Journal and News Scan

Chronic lung allograft dysfunction (CLAD) is associated with significant morbidity after lung transplantation, however, at the time of diagnosis of CLAD, the disease process has usually adversely impacted graft function. The authors studied a scoring system based on the Airway Inflammation 2 (AI2) gene set and found that this score predicted time to graft failure as well as retransplant free survival in patients with CLAD, as compared to a validation cohort that included non-CLAD patients. Although there may be a component of survival bias during matching, this is a highly interesting area of research that could have important clinical implications in early identification of CLAD. 

Congenital and pediatric cardiac surgery are among the most complex, high-stake medical specialties, which requires exceptional cognitive and technical skills. Despite advances in technology and patient safety, the training for future surgeons in this field faces significant challenges. Issues include the increasing complexity of surgeries, reduced opportunities for simpler cases, strict work hour regulations, and public scrutiny of outcomes. These factors contribute to a crisis in training, with many trainees and young surgeons expressing dissatisfaction. 

Mentorship is crucial in overcoming these challenges. It involves a stepwise approach to teaching surgical skills, ongoing guidance during early years of practice, and leadership training for managing interdisciplinary teams. Effective mentorship not only improves technical proficiency but also enhances emotional intelligence and resilience. Despite the lack of tangible rewards and the significant time commitment required, mentoring enriches both the mentor and mentee, ultimately benefiting patient care and advancing the field. 

Ischemic cardiomyopathy (ICM) causes more than 60 percent of congestive heart failure cases, leading to high morbidity and mortality. Myocardial revascularization is vital for patients with left ventricular dysfunction (LVD) and an ejection fraction (LVEF) ≤ 35 percent, aiming to improve survival rates and quality of life. Despite its importance, randomized clinical trials often exclude these patients, relying on observational data. A recent review evaluated surgical revascularization strategies, highlighting ONCABG for multivessel disease in LVD patients with LVEF < 35 percent, and OPCAB for older, high-risk patients. Techniques such as internal thoracic artery skeletonization, BITA, and postoperative glycemic control are crucial for managing risks. Total arterial revascularization improves long-term survival, while hybrid revascularization reduces hospital stays and costs. This review emphasizes the need for tailored revascularization strategies in severe LVD patients.

As the understanding of the natural progression of smaller peripheral lung nodules grows, the treatment options and existing paradigms continue to change. One area that is under intense study involves ground glass nodules (GGOs), which are detected by high resolution CT scans. The authors summarize the recent efforts to classify the aggressiveness of GGOs on imaging with the resulting pathology noted after surgical resection and discuss how such lesions can be over and under treated based on existing classification systems. The authors also discuss algorithms to aid in individualized patient selection for sublobar resections with such lesions.