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Journal and News Scan

Source: World Journal for Pediatric and Congenital Heart Surgery
Author(s): Marshall L. Jacobs, MD, Jeffrey P. Jacobs, MD, Dylan Thibault, MS, Kevin D. Hill, MD, MS, Brett R. Anderson, MD, MBA, MS, Pirooz Eghtesady, MD, PhD, Tara Karamlou, MD, MSc, S. Ram Kumar, MD, PhD, John E. Mayer, MD, Carlos M. Mery, MD, MPH, Meena Nathan, MD, David M. Overman, MD, Sara K. Pasquali, MD, MHS, James D. St. Louis, MD, David Shahian, MD, Sean M. O’Brien, PhD

STAT Mortality Categories (developed 2009) stratify congenital heart surgery procedures into groups of increasing mortality risk to characterize case mix of congenital heart surgery providers. This update of the STAT Mortality Score and Categories is empirically based for all procedures and reflects contemporary outcomes. Cardiovascular surgical operations in the Society of Thoracic Surgeons Congenital Heart Surgery Database (January 1, 2010 – June 30, 2017) were analyzed. In this STAT 2020 Update of the STAT Mortality Score and Categories, the risk associated with a specific combination of procedures was estimated under the assumption that risk is determined by the highest risk individual component procedure. Operations composed of multiple component procedures were eligible for unique STAT Scores when the statistically estimated mortality risk differed from that of the highest risk component procedure. Bayesian modeling accounted for small denominators.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Peter J. Altshuler, Pavan Atluri

A brief editorial with a clear message on the importance of genomics in tailoring aortic surgery to individual patients' long-term bicuspid aortic valve disease in the absence of arch dilatation 

Source: Anesthesia & Analgesia
Author(s): Cristobal Anez, Ángel Becerra-Bolaños, Ariadna Vives-Lopez, Aurelio Rodríguez-Pérez

The authors conducted a systematic literature review for evidence regarding prone positioning during cardiopulmonary resuscitation (CPR).  Three observational or experimental studies determined that systolic blood pressure generated in the prone position was over 20 mmHg higher than supine, tidal volumes were within the recommended range of 6 mL/kg, and a majority of compressions met standard criteria.  An additional CT study led to the recommendation for hand positioning at the T7-T9 level in the midline, where the anatomy of the left ventricle is widest.  Fourteen case reviews revealed that return of spontaneous circulation was achieved in all cases after a median of 5 minutes, without repositioning the patient.  Recommended placement of defibrillator pads are illustrated as bilaterally under the axilla or alternatively, one midline under the left axilla and another above the right scapula.  This evidence suggests that prone CPR may generate superior blood flow due the relative stiffness of the costovertebral joint which allows greater exertional force, displacement of the diaphragm and abdominal viscera, but may be more strenuous for the rescuer. It should be noted that all patients in the case reports experienced a witnessed arrest with a secured airway, and CPR was initiated rapidly. While acknowledging that publication bias is likely, the authors conclude it is reasonable to perform CPR in the prone position for several minutes before repositioning. Given the recent increase in prone positioning due to COVID, this report is a timely review that is of great interest to OR and ICU providers.

Source: The Annals of Thoracic Surgery
Author(s): Sabin J. Bozso, MD, Jeevan Nagendran, MD, PhD, Michael W. A. Chu, MD, Bob Kiaii, MD, Ismail El-Hamamsy, MD, PhD, Maral Ouzounian, MD, PhD, Jorg Kempfert, MD, Christoph Starck, MD, and Michael C. Moon, MD

This article describes midterm results of the Dissected Aorta Repair Through Stent Implantation trial.

Source: The Annals of Thoracic Surgery
Author(s): Krish C. Dewan, BS, Suparna M. Navale, MS, MPH, Sameer A. Hirji, MD, Siran M. Koroukian, PhD, Karan S. Dewan, BS, Lars G. Svensson, MD, PhD, A. Marc Gillinov, MD, Eric E. Roselli, MD, Douglas Johnston, MD, Faisal Bakaeen, MD, and Edward G. Soltesz, MD, MPH

This study looks at the relationship between failure to rescue and patient frailty after cardiovascular surgery.

