Journal and News Scan

This study investigated the true incidence and risk factors for prolonged pleural effusion/chylothorax (PPE/C) following pediatric cardiac surgery, as well as its impact on other postoperative outcomes. This UK-based study collected data prospectively from five centers between 2015 and 2017, analyzing a total of 3,090 procedures (surgical and hybrid). This study found an incidence of 6.5 percent for PPE/C, highest after Fontan and other complex cases, occurring at median postoperative day six. Interestingly, cases of PPE/C with no other morbidity were associated with an eight-day increase in hospital length of stay (LOS), compared to those with multimorbidity, where the LOS was not significantly affected, but early mortality was higher. 

Aortic stenosis is the most prevalent valvular heart condition necessitating surgical intervention, with full sternotomy (FS) traditionally being the standard approach for surgical aortic valve replacement (SAVR). However, many patients undergoing AVR are high-risk candidates, leading to the development and evolution of transcatheter aortic valve replacement (TAVR) as an alternative treatment. Not all patients qualify for TAVR due to anatomical limitations, making minimally invasive AVR a potential solution for certain cases to avoid the risks associated with sternotomy. The most common MIAVR techniques include ministernotomy and upper hemisternotomy, but right anterior minithoracotomy (RAMT) may offer additional benefits by completely avoiding sternotomy. RAMT has also proven to be more cost-effective than sternum-based techniques. 
 
However, RAMT AVR presents technical challenges and a steeper learning curve, which may hinder its widespread adoption. This article provides a comprehensive overview of RAMT AVR, including patient selection, preoperative considerations, and clinical outcomes compared to sternotomy AVR and ministernotomy AVR. Overall, the article highlights the potential of RAMT AVR in managing aortic stenosis while calling for further research to strengthen the evidence base. 

This article examines the critical role of proximal anastomosis in coronary artery bypass grafting (CABG), highlighting its impact on the risk of perioperative stroke. Key points include the importance of thorough preoperative assessments, particularly using CT scans to evaluate ascending aorta calcification, a known risk factor for stroke. Intraoperative epiaortic ultrasound is emphasized as a superior method for assessing aortic condition and guiding surgical strategy, thus reducing stroke risk. The article also advocates for anaortic revascularization techniques to minimize aortic manipulation, which is associated with higher stroke rates. Devices such as Heartstring, Enclose II, and Viola are introduced as alternatives to traditional side-clamping methods, allowing safer proximal anastomoses with less aortic contact. Additionally, the piggyback anastomosis technique is recommended for multivessel surgery to reduce aortic invasiveness. The article also explores alternative sites for proximal anastomosis, such as the axillary and innominate arteries, especially when traditional methods are not suitable. The authors stress the importance of graft assessment using transit time flow measurement (TTFM) to ensure optimal graft function and emphasize meticulous planning regarding graft length and orientation to prevent complications. Finally, the use of radio markers to mark anastomosis sites is suggested to aid future interventions. 

This study investigates racial and ethnic disparities in representation and salary among academic cardiothoracic surgeons in the United States. The authors analyzed data from the Accreditation Council of Graduate Medical Education (ACGME) and the Association of American Medical Colleges (AAMC) from 2021 and 2022. They noted that salary information was limited for groups with fewer than six surgeons. 
 
The findings revealed that out of 758 academic cardiothoracic surgeons, 64.9 percent were White, 25.2 percent were Asian, and underrepresented groups included 3.3 percent Black or African American, 4.9 percent Hispanic or Latino, and 1.7 percent from other ethnicities. Specifically, at the professor level, the demographics were even less diverse, with 74.6 percent White. 
 
Salary disparities were significant. Asian faculty earned between 89 percent to 171 percent, Black or African American faculty between 59 percent to 94 percent, and Hispanic or Latino faculty between 84 percent to 165 percent of the median salaries earned by White faculty. Notably, Black or African American faculty consistently received lower median salaries compared to their White counterparts across all academic ranks, with a statistically significant difference (P = .002). 
 
This study highlights the lack of diversity in the academic cardiothoracic surgery workforce, particularly in higher ranks, and underscores the complex nature of salary equity among different racial and ethnic groups. The persistent underrepresentation and salary disparities faced by Black or African American surgeons calls for further investigation and action to address these inequities in academic medicine.