Journal and News Scan

There is a rediscovered interest in use of a subxiphoid incision to perform lung surgery. This work follows a review of 105 lobectomies published in March 2016 in the Journal of Thoracic Disease from the same institution, Shanghai Pulmonary Hospital.

Although technical limitations exist when compared with transthoracic VATS and despite patient selction being more restrictive than for traditional surgery, the authors demonstrate the feasibility of anatomical lung resection for benign or malignant disease through the subxyphoid port. The conversion rate is acceptable (5.2%) and no post operative mortality in 153 cases (lobectomies and segmental resections) was observed. One of the main outcomes considered is post operative pain.

The authors report on their findings an ongoing Japanese multicentre prospective registry. They evaluate outcomes in 478 patients undergoing transfemoral  TAVI and treated with percutaneous puncture using an expandable sheath, Edwards Sapien XTprosthesis and a Perclose ProGlide system. The primary outcome was percutaneous closure device (PCD) failure. The secondary outcome was the relation between PCD failure and the clinical outcomes (30-day and mid-term mortality rates and the length of hospital stay). PCD failures occurred in 36 patients (8%) and were not associated with the 30-day or the mid-term mortality rates. PCD failures can be predicted by the sheath-to-femoral artery ratio (SFAR). An SFAR threshold of ≥ 1.03 is the recommended cut-off point when PCD and an eSheath are used. Thus, this cut-off value may contribute to the selection of the sheath size, vascular access site, and method of approach.

This study examines the outcomes of bioprosthetic tricuspid valve replacement in patients with tricuspid valve infective endocarditis. Full text available. 

Sixteen patients underwent percutaneous placement of a VSD closure device for management of subarterial VSD with puncture through the chest wall and infundibulum of the RV.  Fifteen were successful, and 1 patient required conversion to mini-thoracotomy for pericardial effusion and tamponade.  Mean LOS was 3.5 days.  No deaths, arrhythmias, valve injury, or residual shunting occurred up to 1 year follow-up.