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Journal and News Scan

Source: Journal of the American Geriatrics Society
Author(s): Yoni Grossman, Israel M. Barbash, Paul Fefer, Ilan Goldenberg, Anat Berkovitch, Ehud Regev, Noam Fink, Sagit Ben-Zekry, Yafim Brodov, Alexander Kogan, Victor Guetta, Ehud Raanani, Amit Segev

The authors analyzed their prospective hospital TAVR register to assess whether the addition of serum albumin as a marker of frailty would improve the ability of the STS and EuroSCORE-2 scores to predict mortality.  TAVR patients were divided into 4 groups based on median serum albumin and median STS and EuroSCORE-2 values. 

Result:  A model including albumin in addition to either conventional score improved the prediction of mortality with either score by more than 40%.  

Conclusion:  Using scores that include serum albumin as a marker of frailty can improve the prediction of mortality in patients undergoing TAVR.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Lytwyn J, Stammers AN, Kehler DS, Jung P, Alexander B, Hiebert BM, Dubiel C, Kimber D, Hamm N, Clarke M, Fraser C, Pedreira B, Duhamel TA, Tangri N, Arora RC

While it is being increasingly understood that frailty in the older adult patient undergoing cardiac surgery is associated with an increased rate of postoperative mortality, it is still unclear if the addition of frailty measures to existing risk-assessment tools contributes to an improved prediction of long-term disabilty. In a prospective observational cohort analysis of 188 older adult patients undergoing cardiac surgery,  Lytwyn and colleagues have sought to determine if a measurement of frailty (using either the Modified Fried Criteria, the Short Physical Performance Battery or the Clinical Frailty Scale) was effective in predicting one-year functional survival (defined as being alive at 1 year with a health-related quality of life score greater than 60 on the EuroQol-Visual Analogue Scale). The authors observed a 2-3 fold worse one-year functional survival in frail cardiac surgery patients, and the addition of any measure to the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) was associated with improved predictive value of negative outcomes. 

Source: Critical Care Medicine
Author(s): Bednarczyk JM, Fridfinnson JA, Kumar A, Blanchard L, Rabbani R, Bell D, Funk D, Turgeon AF, Abou-Setta AM, Zarychanski R

Within the field of Enhanced Recovery after Thoracic and Cardiac Surgery (ERATS and ERACS, respectively), appropriate  fluid administration that avoids the detrimental effects of tissue edema on organ function and wound healing is a potentially important modifier of postoperative outcomes. This use of specific hemodynamic and other targets to provide goals of administered fluids (i.e. goal-directed therapy or GDT) has been suggested as an effective means to provide sufficient volume to facilitate cardiac flow while minimizing the potential harms of excessive fluid resuscitation.  The literature to this point, however, has been inconsistent in demonstrating improvements in clinical outcomes.  Bednarczyk and colleagues have undertaken an important and well-constructed SR/MA to determine if acute volume resuscitation using an objective measure of fluid responsiveness (stroke volume variation, pulse pressure variation, and stroke volume change with passive leg raise/fluid challenge) is associated with improved outcomes. In this analysis, the authors have concluded that the use of GDT guided assessments of fluid responsiveness was associated with reduced mortality, ICU length of stay, and time on mechanical ventilation. Further high quality clinical investigation in the cardiac critical care environment is warranted. 

Source: Innovations
Author(s): Dunning, Joel ; Elsaegh, Mohamed ; Nardini, Marco ; Gillaspie, Erin A. ; Petersen, Rene Horsleben ; Hansen, Henrik Jessen ; Helsel, Bryan ; Naase, Hatam ; Kornaszewska, Malgorzata ; Will, Malcolm B.; Walker, William S. ; Wigle, Dennis; Blackmon, Shanda Haley

Microlobectomy is a novel form of VATS lobectomy.

This paper documents the experience of its use in England, at the Mayo clinic, in Copenhagen, in Edinburgh, Wales, and in Texas.

The rules of microlobectomy are that you must perform no incisions greater than 5 mm in the intercostal spaces, but the ports mirror your usual multiport approach. You use a subxiphoid incision to remove the lobe and perform the stapling, and there are hints and tips to make this easier at

Let us know what you think. Something new or just a mix of well tried and tested approaches?

Twenty-two percent of patients went home day one and 42% day two so if nothing else it shows that well-performed minimally invasive lobectomy results in very early discharges with good short-term outcomes.

