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Journal and News Scan

Source: The Annals of Thoracic Surgery
Author(s): Sophia Wang, MD, Ninotchka Liban Sigua, MD, Shalini Manchanda, MD, Steve Gradney, MD, Sikandar H. Khan, Anthony Perkins, Kenneth Kesler, Babar Khan

The authors measured the risk of obstructive sleep apnea (OSA) preoperatively in patients undergoing thoracic surgery using the “STOP-BANG” questionnaire. A total of 76% of patients were considered intermediate to high risk for OSA, and this group had a longer duration of ICU delirium/coma than the low risk group.

Source: European Heart Journal
Author(s): Finn Gustafsson, Steven Shaw, Jacob Lavee, Diyar Saeed, Yuriy Pya, Thomas Krabatsch, Jan Schmitto, Michiel Morshuis, Joyce Chuang, Laura Damme, Daniel Zimpfer, Jens Garbade

A post-market study (ELEVATE registry) of the fully magnetically levitated continuous flow HeartMate III left ventricular assist device (LVAD) found no pump thrombosis in 463 patients in Europe and Kazakhstan.

Mean age was 55.6 ± 11.7 years, 89% were male, 48% had ischaemic aetiology, and 70% were on inotropes. Indication was bridge-to-transplantation in 66% and destination therapy in 26%. Mean left ventricular ejection fraction was 18.3% and INTERMACS profile was 1–2 in 32%.

In 463 patients, there was no incidence of pump thrombosis; major bleeding was 25%, major infection 35%, and any stroke type 5%. Functional capacity improved significantly (Δ6MWD 230 ± 191 m), as did quality of life (ΔVAS 31 ± 23). Survival at six months was 82 ± 2%. Freedom from unplanned rehospitalizations at six months was 68 ± 2%.

This potential to reduce haemocompatibility-related events is one of the main improvements of HeartMate III over other LVADs. 

Source: RadioGraphics
Author(s): Farhood Saremi , Cameron Hassani, Leah M. Lin, Christopher Lee, Alison G. Wilcox, Fernando Fleischman, Mark J. Cunningham

Farhood Saremi and colleagues from the University of Southern California contributed a comprehensive review of the computed tomography angiographic (CTA) findings that improve the accuracy of diagnosis of thoracic aortic dissection and predict the outcomes of different management strategies for this highly lethal disease. The authors present the concept of aortic remodeling and the spectrum of CTA findings with regard to favorable or failing remodeling. This review also summarizes important image findings that are predictive of positive or negative remodeling before and after thoracic endovascular aortic repair. Knowledge of these imaging findings and their inclusion in a concise radiology report are important for optimum patient care.

Source: Interactive Cardiovascular and Thoracic Surgery
Author(s): Sang Hyun Kim, Ho Jin Kim, Joon Bum Kim, Sung-Ho Jung, Suk Jung Choo, Cheol Hyun Chung, Jae Won Lee

Kim and colleagues sought to determine if a supra-annular aortic valve prosthesis implantation is superior to an intra-annular implantation. The authors retrospectively reviewed outcomes and echocardiographic data for 587 patients who received either supra-annular or intra-annular aortic valve prostheses from St Jude Medical. The implantation technique did not significantly affect the risk of overall mortality or major adverse events, however there were superior hemodynamics with lower peak velocity, lower mean pressure gradient, and improved ventricular mass index in patients with supra-annular implantation.

Source: The Annals of Thoracic Surgery
Author(s): David B. Nelson, Danica J. Lapid, Kyle G. Mitchell, Arlene M. Correa, Wayne L. Hofstetter, Reza J. Mehran, David C. Rice, Boris Sepesi, Garrett L. Walsh, Ara A. Vaporciyan, Stephen G. Swisher, Jack A. Roth, Mara B. Antonoff

In a single institution review comparing acute outcomes for men and women after surgery for non-small cell lung cancer, men were found to have an increased risk of postoperative cardiac complications, whereas women were found to have an increased incidence of 30-day readmission, the latter despite similar frequency of postoperative emergency department visits and presenting symptoms.  Reasons for the higher readmission rate for women are ascribed to a variety of possible causes, but gender bias perhaps also should be considered as a possible explanation.

