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Journal and News Scan

Source: New England Journal of Medicine
Author(s): Rahul Bhatnagar, Emma K. Keenan, Anna J. Morley, Brennan C. Kahan, Andrew E. Stanton, Mohammed Haris, Richard N. Harrison, Rehan A. Mustafa, Lesley J. Bishop, Liju Ahmed, Alex West, Jayne Holme, Matthew Evison, Mohammed Munavvar, Pasupathy Sivasothy, Jurgen Herre, David Cooper, Mark Roberts, Anur Guhan, Clare Hooper, James Walters, Tarek S. Saba, Biswajit Chakrabarti, Samal Gunatilake, Ioannis Psallidas, Steven P. Walker, Anna C. Bibby, Sarah Smith, Louise J. Stadon, Natalie J. Zahan-Evans, Y.C. Gary Lee, John E. Harvey, Najib M. Rahman, Robert F. Miller, Nick A. Maskell

Bhatnagar and colleagues randomized patients with malignant pleural effusion in order to test an outpatient approach to pleurodesis. All patients had indwelling pleural catheters placed for drainage, and they received a daily administration of either talc slurry or placebo through the catheter on an outpatient basis. Pleurodesis was evaluated after 35 days, with 30 of 69 patients (43%) in the talc group and 16 of 70 patients (23%) in the placebo group demonstrating successful pleurodesis.

Source: Interactive Cardiovascular and Thoracic Surgery
Author(s): Graeme L Hickey, Mostafa M Mokhles, David J Chambers, Ruwanthi Kolamunnage-Dona

The EJCTS and ICVTS are publishing a series of Statistical Primers to help clinicians perform and interpret research. In this article, Hickey and colleagues provide a practical introduction to repeated-measures analysis. The authors focus on linear mixed models, which are more amenable to real world data than other methods given their ability to handle mistimed or randomly missing longitudinal data. This primer on a more advanced statistical method could provide crucial information to increase the impact of your next manuscript.

Source: The Annals of Thoracic Surgery
Author(s): Igor Gosev, Michael S. Kiernan, Peter Eckman, Behzad Soleimani, Ahmet Kilic, Nir Uriel, Johnatan D. Rich, Jason N. Katz, Jennifer Cowger, Brian Lima, Siobhan McGurk, Meredith A. Brisco-Bacik, Sanjin Lee, Susan M. Joseph, Chetan B. Patel, for the Evolving Mechanical Support Research Group (EMERG) Investigators

Gosev and colleagues evaluated the baseline characteristics and outcomes in 156 patients from 12 centers who survived at least four years on left ventricular assist device (LVAD) support. Among this group of patients, mean survival was 7.1 years (95% CI 6.7 to 7.5 years). The average readmission rate was 1.1 ± 0.9 per patient-year, and the authors suggest that this low rate of complications could be responsible for the long survival seen in these patients.

Source: Fox News
Author(s): Tyler McCarthy

 70-year-old Arnold Schwarzenegger has undergone successful redo heart surgery at Ceders-Sinai Hospital, after an initial attempt to replace his pulmonic valve percutaneously. He famously underwent an attempted Ross Procedure in 1997, and the pulmonic valve left from that operation now required repeat surgery.

Apparently everything went well, and his first words were "I'm back!"

Source: News from around the web.
Author(s): Claire Vernon

Patient Care

Higher risk of death from coronary artery disease was noted for Americans who drank higher quantities of sugary beverages but not for those who ate more sugary foods.

 

Drugs and Devices

Aymara craftswomen in Bolivia weave textile-art-based patterns into percutaneous devices for occluding structural heart defects in children.

Several groups, including the American Lung Association and the American Heart Association, have sued the US Food and Drug Administration over their decision to delay implementation of a rule that would regulate e-cigarette marketing like marketing of tobacco products.

 

Research, Trials, and Funding

A study of data from the German Aortic Valve Registry suggests that rapid deployment valves lead to shorter surgery duration but not to better outcomes than conventional biological valves.

An observational study from Denmark, published in JAMA Cardiology, found that the risk of thromboembolism from atrial fibrillation (AFib) that began after coronary artery bypass grafting was lower than that seen with nonsurgical, nonvalvular AFib, despite a lower rate of oral anticoagulation therapy.

Researchers in South Africa find that silver-based anticancer drugs show promise in preclinical studies, potentially representing an opportunity to design chemotherapeutic drugs on a less expensive starting material than the current platinum-based drugs.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Nick Freemantle, Marc Ruel, Mario F.L. Gaudino, Domenico Pagano
Freemantle and colleagues discuss evidence evaluating myocardial revascularization strategies, focusing in particular on conclusions that can and cannot be drawn from subgroup analyses. The authors detail the benefits and limitations inherent to meta-analyses, and they comment on dividing left main coronary artery stenosis and multivessel coronary artery disease into subgroups when comparing outcomes between surgical and percutaneous interventions.
Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Frank A. Baciewicz Jr

A brief readable editorial on a retrospective analysis of the costs of coronary artery bypass grafting in Virginia, USA, which suggests the value of enhanced recovery in coronopathy.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Marc de Perrot

A succinct balanced editorial advancing, amongst other things, the position for initial nonintervention for submassive pulmonary embolism.

Source: The Annals of Thoracic Surgery
Author(s): Kambiz Hassan, Nikolai Bayer, Friederike Schlingloff, Martin Oberhoffer, Peter Wohlmuth, Michael Schmoeckel, Stephan Geidel

Hassan and colleagues performed a retrospective analysis of 81 patients who presented for open cardiac surgery while receiving novel oral anticoagulant (NOAC) therapy. Patients were off NOACs for a median of 4 days (IQR, 3 - 6 days) prior to surgery. The authors found the length of the NOAC withdrawal period was significantly related to the postoperative 24-hour drainage volume, which was 480 ml (IQR, 350 - 600 ml). Additionally, 6.2% of patients required rethoracotomy to investigate bleeding. The authors suggest that 10 days of NOAC withdrawal might be preferable prior to elective cardiac surgery.

Source: JAMA Surgery
Author(s): Erika L. Rangel, Douglas S. Smink, Manuel Castillo-Angeles, Gifty Kwakye, Marguerite Changala, Adil H. Haider, Gerard M. Doherty

This survey of general surgeons in the US who had a pregnancy during surgical training identified a number of challenges that may influence career satisfaction.  These included inadequate scheduling support, lactation facilities, and mentoring.  30% of participants would advise a female medical student not to pursue a surgical career.

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