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Journal and News Scan

Source: Weill Cornell Medicine News
Author(s): N/A

Researchers have been awarded a grant to fund cancer vaccine research, including the development of an mRNA vaccine that would target precancerous lung lesions. Eventually, researchers hope to develop an mRNA vaccine that targets groups of shared antigens in people with lung cancer, along with personalized vaccines directed at the genetic structure of each lung cancer patient’s tumor.

Source: The Annals of Thoracic Surgery
Author(s): David K. Bailly, DO, Jeffrey A. Alten, MD, Katja M. Gist, DO, Kenneth E. Mah, MD, MS, David M. Kwiatkowski, MD, Kevin M. Valentine, MD, J. Wesley Diddle, MD, Sachin Tadphale, MD, Shanelle Clarke, MD, David T. Selewski, MD, Mousumi Banerjee, PhD, Garrett Reichle, MS, Paul Lin, MS, Michael Gaies, MD, and Joshua J. Blinder, MD, and the NEPHRON Investigators

After cardiac surgery in neonates, it is crucial to monitor fluid balance metrics to avoid mortality. This study aimed to determine the association between these metrics and infant postoperative mortality. Researchers concluded that time to first negative daily fluid balance, but not percentage fluid overload, is associated with improved outcomes. Treatments to achieve early negative fluid balance may decrease postoperative care requirements.

Source: The Annals of Thoracic Surgery
Author(s): Matthew S. Khouzam, BSc, Douglas E. Wood, MD, Wickii Vigneswaran, MD, MBA, Amit Goyal, MD, Cheryl Czerlanis, MD, Shanda H. Blackmon, MD, MPH, Jessica Donington, MD, Kathy S. Albain, MD, Richard K. Freeman, MD, MBA, Zaid M. Abdelsattar, MD, MSc

This study aimed to measure the population-level impact of federal lung cancer screening recommendations and Medicare coverage. After these decisions were implemented, and when adjusted for age, researchers found that they were associated with an increased incidence of early-stage lung cancer and decreased incidence of advanced-stage lung cancer.

Source: Cureus
Author(s): Ghaith Qsous, Amber Downes, Beata Carroll, Sinead Rowe, Santy Manoj, Rory McFadyen, George Korelidis, Michael Tolan, David G. Healy

Because of the recent advancement in robotic thoracic surgery, this retrospective study aimed to evaluate post-operative chronic pain in robotic versus video-assisted approaches. Although patients who undergo RATS are known to have better immediate post-operative recovery, the results did not find a statistically significant difference in chronic pain among the two methods. Further comparative studies are recommended.

Source: JAMA Network
Author(s): Faisal G. Bakaeen, MD; Danny Chu, MD; Victor Dayan, MD, PhD

This recent JAMA Surgery editorial addresses the controversy associated with the 2021 ACC/AHA/SCAI guidelines on coronary revascularization. It underscores the importance of attention to source data and accurate characterization of evidence.

The core issue was the downgrade of CABG relative to medical therapy in patients with stable ischemic heart disease and severe three-vessel disease, with survival as the endpoint: from Class I (strong recommendation) to Class IIb (weak recommendation) in patients with normal ejection fraction; and from Class I to Class IIa (moderate recommendation) in patients with mild to moderate left ventricular dysfunction. 

There was a global outcry with rebuttals from the AATS, STS, EACTS, LACES, and multiple other professional cardiovascular associations—some of which included cardiologists among their ranks.   

Proponents of the 2021 guidelines insist that they are accurate, and that the controversy arose because of differences in the interpretation of evidence. As stated in this JAMA Surgery editorial, that is simply inaccurate. Examination of the source documents cited as “supportive evidence” to downgrade CABG in the guideline’s recommendation tables tell a different story. 

Many of the actual conclusions of the authors of the source documents are in direct contradiction to what is in the guidelines. In the synthesis of evidence, some studies were arbitrarily given more weight than others and some older studies were rendered irrelevant based solely on date of publication. The guidelines emphasized improvements in medical therapy without a balanced mention of the safety, efficacy, and durability of modern-day CABG. 

