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Journal and News Scan
April 18, 2019
Submitted by: Claire Vernon
Fukui and colleagues retrospectively compared outcomes for patients who were either smokers (410 patients) or never smokers (256 patients) and who underwent resection for primary lung cancer (stage I to III). The authors evaluated 90-day mortality and respiratory complications, both of which were higher for smokers than for never smokers. Smoking cessation mitigated the increased likelihood of pulmonary complications for smokers, and the odds ratios for complications compared to never smoking patients were lowest for those patients with the longest interval of preoperative smoking cessation (more than 12 months). The authors conclude that smoking cessation is always valuable for lung cancer surgery, but that longer periods of time are more efficacious for reducing pulmonary complications.
April 17, 2019
Submitted by: Wei-Guo Ma
Dr Burt gives a brief overview of the considerable advances for patients with thoracic malignancies (non–small cell lung cancer in particular).
April 17, 2019
Submitted by: Mark Ferguson
Cardiothoracic surgeons in the US were the most underpaid specialty, calculated according to undervalued work based on RVUs in comparison to data from the American College of Surgeons National Surgical Quality Improvement Program.
April 17, 2019
Submitted by: Claire Vernon
Buitrago and Restrepo report the largest series to date from Latin America of patients undergoing robot-assisted thoracic surgery. A total of 69 patients underwent robot-assisted procedures with 47 undergoing pulmonary resections, 18 undergoing mediastinal procedures, and 4 undergoing another type of operation. The authors report the outcomes for these procedures, which included no in-hospital mortality. They also report on the association between total operative time and the year that the surgery was performed, finding an approximately 10 minute reduction in total operative time each year.
April 17, 2019
Submitted by: Claire Vernon
Assmann and colleagues conducted a survey of extracorporeal life support (ECLS, extracorporeal membrane oxygenation) usage in cardiac surgery departments across Germany, given that German scientific guidelines call for the use of ECLS for cardiac and circulatory failure. With 78 of 84 departments responding, the authors found variability between respondents in ECLS therapy, from program structure to the management and monitoring of the therapy. Satisfaction was higher in programs that had clearly defined responsibilities. They conclude that there is a need for a multidisciplinary guideline concerning ECLS therapy in Germany.
April 16, 2019
Submitted by: Wei-Guo Ma
The UK Aortic Group report their experience with the frozen elephant trunk (FET) repair for 66 acute type A aortic dissection (ATAAD) patients using the Thoraflex Hybrid graft at eight UK high-volume aortic centers. The in-hospital mortality was 12% (8/66). Postoperative temporary or permanent neurological events and temporary renal replacement therapy occurred in 17% and 20%, respectively. No spinal cord injury events were documented. These data were similar to those reported in literature in the two largest experiences with the use of FET in patients with ATAAD (in-hospital/30-day mortality: 11-12%). This initial experience demonstrated that FET can potentially be adopted as standard approach in life-threatening aortic diseases, with acceptable complication and mortality rates.
April 15, 2019
Submitted by: Wei-Guo Ma
Researchers from Tel Aviv University in Israel reported the first 3D-printed vascularized heart using a patient’s own cells and biological materials. The Primary Investigator claims this is the first time anyone has successfully engineered and printed an entire heart replete with cells, blood vessels, ventricles, and chambers.
April 14, 2019
Submitted by: Wei-Guo Ma
The International Aortic Arch Surgery Study Group assessed the safety of total arch replacement (TAR) with frozen elephant trunk (FET) for acute type A aortic dissection (ATAAD) with respect to the risks of operative mortality, stroke, and paraplegia.
Data from 978 patients who underwent total aortic arch replacement for ATAAD with or without FET placement were analyzed. In propensity-score matching, there were no significant differences between TAR plus FET versus isolated TAR in terms of permanent neurological deficits (11.9% versus 10.1%, p = 0.59) and spinal cord injury (4.0% versus 6.3%, p = 0.52). Post-hoc propensity-score stratification showed that FET was associated with a statistically significantly lower mortality risk (OR = 0.47, 95% CI 0.239-0.929, p = 0.03).
These results show that the use of FET for ATAAD does not appear to increase the risk of paraplegia in appropriately selected patients at experienced centers.
April 13, 2019
Submitted by: Wei-Guo Ma
The Stanford University cardiac surgery team expounds on current evidence for selection of prostheses in valve replacement. While more liberal usage of biologic prostheses in younger patients may be appropriate for the aortic valve, the support for this practice in the mitral position is not as strong. The enthusiasm for biologic valve implantation in the mitral position for young patients should be tempered. As transcatheter technologies continue to develop, the risk-benefit trade-off between biologic and mechanical valves will evolve. However, until procedural safety and long term durability is proven, reliance on these technologies as a routine salvage procedure may be overly optimistic.
April 12, 2019
Submitted by: Claire Vernon
Patient Care and General Interest
Washington state will increase the age at which people can purchase tobacco and vaping products to 21, part of a growing Tobacco 21 law movement in the US that has the goal of reducing tobacco usage among teenagers and young adults.
Airbnb is expanding the reach of its Open Homes for Medical Stays program to help cancer patients afford lodging, if they have to travel long distances for treatment.
A report on US physician compensation from Medscape looks at salary and specialty satisfaction, pay disparities between and within specialties, and amount of time spent on paperwork.
Research, Trials, and Funding
Researchers from Germany report that using a comic-style narrative in the informed consent process for coronary angiography improved patient comprehension and reduced patient anxiety.
After finding that white light exposure overnight was harmful for mice recovering from experimental cardiac arrest, researchers want to know if orange-tinted glasses might help mitigate circadian disruption from hospital lights for heart patients.
Researchers from Australia report on their success with hearts transplanted after circulatory death.