Source: JACC: Cardiovascular Interventions
Author(s): Michel Zeitouni Paul Guedeney

An editorial that may herald the decrease in aspirinization and the rise of ticagrelor monotherapy in Percutaneous stenting of coronary arteries. There might be a peripheral relevance to the group of our patients undergoing urgent surgical revascularisation after failed PCI: the balance of protecting the angioplasty versus minimising peri and postoperative heamorrhage is yet to be achieved.

Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Author(s): Vinod H. Thourani, MD, J. James Edelman, MD, PhD, Sari D. Holmes, PhD, Tom C. Nguyen, MD, John Carroll, MD, Michael J. Mack, MD, Samir Kapadia, MD, Gilbert H. L. Tang, MD, MSc, MBA, Susheel Kodali, MD, Tsuyoshi Kaneko, MD, Christopher U. Meduri, MD, Jessica Forcillo, MD-MSc, MPH, FRCSC, Francis D. Ferdinand, MD, Gregory Fontana, MD, Piotr Suwalski, MD, Bob Kiaii, MD, Husam Balkhy, MD, Joerg Kempfert, MD, Anson Cheung, MD, Michael A. Borger, MD, Michael Reardon, MD, Martin B. Leon, MD, Jeffrey J. Popma, MD, Niv Ad, MD

In this article, Thourani et al present the International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on transcatheter and surgical aortic valve replacement in low- and intermediate-risk patients: A meta-analysis of randomized and propensity-matched studies. The authors conclude with the importance of a multidisciplinary heart team in taking into account each patient and their characteristics and weighing the risk and benefits of TAVR vs. SAVR.

Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Author(s): Alessandra Piarulli, PhD*, Giovanni Alfonso Chiariello, MD, PhD*, Piergiorgio Bruno, MD, Federico Cammertoni, MD, Alessia Rabini, MD, PhD, Natalia Pavone, MD, PhD, Annalisa Pasquini, MD, PhD, Francesco Ferraro, MD, Andrea Mazza, MD, Marialisa Nesta, MD, PhD, Mauro Iafrancesco, MD, Christian Colizzi, MD, Massimo Massetti, MD, PhD

In this article by Piarulli et al, they investigate the effect of a patient's incision for valve surgery on their psychological well-being. They demonstrate in a cohort of 87 patients, with 48 undergoing conventional full sternotomy and 39 undergoing a V-shape hemi-sternotomy approach (n = 39) to their valve surgery, that those with the minimally invasive approach had lower levels of reported depression and anxiety.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Maxwell F. Kilcoyne, DO, Jason J. Han, MD, Krish C. Dewan, MD, Tyler J. Wallen, DO, Tom C. Nguyen, MD

In this article, Kilcoyne et al discuss the current status of training cardiothoracic surgery trainees in structural heart disease and propose a new core curriculum for training surgeons in structural heart disease. 

Source: The Annals of Thoracic Surgery
Author(s): Jason J. Han, MD, Jarvis C. Mays, BA, Amrita Sukhavasi, BA, William L. Patrick, MD, Mark R. Helmers, MD, Amit Iyengar, MD, Benjamin Smood, MD, John J. Kelly, MD, Matthew L. Williams, MD, Wilson Y. Szeto, MD, Marisa Cevasco, MD MPH

In this article, Han et al examined the characteristics of aspiring cardiothoracic surgeons recruited from a pool of students interested in matriculating from a North American training program. Importantly, they demonstrate that just over half belonged to an institution with a cardiothoracic surgery training program and that the majority of students were drawn to cardiothoraicc surgery for its high intensity operative environment. However, students were dissuaded from pursuing cardiothoracic surgery due to its potential for lack of work-life balance and challenging training / work environment, highlighting areas for improvement in our specialty's efforts to recruit the best and brightest into the field.