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Journal and News Scan

Source: Annals of Thoracic Surgery
Author(s): Shinya Unai, MD, My-Le Nguyen, MD, Daizo Tanaka, MD, Nataliya Gorbachuk, BA, Gregary D. Marhefka, MD, Hitoshi Hirose, MD, Nicholas C. Cavarocchi, MD
This single-center study explored the relationship between spontaneous echo contrast (SEC) and the incidence of thromboembolism and CVA in 98 patients undergoing peripheral VA ECMO.  Twenty-two percent of patients had SEC while they were on ECMO.  Those exhibiting SEC had significantly higher rates of intracardiac thrombus (46% v. 13%, p = 0.002) and CVA (36% v. 7.9%, p = 0.002).  The patients who showed SEC had a lower EF and less frequent aortic valve opening. Comment:  Should we be venting the LV more frequently in VA ECMO?  If so, how should we vent the LV?  Alternatively, should we maintain a baseline level of inotropic support on these patients to discourage stasis in the LV?
Source: Annals of Thoracic Surgery
Author(s): Ismail Bouhout, MD, MS, Amine Mazine, MD, MS∗, Lena Rivard, MD, Aly Ghoneim, MD, Ismail El-Hamamsy, MD, PhD, Yoan Lamarche, MD, MS, Michel Carrier, MD, Philippe Demers, MD, MS, Denis Bouchard, MD, PhD
This single center retrospective study analyzed the incidence of permanent pacemaker requirement in 108 consecutive patients undergoing sutureless aortic valve replacement with the Perceval S bioprosthesis.  In-hospital postoperative pacemakers were required in 23% of patients, 3 times the rate reported in earlier studies and approximately 6 times the historical rate following a standard surgical AVR.
Source: Eur Heart J
Author(s): Usman Baber, Michael E. Farkouh, Yaron Arbel, Paul Muntner, George Dangas, Michael J. Mack, Taye H. Hamza, Roxana Mehran, Valentin Fuster
In the FREEDOM trial, 1900 diabetic patients were randomized between coronary bypass surgery and percutaneous coronary intervention (PCI). Of these, 451 patients had chronic kidney disease (CKD) with a GFR 30-60 mL/min/1.73m2, and the remaining patients were categorized as having no CKD. In both groups, bypass surgery performed better over 5-year follow-up than PCI in patients with CKD (26.0% versus 35.6%; HR=0.73, 95% CI 0.50-1.05) and no CKD (16.2% verus 23.6%; HR=0.76, 95% CI 0.58-1.00). Therefore, independent of chronic kidney disease, diabetic patients with multivessel disease should undergo CABG.
Source: Annals of Thoracic Surgery
Author(s): Timothy S Lancaster, Matthew R Schill, Jason W Greenberg, Marc R Moon, Richard B Schuessler, Ralph J Damiano, and Spencer J Melby
In this single institution retrospective study of postoperative cardiac surgery patients, serum potassium and magnesium levels at times when postoperative atrial fibrillation (POAF) occured were compared with levels in patients who did not experience POAF.  The incidence of POAF was 37%, and was associated with increasing magnesium levels.  Prophylactic potassium administration had no effect on POAF, whereas prophylactic magnesium administration was associated with an increase in POAF risk.
Source: Annals of Thoracic Surgery
Author(s): Byung Kwon Chong, Jae Suk Baek, Yu-Mi Im Im, Chun Soo Park, Jeong-Jun Park, and Tae-Jin Yun
This retrospective study evaluated whether a systemic-PA shunt in infants with TOF facilitated enlargement of the pulmonary valve annulus (PVA).  Placement of a shunt was the only factor associated with PVA growth.  This knowledge may affect how repair is staged with an eye towards avoiding a transannular patch.
Source: Annals of Thoracic Surgery
Author(s): Valerie W Rusch, Ritu R Gill, Alan Mitchell, David Naidich, David C Rice, Harvy I Pass, Hedy L Kindler, Marc De Perrot, and Joseph Friedberg
Semiautomated CT volumetric measurements of tumor volume in patients with malignant pleural mesothelioma were compared to stage and overall survival.  CT volumes correlated well with stage and survival.
Source: Annals of Thoracic Surgery
Author(s): Vinod H Thourani, Jessica Forcillo, Nirat Beohar, Darshan Doshi, Rupa Parvataneni, Girma M Ayele, Ajay J Kirtane, Vasilis Babaliaros, Susheel K Kodali, Chandan Devireddy, Wilson Y Szeto, Howard C Herrmann, Raj Makkar, Gorav Ailawadi, Scott Lim, Hersh S. Maniar, Alan Zajarias, Rakesh M Suri, E. Murat Tuzcu, Samir Kapadia, Lars G. Svensson, Jose Condado, Hanna A Jensen, Michael J Mack, and Martin B Leon
This analysis of PARTNER data evaluated the impact of chronic kidney disease (CKD) on outcomes after TAVR.  Patients were grouped according to GFR as none/mild, moderate, and severe renal disease.  Severe disease was most common among women with diabetes.  Severe disease was associated with a 50% increase in 30-day mortality and 1-year cominbed mortality and all-cause rehospitalization.  Assessment of renal function may help risk stratify patients who are candidates for TAVR. 
Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Umberto Benedetto, Mario Gaudino, Massimo Caputo, Robert F. Tranbaugh, Christopher Lau, Antonino Di Franco, Colin Ng, Leonard N. Girardi, Gianni D. Angelini
The authors conducted a meta-analysis of propensity-scored matched patients in published studies to assess outcomes of right internal mammary artery (RIMA) and radial artery (RA) as second conduits for CABG.  Eight studies included nearly 3000 matched pairs.  RITA was associated with better long-term survival and freedom from reoperation, but also was associated with an increased risk of sternal wound infection when pedicled harvest was conducted.   See also: http://www.jtcvsonline.org/article/S0022-5223(16)30538-4/fulltext
Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Luca Di Marco, Davide Pacini, Antonio Pantaleo, Alessandro Leone, Giuseppe Barberio, Giuseppe Marinelli, Roberto Di Bartolomeo
This single institution retrospective review assessed outcomes of AVR in patients with concomitant aortic root disease using a composite graft.  Early mortality was 5.3% and was related to advanced age, poor NYHA status, urgent operation, and associated MVR or CABG.  Late death was related to CRI, COPD, aortic dissection, CABG, and use of the Cabrol technique.  10-year survival was 66%. See also: http://www.jtcvsonline.org/article/S0022-5223(16)30703-6/fulltext
Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Robert J. Cerfolio, Kyle H. Cichos, Benjamin Wei, Douglas J. Minnich
The success of training techniques including dividing robotic lobectomy into graduated steps, reviewing video peformances of trainees, and coaching through challenging technical maneuvers were tracked during a 5-year experience.  Performance of individual steps among general surgery and cardiothoracic surgery trainees increased over time, while metrics of outcomes remained the same or improved. See also: http://www.jtcvsonline.org/article/S0022-5223(16)30833-9/pdf

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