ALERT!
This site is not optimized for Internet Explorer 8 (or older).
Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.
Journal and News Scan
June 15, 2023
Submitted by: Cameron Lind
A new expert consensus on diagnosis, staging, and therapy for early-stage non-small cell lung cancer patients has been released. The experts recommend CT and PET imaging as a necessary part of the diagnosis and staging phase. Recommendations for chemotherapy, radiotherapy, and adjuvant systemic therapy before and after lung resection are also explained in this report. Overall, treatment paradigms have shifted significantly over the past few years and surgeons must be knowledgeable about different treatment options.
June 15, 2023
Submitted by: Joel Dunning
This is a groundbreaking article that, for the first time, compares port access mitral surgery with sternotomy in a randomized multicenter trial. It demonstrates benefits for surgery through a minimal access route and, most importantly, that it is as safe as open surgery. Finally, it demonstrates that expert surgeons are required, whatever the access, to maximize the repair rate for patients.
While this full report is behind a paywall, a detailed abstract is included through the link above.
June 8, 2023
Submitted by: Cameron Lind
Through the Palestine Children’s Relief Fund (PCRF), a group of Italian doctors and nurses traveled to the Gaza Strip to perform cardiac surgery on a group of ten children with congenital heart disease. Since advanced surgical procedures are not readily accessible in the occupied area because of lack of resources and a travel ban, the surgical team was crucial for treating these urgent cases and training local medical professionals.
June 8, 2023
Submitted by: Jo Chikwe
This analysis of 279 neonates with pulmonary atresia and intact ventricular septum who underwent surgical or catheter intervention between 2009 and 2019 in nineteen centers showed that seventy-nine (28 percent) underwent right ventricular decompression, 151 (54 percent) underwent systemic-to-pulmonary shunt or ductal shunt only, thirty-six (13 percent) underwent both, and eleven (4 percent) received transplants. Major adverse events—including in-hospital mortality (8 percent), cardiopulmonary resuscitation (13 percent), stroke (6 percent), and mechanical circulatory support (13 percent)—were reported in fifty-seven patients (20 percent). Lower weight and the presence of two major coronary stenoses predicted major adverse events, and the authors recommend vigilance in procedural planning in patients with these risk factors.
June 8, 2023
Submitted by: Cameron Lind
A study in the United States found that disparities regarding race, socioeconomic status, and rural location result in lack of access to a thoracic surgeon for an esophagectomy. Patients in the study underwent elective esophagectomy for esophageal or gastric cardia cancer, Barrett esophagus, or achalasia. While the proportion of esophagectomies performed by thoracic surgeons increased over the four-year study period, demographic differences persisted. Patients who were uninsured, identified as non-white, received care in a rural setting, or had metastatic cancer were significantly less likely to have their esophagectomy performed by a thoracic surgeon.
June 8, 2023
Submitted by: EACTS Staff
The authors investigated the outcomes of thoracic endovascular aortic repair for retrograde Stanford type A acute aortic dissection (R-AAAD) at their institution. The early- and mid-term outcomes of thoracic endovascular aortic repair for R-AAAD in nineteen patients were satisfactory, but long-term follow-up is needed. The indications for such repair have been expanded to include low-risk and emergency cases at the authors’ institute.
June 1, 2023
Submitted by: Wei-Guo Ma
The first official guidelines for implantable mechanical circulatory support (MCS) were published in 2013 by the International Society for Heart and Lung Transplantation (ISHLT). Ten years later, because of substantial advancements in the MCS field, much of the original report is no longer clinically relevant, so ISHLT commissioned a ten-year update. Like the 2013 MCS guidelines, the 2023 update are organized into individual task forces covering preoperative, intraoperative, and postoperative management of MCS patients treated with implantable left ventricular assist devices (LVADs), including four additional task forces, for a total of nine. With those additions, ISHLT says this 2023 guideline document is the most comprehensive resource guiding the management of patients with durable mechanical circulatory support (DMCS).
The nine task forces are as follows:
- Selection of candidates for durable mechanical circulatory support (DMCS) and risk management before implantation for fixed comorbidities.
- Patient optimization, consent, and appropriate timing for MCS: Modifiable risk management before implantation.
- Intraoperative and immediate postoperative management
- Inpatient management of patients with DMCS.
- Outpatient management of the mechanical circulatory support device recipient.
- VAD in adults with congenital heart disease.
- Evaluation for recovery.
- Biventricular assist devices and total artificial heart specifications.
- Center quality metrics, outcomes, volume, and staffing.
June 1, 2023
Submitted by: Mary Hammon
The authors examined the safety of combining aortic root replacement with frozen elephant trunk (FET) total arch replacement. Outcomes were similar between the FET alone and FET with aortic root replacement groups. Adding aortic root replacement was not associated with increased mortality and there was no difference in overall survival between the groups. Although concomitant root replacement lengthens the operation time, it does not appear to increase risk in an experienced centre with high volumes.
June 1, 2023
Submitted by: Aristotle Protopapas
This five-year follow-up of a large randomized controlled clinical trial on outcomes after transcatheter edge-to-edge repair of severe mitral regurgitation, as compared with outcomes after maximal doses of guideline-directed medical therapy alone, suggests superiority of the transcatheter 'Alfieri' (Mitra-clip) repair over BMT.
It will be interesting to juxtapose transcatheter to surgical repair, especially over a longer period. It's worth noting that more than one in ten recipients suffered device-related complications.
May 25, 2023
Submitted by: Cameron Lind
A study found that patients who underwent a second TAVR procedure were no more likely to experience adverse outcomes than those who have only undergone one TAVR. Because TAVR patients are expanding into younger populations, the analysis of registry data is important in informing decision making among these patients, who are more likely to need a second TAVR in their lifetimes.