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Journal and News Scan
April 18, 2024
Submitted by: Mujtaba Mubashir
This large-scale review of the Dutch Lung Cancer Audit for Surgery Database summarizes the variability in the current practice in surgical care for primary spontaneous pneumothorax. A total of 1,851 patients were reviewed. The most performed surgical procedure across the country was a bullectomy with pleurodesis (83 percent). There was significant variation in length of stay and complication rates across hospitals. This study showcases the power of using large scale national databases to outline current practices nationwide thus identifying target areas and opportunities for improvement nationally.
April 18, 2024
Submitted by: Mujtaba Mubashir
This study reviews 44 patients with stage IB (larger than 4 cm) to IIIA non-small cell lung cancer who were treated on sequential platform arms of the NEOSTAR trial. Twenty-two patients were treated with nivolumab and chemotherapy and 22 patients were treated with ipilimumab, nivolumab, and chemotherapy. While surgical resections are feasible and safe, the vast majority of resections are performed via thoracotomy. Interestingly, the addition of ipilimumab seems to correlate with a higher major pathological response (MPR), and perceived difficulty of resection by surgeons, likely due to increased tissue inflammation. Postoperatively, there did not seem to be a difference in adverse effects amongst the groups, although small sample size may limit conclusions.
April 18, 2024
Submitted by: Jason Trevis
This study aimed to describe the use of perioperative mechanical circulatory support (MCS) and its impact on outcomes in patients with ischemic cardiomyopathy undergoing surgical revascularization. Between 2015 and 2021, data from 378 patients with an ejection fraction below 35 percent and undergoing isolated coronary artery bypass grafting (CABG) were analyzed based on utilization of MCS—no MCS, preoperative MCS and postoperative MCS. Authors included patients requiring intra-aortic balloon pump, extracorporeal membrane oxygenation, or Impella device within the MCS groups. The primary outcome was operative mortality.
April 18, 2024
Submitted by: Jo Chikwe
An international group of clinicians and investigators with expertise in clinical and translational research provide advice to early career cardiac surgeons and anesthesiologists interested in mechanistic studies, randomized clinical trials, observational studies, and meta-analyses.
April 10, 2024
Submitted by: Mateo Marin-Cuartas
This report presents trends and outcomes of cardiac surgery following initial transcatheter aortic valve replacement (TAVR). The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database was queried for all adult patients undergoing cardiac surgery after a previously placed TAVR between January 2012 and March 2023. A total of 5457 patients were identified, of which 2972 (54.5 percent) underwent SAVR (surgical aortic valve replacement), and 2485 (45.5 percent) underwent non-SAVR cardiac surgery. The frequency of cardiac surgery after TAVR increased by 4235.3 percent overall and 144.6 percent per year throughout the study period. The incidence of operative mortality and stroke were 15.5 percent and 4.5 percent, respectively. The observed to expected mortality ratios based on the STS risk score were significantly greater than 1.0, demonstrating a poor performance of the existing STS risk estimation models.
April 10, 2024
Submitted by: Mateo Marin-Cuartas
In preclinical studies, microplastics and nanoplastics have been found to be a potential risk factor for cardiovascular disease. However, there is a lack of clinical evidence that this risk extends to humans. The authors conducted a prospective, multicenter, observational study involving patients undergoing carotid endarterectomy. The excised carotid plaque specimens were analyzed for microplastics and nanoplastics. The primary endpoint of a composite of myocardial infarction, stroke, or death from any cause was compared among patients with evidence of microplastics and nanoplastics in plaque as compared against patients with a plaque that showed no evidence of microplastics and nanoplastics. A total of 304 patients were enrolled in the study, and 257 completed a mean follow up of 34 months. Polyethylene was detected in carotid artery plaque of 150 patients (58.4 percent), with a mean level of 21.7 μg per milligram of plaque. A total of 31 patients (12.1 percent) also had measurable amounts of polyvinyl chloride, with a mean level of 5.2 μg per milligram of plaque. Patients in whom microplastics and nanoplastics were detected within the atheroma were at higher risk for a primary endpoint event than those in whom these substances were not detected (hazard ratio, 4.53; 95 percent confidence interval, 2.00 to 10.27; P<0.001).
April 10, 2024
Submitted by: Javeria Tariq
This study aimed to evaluate the percentage of solitary fibrous pleural tumors presenting unfavorable clinical behavior as to predict negative long-term outcomes. Although historically considered benign neoplasms, this retrospective review identified 25 percent of 74 patients displayed histological evidence of malignancy as per England criteria and the recurrence rate was 21 percent. The authors recommended the pathological differentiation of these tumors into pedunculated, well circumscribed, and sessile growth patterns. They also recommended that all nonpedunculated lesions should be classified as potentially aggressive.
April 10, 2024
Submitted by: Jason Trevis
The authors of this paper explored early postoperative outcomes in all patients (n= 833) undergoing uniportal segmentectomy and lobectomy in their unit between 2017 and 2022. During this study period, the utilization of uniportal access operations increased. The authors concluded that early postoperative outcomes were similar between the segmentectomy and lobectomy groups.
April 3, 2024
Submitted by: EACTS Staff
Defining perioperative myocardial infarction (PMI) after cardiac surgery presents challenges. A multidisciplinary group evaluated the evidence on mechanisms, diagnosis, and prognosis of PMI. The review found that postoperative troponin thresholds associated with increased mortality risk are markedly higher than those found in current PM definitions. Large increases in other biomarkers are also prognostically relevant, even if supporting evidence of ischemia is lacking. A new algorithm for PMI detection was proposed, and researchers recommended that PMI should be included in the primary composite outcome of trials of coronary interventions.
April 3, 2024
Submitted by: Jason Trevis
These updated guidelines give a comprehensive guide on the treatment of atheroscleritoc carotid and vertebral artery disease to prevent stroke and TIA.