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Journal and News Scan
This study aimed to measure the population-level impact of federal lung cancer screening recommendations and Medicare coverage. After these decisions were implemented, and when adjusted for age, researchers found that they were associated with an increased incidence of early-stage lung cancer and decreased incidence of advanced-stage lung cancer.
A Comparison of the Differences in Postoperative Chronic Pain Between Video-Assisted and Robotic-Assisted Approaches in Thoracic Surgery
Because of the recent advancement in robotic thoracic surgery, this retrospective study aimed to evaluate post-operative chronic pain in robotic versus video-assisted approaches. Although patients who undergo RATS are known to have better immediate post-operative recovery, the results did not find a statistically significant difference in chronic pain among the two methods. Further comparative studies are recommended.
2021 Coronary Revascularization Guidelines—Lessons in the Importance of Data Scrutiny and Reappraisal of Evidence
This recent JAMA Surgery editorial addresses the controversy associated with the 2021 ACC/AHA/SCAI guidelines on coronary revascularization. It underscores the importance of attention to source data and accurate characterization of evidence.
The core issue was the downgrade of CABG relative to medical therapy in patients with stable ischemic heart disease and severe three-vessel disease, with survival as the endpoint: from Class I (strong recommendation) to Class IIb (weak recommendation) in patients with normal ejection fraction; and from Class I to Class IIa (moderate recommendation) in patients with mild to moderate left ventricular dysfunction.
There was a global outcry with rebuttals from the AATS, STS, EACTS, LACES, and multiple other professional cardiovascular associations—some of which included cardiologists among their ranks.
Proponents of the 2021 guidelines insist that they are accurate, and that the controversy arose because of differences in the interpretation of evidence. As stated in this JAMA Surgery editorial, that is simply inaccurate. Examination of the source documents cited as “supportive evidence” to downgrade CABG in the guideline’s recommendation tables tell a different story.
Many of the actual conclusions of the authors of the source documents are in direct contradiction to what is in the guidelines. In the synthesis of evidence, some studies were arbitrarily given more weight than others and some older studies were rendered irrelevant based solely on date of publication. The guidelines emphasized improvements in medical therapy without a balanced mention of the safety, efficacy, and durability of modern-day CABG.
The bulk of “new evidence” was centered on trials that did not randomize patients to CABG vs. medical therapy. CABG and PCI were lumped together despite acknowledging that they are different therapies with different indications and outcomes. The new studies excluded patients with heavy atherosclerotic burden, and very few had proximal LAD lesions. A recommendation about a reasonable role for an initial conservative strategy with close follow-up in such patients would have been appropriate and compatible with available evidence. Instead, the guidelines extrapolated findings from patients with relatively favorable cardiovascular risk profiles (who typically would not be referred for CABG in the first place) to inform decision-making and erroneously weaken the CABG recommendations.
The 2021 guidelines are a perfect case study on the importance of attention to the source documents instead of blind acceptance of summary evidence. Otherwise, effective and durable therapies may be replaced by less effective therapies with diminished benefits.
Minimally Invasive Versus Full Sternotomy for Isolated Aortic Valve Replacement in Low-Risk Patients
This comparison of minimally invasive versus full sternotomy surgical aortic valve replacement aimed to analyze outcomes of the two procedures for isolated surgery in patients enrolled in a low-risk trial. For this group of patients, it was found that the two approaches were associated with similar in-hospital and one-year outcomes.
Increased Social Media Utilization and Content Creation by Cardiothoracic Surgery Programs During the Coronavirus Disease 2019 Pandemic
Study Demonstrates Unexpected Electrical Changes in First Successful Transplant of Genetically Modified Pig Heart
Researchers continue to report findings from the first genetically modified pig heart transplant into a human ten months after the surgery. Their latest study found unexpected electrocardiogram results in the patient, which the authors say did not contribute to heart failure. These results provide a first look into the novel field of xenotransplantation. Read the original study at this link.
Congenitally Corrected Transposition Cardiac Surgery: Society of Thoracic Surgeons Database Analysis
Pirruccello and associates from Massachusetts General Hospital developed a prediction model for ascending aortic diameter in a cohort of 30,018 asymptomatic individuals based on eleven variables: age (years), gender, body mass index (kg/m2), heart rate (bpm), systolic and diastolic blood pressure (mm Hg), height (cm), weight (kg), and the presence or absence of a diagnosis of diabetes, hypertension, or hyperlipidemia. The area under the receiver operator characteristic curve ranged from 0.77 to 0.81 for identifying individuals with an ascending aortic diameter 4 cm or greater in validation cohorts. This is an important step in identifying early signs of ascending thoracic aortic disease, a common cause of sudden death in the U.S.
Quite possibly, this manuscript is projected to have the highest impact on patient care and industry for the immediate future. It provides an unusually clear narrative, and findings of a large international randomized clinical trial assert that a good quality venous conduit renders bypass superior to endovascular treatment in infrainguinal critical limb-threatening ischemia.