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Journal and News Scan

Source: Journal of the National Cancer Institute
Author(s): Ryan P. Merkow, Karl Y. Bilimoria, Rajesh N. Keswani, Jeanette Chung, Karen L. Sherman, Lawrence M. Knab, Mitchell C. Posner and David J. Bentrem

In this retrospective study based on a database of 5390 patients with early-stage esophageal cancer, T1a and T1b lesions were treated by endoscopic (26.5%) or surgical resection (73.5%). For patients undergoing surgery, the incidence of lymph node metastasis was 5.0% for T1a and 16.6% for T1b lesions. Size > 2 cm and intermediate-/high-grade lesions were the best predictors of nodal involvement. The risk of nodal metastases should be considered when counseling patients.

Source: Annals of Thoracic Surgery
Author(s): Damien J. LaPar, Alan M. Speir, Ivan K. Crosby, Edwin Fonner Jr., Michael Brown, Jeffrey B. Rich, Mohammed Quader, John A. Kern, Irving L. Kron, Gorav Ailawadi, MDemail, Investigators for the Virginia Cardiac Surgery Quality Initiative

The study provides a risk-adjusted impact of postoperative atrial fibrillation on hospital mortality, resouces utlization, and costs.  49,264 patients from the STS database who underwent cardiac surgery were extracted from 2001-2012.  AF increased operative mortality 2% vs 1%), morbidity, readmission rates, ICU stay, postoperative length of stay, and costs. 

Source: MedPage Today
Author(s): John P Higgins

This interesting overview points out the negative effects of adrenaline on outcomes in a number of observational and randomized studies of patients experiencing cardiac arrest.  The author recommends using Vasopressin after the first dose of adrenaline during resuscitation from cardiac arrest. 

Source: MMCTS
Author(s): Tomaso Bottio*, Jonida Bejko, Michele Gallo, Giacomo Bortolussi and Gino Gerosa

Authors describe an LVAD implantation technique, applying the concept of less invasive cardiac surgery, consisting in the association of reduced surgical approaches, off-pump implantation and reduced administration of heparin dose, in order to achieve rapid extubation and rehabilitation of the patient, preserving low morbidity, and still meeting all the goals of the standard procedure. To reduce the invasiveness, authors combine an anterior left minithoracotomy with T-upper reversed ministernotomy.


Source: MMCTS
Author(s): Sahin Senaya, Ahmet Umit Gullua, Muharrem Kocyigitb, Aleks Degirmenciogluc, Hasan Karabuluta and Cem Alhan

This study demonstrates the basic concepts and technique of totally endoscopic robotic ASD closure. The operation can be performed for secundum or sinus venosus type ASDs and can be combined with right-sided robotic operations including mitral or tricuspid valve pathologies. In the short video clips, authors describe the step-step approach to ASD closure. They applied this technique, using Da Vinci system, in 20 patients without mortality or  complications.

Source: New York Daily news

Five years ago, the Oscar-winning actor underwent surgery at the Cleveland Clinic to replace his aortic valve, fix his mitral valve and correct an irregular heartbeat.

Depression is one side effect of cardiac surgery.

It's unknown exactly when Williams' battle with depression began, but his rep issued a statement after the star's death on Monday at 63, noting he had "been battling severe depression of late."

"Open-heart surgery has historically been known to affect a person's cognitive functioning following recovery," Dr. Jeffrey Lieberman, chief of psychiatry at New York-Presbyterian Hospital Columbia, told the Daily News.

"The valve replacement involves stopping the heart while you're replacing it, and having that kind of procedure with general anesthesia, there is an increased frequency of depression occurring in the aftermath," he said.

A number of factors could contribute to this post-operative depression, said Dr. Tara Narula, associate director of the cardiac care unit at Lenox Hill Hospital and a spokeswoman for the American Heart Association and American Stroke Association.

During open-heart surgery, emboli — little pieces of plaque in the aorta — may break off and travel up to the brain, which could result in changes to the brain's structure and abilities, Narula said. Open-heart surgery also makes use of hypothermia — lowering the body's temperature — which may affect brain chemistry, as could general anesthesia.

