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Journal and News Scan

Source: MMCTS
Author(s): Diana Reser, Tomas Holubec, Murat Yilmaz, Andrea Guidotti and Francesco Maisano

Since the 1990s, minimally invasive cardiac surgery has gained wide acceptance due to patient and economic demand. The advantages are less trauma, less bleeding, less wound infections, less pain and faster recovery. Many studies showed that the outcomes are comparable with those of conventional sternotomy. Right lateral mini-thoracotomy evolved into a routine and safe access in specialized centres for minimally invasive mitral valve surgery. The 6-cm incision is performed over the fifth intercostal space in the inframammary groove. With a double-lumen tube, the right lung is deflated before entering the pleural cavity. A soft tissue retractor is used to minimize rib spreading. The stab incisions for the endoscopic camera and the transthoracic clamp are performed in the right anterior and posterior axillary line in the third intercostal space. Surgery on the mitral valve is performed in a standard fashion under a direct vision with video assistance. One chest tube is inserted. The intercostal space is adapted with braided sutures to prevent lung herniation. Ropivacaine is used for local infiltration. The pectoral muscle, subcutaneous tissue and skin are adapted with running sutures. Complications of a right lateral mini-thoracotomy are rare (conversion to sternotomy, rethoracotomy, phrenic nerve palsy, wound infection and thoracic wall hernia) and well manageable.

Source: Business Spectator
Author(s): Chris Griffith

Surgeons will soon be able to plan heart operations using 3D models of patients’ organs with revolutionary software that recreates working versions of human body parts.

The technology, which also allows companies that make artificial valves and stents to assess exact measurements and simulate the performance of their proposed implants, is part of Paris-based 3D software specialist Dassault Systemes’ ambition to harness the 3D revolution for medicine.

Apart from cardiac health, Dassault Systemes is also exploring opportunities to implement the technology in prenatal care, modelling a mother’s uterus and foetus to identify whether a natural birth is viable or not by simulating the birth process.

 

 

Dassault Systemes’ chief strategy officer Steve Levine said the simulations could supply critical data about the likelihood of problems.

“The technology can be used to understand how much strain it would put on the foetus and the mother,” Dr Levine said.

Source: Time magazine
Author(s): Tessa Berenson

It turns out that marriage may actually mend broken hearts.

A new study published in the Journal of the American Medical Association found that married patients recovered better after heart surgery than single or divorced patients.

After studying 1,576 adults over age 50 who had serious cardiac surgery, the researchers found that unmarried patients had a 40% greater chance of dying or developing complications two years after the surgery.

Source: JAMA Surgery
Author(s): Mark D. Neuman; Rachel M. Werner

Using University of Michigan Health and Retirement Study data, the authors evaluated marital status at the time of cardiac surgery and subsequent survival or deterioration in the ability to perform activities of daily living (ADLs) independently.   At follow-up, those who were married had a 19.4% incidence of death or new disability, which was similar to outcomes for never married individuals.   In contrast, those who were divorced, separated, or widowed had a 32% incidence of adverse outcomes. 

Source: Journal of the American College of Cardiology
Author(s): Tomohiko Taniguchi; Takeshi Morimoto; Hiroki Shiomi; Kenji Ando; Norio Kanamori; Koichiro Murata; Takeshi Kitai; Yuichi Kawase, Chisato Izumi; Makoto Miyake; Hirokazu Mitsuoka; Masashi Kato; Yutaka Hirano; Shintaro Matsuda; Kazuya Nagao; Tsukasa Inada; Tomoyuki Murakami; Yasuyo Takeuchi; Keiichiro Yamane; Mamoru Toyofuku; Mitsuru Ishii; Eri Minamino-Muta; Takao Kato; Moriaki Inoko; Tomoyuki Ikeda; Akihiro Komasa; Katsuhisa Ishii; Kozo Hotta; Nobuya Higashitani; Yoshihiro Kato; Yasutaka Inuzuka; Chiyo Maeda; Toshikazu Jinnai; Yuko Morikami; Ryuzo Sakata; Takeshi Kimura

The investigators in this registry study enrolled 3815 patients with asymptomatic aortic stenosis. Patients underwent either surgical aortic valve replacement (AVR) or conservative therapy. In order to increase comparability, they used propensity score matching to create two more similar groups. The cumulative 5-year incidences of all-cause death and heart failure hospitalization were significantly lower in the initial AVR group compared to the conservative group (15.4% vs. 26.4%, p=0.009 and 3.8% vs. 19.9%, p<0.001). Moreover, 41% of the patients in the conservative treatment group received AVR during follow-up. These results indicate that initial AVR in patients asymptomic severe aortic stenosis might be substantially improved by initial AVR. 

