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Journal and News Scan
Buitrago and Restrepo report the largest series to date from Latin America of patients undergoing robot-assisted thoracic surgery. A total of 69 patients underwent robot-assisted procedures with 47 undergoing pulmonary resections, 18 undergoing mediastinal procedures, and 4 undergoing another type of operation. The authors report the outcomes for these procedures, which included no in-hospital mortality. They also report on the association between total operative time and the year that the surgery was performed, finding an approximately 10 minute reduction in total operative time each year.
Assmann and colleagues conducted a survey of extracorporeal life support (ECLS, extracorporeal membrane oxygenation) usage in cardiac surgery departments across Germany, given that German scientific guidelines call for the use of ECLS for cardiac and circulatory failure. With 78 of 84 departments responding, the authors found variability between respondents in ECLS therapy, from program structure to the management and monitoring of the therapy. Satisfaction was higher in programs that had clearly defined responsibilities. They conclude that there is a need for a multidisciplinary guideline concerning ECLS therapy in Germany.
The UK Aortic Group report their experience with the frozen elephant trunk (FET) repair for 66 acute type A aortic dissection (ATAAD) patients using the Thoraflex Hybrid graft at eight UK high-volume aortic centers. The in-hospital mortality was 12% (8/66). Postoperative temporary or permanent neurological events and temporary renal replacement therapy occurred in 17% and 20%, respectively. No spinal cord injury events were documented. These data were similar to those reported in literature in the two largest experiences with the use of FET in patients with ATAAD (in-hospital/30-day mortality: 11-12%). This initial experience demonstrated that FET can potentially be adopted as standard approach in life-threatening aortic diseases, with acceptable complication and mortality rates.
Researchers from Tel Aviv University in Israel reported the first 3D-printed vascularized heart using a patient’s own cells and biological materials. The Primary Investigator claims this is the first time anyone has successfully engineered and printed an entire heart replete with cells, blood vessels, ventricles, and chambers.
The International Aortic Arch Surgery Study Group assessed the safety of total arch replacement (TAR) with frozen elephant trunk (FET) for acute type A aortic dissection (ATAAD) with respect to the risks of operative mortality, stroke, and paraplegia.
Data from 978 patients who underwent total aortic arch replacement for ATAAD with or without FET placement were analyzed. In propensity-score matching, there were no significant differences between TAR plus FET versus isolated TAR in terms of permanent neurological deficits (11.9% versus 10.1%, p = 0.59) and spinal cord injury (4.0% versus 6.3%, p = 0.52). Post-hoc propensity-score stratification showed that FET was associated with a statistically significantly lower mortality risk (OR = 0.47, 95% CI 0.239-0.929, p = 0.03).
These results show that the use of FET for ATAAD does not appear to increase the risk of paraplegia in appropriately selected patients at experienced centers.
The Stanford University cardiac surgery team expounds on current evidence for selection of prostheses in valve replacement. While more liberal usage of biologic prostheses in younger patients may be appropriate for the aortic valve, the support for this practice in the mitral position is not as strong. The enthusiasm for biologic valve implantation in the mitral position for young patients should be tempered. As transcatheter technologies continue to develop, the risk-benefit trade-off between biologic and mechanical valves will evolve. However, until procedural safety and long term durability is proven, reliance on these technologies as a routine salvage procedure may be overly optimistic.
Patient Care and General Interest
Washington state will increase the age at which people can purchase tobacco and vaping products to 21, part of a growing Tobacco 21 law movement in the US that has the goal of reducing tobacco usage among teenagers and young adults.
Airbnb is expanding the reach of its Open Homes for Medical Stays program to help cancer patients afford lodging, if they have to travel long distances for treatment.
A report on US physician compensation from Medscape looks at salary and specialty satisfaction, pay disparities between and within specialties, and amount of time spent on paperwork.
Research, Trials, and Funding
Researchers from Germany report that using a comic-style narrative in the informed consent process for coronary angiography improved patient comprehension and reduced patient anxiety.
After finding that white light exposure overnight was harmful for mice recovering from experimental cardiac arrest, researchers want to know if orange-tinted glasses might help mitigate circadian disruption from hospital lights for heart patients.
Researchers from Australia report on their success with hearts transplanted after circulatory death.
Currently no frozen elephant trunk (FET) prosthesis are readily available in the United States. This University of Colorado team developed a surgical technique to simplify the FET procedure, termed the Buffalo Trunk, which obviates the need for a hybrid graft and decreases operating times.
This technique utilizes a soft-branched graft along with a stent graft to create a distal anastomosis that incorporates the aorta, stent graft, and soft graft in a zone 2 arch reconstruction. The preliminary results in 37 patients undergoing the Buffalo Trunk versus 28 undergoing FET showed that the Buffalo technique has facilitated shorter circulatory arrest time, and subsequently overall decreased operative times without compromising outcomes.
The debate over the utility of postoperative incentive spirometry continues. In this instance, the use of a high-tech incentive spirometer that included audible reminders and use tracking was associated with clinical benefit.
The culture of health care creates important challenges for health care professionals. In particular, this culture is 1) hierarchical, 2) competitive, and 3) perfectionistic. Unfortunately, the tendency of acquiescing to those demands is contrary to promoting resonant teamwork. It is important for leaders of multidisciplinary teams to understand how to create environments that flatten the hierarchy (by encouraging all team members to contribute and to genuinely seek the wisdom and knowledge of their colleagues), that encourage collaboration and cooperation (emphasizing collective “wins” and “losses” both for the immediate team as well as for all of us, as a profession), and that invites excellence (which is a process) rather than an expectation of perfection (which is an unrealistic outcome).
In this article, the authors outline the concepts that promote development of this kind of leadership thinking, which covers topics like emotional intelligence, professionalism, interpersonal and communication skills, and efficient, timely, equitable, unprejudiced and patient-centered care.
This a must-read for cardiothoracic surgeons, who are always leading their surgical team.