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Journal and News Scan

Source: JAMA Surgery
Author(s): Asanthi Ratnasekera, Paula Ferrada

The authors summarize the rationale and utility of point of care ultrasonography for identifying factors associated with hypotension or hypoxia in a deteriorating surgical patient, including hypovolemia, LV dysfunction, PE, pleural fluid, ascites, etc.  Their claim is that a variety of other diagnostic measures are less accurate, and that a single ultrasonographic exam of the abdomen, lung, pleura, and heart in a single study is efficient, useful, and can be performed in any location.   

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Miguel Sousa-Uva, Stuart J Head, Milan Milojevic, Jean-Philippe Collet, Giovanni Landoni, Manuel Castella, Joel Dunning, Tómas Gudbjartsson, Nick J Linker, Elena Sandoval, Matthias Thielmann, Anders Jeppsson, Ulf Landmesser

The new EACTS Guidelines on perioperative medication in adult cardiac surgery address antithrombotic management, atrial fibrillation, renin–angiotensin–aldosterone system inhibitors, beta-blockers, dyslipidaemia, ulcer prevention and steroids, antibiotic prophylaxis, anaesthesia and postoperative analgesia, and blood glucose management.

Source: JACC: Cardiovascular Interventions
Author(s): Norihiko Kamioka, John Wells, Patricia Keegan, Stamatios Lerakis, Jose Binongo, Frank Corrigan, Jose Condado, Ateet Patel, Jessica Forcillo, Leslie Ogburn, Andy Dong, Hope Caughron, Amy Simone, Bradley Leshnower, Chandan Devireddy, Kreton Mavromatis, Robert Guyton, James Stewart, Vinod Thourani, Peter C. Block and Vasilis Babaliaros

In this study with 663 TAVI patients, the authors investigated the predictors for next day discharge (NDD). After excluding cases that did not have a minimalist transfemoral approach, 150 patients had NDD and 210 patients had non-NDD.

Predictors of NDD include male sex, lower creatinine, absence of atrial fibrillation and younger age. When compared to uncomplicated cases with longer hospital stay, NDD patients had similar 30-day and even superior one-year clinical outcomes.

Source: Journal of Visualized Surgery
Author(s): Omar Matthieu Sarsam, Joel Dunning, Bruno Pochulu, Jean-Marc Baste

In this video-based article, Sarsam and colleagues demonstrate the use of continuous barbed sutures in four robotic procedures, two wedge bronchoplasties and two sleeve bronchoplasties.

Source: The Annals of Thoracic Surgery
Author(s): Kimberly A. Holst, Joseph A. Dearani, Sameh Said, Roxann B. Pike, Heidi M. Connolly, Bryan C. Cannon, Kristen L. Sessions, Megan M. O'Byrne, Patrick W. O’Leary

Holst and colleagues present their experience with cone repair of the tricuspid valve for Ebstein’s anomaly in 235 patients over eight years. They conclude that cone repair is safe and effectively reduces tricuspid regurgitation, which might allow for right ventricular remodeling. The procedure remains a challenge to master, however, due to the rarity of the disease and the highly variable anatomy.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Kezhong Chen, Wei Chen, Jianqiao Cai, Fan Yang, Feng Lou, Xun Wang, Jingbo Zhang, Mingyu Zhao, Jay Zhang, Jun Wang

The authors studied survival in patients with multiple lung cancers and their associated genetic mutations.  There was 90% discordance in driver mutations beween cancers in individual patients that was associated with favorable survival.  The two patients in whom condordance was present suffered recurrent cancer.

Source: JAMA Cardiology
Author(s): Rudolf A. de Boer, Matthew Nayor, Christopher R. deFilippi, Danielle Enserro, Vijeta Bhambhani, Jorge R. Kizer, Michael J. Blaha, Frank P. Brouwers, Mary Cushman, Joao A. C. Lima, Hossein Bahrami, Pim van der Harst, Thomas J. Wang, Ron T. Gansevoort, Caroline S. Fox, Hanna K Gaggin, Willem J. Kop, Kiang Liu, Ramachandran S. Vasan, Bruce M. Psaty, Douglas S. Lee, Hans L. Hillege, Traci M. Bartz, Emelia J. Benjamin, Cheeling Chan, Matthew Allison, Julius M. Gardin, James L. Januzzi Jr, Sanjiv J. Shah, Daniel Levy, David M. Herrington, Martin G. Larson, Wiek H. van Gilst, John S. Gottdiener, Alain G. Bertoni, Jennifer E. Ho

Using a group of nearly 23,000 individuals in four community-based longitudinal cohorts, the authors studied those who developed heart failure (HF) with either preserved (633) or reduced (841) ejection fraction (EF).  HF with reduced EF was more strongly associated with natriuretic peptide, troponin, and C-reactive protein than was HF with preserved EF.

Source: MedPage Today
Author(s): Matthew Beane

Interesting research/opinion piece about how the introduction of robots has forced a change in surgical training, with some residents gaining skill through a process of "shadow learning."

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

Patient Care

Portugal’s first Eurovision winner, Salvador Sobral, has made a good recovery after undergoing a heart transplant in December.

Canada’s first Inuk cardiac surgeon talks about choosing to become a surgeon and the pride she takes in serving her patients.

Surgeons perform the first pneumonectomy at the Cleveland Clinic Abu Dhabi, UAE, for a patient with respiratory failure secondary to a multi-drug resistant infection.

 

Drugs and Devices

The US Food and Drug Administration (FDA) has pushed back approval of AndexXa, which is designed to reverse the anticoagulant effect of Factor Xa inhibitors, as they review additional data.

 

Research, Trials, and Funding

An international group of researchers have developed a robot that pulls on the esophagus to induce cell growth in awake pigs, a technology that could be applied to large-gap esophageal atresia in infants.

Two studies published in the Annals of Internal Medicine come to slightly different conclusions on the benefits of risk-based screening for lung cancer outcomes.

Researchers in Finland look at how 30 minutes in a sauna affects one’s cardiovascular function.

Veterinary researchers in Ontario, Canada, found that atrial fibrillation appears to be a heritable trait in Standardbred racehorses.

Source: Journal of the American College of Surgeons
Author(s): Mark R. Katlic

The authors summarizes a personal experience with 529 patients undergoing VATS operations under local anesthesia and sedation.  No nerve block, epidural, laryngeal mask airway, or endotracheal intubation was used.  Indications were lung nodule, hemothorax, empyema, pleural effusion, pericardial effusion, chylothorax, etc.  There was one unsuccessful attempt using this technique.  

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