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Journal and News Scan
In this article, Thourani et al present the International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on transcatheter and surgical aortic valve replacement in low- and intermediate-risk patients: A meta-analysis of randomized and propensity-matched studies. The authors conclude with the importance of a multidisciplinary heart team in taking into account each patient and their characteristics and weighing the risk and benefits of TAVR vs. SAVR.
In this article by Piarulli et al, they investigate the effect of a patient's incision for valve surgery on their psychological well-being. They demonstrate in a cohort of 87 patients, with 48 undergoing conventional full sternotomy and 39 undergoing a V-shape hemi-sternotomy approach (n = 39) to their valve surgery, that those with the minimally invasive approach had lower levels of reported depression and anxiety.
In this article, Kilcoyne et al discuss the current status of training cardiothoracic surgery trainees in structural heart disease and propose a new core curriculum for training surgeons in structural heart disease.
In this article, Han et al examined the characteristics of aspiring cardiothoracic surgeons recruited from a pool of students interested in matriculating from a North American training program. Importantly, they demonstrate that just over half belonged to an institution with a cardiothoracic surgery training program and that the majority of students were drawn to cardiothoraicc surgery for its high intensity operative environment. However, students were dissuaded from pursuing cardiothoracic surgery due to its potential for lack of work-life balance and challenging training / work environment, highlighting areas for improvement in our specialty's efforts to recruit the best and brightest into the field.
In this article by the COVEC Study Group, they conducted a EuroELSO international survey investigating the clinical outcomes of extracorporeal membrane oxygenation (ECMO) on patients with COVID-19 Acute Respiratory Distress Syndrome (ARDS). They demonstrate that the majority of patients requiring ECMO were veno-venous rather than veno-arterial cannulation, with time on ECMO ranging between less than two weeks to more than four weeks. The majority stated that the reason for discontinuation of ECMO were lack of patient recovery at just over 50%, with the majority stating that they felt patients with COVID-19 and ARDS benefitted from ECMO therapy.
This study analyzed factors associated with aortopulmonary amalgamation or Ross-Konno procedure in patients who underwent surgical repair for interrupted aortic arch/VSD.
This study evaluates the importance of of evaluating patient frailty prior to high-risk cardiothoracic operations.
This study analyzed 1039 adult patients from 2006 to 2017 to determine the rate of pleural complications after lung transplantation.
Rheumatic heart disease (RHD) continues to be responsible for major cardiovascular morbidity and mortality in the developing world. It constitutes a double tragedy because it disproportionately affects economically disadvantaged people and young people, thereby robbing them of the most productive years of life. Often, by the time it is diagnosed, RHD has resulted in substantial valvular damage. This cluster randomized clinical trial investigates if school-based echocardiographic screening in combination with secondary antibiotic prophylaxis in children with evidence of latent rheumatic heart disease may be an effective strategy to reduce the prevalence of definite or borderline rheumatic heart disease in endemic regions.
A Canadian multi-centre RCT of immediate baloon-cryoablation of the pulmonary veins: the intervention was compared to the relevant standard of pharmacological care. The target population was treatment-naive sufferers of de novo paroxysmal atrial fibrillation. The recruitment was successful, and unrestricted funding was secured from the healthcare device industry. The freedom from asymptomatic and symptomatic paroxysms of atrial fibrillation appeared improved at one-year follow-up.
It would be very interesting to additionally see the cardiovascular outcomes of the cohort, the thromboembolic events in particular, given that the subjects remained free from the atrial fibrillation for 99% of that year (having been continuously monitored).
The trial holds some interest for the cardiovascular surgeons practising ablation: The publication comes in the wake of a manuscript suggesting there is an underutilization of ablation during mitral surgery. (https://www.ctsnet.org/jans/variability-and-utilization-concomitant-atri...)