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Journal and News Scan

Source: Interactive Cardiovascular and Thoracic Surgery
Author(s): Graeme L Hickey, Evangelos Kontopantelis, Johanna JM Takkenberg, Friedhelm Beyersdorf

Hickey and colleagues discuss the assumptions that underlie regression models, and they detail approaches to identifying deviations from these assumptions. They illustrate several points using linear regression as the basis but also discuss logistic regression and Cox regression models. The authors present both formal statistical tests and graphical diagnostics that should be used for assessing model assumptions.

Source: The New England Journal of Medicine
Author(s): Jean-François Obadia, David Messika-Zeitoun, Guillaume Leurent, Bernard Lung, Guillaume Bonnet, Nicolas Piriou, Thierry Lefèvre, Christophe Piot, Frédéric Rouleau, Didier Carrié, Mohammed Nejjari, Patrick Ohlmann, et al., for the MITRA-FR Investigators.*

Patients with severe secondary mitral regurgitation with depressed ejection fraction were randomized to either MitraClip and medical therapy vs. medical therapy alone. There was no difference in primary outcomes (i.e. death and unplanned hospitalization) at one year.

Source: News from around the web.
Author(s): Emily Robinson

Patient Care and General Interest

A new study finds that elderly heart surgery patients who exhibit postoperative delirium are sometimes given antipsychotic medications, which are ineffective and may even be dangerous.

A 5-month-old child in St. Louis, Missouri, becomes the youngest documented heart-lung transplant patient in more than a decade.

A 3-year-old boy from Germany with a rare congenital heart disease travelled all the way to Milwaukee, Wisconsin, to undergo a complex procedure.

 

Drugs and Devices

The first clinical use of FRAME external support technology for aneurysm repair in high flow arteriovenous (AV) fistulas took place in Germany.

 

Research, Trials, and Funding

A Harvard study regarding cardiothoracic surgery operating teams suggests that variations in interpersonal and leadership communication patterns may have a strong effect on teamwork.

A novel technique tested at Ohio State University’s Wexner Medical Center allows damaged lungs to be placed on a machine that keeps them alive at normal body temperature, allowing doctors to better assess whether they are viable.

Source: The Annals of Thoracic Surgery
Author(s): Anita Nguyen, Hartzell V. Schaff, Rick A. Nishimura, Joseph A. Dearani, Jeffrey B. Geske, Brian D. Lahr, Steve R. Ommen

Nguyen and colleagues evaluated whether left atrium (LA) enlargement in hypertrophic cardiomyopathy was reversed after septal myectomy. The authors retrospectively reviewed transthoracic echocardiographic measurements of LA volume index from 656 patients who underwent myectomy over eight years at their center. Only patients with both preoperative and postoperative measurements were included. The authors noted both early reduction in LA volume index prior to hospital discharge, and late reduction at two-year follow-up, which they suggest is indicative of continued reverse remodeling. The severity of preoperative mitral regurgitation and the risk of postoperative atrial fibrillation were associated with preoperative LA volume index, but the risks of postoperative stroke and survival were not.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Tirone E. David

A brief, useful editorial advancing the position of watchful waiting in selected aneurysmopathic patients, on the occasion of new AATS guideline on bicuspid aortic valve (BAV) aortopathy.

Source: Annals of Cardiothoracic Surgery
Author(s): G. Chad Hughes

This video and article detail the author’s technique for the classic hybrid arch debranching procedure. It is performed for patients who have had a prior type A dissection repair with aortic arch and descending thoracic aortic dilation but who are not felt to be candidates for more extensive hybrid repairs that require total arch replacement. Hughes emphasizes the importance of appropriate patient selection for the success of this type I hybrid arch repair and discusses his center’s selection criteria.

Source: The Annals of Thoracic Surgery
Author(s): Rishindra M. Reddy, Madhu Lalitha Gorrepati, Daniel S. Oh, Shilpa Mehendale, Michael F. Reed

For high volume surgeons (defined as 20 or more annual lobectomies), the use of a robotic approach had a lower conversion to open rate  and a lower complication rate, while having a mean operating time that was 25 min longer on average compared to a VATS approach.

Source: The Annals of Thoracic Surgery
Author(s): Darren S. Bryan, Robert M. Sade

This cautionary article outlines new trends in how the courts view surgeon responsibility for obtaining informed consent.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Harvey I. Pass

This provocative editorial outlines concepts that thoracic surgeons should understand in the era of immunotherapy for potentially resectable N2 disease.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Elizabeth H. Stephens, Amy G. Fiedler

This is an instructive editorial that reminds us of the challenges women face in CT surgery.  It describes how to go beyond the social online movement to achieve practical changes in training, hiring, and mentoring.

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