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Journal and News Scan

Source: The Annals of Thoracic Surgery
Author(s): Kevin Kulshrestha, Jason W. Greenberg, Amalia M. Guzman-Gomez, John T. Kennedy III, Md Monir Hossain, Yin Zhang, Farhan Zafar, David L.S. Morales

Between 2001 and 2021, 51 percent (n = 28,012) of US pediatric heart donors underwent cardiopulmonary resuscitation (CPR). Donor acceptance was lower after CPR (54 percent versus 66 percent; P < .001) and across successive quartiles of CPR duration (P < .001). Posttransplant survival was worse in donors who received more than 55 minutes of CPR (11.1 years vs 9.2 years; P = .025). There was no survival difference between the recipients of donors who received less than 55 minutes of CPR and no CPR (11.1 years vs 11.2 years; P = .571).

Source: The Annals of Thoracic Surgery
Author(s): Micaela L. Collins, Shale J. Mack, Gregory L. Whitehorn, Brian M. Till, Tyler R. Grenda, Nathaniel R. Evans III, Sarah W. Gordon, Olugbenga T. Okusanya

To assess whether seeking care at multiple Commission on Cancer hospitals is associated with different rates of guideline-concordant care, 44,531 patients undergoing treatment for non-small cell lung cancer between 2004 and 2018 were analyzed. Visiting more than one Commission on Cancer hospital was associated with higher rates of guideline-concordant care for individuals with pN1 to pN2 lung cancer and higher overall survival at five years (54.35 percent vs 45.62 percent, P < .001).

Source: European Heart Journal
Author(s): Stefano Urso, Rafael Sadaba, Victor Dayan

This commentary refers to “PCI or CABG for left main coronary artery disease: the SWEDEHEART registry,” by J. Persson et al. In their commentary, the authors discuss the evidence that shows lower rates of major adverse events at five years in patients who underwent CABG compared with PCI for the treatment of left main disease.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Francesco Pollari, Paolo Nardi, Elisa Mikus, Francesco Ferraro, Marco Gemelli, Ilaria Franzese, Ilaria Chirichilli, Claudia Romagnoni, Giuseppe Santarpino, Salvatore Nicolardi, Roberto Scrofani, Francesco Musumeci, Enzo Mazzaro, Gino Gerosa, Massimo Massetti, Carlo Savini, Giovanni Ruvolo, Michele Di Mauro, Luca Di Marco, Fabio Barili, Alessandro Parolari, Theodor Fischlein, GIROC (Italian Research Group on Outcome in Cardiac Surgery)

In the last decades, four different scores for the prediction of mortality following surgery for type A acute aortic dissection (TAAD) were proposed. Researchers aimed to validate these scores in a large external multicenter cohort. The study retrospectively analyzed patients who underwent surgery for TAAD between 2000 and 2020. Patients were enrolled from ten centers in two European countries. Outcomes were determined for early (30-day and/or in-hospital) and one-year mortality. Discrimination, calibration, and observed/expected (O/E) ratio were evaluated for the GERAADA, the UK Aortic, Centofanti's, and IRAD's score. The GERAADA score showed the best performance in comparison with other scores. However, none of them achieved both a fair discrimination and good calibration for predicting either the early or the one-year mortality.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Maria Nucera, Maximilian Kreibich, Murat Yildiz, Tim Berger, Rosa Klara Kolb, Stoyan Kondov, Sophie Kunzmann, Bartosz Rylski, Vladimir Makaloski, Matthias Siepe, Martin Czerny, Florian S Schoenhoff

In this article the authors aimed to report the midterm outcomes after endovascular aortic repair in patients with Marfan or Loeys-Dietz syndrome. Patients were analyzed based on the timing of the procedure, whether it was an elective or emergency procedure, and the nature of the landing zone (safe vs. unsafe). A population of 419 patients with Marfan (n = 352) or Loeys-Dietz syndrome (n = 67) from two European centers was analyzed. Among them, 39 patients (9 percent) underwent endovascular aortic repair. Thoracic endovascular repair (TEVAR) was performed in 34 patients and abdominal endovascular aortic repair (EVAR) was performed in five patients. The indication for endovascular repair was aortic dissection in 13 (33 percent) patients, aortic aneurysm in 22 (57 percent) patients, and other indications in in 4 (10 percent) patients. There was no statistically significant difference in the rate of reinterventions between patients with unsafe landing zones and the patients with safe landing zones (P = 0.609), and no increased probability for reintervention after elective endovascular intervention compared to emergency procedures (P = 0.916). Hence, the authors concluded that endovascular aortic repair in patients with Marfan or Loeys-Dietz syndrome is feasible and safe in patients with a safe landing zone, and a viable option when employed by a multidisciplinary aortic team even if the landing zone is unsafe.

