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Journal and News Scan

Source: Annals of Surgery
Author(s): Mattar, Samer G; Alseidi, Adnan A; Jones, Daniel B; Jeyarajah, D. Rohan; Swanstrom, Lee L; Aye, Ralph W; Wexner, Steven D; Martinez, José M; Ross, Sharona B; Awad, Michael M; Franklin, Morris E; Arregui, Maurice E; Schirmer, Bruce D; Minter, Rebecca M

This study examines whether graduating general surgery residents are adequately prepared for fellowship with implications for work hour restrictions.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): H Nishikawa, T Oto, S Otani, M Harada, N Iga, K Miyoshi, S Miyoshi.

This experimental study in swine investigated the feasibility of using the right and left upper lobes to perform a left unilateral lung transplant.  They found the technique is feasible and may permit use of bilateral upper lobes in donors whose lungs were rejected because of isolated lower lobe issues.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): NC Cavarocchi, HT Pitcher, Q Yang, P Karbowski, J Miessau, HM Hastings, H Hirose

The authors studied outcomes of using a standard algorithm for weaning venoarterial ECMO using continuous transesophageal echo that employed a miniature probe.  6 of 21 pts had RV and LV recovery, 7 had nonrecoverable LV and RV function, and 8 had RV recovery without LV recovery and underwent LVAD.  RV function was maintained in the latter 8 pts.  The positive predictive value for ventricular recovery was 100% using echo monitoring. 

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Q Chang, C Tian, Y Wei, X Qian, X Sun, C Yu

Outcomes of 21 pts undergoing hybrid total arch repair without deep hypothermic circulatory arrest for Type A dissection were reviewed.  1 and 12 month survival rates were 95% and 90%.  There was no evidence for caudal migration of the endograft, and only one patient experienced a type I endoleak that was corrected surgically.  No late rupture or paraplegia occurred. 

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): PP Drury, AJ Gunn, L Bennet, A Ganeshalingham, K Finucane, D Buckley, J Beca

This study compared short periods of deep hypothermic arrest to bypass alone in 18 infants undergoing arterial switch to assess neurophysiologic outcomes and white matter injury.  Deep hypothermic arrest was associated with reduced oxygen extraction and transient EEG suppression but there was no difference between the groups in white matter injury.     

Source: JACC Cardiovasc Imaging
Author(s): Della Corte A, Bancone C, Buonocore M, Dialetto G, Covino FE, Manduca S, Scognamiglio G, D'Oria V, De Feo M.

Interesting retrospective study evaluating the risk factors affecting the progression of ascending aorta dilatation in 133 patients with bicuspid aortic valve, focusing on aortic morphology and cusp fusion pattern. Dilatation at the level of the sinuses of Valsalva rather than no dilatation or dilatation confined to the ascending aorta appears to be a marker of more rapid progression.

Source: American Heart Association
Author(s): Dr Michael Acker

The trial was a randomised, prospective, non-blinded, multi-institutional study of patients undergoing surgery for severe ischaemic mitral regurgitation with or without coronary revascularisation,” Dr Acker reported. A total of 251 patients were recruited, with approximately half undergoing mitral valve repair and half undergoing replacement. While there was no difference in efficacy or main safety outcomes, there was a difference in the percentage of patients experiencing a recurrence of IMR - 32.6% in the repair group versus 2.3% in the replacement group (p<0.001).

Source: JAMA Internal Medicine
Author(s): Edward F. Patz Jr; Paul Pinsky; Constantine Gatsonis; JoRean D. Sicks; Barnett S. Kramer; Martin C. Tammemägi; Caroline Chiles; William C. Black; Denise R. Aberle; for the NLST Overdiagnosis Manuscript Writing Team

This study examined the rate of overdiagnosis (detection rate of indolent tumors) of lung cancer in the NLST.  They found that 18% of all lung cancers detected were of the indolent type, and nearly 79% of the bronchioalveolar cancers were likely indolent. 

Source: Annals of Thoracic Surgery
Author(s): John M. Stulak, Salil Deo, John Schirger, Keith D. Aaronson,Soon J. Park, Lyle D. Joyce, Richard C. Daly, Francis D. Pagani

This study of 389 pts receiving a continuous flow LVAD evaluated the risk of thromoembolic (TE)complications associated with preop AF.   TE occured in 25% of pts; freedom from TE at 2 years was 46% in those with AF and 72% in those without AF (p<0.001).  AF did not affect late survival.

Source: Annals of Thoracic Surgery
Author(s): Surgery Claude A. Beaty, Kara A. Haggerty, Madeline G. Moser, Timothy J. George,Chase W. Robinson, George J. Arnaoutakis, Glenn J. Whitman

This behavioral modification study covered 6 months at a single institution during which 144 pts underwent 510 transfusion events.  Cardiac surgeons agreed on a Hgb cutoff value of 8 as an indication for transfusion (massive transfusions were excluded).  Surgeons received weekly feedback as to their practice patterns.  Compared to baseline, feedback resulted in a 63% reduction in transfusions and an increase in single transfusions from 77% to 90%.   

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