Source: MedPage Today
Author(s): Ian Ingram

Forty-nine patients with limited metastatic non-small cell lung cancer (three or fewer metastatic sites) who did not progress on initial systemic therapy were randomized to surgery or RT vs standard maintenance therapy.  Overall survival for the intervention group was 41.2 mos vs 17.0 mos in those getting maintenance therapy (p=0.017). 

Source: News from around the web.
Author(s): Emily Robinson

Patient Care and General Interest

The Boston Marathon race director, who has run the marathon 46 straight times, underwent triple bypass surgery last Friday at Boston’s Massachusetts General Hospital.

A 12-year-old patient at Lucile Packard Children’s Hospital Stanford in Palo Alto, California, USA, recently became the youngest and smallest person in the country to receive a HeartMate 3 ventricular assist device.

A study published in Cancer Prevention Research suggests that due to the success of tobacco controls in California, USA, annual lung cancer mortality in the state during 2013 was 28 percent lower than in the rest of the country.

A woman with stage IV lung cancer completed the IRONMAN World Championship race in Kailua Kona, Hawaii, USA, this past Saturday.


Research, Trials, and Funding

A study just published in the Journal of the American Heart Association suggests that a history of percutaneous coronary intervention has a minimal effect on CABG outcomes.

A study conducted by the Cleveland Clinic, Cleveland, Ohio, USA, indicates that biopsies of hand tissue in carpal tunnel patients could detect early signs of cardiac amyloidosis.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): M Czerny, J Schmidli, S Adler, JC van den Berg, L Bertoglio, T Carrel, R Chiesa, RE Clough, B Eberle, C Etz, M Grabenwoger, S Haulon, H Jakob, FA Kari, CA Mestres, D Pacini, T Resch, B Rylski, F Schoenhoff, M Shrestha, H von Tengg-Kobligk, K Tsagakis, TR Wyss, and EACTS/ESVS scientific document group

The European Association for Cardio-Thoracic Surgery and the European Society for Vascular Surgery released a joint expert consensus on the treatment of thoracic aortic pathologies involving the aortic arch, the first guidelines on the diagnosis and treatment of aortic arch disease. This expert consensus includes 11 parts and aims to help medical professionals in understanding the natural history of aortic arch pathologies and choosing the best, latest treatment options for specific subgroups of patients at the most appropriate time, with the best attainable quality.

Source: The Annals of Thoracic Surgery
Author(s): Tianyu Zhou, Jun Li, Hao Lai, Kai Zhu, Yongxin Sun, Wenjun Ding, Tao Hong, Chunsheng Wang

In this single institution study including over 1900 patients with severe degenerative mitral regurgitation (MR) undergoing mitral valve repair, early intervention was associated with a reduced risk of recurrent MR.

Source: Medtronic Education
Author(s): Joel Dunning, Piergiorgio Solli, Luca Bertolaccini

Click on the link below and register for free to gain access to two operations that were performed live in Bologna, Italy, on October 1st, 2018.

The first video is a right upper lobe microthymectomy with energy division of the posterior ascending artery and tumour retrieval from a subxiphoid port with lymphadenectomy, followed by a presentation about microlobectomy. 

Next, there is a case that was set up as for a microthymectomy. The authors used the flexdex needle holder and the L-hook ligasure device, which is a ligasure and a hook cautery in one. In fact, while the case was set up as a thymectomy and the approach was that used for a thymectomy, the mass turned out to be a solitary fibrous tumour of the pleura. It was 6cm in size, so this was again removed through a subxiphoid port and the patient made an excellent recovery. 

I hope you enjoy these videos. You can see more at