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Journal and News Scan
November 4, 2022
Submitted by: Cameron Lind
Although equitable access to care is critical to proper surgical lung cancer management, quality measures (QMs) that assess preoperative access to care are lacking. This study determined the relationship between meeting several preoperative QMs and various short- and long-term outcomes. Adherence to all QMs improved overall survival, but various factors including race and distance to hospital affected the ability to meet QMs.
November 4, 2022
Submitted by: Cameron Lind
Although preoperative exchange transfusion is frequently recommended in patients with homozygous sickle cell anemia undergoing cardiopulmonary bypass, the information regarding the ideal level of sickle hemoglobin for patients undergoing the surgery is still conflicting in the literature. This study presents two cases, adding to the literature and concluding that optimization of baseline Hb and a full team approach are essential to a successful surgery.
November 3, 2022
Submitted by: Wei-Guo Ma
On November 2, 2022, the American College of Cardiology (ACC) and American Heart Association (AHA) published an update to the 2010 ACC/AHA Guidelines for the Diagnosis and Management of Aortic Disease.
The top ten take-home messages are:
1. Multidisciplinary aortic team care in higher volume centers is considered when determining the appropriate timing of intervention.
2. Shared decision-making involving the patient and a multidisciplinary team is highly encouraged to determine the optimal medical, endovascular, and open surgical therapies, particularly in patients with aortic disease who are contemplating pregnancy or who are pregnant.
3. Computed tomography, magnetic resonance imaging, and echocardiographic imaging of patients with aortic disease should follow recommended approaches.
4. In multidisciplinary and experienced centers, the threshold for surgical intervention for sporadic root and ascending aortic aneurysms has been lowered from to 5.0 cm in selected patients, and even lower in patients with heritable thoracic aortic aneurysms.
5. For significantly smaller or taller patients, surgical thresholds may incorporate indexing of the aortic root or ascending aortic diameter to either height or body surface area, or the aortic cross-sectional area to patient height.
6. Rapid root growth or ascending aneurysm growth is defined as ≥0.5 cm in one year or ≥0.3 cm per year in two consecutive years for those with sporadic aneurysms, and ≥0.3 cm in one year for those with heritable thoracic aortic disease or bicuspid aortic valve.
7. During aortic root replacement, valve-sparing aortic root replacement is reasonable if the valve is suitable for repair and when performed by experienced surgeons in a multidisciplinary aortic team.
8. Clinically stable patients with acute type A aortic dissection should be considered for transfer to a high-volume aortic center to improve survival. Operative repair of type A aortic dissection should entail at least an open distal anastomosis rather than just a simple supracoronary interposition graft.
9. There is an increasing role for TEVAR in the management of uncomplicated type B dissection. Clinical trials on thoracoabdominal aortic aneurysm repair with endografts are reporting results that suggest endovascular repair is an option for patients with suitable anatomy.
10. Screening of first-degree relatives with aortic imaging is recommended for patients with aneurysms of the aortic root or ascending aorta, or those with aortic dissection.
October 28, 2022
Submitted by: Cameron Lind
A study was performed to assess the efficacy of topical vancomycin in the reduction of sternal wound infection (SWI), as this topic has become a point of contention. There was no difference between the vancomycin and saline control group at three months postoperatively, and similar findings were observed at one year. The study concluded that applying vancomycin makes no significant difference in SWI.
October 28, 2022
Submitted by: Cameron Lind
This randomized trial assessed the efficacy of vacuum-assisted sternal closure as compared to primary closure technique in the treatment of post-cardiac surgery mediastinitis in a pediatric age group. Out of 101 patients, the chance of survival six months post-surgery was higher for the primary sternal closure group. The study concluded that primary sternal closure technique is favorable over vacuum-assisted closure technique in pediatric cases.
October 28, 2022
Submitted by: Cameron Lind
In Fiji, where complex cardiac surgical care has not previously been available, a team of local surgeons is undergoing training with a team from India. The plan to establish two permanent cardiac surgical teams at Lautoka Hospital will greatly benefit the people of Fiji in the long term.
October 28, 2022
Submitted by: Cameron Lind
After a fetus was diagnosed with severe pulmonary stenosis, the first in-utero percutaneous balloon pulmonary valvuloplasty in western China was performed. Because the baby would be born with serious complications if surgeons decided to wait until after birth, the surgery was performed two months prior to delivery. The baby was born healthy on October 10, 2022.
October 21, 2022
Submitted by: Cameron Lind
A new study shows that white heart transplant patients are twice as likely to receive a heart transplant or ventricular assist device as Black heart transplant patients, perpetuating existing inequalities in healthcare access. Experts emphasize that this is due to differences in education and access, not biological determinants. Read the original study here.
October 21, 2022
Submitted by: Cameron Lind
A new research project, Healthcare Enabled by AI in Real-Time (HEART), aims to capture data from cardiac ICU monitors to analyze and predict a variety of different risk factors. Physicians can use the level of risk assigned by the data to each recovering cardiac surgery patient to determine if a patient needs more intense treatment before complications occur. Healthcare workers involved in critical care praise the project as a crucial advancement in the field.
October 21, 2022
Submitted by: Cameron Lind
An infant born prematurely with a double-outlet right ventricle became the youngest ever patient to undergo a ventricular switch procedure. In this rare case, the ventricular septal defect was remote, preventing a standard repair. The operation was successful, and the patient was discharged from the hospital at sixteen months old.