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Journal and News Scan

Source: The New England Journal of Medicine
Author(s): Ackermann, M et al.

Autopsy examination of lungs from patients who died from SARS-CoV-2 infection, with comparison to the morphologic & molecular features of lungs from patients who died from ARDS secondary to influenza A (H1N1) infection and from uninfected controls. Although a small series, the finding of intussusceptive angiogenesis distinguished the pulmonary pathobiology of Covid-19 from that of equally severe influenza virus infection.





Source: The Lancet
Author(s): Banghu A, et al.

An international, multicenter, cohort study at 235 hospitals in 24 countries including all patients undergoing surgery who had SARS-CoV-2 infection confirmed. Mortality in patients with SARS-CoV-2 was mainly in those who had postoperative pulmonary complications, which was about 50% and at a rate far higher than the pre-pandemic baseline. As hospitals resume routine surgery, it is likely to be in environments that remain exposed to SARS-CoV-2. This study concludes that strategies are urgently required to minimize in-hospital SARS-CoV-2 transmision and mitigate the risk of postoperative pulmonary complications in SARS-CoV-2 infected patients whose surgery cannot be delayed.

Source: The Annals of Thoracic Surgery
Author(s): Eric Lim, Ines Sousa, Pallav L. Shah, Peter Diggle, Peter Goldstraw

This randomized controlled trial conducted by the National Emphysema Treatment Trial (NETT) on the results of lung volume reduction surgery (LVRS) was re-evaluated by the authors for longer-term results. They found long-term benefits to patients randomized to LVRS.

Source: Interactive CardioVascular and Thoracic Surgery
Author(s): Walid Mohamed, George Asimakopoulos

Mohamed and Asimakopoulos published a best evidence topic regarding the optimal INR target for patients with mechanical aortic valves. They analyzed a total of 922 studies and identified seven studies suitable for best evidence analysis. With regards to their results, a target INR below the standard INR target of 2-3 in patients without thrombogenic risk factors seems to be safe and did not increase the risk of thromboembolic events.


Source: European Journal of Cardio-Thoracic Surgery
Author(s): ZhenMei Liao, Hang Chen, Li Lin, Qiang Chen, LiangLong Chen, ZhaoYang Chen

Liao et al. investigated the long-term outcome of conventional surgery repair and perventricular device occlusion for doubly committed subarterial (DCSA) VSD. They analyzed single-center results using propensity score matching. There were no differences in adverse events within the two groups. The interventional treatment resulted in shorter mechanical ventilation times and hospital stay. The authors concluded that interventional device therapy might be an alternative for selected patients with DCSA VSD.

Source: Circulation Research
Author(s): Marie-Eve Piché, André Tchernof, Jean-Pierre Després

a readable review that advances the position that 

Adolphe Quetelet's formula is now clinically obsolete 



Source: Interactive CardioVascular and Thoracic Surgery
Author(s): Wilhelm Korte, Constanze Merz, Felix Kirchhoff, Jan Heimeshoff, Tobias Goecke, Erik Beckmann, Tim Kaufeld, Felix Fleissner, Morsi Arar, Tobias Schilling, Axel Haverich, Malakh Shrestha, Andreas Martens

Korte et al. studied the results of a surgical exposure and assessment program for cardiac surgery residents and fellows. The program constitutes simulator training, self-organized trainings, and instructed workshops, and was evaluated within students, residents, and fellows. This concept could facilitate structured learning success and evaluation in the training for cardiac surgery.

Source: JAMA Surgery
Author(s): Andrew J. Meltzer, MD, MBA; M. Susan Hallbeck, PhD; Melissa M. Morrow, PhD; Bethany R. Lowndes, PhD; Victor J. Davila, MD; William M. Stone, MD; Samuel R. Money, MD

Using wearable technology, Meltzer et al. demonstrated that surgeon-reported risk factors for pain included longer case length, increased years in pratice, use of loupes, and use of headlights. Further research is needed in order to improve surgeon ergonomics, especially around cardio-thoracic surgeons, who routinely wear loupes, headlights, and have some of the longest case lenghts. 

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Joseph E. Bavaria, William T. Brinkman, G. Chad Hughes, Aamir S. Shah, Kristofer M. Charlton-Ouw, Ali Azizzadeh, and Rodney A. White

Bavaria et al reported the five-year outcomes of thoracic endovascular aortic repair (TEVAR) of complicated acute type B aortic dissection (TBAD) in the DISSECTION trial. In this prospective, nonrandomized study, 50 patients were treated with the Valiant Captivia thoracic stent graft for acute complicated TBAD. Prior to TEVAR, malperfusion was seen in 86% (43/50), ruptures in 20% (10/50), and DeBakey class IIIb dissections in 94% (46/49).

At five years, clinical and imaging follow-up was available in 78% (18/23); freedom from dissection-related mortality, secondary procedures related to dissection, and endoleak were 83%, 86%, and 85%, respectively; complete thrombosis of false lumen across the stented aortic segment was seen in 89% (16/18); true lumen diameter across the stent graft was stable or increased in 94% (16/17); and false lumen diameter was stable or decreased in 77% (13/17) of patients. 

These results show that patients with complicated TBAD experienced positive and sustained measures of aortic remodeling after TEVAR and the Valiant Captivia thoracic stent graft system was effective in the long-term management of acute complicated type B aortic dissections in this challenging patient population.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Hongliang Zhao, Wanling Ma, Didi Wen, Weixun Duan, Minwen Zheng

This article by Zhao et al. analyzes the risk of stroke in patients suffering from type A dissection depending on preoperative CT findings. They identified aortic regurgitation, dissection of the common carotid artery, and the ratio of the true lumen to the diameter of the involved ascending aorta as independent risk factors.