes and hemodynamics between rapid deployment aortic valve replacement (RDAVR) and standard AVR. The authors conclude that RDAVR required shorter aortic cross-clamp times and allowed for larger prostheses, achieving better hemodynamics than standard AVR. The two procedures had similar rates of postoperative complications.