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Journal and News Scan

Source: The New England Journal of Medicine (NEJM)
Author(s): Jason G. Andrade, George A. Wells, Marc W. Deyell, Matthew Bennett, Vidal Essebag, Jean Champagne, Jean-Francois Roux, Derek Yung, Allan Skanes, Yaariv Khaykin, Carlos Morillo, Umjeet Jolly, Paul Novak, Evan Lockwood, Guy Amit, Paul Angaran, John Sapp, Stephan Wardell, Sandra Lauck, Laurent Macle, Atul Verma. for the EARLY-AF Investigators

A Canadian multi-centre RCT of immediate baloon-cryoablation of the pulmonary veins: the intervention was compared to the relevant standard of pharmacological care. The target population was treatment-naive sufferers of de novo paroxysmal atrial fibrillation. The recruitment was successful, and unrestricted funding was secured from the healthcare device industry. The freedom from asymptomatic and symptomatic paroxysms of atrial fibrillation appeared improved at one-year follow-up.
It would be very interesting to additionally see the cardiovascular outcomes of the cohort, the thromboembolic events in particular, given that the subjects remained free from the atrial fibrillation for 99% of that year (having been continuously monitored).
The trial holds some interest for the cardiovascular surgeons practising ablation: The publication comes in the wake of a manuscript suggesting there is an underutilization of ablation during mitral surgery. (https://www.ctsnet.org/jans/variability-and-utilization-concomitant-atri...)

Source: The Annals of Thoracic Surgery
Author(s): J. Hunter Mehaffey, MD, MSc, Elizabeth Krebs, MD, MSc, Robert B. Hawkins, MD, MSc, Eric J. Charles, MD, PhD, Shawn Tsutsui, BS, Irving L. Kron, MD, Alan M. Speir, MD, Mohammed Quader, MD, Leora Yarboro, MD, Kenan Yount, MD, MBA, and Gorav Ailawadi, MD

This study looked into the implementation of concomitant surgical ablation for atrial fibrillation during mitral valve surgery.

Source: Journal of Thoracic Oncology
Author(s): Jean-Louis Pujol, Pascal-Alexandre Thomas, Philippe Giraud, Marc G. Denis, Brigitte Tretarre, Benoît Roch, Sebastien Bommart

An open-access detailed editorial from the official periodical of the International Association for the Study of Lung Cancer

Source: The Annals of Thoracic Surgery
Author(s): Zara Khachatryan, Josephina Haunschild, Konstantin von Aspern, Michael A. Borger, Christian D. Etz

This is a comprehensive review on ischemic spinal cord injury following of descending and thoracoabdominal aortic repair, including monitoring, early diagnosis, blood and cerebrospinal fluid biomarkers, and preventive measures. 

Source: European Journal of Vascular & Endovascular Surgery
Author(s): Stavros K. Kakkos , Manjit Gohel , Niels Baekgaard , Rupert Bauersachs, Sergi Bellmunt-Montoya , Stephen A. Black , Arina J. ten Cate-Hoek , Ismail Elalamy , Florian K. Enzmann , George Geroulakos , Anders Gottsäter, Beverley J. Hunt, Armando Mansilha , Andrew N. Nicolaides , Per Morten Sandset , Gerard Stansby , ESVS Guidelines Committee , Gert J. de Borst, Frederico Bastos Gonçalves, Nabil Chakfé, Robert Hinchliffe, Philippe Kolh, Igor Koncar, Jes S. Lindholt, Riikka Tulamo, Christopher P. Twine, Frank Vermassen, Anders Wanhainen, Marianne G. De Maeseneer, Anthony J. Comerota, Peter Gloviczki, Marieke J.H.A. Kruip, Manuel Monreal, Paolo Prandoni, Melina Vega de Ceniga

A recent European consensus paper. Relatively easily read, and favouring meta-analyses over randomised trials. The bulk of the manuscript is of interest to all healthcare providers. The chapters 2.8.1 and 3.1.2 are of additional relevance to the ctsnet readership, as they summarise guidance on interventions. The chapter 2.3.4.2manucript is also of value with regards to reversal of novel oral anticoagulants.

Source: European Journal of Vascular & Endovascular Surgery
Author(s): Philippe Charbonneau, Tilo Kölbel, Fiona Rohlffs, Wolf Eilenberg, Olivier Planche, Matthias Bechstein, Robin Ristl, Roger Greenhalgh, Stephan Haulon, on behalf of STEP collaborators

Advances in neuromonitoring and related screening by imaging constitute an expanding field of cardiovascular perioperative care, attracting the readership of interventional and conventional surgical providers. This pilot retrospective case series from two European hospitals provides some up to date insight to cerebral findings that are by and large 1:  bi-spherical (and hence difficult to attribute to particle or gaseous embolization) and 2: anatomically related to the middle cerebral artery. It will be useful to discern , in this or a larger cohort of the 'Stroke from thoracic endovascular procedures' Registry, the theory and causation of the 'silent' (albeit including two TIA's and one possible paraplegic) bilateral lesions, and any association to current endovascular practice : a simple research idea would be to re-scan the subjects and obtain a robust neurocognitive follow-up by any of the relevant batteries ( sickness-impact-profile , Hopkins Verbal Learning Test, Rey Auditory Verbal Learning Test or other questionnaire ). The interval between TEVAR and imaging may have masked Transient Neurological Events. The exact anatomy, especially the variations of the Circe of Willis, may provide further opportunities for patient-centred research.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Kenan Can Ceylan, Guntug Batihan, Serkan Yazgan, Soner Gürsoy, Sami Cenk Kıraklı, Sena Ataman

Ceylan et al. present a retrospective study regarding the prevention of viral transmission via chest tube in COVID-19 patients. Out of 542 hospitalized COVID-19 patients, 13 (3.8%) required chest tube insertion. In these patients, a two-bottle technique combined with a HEPA filter was used to prevent viral transmission. The incidence of bloodstream infections was 32.1% within the first year. This event was associated with increased risk of death and stroke. Risk factors of bloodstream infections were identified as lower albumin and ECMO/IABP prior to LVAD implantation.

Source: The Annals of Thoracic Surgery
Author(s): Christopher W. Towe, MD, Sudershan Srinivasan, MS, Vanessa P. Ho, MD, MPH, Katelynn Bachmann, MD, Stephanie G. Worrell, MD, Yaron Perry, MD, Luis M. Argote-Green, MD, and Philip A. Linden, MD

This study analyzed the association of antibiotic resistance with morbidity and mortality for patients with empyema.

Source: The Annals of Thoracic Surgery
Author(s): Burak Onan, Ismihan Selen Onan

A large series of closure of atrial septal defects ( mostly secundum) in adult and some adolescent patients. There are token cases of other (moderate to severe) congenital cases included in this narrative. The Onans offer details on the evolution of their Da Vinci program in Istanbul.

Source: Journal of Vascular Surgery
Author(s): Matthew L Carnevale , Issam Koleilat , Evan C Lipsitz , Patricia Friedmann , Jeffrey E Indes

An interesting retrospective study on the efficacy of the the US screening program for aortic aneurysmal disease in the abdomen. The discussion on the detective importance of clinical examination being complementary to sonography is pertinent. Additionally, we note the relevance of the paper to a recent call for relevant screening of the supradiaphragmatic proximal aorta: https://www.ctsnet.org/jans/commentary-lack-screening-makes-primary-prev....

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