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Journal and News Scan

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Alexander Wahba, Milan Milojevic, Christa Boer, Filip M J J De Somer, Tomas Gudbjartsson, Jenny van den Goor, Timothy J Jones, Vladimir Lomivorotov, Frank Merkle, Marco Ranucci, Gudrun Kunst, Luc Puis, EACTS/EACTA/EBCP Committee Reviewers

The 2019 EACTS/EACTA/EBCP Guidelines on cardiopulmonary bypass in adult cardiac surgery is setting a worldwide benchmark on cooperation of perfusionists and cardiac surgeons in the joined care of cardiac surgery patients. This is the first European document on guidelines regarding the conduction of cardiopulmonary bypass. Many recommendations are based on expert consensus, thereby urging joined research efforts within this important field.

Source: The Annals of Thoracic Surgery
Author(s): Tamar B. Nobel, Nikita Dave, Mahmoud Eljalby, Xinxin Xingg, Arianna Barbetta, Meier Hsu, Kay See Tan, Yelena Janjigian, Manjit S. Bains, Smita Sihag, David R. Jones, Daniela Molena

In this retrospective study of 1760 patients undergoing esophagectomy for cancer at Memorial Sloan Kettering, isolated brain metastases occurred in 2% during follow-up. More than half of those developed within one year of resection. Response to induction therapy was associated with long-term survival in these patients.

Source: Innovations
Author(s): Joseph Zacharias, Peter Perier

The authors attempt to capture the main reasons why some centers are successful in embarking on an endoscopic mitral valve surgery program. The supplementary material includes videos of two alternative cross-clamping options by the authors.

Source: Journal of Clinical Oncology
Author(s): Bryan J. Schneider, Nofisat Ismaila, Joachim Aerts, Caroline Chiles, Megan E. Daly, Frank C. Detterbeck, Jason W.D. Hearn, Sharyn I. Katz, Natasha B. Leighl, Benjamin Levy, Bryan Meyers, Septimiu Murgu, Larissa Nekhlyudov, Edgardo S. Santos, Navneet Singh, Joan Tashbar, David Yankelevitz, and Nasser Altorki

The newest version of the ASCO guidelines for lung cancer surveillance after curative lung cancer therapy is presented. The overall quality of supportive evidence is low, and the strength of recommendations is moderate. CT is recommended as the optimal imaging modality. Of interest, PET and circulating biomarkers are not recommended for routine surveillance.

Source: The Annals of Thoracic Surgery
Author(s): Shinobu Itagaki, Joanna Chikwe, Erick Sun, Danny Chu, Nana Toyoda, Natalia Egorova

Among 7830 patients undergoing arch or hemiarch replacement with hypothermic circulatory arrest in the STS Database, risk factors for the composite of mortality or major permanent neurologic complications were assessed. The incidence of the outcome was 10.9%. The use of antegrade or retrograde cerebral perfusion was protective compared to no cerebral perfusion.

Source: JAMA Cardiology
Author(s): Megan Coylewright, Elizabeth O’Neill, Ariel Sherman, Megan Gerling, Kaavya Adam, Keren Xu, Stuart W. Grande, Harold L. Dauerman, Shayne E. Dodge, Navjot Kaur Sobti, Catherine H. Saunders, Stacey L. Schott, Glyn Elwyn, Marie-Anne Durand

Use of a novel decision aid for patients with symptomatic aortic stenosis resulted in greater patient knowledge and satisfaction, although decisional conflict was unchanged.  Physicians, on the other hand, felt that the aid was not understood by elderly patients, and believed that they used shared decision-making in their usual practice, without the use of a decision aid.

Source: Nature
Author(s): Kenichi Yoshida, Kate H. C. Gowers, Henry Lee-Six, Deepak P. Chandrasekharan, Tim Coorens, Elizabeth F. Maughan, Kathryn Beal, Andrew Menzies, Fraser R. Millar, Elizabeth Anderson, Sarah E. Clarke, Adam Pennycuick, Ricky M. Thakrar, Colin R. Butler, Nobuyuki Kakiuchi, Tomonori Hirano, Robert E. Hynds, Michael R. Stratton, Iñigo Martincorena, Sam M. Janes, Peter J. Campbell

This interesting study compared bronchial epithelial mutation burden, the primary source of new lung cancers, among nonsmokers, former smokers, and current smokers.  Smoking typically adds 1,000 to 10,000 mutations per cell.  Smoking cessation in this study was associated with replenishment of the abnormal epithelium with cells that are typical of nonsmokers and have a normal mutagenic potential.

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