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Journal and News Scan

Source: The Annals of Thoracic Surgery
Author(s): Pierre Tibi, R. Scott McClure, FRCSC, Jiapeng Huang, Robert A. Baker, David Fitzgerald, C. David Mazer, Marc Stone, Danny Chu, Alfred H. Stammers, Tim Dickinson, Linda Shore-Lesserson, Victor Ferraris, Scott Firestone, Kalie Kissoon, and Susan Moffatt-Bruce

The Society of Thoracic Surgeons (STS), the Society of Cardiovascular Anesthesiologists (SCA), the American Society of ExtraCorporeal Technology (AmSECT), and the Society for the Advancement of Blood Management (SABM) published an update to the "2011 Update to The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Blood Conservation Clinical Practice Guidelines."

Source: JAMA Surgery
Author(s): Benoit D'Journo X and members of the International Esodata Study Group

Data from the Esodata project used more than 8,000 patients undergoing esophagectomy for cancer to develop a risk prediction score for 90-day mortality.  Development and validation groups were used.  There were 10 variables that emerged as significant predictors, and weighted values were developed into the model.  The model identified 5 risk levels for 90-day mortality, which may help in patient selection and in informed discussions. 

Source: Resuscitation 2021
Author(s): Gutierrez A, Carlson C, Kalra R, Elliott AM, Yannopoulos D, Bartos JA.
This retrospective, single-center analysis reviewed 142 consecutive patients with cardiac arrest treated with veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and targeted temperature management (TTM) to determine the impact of enteral feeding on clinical outcomes and survival. The authors propose that feeding may lead to redistribution of blood flow from the brain to the gut, thus decreasing brain perfusion at a vulnerable time. In contrast to other studies which demonstrate benefits with early feeding in critically ill patients, this study included a population that was presumably well nourished and ambulatory prior to admission. Additionally, TTM was used for all patients and may have contributed to reduced gut motility. Despite limitations that include a non-randomized, single-center design, this study provides important cautions about early enteral feeding in this “ultra-sick” population that warrant further study.
Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Valentino Bianco, Arman Kilic, Thomas G. Gleason, Edgar Aranda-Michel, Yisi Wang, Forozan Navid, Ibrahim Sultan

Fascinating confirmation of null hypotheses including bleeding complications and survival in a Pennsylvanian cohort study, despite the easily predictable previous PCI, hock, and IABP prevalence in the emergency group. The statistical model is elaborate and complex. Perhaps a randomized trial could now be justified!

Source: Circulation Research
Author(s): Joshua A. Beckman, Peter A. Schneider, Michael S. Conte

A useful detailed review (or state-of-the-art article) on revascularisation in extracardiac vascular stenoocclusive atheromatosis.

Source: The New England Journal of Medicine
Author(s): Jan A. Deprest, Kypros H. Nicolaides, Alexandra Benachi, Eduard Gratacos, Greg Ryan, Nicola Persico, Haruhiko Sago, Anthony Johnson, Mirosław Wielgoś, Christoph Berg, Ben Van Calster, and Francesca M. Russo for the TOTAL Trial for Severe Hypoplasia Investigators

A glimpse of what could be a future for surgery..........

Source: Annals of Surgery
Author(s): Brown LM, Thibault DP, Kosinski AS, Cooke DT, Onaitis MW, Gaissert HA, Romano PS

This examination of readmission rates is based on data from nearly 40,000 patients from the STS Database having undergone elective pulmonary lobectomy.   Readmission was driven by complications during the index operation, notably pulmonary embolism, empyema, pleural effusion, and pneumothorax.  Improved pleural space management may offer a means to mitigate readmission rates.

Source: Annals of Thoracic Surgery
Author(s): Subramanian MP, Sahrmann JM, Nickel KB, Olsen MA, Bottros M, Heiden B, Semenkovich TR, Meyers BF, Kozower BD, Patterson GA, Nava RG, Kreisel D, Puri V.

Over 30% of lung resection patients in the STS Database had prior exposure to opioid use.  They experienced longer length of postoperative stay, more frequent visits to the ED, and a higher incidence of readmission within 90 days.  Athough there is growing interest in standardized enhanced recovery pathways after lung resection, this challenging subset of patients appears to require unique targeted postoperative interventions.

Source: Annals of Surgical Oncology
Author(s): Pamela Milito, Jakub Chmelo, Lorna Dunn, Sivesh K. Kamarajah, Anantha Madhavan, Shajahan Wahed, Arul Immanuel, S. Michael Griffin, Alexander W. Phillips

Chyle leak remains a challenging postoperative complication to manage, and avoidance is always easier than mitigation.  The only predisposing factor identified in this study was low BMI.  Although ICU stay was longer in affected patients, operative mortality, hospital LOS, and survival were not negatively impacted by the presence of a leak. 

Source: Journal of Thoracic and Cardiovascular Surgery Techniques
Author(s): Abigail White, MD; Sabin J. Bozso, MD; Maral Ouzounian, MD, PhD; Michael W. A. Chu, MD; Michael C. Moon, MD; on behalf of Canadian Thoracic Aortic Collaborative

A good discussion on the concepts of:

1. aortic true lumen and false lumen behavior after repair of acute Type A aortic dissection
2. distal anastomotic new entry tear after hemiarch repair
3. impact of above on clinical outcomes
4. strategies on preventing distal anastomotic entry tear

The authors communicate that improved understanding of these hemodynamic conditions may serve to improve surgical technique, guide creation of novel devices toward new therapeutic targets, reduce surgical risk, and ultimately improve patient outcomes.