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Journal and News Scan

Source: Annals of Thoracic Surgery
Author(s): Heather L. Lander, Julius I. Ejiofor, Siobhan McGurk, Kaneko Tsuyoshi, Prem Shekar, Simon C. Body
The authors investigated the efficacy of vancomycin paste applied to the sternal edges during cardiac surgery in reducing the risk of deep sternal wound infection among nearly 14,500 cardiac surgical patients.  The incidence of such infections was 09.%.  In a multivariable analysis, BMI, NYHA class, and the STS DSWI risk index were significantly associated with deep sternal wound infection.  Vancomycin paste did not reduce the incidence of infection.
Source: Annals of Thoracic Surgery
Author(s): Nikola Dobrilovic, Jaishankar Raman, James G. Fingleton, Andrew Maslow, Arun K. Singh
Mitral valve surgery complicated by atrioventricular groove disruption has a high mortality rate.  The authors describe results of an external repair for this injury, directly suturing the atrioventricular groove.  In a 20-year experience involving over 3,000 mitral valve operations, 13 such injuries occurred.  30-day and hospital mortality were 15% and 23%.  1-year survival was 73%.   The external repair approach appears to offer favorable results after this devastating complication.
Source: Annals of Thoracic Surgery
Author(s): Adnan M. Al-Ayoubi, Sadiq S. Rehmani, Catherine F. Sinclair, Robert S. Lebovics, Faiz Y. Bhora
Using pigs as an experimental model, the authors demonstrated incorporation of bioengineered tracheal grafts in large tracheal defects.  The grafts were constructed of acellular bovine dermis extracellular matrix and human mesenchymal stem cells incubated with chondogenic factors.  The authors demonstrated that the use of stem cells resulted in chondrogenesis, and that the grafts developed neovascularization and epithelialization, all of which are important in supporting tracheal healing and growth.
Source: Journal of the American College of Cardiology
Author(s): David W.M. Muller, Robert Saeid Farivar, Paul Jansz, Richard Bae, Darren Walters, Andrew Clarke, Paul A. Grayburn, Robert C. Stoler, Gry Dahle, Kjell A. Rein, Marty Shaw, Gregory M. Scalia, Mayra Guerrero, Paul Pearson, Samir Kapadia, Marc Gillinov, Augusto Pichard, Paul Corso, Jeffrey Popma, Michael Chuang, Philipp Blanke, Jonathon Leipsic, Paul Sorajja, Tendyne Global Feasibility Trial Investigators
Results are reported of a global feasibility study in which 30 patients at high risk for mitral valve surgery were enrolled at 8 study sites. Patients underwent transapical mitral valve replacement with a Tendyne transcatheter mitral valve. A mitral prosthesis was successfully implanted in 93%. In these 28 patients, the residual MR (valvular or paravalvular) was grade 0 in all but 1 patient and there was no LVOT obstruction. There was no device embolization or cardiac perforation. At 30 days, there was only one death (3.3%). Repeat echocardiography showed no evidence of prosthesis dysfunction. There were no strokes, no myocardial infarctions, and no additional device-related complications during hospitalization. The authors conclude that transcatheter mitral valve replacement using a prosthesis specifically designed for the mitral valve is feasible and can be performed safely.
Source: The Annals of Thoracic Surgery
Author(s): STS Workforce on Resuscitation of patients who arrest after cardiac surgery
This New STS Expert Consensus Statement is now available to download. For the first time this protocol gives units who look after patients after cardiac surgery a complete guide for the management for patients who arrest. Most notably there is a recommendation that patients should undergo an emergency resternotomy within 5 minutes if quickly reversible factors are not found, in order to save those patients who have arrested due to tamponade, for whom external CPR is ineffective. There are recommendations for the organisation of the team, recommendations against the use of epinephrine, recommendations on how to identify rapidly reversible causes for the arrest and importantly there is advice as to how to implement this guidance into your unit and how to get trained. The APACVS have also set up a training arm to help with the implementation of the protocol that can be found at www.csu-als.com
Source: Toronto General Hospital
Author(s): Dr. Shaf Keshavjee
In a bold and very challenging move, thoracic surgeons at Toronto General Hospital (TGH) removed severely infected lungs from a dying mom, keeping her alive without them for six days, so that she could recover enough to receive a life-saving lung transplant.
Source: J Thorac Cardiovasc Surg. 2016 Apr;151(4):1081-9
Author(s): Rosenblum JM, Harskamp RE, Hoedemaker N, Walker P, Liberman HA, de Winter RJ, Vassiliades TA, Puskas JD, Halkos ME
This article is a propensity matched analysis comparing patients undergoing hybrid coronary revascularization (HCR) with minimally invasive left internal mammary artery to left anterior descending artery (LAD) bypass and percutaneous coronary intervention (PCI) to non-LAD arteries to patients undergoing conventional coronary artery bypass grafting (CABG) with either single (SIMA) or bilateral internal mammary arteries (BIMA).  A total of 306 patients underwent HCR from 2003 to 2013 compared with 8254 patients undergoing CABG.  In the HCR group LIMA harvest was performed endoscopically before 2009 and with robotic assistance thereafter.   In the matched study populations, cardiopulmonbary bypass was used in 0% of patients in HCR group, 21% in SIMA group and 7% in BIMA group.  Patient factors that were associated with HCR use were older age, lower body mass index, history of PCI, and 2-vessel coronary disease. In the HCR group, 84% of non-LAD lesions were treated with drug eluting stents.  At 30 days, there was no significant difference in major cerebrovascular and cardiac events between groups.  In hospital complications,  the need for blood transfusions, and hospital stay duration were lower for the HCR group.  There was no difference in survival between the matched groups at midterm followup (median follow-up 2.8 years).   The authors conclude that HCR in selected patients may be a safe and less invasive alternative to conventional CABG with similar short and midterm outcomes.
Source: JACC: Heart Failure
Author(s): Jacqueline Baras Shreibati, Jeremy D. Goldhaber-Fiebert, Dipanjan Banerjee, Douglas K. Owens, Mark A. Hlatky
With the everpresent question of potentially extending LVAD therapy to ambulatory patients with advanced heart failure, the authors--using a Markov model--projected the incremental cost-efffectiveness ratio (ICER) of DT LVADs in this population as compared to conventional medical therapy.   The authors find that, although LVADs clearly extend quality-adjusted life-years (QALYs), the ICER is >$200K per QALY.  (Conventional cut-offs for ICER acceptability range from <$50K to <$100K.)  This ICER is thus cost-ineffective at present.   The study finds that this excessive cost is driven predominantly by follow-up care and readmissions, which suggests a potential target for improving ICER in the future.
Source: AORTA, August 2016, Volume 4, Issue 4:124-130
Author(s): Curtis AE, Smith TA, Ziganshin BA, Elefteriades JA
A comprehensive discussion on an important parameter for cardiologists and surgeons dealing with congenital and structural / valve disease, as applicable to the systemic circulation 
Source: The Thoracic and Cardiovascular Surgeon
Author(s): Henning Gaissert, Susan R. Wilcox
 This review discusses diaphragmatic disorders and postoperative respiratory failure caused by unilateral or bilateral diaphragmatic impairment. 

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