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Journal and News Scan

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Elizabeth L. Norton, David M. Williams,Karen M. Kim, Minhaj S. Khaja, Xiaoting Wu, Himanshu J. Patel, Michael Deeb, Bo Yang, MD, PhDc

The initial experience from Ann Arbor throughout a quarter of a century in malperfusion syndrome from type B (De Bakey III) aortic dissection is presented in this paper, juxtaposing early fenestrating and adjunct endovascular techniques to conservative treatments.

Half of the relatively young patients were not alive after ten years, although radiological success was claimed in more than nine out of ten cases.

The growing interest in early intervention for type B, and the advances in endovascular and hybrid solutions for aortic disease will rend this retrospective manuscript an interesting read.

Source: Pfizer Press Release
Author(s): Pfizer Inc. and BioNTech SE

In a press release early this morning, Pfizer and BioNTech accounced the results of their vaccine candidate against SARS-CoV-2 in the first interim efficacy analysis of its Phase 3 clinical study.

This vaccine candiate, BNT162b2, was found to be more than 90% effective in preventing COVID-19 in 94 participants without evidence of prior SARS-CoV-2 infection. 

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Daniele Linardi, Beat Walpoth, Romel Mani, Angela Murari, Maddalena Tessari, Stiljan Hoxha, Marco Anderloni, Ilaria Decimo, Sissi Dolci, Elena Nicolato, Pietro Bontempi, Flavia Merigo, Giovanni B Luciani, Giuseppe Faggian, Alessio Rungatscher

This original article by Linardi et al. analysis the outcome of slow versus fast rewarming after hypothermic circulatory arrest in a rat model. They observed reduced inflammatory and oxidative stress and also a higher cerebral blood flow within the slow rewarming group compared to the fast rewarming group. Therefore they suspect slow rewarming might be superior regarding neurologic outcome after hypothermic circulatory arrest.

Source: Medscape
Author(s): Deborah Cohen and Ed Brown

This hard hitting article summarises the current situation with the Excel trial and the situation regarding the evidence of PCI vs CABG in left main stem disease. 

It exposes a legion of errors and scandals which were first exposed by Professor David Taggart then the BBC then EACTS. 

It lists the 30% of the writing taskforces declaration of interest with stent manufacturers

It finally reports the possible resolution by a change in the guidelines which is now being planned. 

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Christopher K. Mehta, S. Chris Malaisrie, Ashley N. Budd, Yutaka Okita, Hitoshi Matsuda, Fernando Fleischman, Yuichi Ueda, Joseph E. Bavaria, and Marc R. Moon

This joint consensus document aims to facilitate triage and management of patients with aortic dissection, rupture, and malperfusion syndromes during the  COVID-19 pandemic. The following issues have been addressed in the care of COVID-19–positive or status unknown patients with aortic emergencies:

1. Management and triage

2. Management of interfacility transfers

3. Preoperative considerations to minimize risk to health care personnel 

4. Important anesthetic considerations

5. Precautions to be taken by surgical personnel during the procedure

6. Postoperative considerations

Source: JAMA Internal Medicine
Author(s): Mario Gaudino, Irbaz Hameed, Michael E. Farkouh, Mohamed Rahouma, Ajita Naik, N. Bryce Robinson, Yongle Ruan, Michelle Demetres, Giuseppe Biondi-Zoccai, Dominick J. Angiolillo, Emilia Bagiella, Mary E. Charlson, Umberto Benedetto, Marc Ruel, David P. Taggart, Leonard N. Girardi, Deepak L. Bhatt, Stephen E. Fremes,

Within the limitations of a meta-analysis, a useful work advancing that PCI may have a hitherto masked or hidden mortality

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Lieven P Depypere, Niccolò Daddi, Michael R Gooseman, Hasan F Batirel, Alessandro Brunelli on behalf of the ESTS Learning Affairs Committee

Depypere et al. report on a survey among members of the European Society of Thoracic Surgeons (ESTS) regarding the impact of coronarvirus disease 2019 on thoracic oncology surgery. They recorded an almost universal impact on surgical practice regardless of the country and the numbers of COVID-19 infected patients. Furthermore, there was no consensus regarding surgical priorities in lung cancer patients, which represents the need of further guideline work within this area.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Ai Kawamura, Daisuke Yoshioka, Koichi Toda, Ryoto Sakaniwa, Shigeru Miyagawa, Yasushi Yoshikawa, Hiroki Hata, Kazuo Shimamura, Keiwa Kin, Satoshi Kainuma, Takuji Kawamura, Kenta Masada, Masayuki Sakaki, Osamu Monta, Toru Kuratani, Yoshiki Sawa Osaka Cardiovascular Surgery Research Group (OSCAR)

Kawamura et al. present a retrospective multicenter study of 84 patients who underwent concomitant CABG to aortic surgery and anastomosis of the 109 CABG graft anastomosed either to the native aorta or to the vascular prosthesis. The patency evaluated by CT angiography or coronary angiography was significantly worse for those grafts anastomosed to the vascular graft compared to the native aorta.

Source: The Annals of Thoracic Surgery
Author(s): DuyKhanh P. Ceppa, John S. Ikonomidis, Lava R. Timsina, Natalie Boden, Lauren C. Kane, Jessica S. Donington

In this article, Drs Ceppa et al provide an ad hoc analysis of women in cardiothoracic surgery from the Society of Thoracic Surgeons 2019 workforce report. 

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Elizabeth L. Norton, MS, David M. Williams, MD, Karen M. Kim, MD, Minhaj S. Khaja, MD, MBA, Xiaoting Wu, PhD, Himanshu J. Patel, MD, G. Michael Deeb, MD, Bo Yang, MD, PhD

In this article in the Journal of Thoracic and Cardiovascular Surgery, Drs Norton et al performed a single institution retrospective analysis of outcomes of 182 patients with acute type B aortic dissection who underwent fenestration/stenting for suspected malperfusion. They demonstrate the laudible outcomes in this patient population, with 0% new onset paraplegia and 7.7% in-hospital mortality in this high-risk patient population, where acute paralysis was a significant risk factor for late mortality. Overall, endovascular fenestration/stenting can be associated with acceptable short- and long-term outcomes.