Source: SCTS
Author(s): Joint Committee on Surgical Training

Download the 5 year plan for workforce planning across the whole of the UK here. This is probably a template also for workforce planning internationally for Cardiac Surgery, Thoracic Surgery, Congenital Heart surgery and Transplantation as it discusses future surgical requirements, age demographics of surgeons and many other issues that are all key factors in planning for numbers in these specialties for the future.

This is a very high quality document that the many authors should be phenomenally proud of

 

 

 

 

Source: The American Journal of Cardiology
Author(s): Santarpino G, Pfeiffer S, Jessl J, Dell'Aquila A, Vogt F, von Wardenburg C, Schwab J, Sirch J, Pauschinger M, Fischlein T.

In this manuscript the authors report on the results of a retrospective propensity score analysis in 102 matched pairs of patients, considered to be in a “grey zone” of surgical risk for either TAVI (Edwards Sapiens, Medtronic CoreValve or Symetis Acurate TA prosthesis) or aortic valve replacement (AVR) with a sutureless prosthesis (Sorin Perceal). There were no significant differences in intra-procedural complications, postoperative renal, neurological or respiratory complications and the need for pacemaker between the patients undergoing TAVI and sutureless AVR. Patients receiving TAVI had shorter ICU and hospital stay, and required less blood transfusion, but suffered vascular complications significantly more frequently than patients receiving a sutureless prosthesis. There was no significant difference in hospital mortality. At follow up, paravalvular leak was more frequent in the TAVI group. Survival rate was significantly better in the sutureless AVR group. Outcomes regarding the cost associated to the two procedures showed than when the cost of the device was included, sutureless AVR resulted as a cost-saving treatment compared with TAVI.

Source: American Journal of Surgery
Author(s): Nicholas E. Anton, M.S. , Paul N. Montero, M.D. , Lisa D. Howley, Ph.D. , Charles Brown, Ph.D. , Dimitrios Stefanidis, M.D., Ph.D.correspondenceemail

Using an anonymous survey, surgeons at a single institution were asked to rate the impact of 9 stressors on performance and outcomes.  Complex cases, rarely performed cases, and lack of adequate assistance were assocated with the most stress.  A stress-related intraoperative complication occurrence was reported by 40%.  More than 80% indicated that training in stress management would be useful.

Source: Annals of Thoracic Surgery
Author(s): Michael P. Robich, MD, MSPH, Andrew Flagg, BA, Damien J. LaPar, MD, MS, David D. Odell, MD, MS, William Stein, MD, Muhammad Aftab, MD, Kathleen S. Berfield, MD, Amanda L. Eilers, DO, Shawn S. Groth, MD, MS, John F. Lazar, MD, Asad A. Shah, MD, Danielle A. Smith, MD, Elizabeth H. Stephens, MD, PhD, Cameron T. Stock, MD, Walter F. DeNino, MD, Vakhtang Tchantchaleishvili, MD, Edward G. Soltesz, MD, MPH

During the 2013 In-Training Exam for cardiothoracic surgery residents, 312 residents were surveyed regarding their training.  Residents self-reported that only 70-75% of the cases they claimed 'surgeon' credit met the ABTS definition for 'surgeon'--i.e., the resident performs "those technical manipulations that constituted the essential parts of the procedure itself" and has substantial involvement in preoperative and postoperative care.  What are the reasons that residents feel they need to 'over-report' their cases?  What are the implications of this study?

Source: Annals of Thoracic Surgery
Author(s): Michael W. Cullen, MD, John M. Stulak, MD, Zhuo Li, Brian D. Powell, MD, Roger D. White, MD, Naser M. Ammash, MD, Vuyisile T. Nkomo, MD, MPH

The authors retrospectively reviewed the postoperative TEEs on patients undergoing DCCV within 30 days after cardiac surgery that included LAA closure (n=93 patients).  The presence of a residual communication between the LAA and the left atrium was 37% overall.  The LAA patency rates according to LAA technique were as follows:  amputation, 0%; suture closure, 51%; staple exclusion, 29%.  These results beg the question:  should the appendage always be amputated?

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