Source: Journal of the American Heart Association
Author(s): Zakeih Chaker, Vinay Badhwar, Fahad Alqahtani, Sami Aljohani, Chad J. Zack, David R. Holmes, Charanjit S. Rihal, Mohamad Alkhouli

The Nationwide Inpatient Sample (NIS) was queried for aortic valve replacements conducted between 2003 and 2014.  The data on a total of 166,809 patients (37% female) were analyzed with respect to outcomes in men vs. women.   Hospital mortality was 40% higher in women than men (5.6% v. 4%, p<0.001).   When isolated AVRs were analyzed and propensity-matched, hospital mortality was 14% higher in women than men (3.3% v. 2.9%, p=0.001).    The differential outcomes appear to be driven by a distinct risk profile.  

Source: The Daily Mail
Author(s): Helen Weather

NHS surgeon, 52, who earned £125,000 a year is sacked after blowing the whistle on shocking hospital malpractice - and now works as an Uber driver.

  • Peter O'Keefe was sacked in 2015 by the Cardiff & Vale University Health Board.
  • It came three years after he raised questions about patient safety at the hospital.
  • The Health Board said he was fired after complaints that he bullied colleagues.
  • O'Keefe became an Uber driver and to his surprise - he's loving the new job.
Source: Anaesthesia
Author(s): L. Lei, R. Katznelson, L. Fedorko, J. Carroll, H. Poonawala, M. Machina, R. Styra, V. Rao, G. Djaia

The authors conducted a double-blinded prospective, randomized clinical trial in 249 patients >60 years of age who underwent cardiac surgery with cardiopulmonary bypass to assess whether interventions based on cerebral oximetry would decrease the incidence of postoperative delirium.  Two groups were compared:  The control group, in which the results of cerebral oximetry were blinded, and the intervention group, in which an algorithm was instituted for oximetry values below 75% of baseline.  

Results:  Postop delirium occurred in 24.4%  and 24.6% of the intervention and control groups, respectively (p=0.97).  Thus, interventions based on cerebral oximetry data do not appear to alter the incidence of postop delirium.  Incidentally, a higher baseline cerebral oximetry value was associated with a lower incidence of postoperative delirium.

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

Patient Care

Updated guidelines on dual antiplatelet therapy in coronary artery disease have been published by the European Association for Cardio-Thoracic Surgery and the European Society of Cardiology.

Heart patients at Mongkutwattana General Hospital in Bangkok, Thailand, will continue receiving percutaneous coronary interventions under the universal healthcare scheme, despite the hospital having a part-time rather than a full-time cardiothoracic surgeon.

Children’s Health in Dallas, Texas, joins hospitals in Washington, DC, and London, UK, in conducting radiation-free cardiac catheterization procedures.


Drugs and Devices

Medtronic has launched a post-market clinical study of its CoreValve Evolut Pro implant across 35 European centers.


Research, Trials, and Funding

Engineers and clinicians in Rochester, New York, were awarded a grant to develop a noninvasive medical technology for mobile devices that would detect atrial fibrillation.

A report finds that, between 2006 and 2014, lung cancer cases in Northern Ireland increased by more than 30%.

Source: The Thoracic and Cardiovascular Surgeon
Author(s): Georg Daniel Duerr, Jan-Malte Sinning, Armin Georg Welz, Fritz Mellert

Duerr and colleagues describe the experimental development of a mitral anuloplasty ring, which should facilitate later transcatheter valve-in-ring implantation. Two accompanying videos demonstrate valve expansion and implantation within the ring. The article illustrates the potential importance these new technologies are expected to gain in the near future.

Source: The Annals of Thoracic Surgery
Author(s): Vladimiro L. Vida, Lorenza Zanotto, Lucia Zanotto, Giovanni Stellin and the European Congenital Heart Surgeons Association (ECHSA) Study Group, Massimo Padalino, Georges Sarris, Eleftherios Protopapas, Carol Prospero, Christian Pizarro, Edward Woodford, Thomas Tlaskal, Hakan Berggren, Martin Kostolny, Ikenna Omeje, Boulos Asfour, Alexander Kadner, Thierry Carrel, Paul H. Schoof, Matej Nosal, Josè Fragata, Michał Kozłowski, Bohdan Maruszewski, Luca A. Vricella, Duke E. Cameron, Vladimir Sojak, Mark Hazekamp, Jukka Salminen, Ilkka P. Mattila, Julie Cleuziou, Patrick O. Myers, Viktor Hraska

Vida and colleagues retrospectively reviewed 111 left-sided reoperations after an arterial switch operation (ASO) across 17 ECHSA centers between 1975 and 2010. The authors found a low reoperation frequency of 1.4% after ASO. Initial diagnosis of D-transposition of the great arteries (D-TGA) was more common among patients who required reoperation than was diagnosis of double-outlet right ventricle TGA-type, however a greater percentage of the latter group encountered postoperative complications (5 of 12, versus 16 of 99). The majority of survivors were asymptomatic at last follow-up, with only 13% in New York Heart Association class II and only 3% in class III.

CME related to this article is available through The Annals' website.