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Journal and News Scan

Source: Thoracic Surgery Residents Association
Author(s): Clauden Louis, Panos Vardas, Peter Chen, Jennifer Dixon, Parth B. Amin.

The Throacic Surgery Residents Association (TSRA) Decision Algorithms in Cardiothoracic Surgery is a 100-chapter compendium with an individual algorithm for clinical decisions spanning the entire scope of cardiothoracic surgery. The resource was developed for cardiothoracic surgery residents by residents and cardiothoraicc surgery faculty. The TSRA Decision Algorithms in Cardiothoracic Surgery is fresh off the press and available for purchase on Amazon -

Check out all the other resources available through the TSRA including, but not limited, to the following -

1. TSRA podcasts -

2. TSRA Pocket Mentor -

3. TSRA Intern Survival Guide -

4. TSRA Review of Cardiothoracic Surgery -

5. Cardiopulmonary Bypass: A Primer -

6. TSRA Multiple Choice Review of Cardiothoracic Surgery -

7.  TSRA Primer of Cardiothoraicc Surgery -

8. TSRA Clinical Scenarios in Cardiothoracic Surgery -

9. TSRA Operative Dictations in Cardiothoracic Surgery -

10. Fighting Fatigue: A Guide for Cardiothoracic Surgery Residents -

And many more ... 

Source: Journal of International Medical Research
Author(s): Amer Harky, Rizwan Iqbal, Vincenzo Giordano, Ahmed Al-Adhami

In this brief review, the authors elaborate on status quo of the use of endovascular stent grafts in the management of patients with connective tissue disorders. Because the radial force and circumferential stress on the native aorta remains a signficant issue that leads to stent graft failure, open surgical repair remains the gold standard in most of such patients.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Emma C Hansson, Arnar Geirsson, Vibeke Hjortdal, Ari Mennander, Christian Olsson, Jarmo Gunn, Igor Zindovic, Anders Ahlsson, Shahab Nozohoor, Raphaelle A Chemtob, Aldina Pivodic, Tomas Gudbjartsson, Anders Jeppsson; on behalf of the NORCAAD Collaboration

Hansson and colleagues analyzed the effect of preoperative dual antiplatelet therapy on outcomes for patients undergoing surgery for acute aortic dissection type A. Among 1,141 patients with acute type A dissection, 108 had aspirin and clopidogrel, and 11 had aspirin and ticagrelor. Dual antiplatelet therapy led to more bleeding and more transfusions but not to more deaths. However, major bleeding was associated with higher mortality. The authors conclude that correct diagnosis is important to avoid dual antiplatelet therapy and reduce bleeding complications in patients with type A dissection.

Source: Innovations
Author(s): Bobby Yanagawa, Amine Mazine, Ismail El-Hamamsy

Yanagawa and colleagues review the current understanding of factors that predict the failure of aortic valve repair. They highlight factors that include unaddressed annular dilatation, residual cusp prolapse, commissural orientation, and the use of patch material, and they note that better understanding of these repair elements results in continually refined techniques that can improve patient outcomes.

Source: Nature
Author(s): Nenad Tomašev, Xavier Glorot, Jack W. Rae, Michal Zielinski, Harry Askham, Andre Saraiva, Anne Mottram, Clemens Meyer, Suman Ravuri, Ivan Protsyuk, Alistair Connell, Cían O. Hughes, Alan Karthikesalingam, Julien Cornebise, Hugh Montgomery, Geraint Rees, Chris Laing, Clifton R. Baker, Kelly Peterson, Ruth Reeves, Demis Hassabis, Dominic King, Mustafa Suleyman, Trevor Back, Christopher Nielson, Joseph R. Ledsam, Shakir Mohamed

Using deep learning employing data from over 700,000 patients (6 billion data points), an algorithm for continuous prediction of the risk of acute kidney injury (AKI) was developed. The model correctly predicted over 90% of AKI requiring dialysis with a lead time of up to 48 hours, with 2 false alerts for every true alert.

