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Journal and News Scan

Source: MedPage Today
Author(s): Matthew Beane

Interesting research/opinion piece about how the introduction of robots has forced a change in surgical training, with some residents gaining skill through a process of "shadow learning."

Source: News from around the web.
Author(s): Claire Vernon

Patient Care

Portugal’s first Eurovision winner, Salvador Sobral, has made a good recovery after undergoing a heart transplant in December.

Canada’s first Inuk cardiac surgeon talks about choosing to become a surgeon and the pride she takes in serving her patients.

Surgeons perform the first pneumonectomy at the Cleveland Clinic Abu Dhabi, UAE, for a patient with respiratory failure secondary to a multi-drug resistant infection.


Drugs and Devices

The US Food and Drug Administration (FDA) has pushed back approval of AndexXa, which is designed to reverse the anticoagulant effect of Factor Xa inhibitors, as they review additional data.


Research, Trials, and Funding

An international group of researchers have developed a robot that pulls on the esophagus to induce cell growth in awake pigs, a technology that could be applied to large-gap esophageal atresia in infants.

Two studies published in the Annals of Internal Medicine come to slightly different conclusions on the benefits of risk-based screening for lung cancer outcomes.

Researchers in Finland look at how 30 minutes in a sauna affects one’s cardiovascular function.

Veterinary researchers in Ontario, Canada, found that atrial fibrillation appears to be a heritable trait in Standardbred racehorses.

Source: Journal of the American College of Surgeons
Author(s): Mark R. Katlic

The authors summarizes a personal experience with 529 patients undergoing VATS operations under local anesthesia and sedation.  No nerve block, epidural, laryngeal mask airway, or endotracheal intubation was used.  Indications were lung nodule, hemothorax, empyema, pleural effusion, pericardial effusion, chylothorax, etc.  There was one unsuccessful attempt using this technique.  

Source: Annals of Cardiothoracic Surgery
Author(s): Hector W. L. de Beaufort, Santi Trimarchi, Amit Korach, Marco Di Eusanio, Dan Gilon, Daniel G. Montgomery, Arturo Evangelista, Alan C. Braverman, Edward P. Chen, Eric M. Isselbacher, Thomas G. Gleason, Carlo De Vincentiis, Thoralf M. Sundt, Himanshu J. Patel, Kim A. Eagle

De Beaufort and colleagues assessed the outcomes of acute aortic dissections in 258 consecutive patients with Marfan syndrome in the International Registry of Acute Aortic Dissection (IRAD) database, comparing these with the dissection outcomes in the general population. Patients with Marfan syndrome were younger and had fewer comorbidities.  In-hospital mortality rates were lower for patients with Marfan syndrome than for the general population (10.9% versus 16.9%, p = 0.01). There was lower mortality after open surgical repair of type B aortic dissection when compared to the general population (0% versus 17.6%, p = 0.011).  As expected, the freedom from reintervention in the cohort of patients with Marfan syndrome was significantly less than in the general population (44.7% versus 81.5%, p<0.001).

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Thierry Folliguet, Nicolas Laurent, Maxime Bertram, Konstantinos Zannis, Mazen Elfarra, Fabrice Vanhuyse, Pablo Maureira, Thomas Modine

Folliguet and colleagues report on 145 patients from three French centers who underwent transcarotid aortic valve implantation. The procedures were successful in all. Eight patients suffered a stroke, and one patient had a localized carotid dissection. There were no intraoperative conversions and no postoperative respiratory complications were observed.

Source: Annals of Thoracic Surgery
Author(s): Jessica L. Hudson, Jennifer M. Bell, Traves D. Crabtree, Daniel Kreisel, G. Alexander Patterson, Bryan F. Meyers, Varun Puri

The authors compared low risk patients undergoing office spirometry only (FEV1 of >60%) to those undergoing laboratory spirometry followed by lung resection. Outcomes for propensity score matched patients were similar for complications, length of stay, and readmission.  Use of office-based spirometry was estimated to save their insitution $38,000 annually.

Source: Annals of Thoracic Surgery
Author(s): Mark W. Onaitis, Anthony P. Furnary, Andrzej S. Kosinski, Sunghee Kim, Daniel Boffa, Betty C. Tong, Patricia Cowper, Jeffrey P. Jacobs, Cameron D. Wright, Joe B. Putnam Jr., Felix G. Fernandez

Among patients aged 65 and older undergoing lung resection for NSCLC, long-term survival was related to cancer stage and patient age. Lobectomy patients fared better than those undergoing parenchymal-sparing resections or pneumonectomy. VATS approaches provided better long-term survival.

Source: Annals of Thoracic Surgery
Author(s): Janani S. Reisenauer, Carlos A. Puig, Chris J. Reisenauer, Mark S. Allen, Emily Bendel, Stephen D. Cassivi, Francis C. Nichols, Rob K. Shen, Dennis A. Wigle, Shanda H. Blackmon

The authors review their clinical experience with management of postoperative chylothorax among 97 patients.  They favor duct ligation over embolization, and recommend intervention in patients with outputs greater than 1,100/day.

Source: Annals of Thoracic Surgery
Author(s): Eric Goudie, Ricardo L. Oliveira, Vicky Thiffault, Adeline Jouquan, Edwin Lafontaine, Pasquale Ferraro, Moishe Liberman

The authors demonstrate that use of an ultrasonic sealing device is safe for pulmonary artery branches 7 mm or less in diameter. This information could substantially reduce costs for lobectomy related to stapler use.

Source: Annals of Thoracic Surgery
Author(s): Lisa M. Brown, David T. Cooke, James R. Jett, Elizabeth A. David

The authors explored the optimal extent of LN resection for T1aN0 carcinoid tumors undergoing lung resection using the National Cancer Data Base. Twenty-five percent of patients had no nodes evaluated.  Four percent of patients were upstaged based on node status.  Survival was similar comparing lobectomy to sublobar resection.