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Journal and News Scan

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.

Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Author(s): S. Chris Malaisrie MD, Christopher K. Mehta, MD

In this article, Drs Malaisrie and Mehta discuss updates on the indications for TEVAR in type B aortic dissection with comparison of the guidelines from The Society of Thoracic Surgeons, Society of Vascular Surgery, American Heart Association, American College of Cardiology, the European Society of Cardiology, and the Japanese Circulation Society. 

Source: Interactive CardioVascular and Thoracic Surgery
Author(s): Zhigang Wang, Min Ge, Tao Chen, Cheng Chen, Qiuyan Zong

Wang et al. present a retrospective single-center study on 712 patients with acute type A dissection who underwent repair utilizing hypothermic circulatory arrest. Within their cohort, preoperative Cystatin-C level and mechanical ventilation times were independent risk factors for acute kidney injury after aortic surgery. Furthermore, acute kidney injury was associated with increased short-term mortality.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Tadashi Kitamura, Shinzo Torii, Takashi Miyamoto, Toshiaki Mishima, Hirotoki Ohkubo, Shunichiro Fujioka, Kazuki Yakuwa, Haruna Araki, Shin Kondo, Yoshimi Tamura, Yuki Tadokoro, Yoshihiko Onishi, Kagami Miyaji

Kitamura et al. present a single-center study looking into the outcomes of patients with acute type A intramural hematoma. Within their Japanese collective, patients showing an aortic diameter ≤ 50 mm, no ulcer-like projection, and a pain score of ≤ 3/10 had to be operated on in only 17% of cases, and had a low hospital mortality of 4%. They conclude a watch-and-wait strategy to be reasonable in this very specific patient cohort.

Source: Journal of the American College of Cardiology
Author(s): John Gregson, Gregg W. Stone, Ori Ben-Yehuda, Björn Redfors, David E. Kandzari, Marie-Claude Morice, Martin B. Leon, Ioanna Kosmidou, Nicholas J. Lembo, W. Morris Brown iii, Dimitri Karmpaliotis, Adrian P. Banning, Jose Pomar, Manel Sabaté, Charles A. Simonton, Ovidiu Dressler, Arie Pieter Kappetein, Joseph F. Sabik iii, Patrick W. Serruys and Stuart J. Pocock

An analysis, from the cardiology viewpoint, of the MI nomenclature issues around the external validity of the EXCEL trial that undermined the EACTS support of the relevant 2018 guidelines