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Journal and News Scan

Source: The BMJ
Author(s): Joseph Shalhoub, Rebecca Lawton, Jemma Hudson, Christopher Baker, Andrew Bradbury, Sampson Gamgee, Karen Dhillon, Tamara Everington, Manjit S Gohel, Zaed Hamady, Beverley J Hunt, Gerrard Stansby, David Warwick, John Norrie, Alun H Davies, on behalf of the GAPS trial investigators

A medium-sized RCT from the Imperial College. The research question are of interest for all cardiovascular, thoracic, and general surgeons as well as all healthcare professionals. 

Source: JAMA Cardiology
Author(s): Louise Y. Sun, Mario Gaudino, Robert J. Chen, Anan Bader Eddeen, Marc Ruel,
This original article using very carefully the propensity match analysis tried to answer the question regarding long-term outcomes of patients with severely reduced left ventricular ejection fraction (LVEF) who undergo revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).
 
It had analysed retrospectively a  cohort study from 8 years period with LVEFs less than 35% and left anterior descending (LAD), left main, or multivessel coronary artery disease (with or without LAD involvement) who underwent PCI or CABG.The primary outcome was all-cause mortality. Secondary outcomes were death from cardiovascular disease, major adverse cardiovascular events (MACE; defined as stroke, subsequent revascularization, and hospitalization for MI or heart failure), and each of the individual MACE. A total of 12 113 patients (mean [SD] age, 64.8 (11.0) years for the PCI group and 65.6 [9.7] years for the CABG group; 5084 (72.5%) male for the PCI group and 4229 (82.9%) male for the PCI group) were propensity score matched on 30 baseline characteristics: 2397 patients undergoing PCI and 2397 patients undergoing CABG. The median follow-up was 5.2 years (interquartile range, 5.0-5.3). Patients who received PCI had significantly higher rates of mortality (hazard ratio [HR], 1.6; 95% CI, 1.3-1.7), death from cardiovascular disease (HR 1.4, 95% CI, 1.1-1.6), MACE (HR, 2.0; 95% CI, 1.9-2.2), subsequent revascularization (HR, 3.7; 95% CI, 3.2-4.3), and hospitalization for MI (HR, 3.2; 95% CI, 2.6-3.8) and heart failure (HR, 1.5; 95% CI, 1.3-1.6) compared with matched patients who underwent CABG.
 
This study concludes that there is higher rates of mortality and MACE in patients with severely reduced left ventricular ejection who received PCI compared with those who underwent CABG.The authors suggested that these findings may provide insight to physicians who are involved in decision-making for these patients.
Source: Jama Surgery
Author(s): Andrew J. Meltzer, MD, MBA1; M. Susan Hallbeck, PhD2,3,4; Melissa M. Morrow, PhD2,3; et al

Surgeon ergonomics is an underappreciated occupational hazard.  This study uses inertial measurement units to monitor ergonomics of surgeons, including a small handful of cardiac surgeons.  More research and discussion is needed in the this space.

Source: Circulation Research
Author(s): Jaime Ibarrola, Amaia Garcia-Peña, Lara Matilla, Benjamin Bonnard, Rafael Sádaba, Vanessa Arrieta, Virginia Alvarez, Amaya Fernández-Celis, Alicia Gainza, Adela Navarro, Diego Alvarez de la Rosa, Patrick Rossignol, Frederic Jaisser, Natalia López-Andrés

Interesting hypothesis in a rodent model of myxomatous degeneration.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Ilhan Inci, Martina Benker, Necati Çitak, Didier Schneiter, Claudio Caviezel, Sven Hillinger, Isabelle Opitz, Walter Weder

This original article compares the outcome of sleeve lobectomy compared to conventional lobectomy in the treatment of patients with lung cancer. Inci et al. investigated 187 patients who underwent sleeve lobectomy and compared it to 568 patients who underwent conventional lobectomy. They found no difference in safety end-points or mid-term follow-up regarding the two different groups.

Source: Interactive CardioVascular and Thoracic Surgery
Author(s): Ning Dong, Hulin Piao, Yu Du, Bo Li, Jian Xu, Shibo Wei, Kexiang Liu

Dong et al developed a score to predict renal failure after surgery for Stanford type A dissection. This score includes age, BMI, white blood count, perioperative hemoglobin levels, CPB duration, and renal malperfusion. The score derives from a retrospective analysis of 326 patients from the author’s institution and validated in a group of more than 100 patients from a separate institution. The receiver operating curve proves a good prediction of perioperative renal failure by the new score.

Source: The New England Journal of Medicine
Author(s): Thomas F. Khairy, Marie-Andrée Lupien, Santiago Nava, Frank Valdez Baez, Fernando Solares Ovalle, Nery E. Linarez Ochoa, Gerardo Sosa Mendoza, Cesar A. Carrazco, Christine Villemaire, Richard Cartier, Denis Roy, Mario Talajic, Marc Dubuc, Bernard Thibault, Peter G. Guerra, Lena Rivard, Katia Dyrda, Blandine Mondésert, Rafik Tadros, Julia Cadrin-Tourigny, Laurent Macle, Paul Khairy

Access to pacemakers and defibrillators is problematic in places with limited resources. A multinational program was initiated in 1983 to provide tested and resterilized pacemakers and defibrillators to underserved nations; a prospective registry was established in 2003. The incidence of infection or device-related death at two years was 2.0%, an incidence that did not differ significantly from that seen among matched control patients with new devices in Canada.

Source: The Annals of Thoracic Surgery
Author(s): David A. Wood, Ehtisham Mahmud, Vinod H. Thourani, Janarthanan Sathananthan, Alice Virani, Athena Poppas, Robert Harrington, Joseph A. Dearani, Madhav Swaminathan, Andrea M. Russo, Ron Blankstein, Sharmila Dorbala, James Carr, Sean Virani, Kenneth Gin, Alan Packard, Vasken Dilsizian, Jean-François Légaré, Jonathon Leipsic, John G. Webb, Andrew D. Krahn

This article describes recommendations from the North American leadership in regards to the safe reintroduction of cardiovascular services during the COVID-19 pandemic including, but not limited to, ethical considerations, the importance of collaboration amongst public health officials and cardiovascular specialties, and protection of healthcare workers. In addition, they include detailed recommendations stratified by the level of response customized for institutions and guidance on how to reserve capacity for potential re-surgence of COVID-19. 

Source: Journal of Vascular Surgery: Venous and Lymphatic Disorders
Author(s): Fedor Lurie, Fedor Lurie,Fedor Lurie, Marc Passman, Mark Meisner, Michael Dalsing, Elna Masuda, Harold Welch, Ruth L. Bush, John Blebea, Patrick H. Carpentier, Marianne De Maeseneer, Anthony Gasparis, Nicos Labropoulos, William A. Marston, Joseph Rafetto, Fabricio Santiago, Cynthia Shortell, Jean Francois Uhl, Tomasz Urbanek, André van Rij, Bo Eklof, Peter Gloviczki, Robert Kistner, Peter Lawrence, Gregory Moneta, Frank Padberg, Michel Perrin, Thomas Wakefield

Use of anatomic abbreviations instead of numbers seems pro-intuitive ...

Source: JAMA
Author(s): Rishi K. Wadhera, Jose F. Figueroa, Karen E. Joynt Maddox, Lisa S. Rosenbaum, Dhruv S. Kazi, Robert W. Yeh

This is a research letter the looks at the investment that CMS has made in developing quality measures.  It points out the limited value of many of them and discusses recommendations for implementation and evaluation of these measures.

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