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Journal and News Scan
May 19, 2020
Submitted by: Saurabh Gupta
Using wearable technology, Meltzer et al. demonstrated that surgeon-reported risk factors for pain included longer case length, increased years in pratice, use of loupes, and use of headlights. Further research is needed in order to improve surgeon ergonomics, especially around cardio-thoracic surgeons, who routinely wear loupes, headlights, and have some of the longest case lenghts.
May 15, 2020
Submitted by: Wei-Guo Ma
Bavaria et al reported the five-year outcomes of thoracic endovascular aortic repair (TEVAR) of complicated acute type B aortic dissection (TBAD) in the DISSECTION trial. In this prospective, nonrandomized study, 50 patients were treated with the Valiant Captivia thoracic stent graft for acute complicated TBAD. Prior to TEVAR, malperfusion was seen in 86% (43/50), ruptures in 20% (10/50), and DeBakey class IIIb dissections in 94% (46/49).
At five years, clinical and imaging follow-up was available in 78% (18/23); freedom from dissection-related mortality, secondary procedures related to dissection, and endoleak were 83%, 86%, and 85%, respectively; complete thrombosis of false lumen across the stented aortic segment was seen in 89% (16/18); true lumen diameter across the stent graft was stable or increased in 94% (16/17); and false lumen diameter was stable or decreased in 77% (13/17) of patients.
These results show that patients with complicated TBAD experienced positive and sustained measures of aortic remodeling after TEVAR and the Valiant Captivia thoracic stent graft system was effective in the long-term management of acute complicated type B aortic dissections in this challenging patient population.
May 15, 2020
Submitted by: Emily Robinson
This article by Zhao et al. analyzes the risk of stroke in patients suffering from type A dissection depending on preoperative CT findings. They identified aortic regurgitation, dissection of the common carotid artery, and the ratio of the true lumen to the diameter of the involved ascending aorta as independent risk factors.
May 15, 2020
Submitted by: Aristotle Protopapas
A medium-sized RCT from the Imperial College. The research question are of interest for all cardiovascular, thoracic, and general surgeons as well as all healthcare professionals.
May 13, 2020
Submitted by: Thomas Theologou
This original article using very carefully the propensity match analysis tried to answer the question regarding long-term outcomes of patients with severely reduced left ventricular ejection fraction (LVEF) who undergo revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).
It had analysed retrospectively a cohort study from 8 years period with LVEFs less than 35% and left anterior descending (LAD), left main, or multivessel coronary artery disease (with or without LAD involvement) who underwent PCI or CABG.The primary outcome was all-cause mortality. Secondary outcomes were death from cardiovascular disease, major adverse cardiovascular events (MACE; defined as stroke, subsequent revascularization, and hospitalization for MI or heart failure), and each of the individual MACE. A total of 12 113 patients (mean [SD] age, 64.8 (11.0) years for the PCI group and 65.6 [9.7] years for the CABG group; 5084 (72.5%) male for the PCI group and 4229 (82.9%) male for the PCI group) were propensity score matched on 30 baseline characteristics: 2397 patients undergoing PCI and 2397 patients undergoing CABG. The median follow-up was 5.2 years (interquartile range, 5.0-5.3). Patients who received PCI had significantly higher rates of mortality (hazard ratio [HR], 1.6; 95% CI, 1.3-1.7), death from cardiovascular disease (HR 1.4, 95% CI, 1.1-1.6), MACE (HR, 2.0; 95% CI, 1.9-2.2), subsequent revascularization (HR, 3.7; 95% CI, 3.2-4.3), and hospitalization for MI (HR, 3.2; 95% CI, 2.6-3.8) and heart failure (HR, 1.5; 95% CI, 1.3-1.6) compared with matched patients who underwent CABG.
This study concludes that there is higher rates of mortality and MACE in patients with severely reduced left ventricular ejection who received PCI compared with those who underwent CABG.The authors suggested that these findings may provide insight to physicians who are involved in decision-making for these patients.
May 13, 2020
Submitted by: Tom C. Nguyen
Surgeon ergonomics is an underappreciated occupational hazard. This study uses inertial measurement units to monitor ergonomics of surgeons, including a small handful of cardiac surgeons. More research and discussion is needed in the this space.
May 11, 2020
Submitted by: Aristotle Protopapas
Interesting hypothesis in a rodent model of myxomatous degeneration.
May 8, 2020
Submitted by: Emily Robinson
This original article compares the outcome of sleeve lobectomy compared to conventional lobectomy in the treatment of patients with lung cancer. Inci et al. investigated 187 patients who underwent sleeve lobectomy and compared it to 568 patients who underwent conventional lobectomy. They found no difference in safety end-points or mid-term follow-up regarding the two different groups.
May 8, 2020
Submitted by: Emily Robinson
Dong et al developed a score to predict renal failure after surgery for Stanford type A dissection. This score includes age, BMI, white blood count, perioperative hemoglobin levels, CPB duration, and renal malperfusion. The score derives from a retrospective analysis of 326 patients from the author’s institution and validated in a group of more than 100 patients from a separate institution. The receiver operating curve proves a good prediction of perioperative renal failure by the new score.
May 7, 2020
Submitted by: Emily Farkas
Access to pacemakers and defibrillators is problematic in places with limited resources. A multinational program was initiated in 1983 to provide tested and resterilized pacemakers and defibrillators to underserved nations; a prospective registry was established in 2003. The incidence of infection or device-related death at two years was 2.0%, an incidence that did not differ significantly from that seen among matched control patients with new devices in Canada.