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Journal and News Scan

Author(s): Babu Naidu and the Birmingham Heartlands Hospital

Check out this very interesting website that has been set up to help patients who are looking for information on thoracic surgery prior to an operation. 

It is really friendly and comprehensive and is a great resource for all patients who may want to find out more about their  operation. 

Source: Injury
Author(s): Fredric M. Pieracci, , , Sarah Majercik, Francis Ali-Osman, Darwin Ang, Andrew Doben, John G. Edwards, Bruce French, Mario Gasparri, Silvana Marasco, Christian Minshall, Babak Sarani, William Tisol, Don H. VanBoerum, Thomas W. White

These guidelines are intended to be a detailed, evidence-based resource for surgeons who practice SSRF. The goal of the author group was to both update and expand upon previous guidelines by focusing on SSRF specifically and incorporating the rapid increase in both literature and technology observed over the last five years.

Source: World Journal for Pediatric and Congenital Heart Surgery
Author(s): Anthony A. Sochet, MD, MSHS, Alexander M. Cartron, BS, Aoibhinn Nyhan, BS, Michael C. Spaeder, MD, Xiaoyan Song, PhD, Anna T. Brown, MD, and Darren Klugman, MD

A retrospective, matched cohort study to determine attributable hospital costs associated with surgical site infection after pediatric cardiothoracic surgery was performed. Of the 981 surgical cases within the study period, 12 with surgical site infection were identified. Compared to individually matched controls, children with surgical site infection had an associated increase in hospital costs of $136,950/case and hospital length of stay of 9.5 days/case. These data stress the importance of infection surveillance and prevention.

Source: Canadian Journal of Cardiology
Author(s): Nagpal AD, Singal RK, Arora RC, Lamarche Y

The authors of this review article offer an approach to the utilization of a contempory mechanical circulatory support devices.  They further provide insights of the key role that well-functioning interdisciplinary teams contribute to the success of a MCS program and future directions to consider as this field continues to rapidly evolve.

Source: Canadian Journal of Cardiology
Author(s): Beaubien-Souligny W, Bouchard J, Desjardins G, Lamarche Y, Liszkowski M, Robillard P, Denault A.

Appropriate perioperative fluid management is of increasing interest for the team caring for  the critically ill cardiac patient as fluid overload has been shown to have negative effects on organ function.  The Authors provide the reader with practical ultrasonographic techniques to examine patients for signs of extracardiac fluid overload and how to use this information to tailor management for the patient in a cardiac ICU.

Source: Canadian Journal of Cardiology
Author(s): Arora RC, Djaiani G, Rudolph JL

In this is review article the authors have proposed a "3-strike" model of risk that increases the likelihood of experiencing postoperative delirium in older adults undergoing cardiac surgery. The 3 strikes consists of a baseline vulnerability (such as frailty), the intraoperative surgical stressor and the postoperative hemodynamic perturbations (and other process of care factors) that can contribute to the occurance of postoperative delirium. Pratical tips on how cardiac team can begin to address this important issue are provided in this review.

Source: Annals of Thoracic Surgery
Author(s): Keti Vitanova, Julie Cleuziou, Jelena Pabst von Ohain, Melchior Burri, Andreas Eicken, Rüdiger Lange

The authors assessed the influence of patch material type on the incidence of recoarctation in infants undergoing Norwood I repair for hypoplastic left heart syndrome.  Among 145 patients, recoarctation developed in 18% at a median of 4.3 months.  At 2 years, freedom from recoarctation was about 85% for homograft and autologous pericardium, whereas it was 30% for equine pericardium; use of the latter was the only risk factor for recoarctation in multivariable analysis.

Source: Annals of Thoracic Surgery
Author(s): Heather L. Lander, Julius I. Ejiofor, Siobhan McGurk, Kaneko Tsuyoshi, Prem Shekar, Simon C. Body

The authors investigated the efficacy of vancomycin paste applied to the sternal edges during cardiac surgery in reducing the risk of deep sternal wound infection among nearly 14,500 cardiac surgical patients.  The incidence of such infections was 09.%.  In a multivariable analysis, BMI, NYHA class, and the STS DSWI risk index were significantly associated with deep sternal wound infection.  Vancomycin paste did not reduce the incidence of infection.

Source: Annals of Thoracic Surgery
Author(s): Nikola Dobrilovic, Jaishankar Raman, James G. Fingleton, Andrew Maslow, Arun K. Singh

Mitral valve surgery complicated by atrioventricular groove disruption has a high mortality rate.  The authors describe results of an external repair for this injury, directly suturing the atrioventricular groove.  In a 20-year experience involving over 3,000 mitral valve operations, 13 such injuries occurred.  30-day and hospital mortality were 15% and 23%.  1-year survival was 73%.   The external repair approach appears to offer favorable results after this devastating complication.

Source: Annals of Thoracic Surgery
Author(s): Adnan M. Al-Ayoubi, Sadiq S. Rehmani, Catherine F. Sinclair, Robert S. Lebovics, Faiz Y. Bhora

Using pigs as an experimental model, the authors demonstrated incorporation of bioengineered tracheal grafts in large tracheal defects.  The grafts were constructed of acellular bovine dermis extracellular matrix and human mesenchymal stem cells incubated with chondogenic factors.  The authors demonstrated that the use of stem cells resulted in chondrogenesis, and that the grafts developed neovascularization and epithelialization, all of which are important in supporting tracheal healing and growth.