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Journal and News Scan
June 4, 2016
Submitted by: Mark Ferguson
The authors used data from the NCDB to assess long-term outcomes after SBRT (1,781) or lobectomy (13,562) for clinical stage I NSCLC in patients without important co-morbidities. Overall survival was significantly better after lobectomy for T1N0 (HR 0.38) and for T2N0 patients (HR 0.38). Propensity score matched patients (1781 pairs) also had significantly better survival at 5-years after lobectomy (59% vs 29%). Commentary: http://www.jtcvsonline.org/article/S0022-5223(16)30061-7/abstract
The porcine study explores 3-dimensional geometrical deformation of the aortic root following the David procedure. It demonstrates by various measurements and by simulation that the parts of the aortic root are exposed to high pressure and low shear stress for much longer periods after David procedure compared to the native anatomy.
This award-winning study estimates the required thoracic surgery workforce until 2050 in consideration of the incidence of non-small-cell lung cancer, appropriate use of stereotactic ablative radiotherapy and a nation-wide CT-screening program at the example of Canada.
Aortic clamps can cause injuries of the vascular wall. This elegant study explores pressure distributions along the jaws of seven commonly used clamps.
May 23, 2016
Μinimal invasive extracorporeal circulation (MiECC) systems have initiated important efforts within science and technology to further improve the biocompatibility of cardiopulmonary bypass components aiming to minimize the adverse effects and improve end-organ protection. The Minimal invasive Extra-Corporeal Technologies international Society (MiECTiS) was founded to create an international forum for the exchange of ideas on clinical application and research of Minimal invasive Extra-Corporeal Circulation technology. The present work is a consensus document developed to standardize the terminology and the definition of minimal invasive extracorporeal circulation technology as well as to provide recommendations and promote the use of MiECC systems into clinical practice as a multidisciplinary strategy involving cardiac surgeons, anaesthesiologists and perfusionists.
May 21, 2016
Submitted by: Tom C. Nguyen
This review provides an excellent summary of patient outcomes following LVAD explantation. The authors review 11 studies comprosing of 213 patients and conclude that excellent 10 year survival outcomes can be maintained after LVAD explantation in carefully selected patients.
May 14, 2016
Submitted by: Joel Dunning
The Workforce on Evidence-Based Surgery has created an expert consensus statement on the management of resuscitation in patients who arrest after cardiac surgery. The STS believes that if a patient arrests after cardiac surgery and external cardiac massage is not providing adequate perfusion with a systolic over 60mmHg, then am emergency resternotomy should always be performed in under 5 minutes to prevent irreversible brain injury. This is not easy to achieve and this document provides comprehensive advice regarding rapidly reversible causes of arrests to avoid a resternotomy, how to organize your teams to achieve a good outcome and how to train your teams to provide the best outcomes possible. The STS provides a one page poster as a summary of this advice. This document is currently out for consultation and we want your advice and opinions. Please click on this link to provide your ideas and feedback. http://www.sts.org/Expert-Consensus-for-the-Resuscitation-of-Patients-who-Arrest-After-Cardiac-Surgery We would like to know : Do you like the presented STS protocol ? Do you agree that in VF arrest, you should proceed to deliver 3 shocks prior to external massage ? Do you agree that epinephrine and atropine should not be a routine part of the algorithm ? Do you agree that for a patient who arrests and external massage is not generating an adequate perfusion pressure, that this person needs an urgent resternotomy once all rapidly reversible causes have been excluded ? We have paired up with the APACVS who has created a charity to provide training in this protocol. Training will be provided by a network of trained and experienced physicians assistants and senior nurse practitioners. www.csu-als.org Do you have any ideas or suggestions for the national training program that they will be leading ? Thank you very much for your interest. Please do get in contact if you have any questions. Joeldunning@doctors.org.uk Chairman of the STS workforce on resuscitation in arrest after cardiac surgery firstname.lastname@example.org Lead systematic reviewer for the STS evidence based workforce.
May 13, 2016
Postoperative inspiratory muscle training (IMT) was compared to standard physiotherapy in a randomized clinial trial on lung cancer patients. Whereas respiratory muscle strength was similar, IMT resulted in improved oxygenation.
May 11, 2016
Submitted by: Joseph Basha
This is a very interesting study. The authors tried to find if the weekend effect would affect the outcomes of both elective surgery and urgent surgery (cardiac and non-cardiac surgery). This retrospective study enrolled more than 300K patients undergoing surgery including CABG. The authors compared the in-hospital mortality and major complications for weekday versus weekend surgery using multivariable logistic regression analysis. Results showed that weekend elective and urgent surgery were associated with higher risk of death and major complications compared to the week day surgery (p<0.001). Can we suggest surgeons avoid the elective (non-emergency) cardiac surgery on weekends based on this study?
May 10, 2016
Conventional extracorporeal circulation (CECC), miniaturized extracorporeal circulation (MECC) and off-pump coronary artery bypass (OPCAB) for coronary bypass grafting were compared in a meta-analysis which included 22 778 patients. Better perioperative outcomes were observed for MECC and OPCAP compared to CECC. MECC could be considered a compromise between OPCAB and CECC.