"It's multifactorial but certainly it is something that we know exists," Narula said of cardiac depression, adding that it affects 20-40% of heart surgery patients. She said patients and doctors need to educate themselves more about the link.

"There are so many things we can do to help people with depression, but if you don't recognize you have it, you're never going to be able to get treatment," she said.

The stress of Williams' open-heart surgery could have also led to "a reactive depression," said Dr. Alan Rozanski, chief of cardiology at Mount Sinai St. Luke’s and Mount Sinai Roosevelt. He noted that up to 10% of people can develop post-traumatic stress symptoms in the wake of a major medical procedure.

"We need to be increasingly aware of that link," he said.



another article on this issue



Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Harskamp RE, et a

The study aims to compare outcomes between minimally invasive coronary artery bypass (MINI–CAB) and drug–eluting stent (DES) implantation for isolated left anterior descending (LAD) disease. Given the available evidence, MINI–CAB results in lower TVR rates, but otherwise similar clinical outcomes when compared with DES in patients with LAD disease.


  • Randomized and observational comparative publications were identified using Medline and Google Scholar databases (January 2003 until December 2013).
  • Studies without outcome data, without DES use, or utilizing conventional bypass surgery, were excluded.
  • Outcomes of interest were cardiac death, myocardial infarction (MMI), target vessel revascularization (TVR) and peri-procedural stroke.
  • Data were compared using the Mantel Haenszel methods, and presented as odds ratio (OR) with 95% confidence interval, and number needed to treat (NNT).



  • From 230 publications, the authors identified 4 studies (2 randomized and 2 observational) that included a total of 941 patients (478 underwent MINI-CAB, and 463 received DES).
  • The incidence of TVR at maximum follow-up (6-60 months) was significantly lower in the MINI-CAB group (OR:0.16 [0.08-0.30], p<0.0001, NNT=13).
  • Cardiac mortality and MI were similar between MINICAB and DES at follow-up (OR:1.05 [0.44-2.47] and OR:0.83 [0.43-1.58], respectively). In addition, similar peri-procedural death (OR: 0.85 [0.21-3.47], p=0.82), MI (OR: 0.98 [0.38-2.58], p=0.97) and stroke (OR: 1.36 [0.28-6.70], p=0.70) were observed between the two treatment modalities.


Source: European Journal of Cardio-Thoracic Surgery
Author(s): Young-Joon Seol, Hyun-Wook Kang, Sang Jin Lee, Anthony Atala, and James J. Yoo

Bioprinting, the production of tissue by 3D printing, is a rapidly emerging technology with high potential for tissue engineering also in cardiac surgery. The paper provides insight in currently available techniques, opportunities for application and perspectives of this revolution in medicine. 


Source: European Journal of Cardio-Thoracic Surgery
Author(s): Ruben L. Osnabrugge, Alan M. Speir, Stuart J. Head, Clifford E. Fonner, Edwin Fonner, A. Pieter Kappetein and Jeffrey Rich.

The European system for cardiac operative risk evaluation II (EuroSCORE II) and the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) were validated for overall in-hospital mortality in an US cardiac surgery database comprising >50.000 patients. More reliable results were achieved with the STS-PROM. However, also the EuroSCORE II was found to be reliable in low-risk patients. The authors advert to the risk of overtreatment in these patients referring to the use of (investigational) transcatheter aortic valve implantation and advocate decision making by multidisciplinary heart teams.


Source: European Journal of Cardio-Thoracic Surgery
Author(s): Enrico Ruffini, Frank Detterbeck, Dirk Van Raemdonck, Gaetano Rocco, Pascal Thomas, Walter Weder, Alessandro Brunelli, Andrea Evangelista and Federico Venuta on behalf of the European Association of Thoracic Surgeons (ESTS) Thymic Working Group


2151 cases of surgery for thymomas were analyzed based on a retrospective EACTS database. Recurrence rate and survival were negatively associated with Masaoka stages III–IV, incomplete resection and non-thymoma histology, whereas adjuvant therapy after complete resection correlated to improved survival.