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Journal and News Scan
This review details the risks of surgical smoke exposure, which include lung injury and cancer. The level of risk has yet to be determined. Most operating rooms do not require smoke evacuation devices, but their use should be considered.
In this best evidence topic paper, the authors examined outcome and safety of innominate artery cannulation versus axillary artery cannulation in thoracic aortic surgery. There were no significant differences in mortality with innominate artery cannulation compared to axillary artery cannulation. In most studies, a stroke occurred slightly less frequently in patients receiving innominate artery cannulation compared to axillary artery cannulation. The authors conclude that innominate artery cannulation is noninferior to axillary artery cannulation.
Gershengorn and colleagues evaluated the incidence and safety of overnight extubation following coronary artery bypass grafting (CABG), using retrospective data from The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Between 2014 and 2017, 42% of patients undergoing elective CABG had an overnight extubation, a rate that the authors report is similar to patients undergoing other cardiac procedures. For patients who had mechanical ventilation duration of six to eight hours, overnight extubation was associated with increased reintubation and longer intensive care unit stays, but less reintubation and reduced length of stay were observed for patients extubated overnight who had mechanical ventilation durations between nine and 20 hours. No difference in mortality was noted with overnight extubation, and the authors conclude that the practice is prevalent after cardiac surgery and that it is associated with little risk.
Using an approach that minimizes valve depth relative to the membranous septum, the authors reduced the need for permanent pacemaker placement to a reliable and predictable 3% compared to the accepted standard of 10%.
An interesting meta-analysis discouraging perhaps the use of this KATP modulator, especially after surgical revascularization where optimization of serum potassium is generally sought.
Dartmouth-Hitchcock Heart and Vascular Center, through support from the National Institutes of Health and the Cardiothoracic Surgical Trials Network, announces a call for applications for the Dartmouth National Implementation Science Program (NISP) Scholar in cardiothoracic surgery – an innovative translational research program designed to train the next generation of clinical investigators. The program can be completed during residency and particularly seeks applications from women and underrepresented minorities. More information on the program and application materials can be found at: https://www.hvcresearch.com/implementation-science.html Applications are due by October 1, 2019.
Using data from more than 3.3 million patients in the NCDR CathPCI Registry, researchers used machine learning to develop an algorithm that predicts post-PCI major bleeding with a C-statistic of 0.82.
In an era of increased use of MitraClip, surgical mitral valve repair still offers a durable solution. Tirone David and colleages report 1,234 consecutive patients who had mitral valve repair with 20 year follow-up.
Zhang and colleagues examined serum biomarker levels in patients undergoing a lobectomy using video-assisted thoracic surgery. Among 626 patients, they found that preoperative serum LDH was an independent predictor of 90-day cardiopulmonary complications. The authors recommend including LDH measurements in the risk assessment process prior to major lung resection.
Egyud and colleagues evaluated plasma levels of circulating tumor (ct)DNA in patients with esophageal adenocarcinoma, ranging from stage I to stage IV. The quantity of ctDNA and likelihood of ctDNA detection was greater at later stages, suggesting that it may be challenging to use for early-stage diagnosis. However, changes in ctDNA levels were indicative of response to therapy and recurrence, and the authors conclude that they may serve as a dynamic biomarker to monitor a patient’s response to treatment.