Journal and News Scan

In a single-center experience of 397 patients undergoing esophagectomy for adenocarcinoma (76 percent) or squamous cell carcinoma (22 percent)—of whom 60 percent were either pathologic stage one or two and 90 percent had neoadjuvant therapy—forty-two patients had fewer than fifteen lymph nodes resected and examined. Resecting at least fifteen lymph nodes was associated with a survival benefit in multivariate analysis. The authors conclude that a minimum nodal yield of fifteen should remain standard of care.

Although septal myectomy and concomitant mitral valve surgery are typical in the treatment of hypertrophic obstructive cardiomyopathy (HOCM), the combination of these procedures through right anterior mini-thoracotomy has rarely been presented in the literature. This study presents a minimally invasive surgical technique and the clinical results of one institution’s experience with this technique over the past four years.

This outstanding document has been put together by the guidelines committee of the European Association of Cardiothoracic surgery in response to the two major studies that have just been published on segmentectomy versus lobectomy. This document lays out new international guidance for segmentectomy, including management of the lymph node suitability for the procedure and technical advice, and will serve for many years to come in supporting the move towards segmentectomy as the standard of care for tumors less than 2 cm. 

While this full report is behind a paywall, a detailed abstract is included through the link above.
 

Transcatheter aortic valve implantation (TAVI) is now a standard procedure for the treatment of symptomatic aortic valve stenosis in many patients. In Germany, according to the annual reports from the German Institute for Quality Assurance and Transparency in Healthcare, the rate of serious intraprocedural complications, such as valve malpositioning or embolization, coronary obstruction, aortic dissection, annular rupture, pericardial tamponade, or severe aortic regurgitation requiring emergency cardiac surgery has decreased markedly in recent years from more than 5.5 percent in 2012 to 2 percent in 2019. However, with increased use, the total number of adverse events remains about 500 per year, about 100 of which require conversion to sternotomy. These sometimes fatal events can occur at any time and are still challenging. Therefore, the interdisciplinary TAVI heart team should be prepared and aware of possible rescue strategies.