Source: JAMA Internal Medicine
Author(s): Ling Zhao, Dehua Li, Hui Zheng, Xiaorong Chang, Jin Cui, Ruihui Wang, Jing Shi, Hailong Fan, Ying Li, Xin Sun, Fuwen Zhang, Xi Wu, Fanrong Liang

In this trial involving over 400 patients, accupuncture was compared to two sham groups and an observation group. The intervention group experienced a nearly two-thirds reduction in the frequency of angina attacks during the 20-week treatment period, significantly better than the sham and observation groups.

Source: The Annals of Thoracic Surgery
Author(s): Juan B. Umana-Pizano, Alexander P. Nissen, Stephanie Nguyen, Carson Hoffmann, Ann Guercio, Gina De La Guardia, Anthony L. Estrera, Tom C. Nguyen

In this article, Umana-Pizana et al performed a phases-of-care mortality analysis amongst 5141 cardiac surgery cases with a 4.6% crude mortality in a population with a median STS risk score of 5.8%. They demonstrate that triggers for mortality occured primarily preoperatively (49.3%), followed by in the intensive care unit (23.9%), intraoperatively (13.4%), discharge phase (10.4%), and postoperative floor (3.0%). Importantly, their findings demonstrate that the mortality distribution is bimodal, occuring in those at lowest and highest risk, and they provide targets for areas of improvement and elimination of triggers for mortality in the cardiac surgical patient.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Erin M. Corsini, Kyle G. Mitchell, Tom C. Nguyen, Ara A. Vaporciyan, Mara B. Antonoff

Corsini et al examined the results of a single-institution's 5-year experience of cardiothoracic surgery mock oral examinations. They demonstrate that this time- and labor-intensive exercise where trainees verbalize and practice their certification examination in a safe, controlled environment with their faculty can lead to improvement in preparation for the high-stakes real examination, with an impressive 5-year 100% pass rate for trainees involved in this experience.

These results are encouraging for surgical educators and trainees alike in our quest to better prepare tomorrow's cardiothoracic surgeons for their transition to practice.

Source: U.S. News Health
Author(s): U.S. News & World Report

U.S. News has just released the 2019-2020 best hospitals in the United States based on data from nearly 5,000 medical centers.

In the category for Cardiology & Heart Surgery, Cleveland Clinic in Cleveland, Ohio, Mayo Clinic in Rochester, Minnesota, Cedars-Sinai Medical Center in Los Angeles, California, New York-Presbyterian Hospital-Columbia and Cornell in New York, and Massachusetts General Hospital in Boston make up the top five.  

Also published is a roster of the best U.S. hospitals for congestive heart failure, heart bypass surgery, and aortic valve replacement.

Source: The Annals of Thoracic Surgery
Author(s): Paul A.J. Beckers, Michel I.M. Versteegh, Thomas J. Van Brakel, Jerry Braun, Bart Van Putte, Alexander P.W.M. Maat, Wim Vergauwen, Inez Rodrigus, Willem Den Hengst, Filip Lardon, Ernst De Bruijn, Gunther Guetens, Gert De Boeck, Jan F. Gielis, Patrick Lauwers, Laurens Denissenb, Jeroen M.H. Hendriks, Paul E. Van Schil

Beckers and colleagues evaluated toxicity and outcomes of regional chemotherapeutic treatment with isolated lung perfusion of melphalan combined with metastasectomy for patients with resectable pulmonary metastases. The prospective study included 107 patients with metastases of colorectal carcinoma, osteosarcoma, or soft-tissue sarcoma. The authors report low morbidity and no long-term pulmonary toxicity. The disease-free and progression-free rates at 5 years were 26% and 44% for patients with colorectal carcinoma and 29% and 63% for patients with sarcoma. The authors conclude that isolated lung perfusion with melphalan combined with metastasectomy is both feasible and safe, and that further evaluation of this approach is warranted.