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Journal and News Scan

Source: Journal of the American Medical Association
Author(s): Douglas K. Owens, Karina W. Davidson, Alex H. Krist, Michael J. Barry, Michael Cabana, Aaron B. Caughey, Chyke A. Doubeni, John W. Epling Jr, Martha Kubik, C. Seth Landefeld, Carol M. Mangione, Lori Pbert, Michael Silverstein, Melissa A. Simon, Chien-Wen Tseng, and John B. Wong

On December 9, the US Preventive Services Task Force (USPSTF) published updated recommendations on the screening of abdominal aortic aneurysm (AAA) based on patient's gender, age, history of smoking, and family history of AAA for symptomatic adults:

  1. In men aged 65-75 years who have EVER smoked  =>  One-time screening for AAA with ultrasonography  (B recommendation);
  2. In men aged 65-75 years who have NEVER smoked  =>  Selective screening for AAA with ultrasonography (C recommendation);
  3. In women who have NEVER smoked and have NO family history of AAA  =>  Routine ultrasonographic screening for AAA is NOT recommended (D recommendation);
  4. Current evidence is insufficient to assess the balance of benefits and harms of screening for AAA with ultrasonography in women aged 65-75 years who have ever smoked or have a family history of AAA (I statement).
Source: BBC
Author(s): Deborah Cohen and Ed Brown

Following the withdrawal of Professor Taggart’s name from the author list of the EXCEL trial, the BBC in the UK have filmed a full exposé of some of the background to this decision. Secretary General of EACTS, Dominic Pagano, has stated that if the allegations are true, then perhaps support should be withdrawn for the current guidelines that PCI is equivalent to bypass grafting. 

It looks like the published results of this trial in The New England Journal of Medicine are unravelling and either this paper will need to be withdrawn and re-published, or extensive modifications must be made. Let us know what you think after reading this article.

Source: Circulation Research
Author(s): Biqi Wang, Kathryn Lunetta, Josée Dupuis, Steven A Lubitz, Ludovic Trinquart, Lixia Yao, Patrick T Ellinor, Emelia J Benjamin, and Honghuang Lin

Given the escalating importance of atrial fibrillation for surgeons, this genomics article may be of considerable interest in future.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Tomonobu Abe, Hiroyuki Yamamoto, Hiroaki Miyata, Noboru Motomura, Yoshiyuki Tokuda, Kazuo Tanemoto, Akihiro Usui, and Shinichi Takamoto

Abe and associates reported the trends in the early outcomes of surgical repair for acute type A aortic dissection in 11,843 patients from the Japan Cardiovascular Surgery Database between 2008 and 2015. Operative mortality was 9.5% and 30-day mortality was 7.6%. The number of surgically treated cases increased by 45% during the interval. A signficant upward trend was found in patient age and the incidences of preoperative renal failure. Unadjusted operative mortality rate with arch replacement showed a significant downward trend (P = 0.01). Risk-adjusted mortality rate showed a downward trend both in ascending aortic or hemiarch and arch replacement, which did not reach statistical signficance.  

Source: JAMA Network
Author(s): Rahul Bhatnagar, Hania E. G. Piotrowska, Magda Laskawiec-Szkonter, Brennan C. Kahan, Ramon Luengo-Fernandez, Justin C. T. Pepperell, Matthew D. Evison, Jayne Holme, Mohamed Al-Aloul, Ioannis Psallidas, Wei Shen Lim, Kevin G. Blyth, Mark E. Roberts, Giles Cox, Nicola J. Downer, Jurgen Herre, Pasupathy Sivasothy, Daniel Menzies, Mohammed Munavvar, Moe M. Kyi, Liju Ahmed, Alex G. West, Richard N. Harrison, Benjamin Prudon, Gihan Hettiarachchi, Biswajit Chakrabarti, Ajikumar Kavidasan, Benjamin P. Sutton, Natalie J. Zahan-Evans, Jack L. Quaddy, Anthony J. Edey, Amelia O. Clive, Steven P. Walker, Matthew H. R. Little, Xue W. Mei, John E. Harvey, Clare E. Hooper, Helen E. Davies, Mark Slade, Merle Sivier, Robert F. Miller, Najib M. Rahman, Nick A. Maskell

In this multi-institutional randomized trial comparing talc slurry through a chest tube to talc pudrage during VATS, success rates at 90 days were similar.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Mark Helmers, Pavan Atluri

Succinct commentary on the challenge of vascular access in ECMO circuits on the occasion of a manuscript on a novel design of a multi-access adaptor.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Jonas Pausch, Eva Harmel, Christoph Sinning, Hermann Reichenspurner, Evaldas Girdauskas

In this study, the authors report on the outcome of mitral valve repair, applying subannular repair for functional mitral valve regurgitation. Included are 108 patients who underwent annuloplasty with subannular repair (n=60) versus patients with annuloplasty only (n=48). Repositioning of the papillary muscle lead to excellent outcomes with less mitral valve regurgitation recurrence.

Source: The Annals of Thoracic Surgery
Author(s): Alexander A. Brescia, Himanshu J. Patel, Donald S. Likosky, Tessa M.F. Watt, Xiaoting Wu, Raymond J. Strobel, Karen M. Kim, Shinichi Fukuhara, Bo Yang, G. Michael Deeb, Michael P. Thompson

Higher case volumes (>10 annually) were associated with  decreased mortality for surgical treatment of aortic dissection. This relationship was not evident for thoracic endovascular aortic repair.  

Source: The New England Journal of Medicine
Author(s): Clive Kearon, Kerstin de Wit, Sameer Parpia, Sam Schulman, Marc Afilalo, Andrew Hirsch, Frederick A. Spencer, Sangita Sharma, Frédérick D’Aragon, Jean-François Deshaies, Gregoire Le Gal, Alejandro Lazo-Langner, Cynthia Wu, Lisa Rudd-Scott, Shannon M. Bates, and Jim A. Julian, M.Math. for the PEGeD Study Investigators

Well-presented Canadian prospective study juxtaposing a combination of Wells scoring and dimers to the imaging gold standard.

It was particularly fascinating to read the referenced assertion that:

.....the prevalence of pulmonary embolism among patients who undergo diagnostic testing is substantially higher in Europe than in North America.. (Penultimate paragraph): We wonder what would be the robust causes of such disparity........

Source: Journal of Cardiothoracic and Vascular Anesthesia
Author(s): Vasileios Zochios, Joht Singh Chandan, Marcus J. Schultz, Andrew Conway Morris, Ken Kuljit Parhar, Marc Gimenez-Mila, Caroline Gerrard, Alain Vuylsteke, Andrew A. Klein

 Cohort study from the UK, fuelling the escalating debate on blood management in perioperative cardiovascular care.