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Journal and News Scan

Source: Annals of Thoracic Surgery
Author(s): Michael H. Hall, Rick A. Esposito, Renee Pekmezaris, Martin Lesser, Donna Moravick, Lynda Jahn, Robert Blenderman, Meredith Akerman, Christian N. Nouryan, Alan R. Hartman

A transitional care program was instituted for CABG patients to improve care continuity after hospital discharge.  The composite outcome was a combination of hospital readmission and death.  Among 169 pts who entered the program compared to 232 control patients, program participation was the only independent predictor of improved outcome.  The incidence of the composite outcome was reduced by two-thirds for patients in the program.

Source: Journal of Thoracic Oncology
Author(s): Gulati, Caroline M; Schreiner, Andrew M; Libby, Daniel M; Port, Jeffrey L; Altorki, Nasser K; Gelbman, Brian D

67 patients without a previous history of lung cancer underwent FNA of a GGO with results suspicious for, but not diagnostic of, adenocarcinoma.  47 pts who elected to undergo resection were compared to 16 who opted for observation.  6/16 observed pts developed interval growth or increase in the solid component of the GGO and 5 underwent resection or radiation therapy.  The observed group experienced no cancer-related death or distant recurrence of cancer.  The resected group experienced metastatic spread (2), development of new cancers (5), and size progression in other GGOs.

Source: Journal of Clinical Oncology
Author(s): Jung-Jyh Hung, Yi-Chen Yeh, Wen-Juei Jeng, Kou-Juey Wu, Biing-Shiun Huang, Yu-Chung Wu, Teh-Ying Chou and Wen-Hu Hsu

Clinical outcomes of patients with lung adenocarcinoma were analyzed with respect to the histologic subtype of adenocarcinoma.  Histologic pattern was associated with sex, T status, N status, and stage.  Recurrence was higher in patients with micropapillary and solid tumors. These subtypes were associated with extrathoracic-only recurrence.  They were also independent predictors of survival.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Leah Backhus, Jonathon Sargent, Aaron Cheng, Steven Zeliadt, Douglas Wood, Michael Mulligan

Outcomes of patients undergoing lung transplant after LVRS were compared to those of patients undergoing LVRS or transplant alone.  OR time and LOS were longer in the combined group.  Morbidity and mortality were similar among the groups.  Post-transplant survival was substantially lower in the combined group.  However, if time from LVRS to transplant was added to transplant survival, long-term survival was similar among the 3 groups.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Zoe K. McQuilten, Nick Andrianopoulos, Erica M. Wood, Merrole F. Cole-Sinclair, John J. McNeil, Peter A. Cameron, Christopher M. Reid, Andrew E. Newcomb, Julian A. Smith, Louise E. Phillips

The authors reviewed transfusion practices after cardiac surgery in Australia and New Zealand using a database of nearly 43,000 patients.  Transfusion rates for >=1 unit varied 3-fold (22% to 67%), for >=5 units varied 5-fold, >=1 platelet pack varied 3-fold, >=1 FFP varied 4 fold, and >=1 cryoprecipitate varied 20-fold.  The differences were not explained by patient, surgical, or hospital characteristics.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Bo Ye, Ji-Cheng Tantai, Xiao-Xiao Ge, Wang Li, Jian Feng, Ming Cheng, Jian-Xing Shi, Heng Zhao

The authors compared outcomes of surgical management of early stage thymoma in 125 patients undergoing unilateral VATS to 137 patients undergoing transsternal resection.  OR time, blood loss, chest tube drainage, chest tube duration, and LOS were less in the VATS group.  Complication rates and local recurrence rates were similar. 

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Liselotte M. Klitsie, Arno A.W. Roest, Irene M. Kuipers, Mark G. Hazekamp, Nico A. Blom, Arend D.J. Ten Harkel

This study compared early and intermediate biventricular function after early arterial switch in 26 infants and 20 age-matched controls. At 1 year LV performance was similar in ASO and controls, whereas RV systolic and diastolic function remained impaired.  This stresses the need for ongoing monitoring of RV function after ASO.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Denis Bouchard, Henrik Jensen, Michel Carrier, Philippe Demers, Michel Pellerin, Louis P. Perrault, Jean Lambert

Appropriate management of functional ischemic MR at the time of CABG is unknown.  This study randomized 31 patients with moderate functional ischemic MR to CABG alone or in combination with ring annuloplasty.  Moderate differences in outcomes were evident at 3 months, but at 12 months the groups were similar in LVEF and MR improvement.  

Source: British Journal of Surgery
Author(s): A. Lai, N. Davidson, S. W. Galloway and J. Thachil

This is a really nice summary article of the new oral antocoagulants which is freely available in full. 

It describes the particular complications of the NOAC and cautions in renal failure and recommends safe stopping times before surgery 

Source: Circulation
Author(s): Saleeb SF, Newburger JW, Geva T, Baird CW, Gauvreau K, Padera RF, Del Nido PJ, Borisuk MJ, Sanders SP, Mayer JE.

In this manuscript, the authors describe their findings after reviewing 27 young patients (between 7 and 30 years of age) who had undergone aortic valve replacement with two types of bovine pericardial biological prosthesis: Mitroflow® LXA (15 patients) and PERIMOUNT Magna® and Magna Ease® (12 patients) valves.

Life-threatening aortic bioprosthetic valve stenosis at 1.5 to 3 years after Mitroflow® LXA valve implantation occurred in 5 patients (33%). Freedom from valve failure at 3 years among those with a Mitroflow® LXA valve was 18%, and progression from less than mild to severe aortic stenosis was observed over a median of 6 months. No valve failures were noted in the observation period among 12 patients with a Magna® or Magna Ease® aortic bioprosthesis.

Based on their findings, the authors conclude that children and very young adults who have received a Mitroflow® LXA pericardial aortic bioprosthesis are at elevated risk for rapid prosthetic valve failure.