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Journal and News Scan

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.

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.