Source: The Annals of Thoracic Surgery
Author(s): Michel Pompeu Sá, Xander Jacquemyn, Ahmed K. Awad, James A. Brown, Danny Chu, Derek Serna-Gallegos, Fabian A. Kari, Ibrahim Sultan

Valve sparing aortic root replacement has recently emerged as the preferred procedure, when feasible, for patients undergoing aortic root surgery. Two main options are available to achieve this: the Yacoub procedure (remodeling) and the David procedure (reimplantation). With these techniques differing considerably, the authors completed a meta-analysis of available outcome data to evaluate overall survival and need for reintervention.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Hsiung P-Y, Shih P-Y, Wu Y-L, Chen H-T, Hsu H-H, Lin M-W et al

Postoperative neurocognitive disorder after thoracoscopic surgery with general anesthesia may be linked to reduced intraoperative cerebral oxygenation and perioperative inflammation, both of which might be exacerbated by mechanical ventilation. This study randomized 110 patients into two groups, intubated and nonintubated, and measured cerebral oxygenation during surgery. Neuroinflammatory biomarkers were measured 24 hours before (as a baseline) and after surgery. Neurocognitive test scores were taken at baseline, 24 hours, and six months after surgery. Cerebral oxygenation during surgery was more stable in the nonintubated group. The nonintubated group had significantly higher neurocognitive test scores at 24 hours and six months. Inflammatory markers were higher in the intubated group. Further, the nonintubated patients had a significantly lower comprehensive complication Index. Nonintubated thoracoscopic surgery appears to offer significant benefits for the patient.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Traxler D, Krotka P, Reichardt B, Copic D, Veraar C, Mildner M et al

This population-based cohort study examined midterm outcomes of surgical aortic valve replacement with mechanical or bioprosthetic valves in patients less than 50 years old. A total of 991 patients were included. Multivariable Cox regression showed no significant difference in overall survival, with a median follow up period of 6.2 years. However, reoperation-free survival was significantly decreased and risk of reoperation was increased in those who received bioprosthetic valves. Although a difference in overall survival was not apparent in this study, the lower rate of reoperation with mechanical valves might have an impact on long-term survival.

Source: The Thoracic and Cardiovascular Surgeon
Author(s): Shiho Naito, Hermann Reichenspurner, Björn Sill

The impact of the surgeon’s experience on outcomes following off-pump coronary artery bypass grafting (OPCAB) is widely known. However, there is a lack of safe and effective strategies for OPCAB training. In this study, a total of 180 patients who underwent an off-pump isolated single coronary bypass of the left anterior descending artery (LAD) using the left internal mammary artery (LIMA) as an in-situ graft via median sternotomy were analyzed. Outcomes were compared in two groups: operations performed by residents in training under supervision (group 1: n = 63) and experienced surgeons (group 2: n = 117). Trainees were already experienced in on-pump coronary artery bypass grafting. There was no significant difference in the rate of major adverse cardiac and cerebrovascular events between the two groups. The authors conclude that a single off-pump LAD bypass might be a reasonable training strategy for OPCAB.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Li J, Wei X

A novel transapical beating-heart septal myectomy (TA-BSM) procedure was performed for patients with latent obstruction and outcomes were compared with those for patients with resting obstruction. The population was comprised of 120 patients with symptomatic hypertrophic obstructive cardiomyopathy, 33 with latent obstruction, and 87 with resting obstruction. There were no important differences in baseline characteristics, but those with latent obstruction had lower basal septal thickness, higher midventricular thickness, smaller left atria, and higher frequency of mitral subvalvular anomalies. After surgery, there was no significant difference in early deaths or midterm survival and the New York Heart Association class was significantly improved. This novel TA-BMS procedure achieved equivalent outcomes regardless of resting left ventricular outflow tract gradients.