The bulk of “new evidence” was centered on trials that did not randomize patients to CABG vs. medical therapy. CABG and PCI were lumped together despite acknowledging that they are different therapies with different indications and outcomes. The new studies excluded patients with heavy atherosclerotic burden, and very few had proximal LAD lesions. A recommendation about a reasonable role for an initial conservative strategy with close follow-up in such patients would have been appropriate and compatible with available evidence. Instead, the guidelines extrapolated findings from patients with relatively favorable cardiovascular risk profiles (who typically would not be referred for CABG in the first place) to inform decision-making and erroneously weaken the CABG recommendations.

The 2021 guidelines are a perfect case study on the importance of attention to the source documents instead of blind acceptance of summary evidence. Otherwise, effective and durable therapies may be replaced by less effective therapies with diminished benefits.

Source: The Annals of Thoracic Surgery
Author(s): Mark J. Russo, MD, MS, Vinod H. Thourani, MD, David J. Cohen, MD, MSc, S. Chris Malaisrie, MD, Wilson Y. Szeto, MD, Isaac George, MD, Susheel K. Kodali, MD, Raj Makkar, MD, Michael Lu, PhD, Mathew Williams, MD, Tom Nguyen, MD, Gabriel Aldea, MD, Philippe Genereux, MD, H. Kenith Fang, MD, Maria C. Alu, MS, Erin Rogers, MEng, Alexis Okoh, MD, Howard C. Herrmann, MD, Samir Kapadia, MD, John G. Webb, MD, Craig R. Smith, MD, Martin B. Leon, MD, and Michael J. Mack, MD

This comparison of minimally invasive versus full sternotomy surgical aortic valve replacement aimed to analyze outcomes of the two procedures for isolated surgery in patients enrolled in a low-risk trial. For this group of patients, it was found that the two approaches were associated with similar in-hospital and one-year outcomes.

Source: JTCVS
Author(s): Mohamed Gadelkarim, Layan Alrahmani, Celsa Tonelli, Richard Freeman, Wissam Raad, James Lubawski Jr., Wickii T. Vigneswaran, Zaid M. Abdelsattar
Because of increased social media overall during the COVID-19 pandemic, this study examined social media activity among cardiothoracic surgery programs. It was found that cardiothoracic program social media presence has increased during the pandemic, with the most activity occurring on Twitter. Accounts are largely run by trainees in these programs, which the authors suggested could benefit from added training resources on social media.
Source: TCTMD
Author(s): Yael L. Maxwell
According to a recent phase II NOVA study, using botulinum toxin type A in cardiac surgery patients does not reduce the risk of atrial fibrillation overall, but may have some benefit in certain subgroups. Although postoperative AF affects one to two-thirds of patients after cardiac surgery, there is not a standard treatment for it. This study, while small, is a promising start in the effort to find effective treatment.
Source: News Medical
Author(s): Emily Henderson

Researchers continue to report findings from the first genetically modified pig heart transplant into a human ten months after the surgery. Their latest study found unexpected electrocardiogram results in the patient, which the authors say did not contribute to heart failure. These results provide a first look into the novel field of xenotransplantation. Read the original study at this link.

Source: The Annals of Thoracic Surgery
Author(s): Joshua D. Chew, MD, Kevin D. Hill, MD, Jonathan H. Soslow, MD, Marshall L. Jacobs, MD, Jeffrey P. Jacobs, MD, Pirooz Eghtesady, MD, PhD, Dylan Thibault, MS, Karen Chiswell, PhD, David P. Bichell, MD, and Justin Godown, MD
Contemporary surgical practices for the management of congenitally corrected transposition of the great arteries (ccTGA) have not previously been described in multicenter analyses. This study defines contemporary outcomes in a multicenter cohort, concluding that patients with ccTGA remain a cohort with significant diversity in the operations used and substantial operative mortality and morbidity.

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