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Journal and News Scan
A most educative cross-Atlantic retrospective study on an always important question. The short accompanying video is also valuable!
Colleagues from Italy and Germany compared the short- and mid-term outcomes of the straight tube graft (David-I) and the Valsalva graft in 232 patients undergoing an isolated David procedure. The two groups did not differ significantly in 30-day mortality (1% vs 2%), late survival (p = 0.799), or valve-related reoperation (p = 0.241). Although with more cusp repairs (22% vs 4%), patients with Valsalva graft showed a higher incidence of aortic insufficiency ≥ II° after surgery (17% vs 0%) and at follow-up (39% vs 22%). This study also identified bicuspid aortic valve (OR = 3.435, p = 0.005) and postoperative aortic insufficiency ≥ II° (OR = 5.988, p < 0.001) as risk factors for reoperation on the aortic valve.
The authors in this study performed a post-hoc analysis of the coronary artery bypass grafting (CABG) cohort in the multicenter randomized EXCEL trial, comparing patients undergoing on-pump versus off-pump procedures for left main disease. Of note, in both groups some of the most experienced CABG surgeons in the world participated. The 3-year outcomes of the two CABG groups were compared using inverse-probability-of-treatment weighting for treatment effect estimation. For the 923 CABG patients, 71% and 29% underwent on-pump versus off-pump CABG, respectively.
Outcomes: Off-pump CABG was associated with a lower rate of revascularization of both the circumflex and right coronary artery territories in patients with obstruction of those territories. Moreover, the 3-year all-cause death was roughly double for the off-pump group as compared to the on-pump group (8.8% versus 4.5%, p = 0.02).
Retrospectively using a longitudinal echocardiography database, the authors analyzed the data of 3,276 patients with isolated severe tricuspids regurgitation (TR) from 2001 through 2016. Of these patients, 5% underwent tricuspid valve surgery. Within the group undergoing surgery, 84% of patients underwent a repair versus 16% who underwent a replacement. The authors found, in a propensity-matched sample, that there was no difference in long-term survival between patients treated medically versus surgically. In addition, there was no difference in survival between those undergoing repair versus replacement.
A detailed and robust meta-analysis asserting lack of strong evidence supporting either modality.
The authors in this study ask—given the known racial disparities in the US healthcare system—what happens in a universal insurance program like TRICARE in terms of quality of care after coronary artery bypass grafting (CABG)? Using the TRICARE database, the authors retrospectively analyzed the postoperative care of CABG patients using National Quality Forum metrics. They found that there were no risk-adjusted differences in outcomes between black and white patients.
Of what relevance are the results of this study, in terms of the impact of universal health insurance, on access to quality care based on race?
Ng and colleagues evaluated 145 studies in order to provide evidence-based statements on the optimal approach for lobectomy for non–small cell lung cancer, comparing thoracotomy, multiport video-assisted thoracic surgery (VATS), robotic VATS, and uniportal VATS. The authors considered which minimally invasive approach was associated with the best outcomes and fewest complications, which was optimal for lymph node evaluation, which was most compatible with required adjuvant therapy, and which approach most reduced pain and shortened the length of hospital stay compared to open techniques.
In this 5-year review covering multiple centers in Australia and New Zealand, the overall major complication rate related to new implanation of a pacemaker or ICD was 8.2%. Among hospitals performing implants there was a 3-fold range in the incidence of complications, indicating important variations in care quality.
The Throacic Surgery Residents Association (TSRA) Decision Algorithms in Cardiothoracic Surgery is a 100-chapter compendium with an individual algorithm for clinical decisions spanning the entire scope of cardiothoracic surgery. The resource was developed for cardiothoracic surgery residents by residents and cardiothoraicc surgery faculty. The TSRA Decision Algorithms in Cardiothoracic Surgery is fresh off the press and available for purchase on Amazon - https://www.amazon.com/TSRA-Decision-Algorithms-Cardiothoracic-Surgery-e...
Check out all the other resources available through the TSRA including, but not limited, to the following - https://www.tsranet.org/resources/tsra-resources-for-residents/
1. TSRA podcasts - https://soundcloud.com/tsrapodcast
2. TSRA Pocket Mentor - https://www.tsranet.org/wp-content/uploads/2017/07/7-2-TSRAPOCKETMENTOR.pdf
3. TSRA Intern Survival Guide - https://www.tsranet.org/wp-content/uploads/2016/09/TSRA-INTERN-SURVIVAL-...
4. TSRA Review of Cardiothoracic Surgery - https://www.amazon.com/TSRA-Review-Cardiothoracic-Surgery-2nd/dp/1523217...
5. Cardiopulmonary Bypass: A Primer - https://books.apple.com/us/book/cardiopulmonary-bypass-primer/id1024775439
6. TSRA Multiple Choice Review of Cardiothoracic Surgery - https://apps.apple.com/us/app/tsra-multiple-choice-review/id969793444
7. TSRA Primer of Cardiothoraicc Surgery - https://books.apple.com/us/book/tsra-primer-cardiothoracic/id679752158?m...
8. TSRA Clinical Scenarios in Cardiothoracic Surgery - https://www.amazon.com/TSRA-Clinical-Scenarios-Cardiothoracic-Surgery-eb...
9. TSRA Operative Dictations in Cardiothoracic Surgery - https://www.amazon.com/TSRA-Operative-Dictations-Cardiothoracic-Surgery/...
10. Fighting Fatigue: A Guide for Cardiothoracic Surgery Residents - https://www.tsranet.org/wp-content/uploads/2013/01/Fighting_Fatigue.pdf
And many more ...
In this brief review, the authors elaborate on status quo of the use of endovascular stent grafts in the management of patients with connective tissue disorders. Because the radial force and circumferential stress on the native aorta remains a signficant issue that leads to stent graft failure, open surgical repair remains the gold standard in most of such patients.