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Journal and News Scan

Source: Annals of Thoracic Surgery
Author(s): J. Matthew Brennan, David R. Holmes, Matthew W. Sherwood, Fred H. Edwards, John D. Carroll, Fred L. Grover, E. Murat Tuzcu, Vinod Thourani, Ralph G. Brindis, David M. Shahian, Lars G. Svensson, Sean M. O’Brien, Cynthia M. Shewan, Kathleen Hewitt, James S. Gammie, John S. Rumsfeld, Eric D. Peterson, Michael J. Mack

This study examined the effect of the introduction of TAVR on overall AVR rates in the US using the STS and STS/ACC registries.  From 2008 to 2013, AVR rates increased at hospitals performing TAVR by 69%, including a 22% increase in surgical AVR; the latter increase was primarily in low- and moderate-risk patients.  In contrast, non-TAVR hospital AVR volume increased by 16%.  Overall survival rates improved during the period in both settings.

Source: Annals of Thoracic Surgery
Author(s): John H. Calhoon, Clint Baisden, Ben Holler, George L. Hicks, Ed L. Bove, Cameron D. Wright, Walter H. Merrill, Dave A. Fullerton

Program directors from 6 distinctly different training centers assessed educational costs for CT resident training.  Before formal accounting information was explored, the PDs estimated the annual cost per resident to be $250,000.  The actual costs per year per resident ranged from $330,000 to $667,000, with a mean of $483,000.  Faculty teaching costs made up more than half of the total costs, whereas simulation costs comprised 0 to $80,000.  The contributions of the residents to program savings averaged $37,000. 

Source: Annals of Thoracic Surgery
Author(s): Leah M. Backhus, Farhood Farjah, Steven B. Zeliadt, Thomas K. Varghese, Aaron Cheng, Larry Kessler, David H. Au, David R. Flum

This study explored recent patterns of surveillance imaging 4-8 mos after surgical treatment of early stage lung cancer using the SEER database.  Initial imaging consisted of CXR (60%), CT (25%) and PET (3%).  13% of patients received no imaging.  NCCN guidelines adherence for receipt of CT was 47%, but increased from 28% to 60% over the period of study.  Adherence was reduced in pts with stage I disease and those who had surgery as a single treatment modality.

Source: Journal of the American College of Cardiology
Author(s): Florence Dumas; Wulfran Bougouin; Guillaume Geri; Lionel Lamhaut; Adrien Bougle; Fabrice Daviaud; Tristan Morichau-Beauchant; Julien Rosencher; Eloi Marijon; Pierre Carli; Xavier Jouven; Thomas D. Rea; Alain Cariou

This study determined the relationship of pre-hospital use of epinephrine during resuscitation to survival in patients who experienced return of spontaneous circulation after out of hospital cardiac arrest. 73% received epinephrine, and 17% of those patients experienced a good outcome (discharged alive with good neurologic status).  Of those who did not received epinephrine, 63% had a good outcome.  There was a dose-response effect.  Delayed administration of epinephrine had the worst outcomes. 

Source: Thorax
Author(s): J Michael B Hughes, Colin D R Borland

This is an interesting historical vignette describing the discovery of transfer factor (TLCO, DLCO) and its subsequent importance in pulmonary physiology and cardiorthoracic risk assessment.

Source: European Heart Journal
Author(s): Sylvain Beurtheret, Pierre Mordant, Xavier Paoletti, Eloi Marijon, David S. Celermajer, Philippe Léger, Alain Pavie, Alain Combes, Pascal Leprince

This is an excellent article on the feasibility of offering Veno Arterial ECMO in outlying community hospitals for Refractory Cardiogenic Shock (RCS).  The Authors review a four year time period and describe assessing 104 patients of whom 87 were deemed eligible for V-A ECMO therapy. The authors conclude that providing V-A ECMO therapy in a community hospital environment for RCS is both feasible and resulted in an impressive mortality reduction of 30%.  The Authors present points regarding the need for a constantly available dedicated staff, strong logistical support, and dedicated ICU beds. In addition, the authors discuss the probability of increased costs and resource utilization.


Author(s): T Sloane Guy

This is a stunning video of a myectomy and mitral anterior leaflet repair. It really shows the abilities of the robot very well indeed. Well done 

Source: Journal of the National Cancer Institute
Author(s): David S. Gierada, Paul Pinsky, Hrudaya Nath, Caroline Chiles, Fenghai Duan and Denise R. Aberle

A reexamination of data from the National Lung Screening Trial (NLST) with nodules above the 4mm, has been shown that increasing the nodule size threshold for a positive screen, substantially reduces the false-positive CT screenings rate and increase slightly the lung cancer missed or delayed but without affecting the survival.

Source: New England Journal of Medicine
Author(s): Ronald V. Lacro, M.D., Harry C. Dietz, M.D., Lynn A. Sleeper, Sc.D., Anji T. Yetman, M.D., Timothy J. Bradley, M.B., Ch.B., Steven D. Colan, M.D., Gail D. Pearson, M.D., Sc.D., E. Seda Selamet Tierney, M.D., Jami C. Levine, M.D., Andrew M. Atz, M.D., D. Woodrow Benson, M.D., Ph.D., Alan C. Braverman, M.D., Shan Chen, M.S., Julie De Backer, M.D., Ph.D., Bruce D. Gelb, M.D., Paul D. Grossfeld, M.D., Gloria L. Klein, M.S., R.D., Wyman W. Lai, M.D., M.P.H., Aimee Liou, M.D., Bart L. Loeys, M.D., Ph.D., Larry W. Markham, M.D., Aaron K. Olson, M.D., Stephen M. Paridon, M.D., Victoria L. Pemberton, R.N., M.S., Mary Ella Pierpont, M.D., Ph.D., Reed E. Pyeritz, M.D., Ph.D., Elizabeth Radojewski, R.N., Mary J. Roman, M.D., Angela M. Sharkey, M.D., Mario P. Stylianou, Ph.D., Stephanie Burns Wechsler, M.D., Luciana T. Young, M.D., and Lynn Mahony, M.D

Randomized multicenter trial comparing losartan versus atenolol in young patients with Marfan's syndrome with no significant difference in aortic root dilation between groups.

Source: Annals of Thoracic Surgery
Author(s): Vinod H. Thourani, MDemail, Rakesh Suri, MD, DPhil, Rebecca L. Gunter, MD, Shubin Sheng, PhD, Sean M. O’Brien, PhD, Gorav Ailawadi, MD, Wilson Y. Szeto, MD, Todd M. Dewey, MD, Robert A. Guyton, MD, Joseph E. Bavaria, MD, Vasilis Babaliaros, MD, James S. Gammie, MD, Lars Svensson, MD, PhD, Mathew Williams, MD, Vinay Badhwar, MD, Michael J. Mack, MD

141,905 isolated primary surgical aortic valve replacements (SAVR) were stratified by STS risk of mortality.   SAVR outcomes were superior to those by the predicted risk models.