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Journal and News Scan

Source: New England Journal of Medicine
Author(s): Harry J. de Koning, Carlijn M. van der Aalst, Pim A. de Jong, Ernst T. Scholten, Kristiaan Nackaerts, Marjolein A. Heuvelmans, Jan-Willem J. Lammers, Carla Weenink, Uraujh Yousaf-Khan, Nanda Horeweg, Susan van ’t Westeinde, Mathias Prokop, Willem P. Mali, Firdaus A.A. Mohamed Hoesein, Peter M.A. van Ooijen, Joachim G.J.V. Aerts, Michael A. den Bakker, Erik Thunnissen, Johny Verschakelen, Rozemarijn Vliegenthart, Joan E. Walter, Kevin ten Haaf, Harry J.M. Groen, and Matthijs Oudkerk

Individuals at high risk for lung cancer were randomized to low dose CT screening (years 0, 1, 3, and 5.5) or observation.  At 10 years the cumulative rate ratio for lung cancer death was 0.76 in the screened population of men (p=0.01) and 0.67 in the screened population of women, demonstrating a strong benefit for screening.  

Source: Interactive CardioVascular and Thoracic Surgery
Author(s): Daniel Hernandez-Vaquero, Rocio Diaz, Alberto Alperi, Marcel G Almendarez, Alain Escalera, Hector Cubero-Gallego, Pablo Avanzas, Cesar Moris, Isaac Pascual

This study investigated whether the life expectancy of patients undergoing surgical aortic valve replacement was fully restored compared to the matched general population.

The authors investigated the long-term outcomes of 614 patients above the age of 75 years undergoing surgical aortic valve replacement and compared it to a set of 100 age and sex matched people from the general population.

Those patients who survived the initial postoperative period had life expectancies and survival rates comparable to the general population.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): James K. Kirklin, Francis D. Pagani, Daniel J. Goldstein, Ranjit John, Joseph G. Rogers, Pavan Atluri, Francisco A. Arabia, Anson Cheung, William Holman, Charles Hoopes, Valuvan Jeevanandam, Ulrich P. Jorde, Carmelo A. Milano, Nader Moazami, Yoshifumi Naka, Ivan Netuka, Salpy V. Pamboukian, Sean Pinney, Craig H. Selzman, Scott Silverstry, Mark Slaughter, John Stulak, Jeff Teuteberg, Juliane Vierecke, Stephan Schueler, David A. D'Alessandro

The American Association for Thoracic Surgery and International Society for Heart and Lung Transplantation provide a consensus guidelines document on ten important aspects in mechanical circulatory support.  These include:

1. Preoperative Evaluation and Optimization
2. Support Techniques in Cardiogenic Shock
3. Biventricular Support
4. Surgical Approach
5. Management of Postoperative Bleeding
6. Anticoagulation Management
7. Optimizing Pump Speed
8. Diagnosis and Management of Pump Malfunction
9. Management of Pump-Related Infections
10. Strategies to Promote Myocardial Recovery
Source: The Annals of Thoracic Surgery
Author(s): Joseph V. Lombardi, G. Chad Hughes, Jehangir J. Appoo, Joseph E. Bavaria, Adam W. Beck, Richard P. Cambria, Kristofer Charlton-Ouw, Mohammad H. Eslami, Karen M. Kim, Bradley G. Leshnower, Thomas Maldonado, T. Brett Reece and Grace J. Wang

In this consensus statement, a new anatomic classfication system is proposed for thoracic aortic dissections.  The acuity of aortic dissection and complicated vs uncomplicated dissections are clearly defined.  Risk factors, presentations, management, and complications are expounded.  Follow-up criteria are also discussed with nomenclature for false lumen status, in addition to measurement criteria and definitions of aortic remodeling.  This expert consensus provides a comprehensive document that facilitates communcations and reporting of aortic dissection among the aortic community. 

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Sinan Sabit Kocabeyoglu, Umit Kervan, Dogan Emre Sert, Mehmet Karahan, Emre Aygun, Osman Fehmi Beyazal, Ertekin Utku Unal, Yesim Akin, Burcu Demirkan, Mustafa Pac

This study investigated the impact of preoperative levosimendan administration in patients undergoing LVAD implantation. The authors report on outcomes of patients who received preoperative optimization with levosimendan (n=58) versus patients optimized without a Calcium-sensitizer (n=27).

Although the patients’ characteristics have not been different at baseline, the end-organ function recovered to a greater extent within the levosimendan group. In this small group however, the mortality, as well as length of stay and ventilation, were not different within the two groups. The authors state that levosimendan administration prior to LVAD implantation is safe and well-tolerated.

Source: The Annals of Thoracic Surgery
Author(s): Amy G. Fiedler, Erik E. Lewis, and Joshua L. Hermsen

In this How-I-Teach-It tutorial, Dr Hermsen and associates from the the University of Wisconsin in Madison provide a step-by-step introduction to how they instituted their introductory CPB training course. 

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Yoshinori Handa, Yasuhiro Tsutani, Takahiro Mimae, Yoshihiro Miyata, Morihito Okada

Two groups of Clinical Stage IA lung cancer patients were retrospectively investigated. Ninety-nine patients underwent complex segmentectomy, and 94 patients underwent location-adjusted lobectomy. The results of these two different strategies were compared. Outcomes have been comparable regarding mortality, morbidity, overall survival, and recurrence-free survival rates.

 The authors concluded that complex segmentectomy can provide comparable outcomes in Stage IA lung cancer treatment.

Source: World Journal of Critical Care Medicine
Author(s): Massimo Capoccia and Marc O Maybauer

Capoccia and Maybauer performed a system review of 29 publications related to the use of ECMO in aortic surgery and aortic dissection. A total of 194 patients who had been treated with ECMO support were identified, with a survival rate of 39.7% (77/194). The authors conclude that the use of ECMO in major aortic surgery or dissection is justified, despite that there is no compelling evidence for or against the use of ECMO in this patient population. 

Source: YouTube
Author(s): Diego Gonzalez Rivas

Surely there can be no better example of how healthcare can break down all boundaries between people than this? 

While Trump and Iran ramp up tensions in the region, Diego Gonzalez Rivas makes good on his promise to go and do a materclass in Kurdistan in Iraq. What a fantastic example of putting people and patients ahead of politics! 

Diego, you should be put in charge of the United Nations. It looks like even in Iraq there are excellent surgeons and a need for the best surgery available for lung cancer. 

Source: World Journal for Pediatric and Congenital Heart Surgery
Author(s): Joseph A. Dearani

In this editorial, Dr Joseph Dearani, Chair of the Department of Cardiovascular Surgery at Mayo Clinic in Rochester, Minnesota, addresses the important and timely subject of outcomes measurement, and of transparency and public reporting of cardiac surgery outcomes.

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