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Journal and News Scan

Source: The Annals of Thoracic Surgery
Author(s): Graham Skelhorne-Gross, MD PhD, Carmine Simone, MD FRCSC, Sayf Gazala, MD FRCSC, Robert Allan Zeldin, MD FRCSC, Najib Safieddine, MD FRCSC

In this article, Dr. Skelhorne-Gross et al. discuss the utility of a standardized minimal opioid pain prescription post minimally invasive thoracic surgery to limit postoperative opioid prescriptions. They provided patients with a standardized prescription of Hydromorphine (2mg x 15 tabs), Acetaminophen (1g tid x 7 days), and Ibuprofen (400mg po tid x 3 days), and demonstrate that the pain was successfully controlled in the majority of patients. 



Source: The Annals of Thoracic Surgery
Author(s): Jeffrey P. Jacobs, MD, Alfred H. Stammers, MSA, James D. St. Louis, MD, J.W. Awori Hayanga, MD, Michael S. Firstenberg, MD, Linda B. Mongero, CCP, Eric A. Tesdahl, PhD, Keshava Rajagopal, MD, PhD, Faisal H. Cheema, MD, Kirti Patel, CCP, Tom Coley, CCP, Anthony K. Sestokas, PhD, Marvin J. Slepian, MD, Vinay Badhwar, MD

In this article, Jacobs et al. provide a multi-institutional outcomes review of 200 consecutive patients with confirmed COVID-19 supported with ECMO. The mean time on ECMO was 15 days with survival on VV-ECMO of 46.3% and survival on VA-ECMO of 25%. Predictors of survival included a lower median age and shorter median time from COVID-19 diagnosis to ECMO initiation.

Source: Journal of Cardiothoracic Surgery
Author(s): Fausto Biancari, Giovanni Mariscalco, Hakeem Yusuff, Geoffrey Tsang, Suvitesh Luthra, Francesco Onorati,Alessandra Francica, Cecilia Rossetti,Andrea Perrotti, Sidney Chocron, Antonio Fiore, Thierry Folliguet, Matteo Pettinari, Angelo M. Dell’Aquila, Till Demal, Lenard Conradi, Christian Detter, Marek Pol, Peter Ivak, Filip Schlosser, Stefano Forlani, Govind Chetty, Amer Harky, Manoj Kuduvalli, Mark Field, Igor Vendramin, Ugolino Livi, Mauro Rinaldi, Luisa Ferrante, Christian Etz, Thilo Noack, Stefano Mastrobuoni, Laurent De Kerchove, Mikko Jormalainen, Steven Laga, Bart Meuris, Marc Schepens, Zein El Dean, Antti Vento, Peter Raivio, Michael Borger and Tatu Juvonen

This registry, involving multiple centers, aims to provide conclusive results reflecting the importance of critical preoperative conditions and different treatment strategies to reduce the risk of early adverse events after surgery for acute TAAD.

Source: European Heart Journal Acute Cardiovascular Care
Author(s): Tetsuo Yamaguchi, Michikazu Nakai, Takao Yano, Masakazu Matsuyama, Hideaki Yoshino, Yoshihiro Miyamoto, Yoko Sumita, Hitoshi Matsuda, Yousuke Inoue, Yutaka Okita, Kenji Minatoya, Yuichi Ueda, Hitoshi Ogino

Based on data of patients with acute aortic dissection in a hospital of Nobeoka City from 2016-2018, Yamaguchi and associates found the incidence of acute aortic dissection was 17.6 per 100,000 (11.3 for type A, 6.2 for type B).  This incidence is 4 times higher than reported in the Olmsted County study (3.5 per 100,000).

Source: The Annals of Thoracic Surgery
Author(s): Chris J. Bond, MB ChB, Milan Milojevic, MD, PhD, Chang He, MS, Patricia F. Theurer, MSN, Melissa Clark, MSN, Andrew L. Pruitt, MD, Divyakant Gandhi, MD, Alphonse DeLucia, MD, Robert N. Jones, MD, MHA, Reza Dabir, MD, and Richard L. Prager, MD
This article outlines a statewide collaborative-based approach to improving utilization of arterial conduits in the United States.
Source: The Annals of Thoracic Surgery
Author(s): Pierre Tibi, R. Scott McClure, FRCSC, Jiapeng Huang, Robert A. Baker, David Fitzgerald, C. David Mazer, Marc Stone, Danny Chu, Alfred H. Stammers, Tim Dickinson, Linda Shore-Lesserson, Victor Ferraris, Scott Firestone, Kalie Kissoon, and Susan Moffatt-Bruce

The Society of Thoracic Surgeons (STS), the Society of Cardiovascular Anesthesiologists (SCA), the American Society of ExtraCorporeal Technology (AmSECT), and the Society for the Advancement of Blood Management (SABM) published an update to the "2011 Update to The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Blood Conservation Clinical Practice Guidelines."

Source: JAMA Surgery
Author(s): Benoit D'Journo X and members of the International Esodata Study Group

Data from the Esodata project used more than 8,000 patients undergoing esophagectomy for cancer to develop a risk prediction score for 90-day mortality.  Development and validation groups were used.  There were 10 variables that emerged as significant predictors, and weighted values were developed into the model.  The model identified 5 risk levels for 90-day mortality, which may help in patient selection and in informed discussions. 

Source: Resuscitation 2021
Author(s): Gutierrez A, Carlson C, Kalra R, Elliott AM, Yannopoulos D, Bartos JA.
This retrospective, single-center analysis reviewed 142 consecutive patients with cardiac arrest treated with veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and targeted temperature management (TTM) to determine the impact of enteral feeding on clinical outcomes and survival. The authors propose that feeding may lead to redistribution of blood flow from the brain to the gut, thus decreasing brain perfusion at a vulnerable time. In contrast to other studies which demonstrate benefits with early feeding in critically ill patients, this study included a population that was presumably well nourished and ambulatory prior to admission. Additionally, TTM was used for all patients and may have contributed to reduced gut motility. Despite limitations that include a non-randomized, single-center design, this study provides important cautions about early enteral feeding in this “ultra-sick” population that warrant further study.
Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Valentino Bianco, Arman Kilic, Thomas G. Gleason, Edgar Aranda-Michel, Yisi Wang, Forozan Navid, Ibrahim Sultan

Fascinating confirmation of null hypotheses including bleeding complications and survival in a Pennsylvanian cohort study, despite the easily predictable previous PCI, hock, and IABP prevalence in the emergency group. The statistical model is elaborate and complex. Perhaps a randomized trial could now be justified!

Source: Circulation Research
Author(s): Joshua A. Beckman, Peter A. Schneider, Michael S. Conte

A useful detailed review (or state-of-the-art article) on revascularisation in extracardiac vascular stenoocclusive atheromatosis.