Journal and News Scan

The optimal revascularization strategy after extracorporeal cardiopulmonary resuscitation (ECPR) remains unclear, with limited existing data. This study compared outcomes for patients who underwent coronary artery bypass grafting (CABG) and those who received percutaneous coronary intervention (PCI) after ECPR using databases from two referral centers. Forty patients in each category were compared. Researchers found that the CABG group had better early outcomes (hospital survival- 56.4 percent vs 32.4 percent, p = 0.04 and success of ECPR weaning: 71.1 percent vs 48.7 percent, p = 0.05) compared to the PCI group. Late outcomes were similar among groups, although the PCI group appeared to have more endovascular interventions.

Minimally-invasive pulmonary segmentectomy is an effective method for treating selective cases while preserving lung parenchyma and minimizing perioperative morbidity and length of hospital stay. A fully thoracoscopic multiport approach is often preferred due to its straightforwardness and flexibility, allowing adaptation to unexpected intraoperative findings.  

The S1 (apical) segment of the right upper lobe poses challenges for a conventional anterior approach due to its complex vascular anatomy. A posterior approach may address these challenges by providing direct access to the segmental bronchus and better alignment for dissection for the apical artery, however, success depends on individual anatomy.  

Chronic lung allograft dysfunction (CLAD) is associated with significant morbidity after lung transplantation, however, at the time of diagnosis of CLAD, the disease process has usually adversely impacted graft function. The authors studied a scoring system based on the Airway Inflammation 2 (AI2) gene set and found that this score predicted time to graft failure as well as retransplant free survival in patients with CLAD, as compared to a validation cohort that included non-CLAD patients. Although there may be a component of survival bias during matching, this is a highly interesting area of research that could have important clinical implications in early identification of CLAD. 

Congenital and pediatric cardiac surgery are among the most complex, high-stake medical specialties, which requires exceptional cognitive and technical skills. Despite advances in technology and patient safety, the training for future surgeons in this field faces significant challenges. Issues include the increasing complexity of surgeries, reduced opportunities for simpler cases, strict work hour regulations, and public scrutiny of outcomes. These factors contribute to a crisis in training, with many trainees and young surgeons expressing dissatisfaction. 

Mentorship is crucial in overcoming these challenges. It involves a stepwise approach to teaching surgical skills, ongoing guidance during early years of practice, and leadership training for managing interdisciplinary teams. Effective mentorship not only improves technical proficiency but also enhances emotional intelligence and resilience. Despite the lack of tangible rewards and the significant time commitment required, mentoring enriches both the mentor and mentee, ultimately benefiting patient care and advancing the field.