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Journal and News Scan
June 27, 2024
Submitted by: Jo Chikwe
Of 1,579 patients undergoing esophagectomy for esophageal cancer, 60 patients underwent up-front surgery for cT2 N0 M0 esophageal cancer, of whom 8 (13 percent) were found to have pathologic T2 N0 M0, 16 (27 percent) were pathologically downstaged, and 36 (60 percent) were upstaged, 7 (19 percent) on the basis of pathologic T stage, 14 (39 percent) on pathologic N stage, and 15 (42 percent) had upstaging of T and N stages. Dysphagia and high maximum standardized uptake value of the tumor were predictive of more advanced underlying disease.
June 27, 2024
Submitted by: Mateo Marin-Cuartas
This study evaluated the outcomes after the use of cardiac shockwave therapy (SWT) combined with coronary artery bypass surgery (CABG) in patients with reduced left ventricular ejection fraction (LVEF) due to ischemic cardiomyopathy. Patients with LVEF ≤ 40 percent requiring CABG were enrolled in this single-blind, parallel-group, sham-controlled trial. Patients were randomly assigned to undergo direct cardiac SWT or sham treatment in addition to CABG. The primary efficacy endpoint was the improvement in LVEF measured by cardiac magnetic resonance imaging from baseline to 360 days. A total of 63 patients were randomized, 30 patients in the SWT group and 28 patients in the sham group. A greater improvement in LVEF was observed in the SWT group (Δ from baseline to 360 days: SWT 11.3 percent; Sham 6.3 percent, SD 7.4, P = 0.0146). Furthermore, patients in the SWT group significantly improved in the six minute walking test 360 days after randomization. The authors conclude that direct cardiac SWT, in addition to CABG, improves LVEF and physical capacity in patients with ischemic heart failure.
June 27, 2024
Submitted by: Aristotle Protopapas
This video is a balanced, gripping presentation on an increasingly common emergency problem for the on-call cardiac surgeon. Professor Oo discusses the evolving landscape of surgery for acute De Bakey I and II pathologies of the aortic organ. He discusses device use for malperfusion and juxtaposes it with FET and more simple, traditional options to treat acute type A aortic dissections.
June 20, 2024
Submitted by: Mujtaba Mubashir
This consensus paper released by the AATS puts forth 17 recommendations regarding subsolid lung nodules. These consensus statements relate to the radiological and pathological definitions of subsolid nodules, growth rate, recommendations for diagnosis of these nodules, initial and long-term surveillance based on their appearance and type, as well as timing and type of surgical intervention. Several recommendations are also laid forth regarding management of multiple subsolid lung nodules.
June 20, 2024
Submitted by: Jason Trevis
In this phase three national, multicenter, UK randomized controlled trial, the authors seek to compare outcomes after extended pleurectomy decortication plus chemotherapy versus chemotherapy alone. The trial recruited patients between 2015 and 2021 from 26 UK hospitals, recruiting and randomly assigning patients with a 1:1 allocation ratio. In total 335 patients were randomized, 87 percent of which were male. The authors concluded that extended pleurectomy decortication was associated with a worse survival up to two years.
June 20, 2024
Submitted by: Jo Chikwe
The prevalence of anomalous aortic origin of a coronary artery is 0.4 percent to 0.8 percent. The decision to operate and choice of procedure can be challenging. This invited expert review by a panel of congenital cardiac surgeons, cardiologists, and imaging practitioners summarizes a systematic survey of publications since 2010, providing practical advice for surgical management.
June 20, 2024
Submitted by: Mateo Marin-Cuartas
This study assessed the incidence rates of permanent pacemaker implantation (PPM) and the associated long-term clinical consequences of PPM implantation after isolated mitral valve (MV) repair compared to concomitant MV repair and tricuspid annuloplasty. Data from public hospital discharge databases from New York and California were queried for patients undergoing MV repair (isolated or with concomitant tricuspid annuloplasty) between 2004 and 2019. Patients were stratified by whether they received a PPM within 90 days of index surgery. After propensity score matching, survival, heart failure hospitalizations, endocarditis, stroke, and reoperation were compared between patients with or without PPM. A total of 32,736 patients underwent isolated MV repair (n = 28,003) or MV repair with tricuspid annuloplasty (n = 4,733). The incidence of PPM implantation less than 90 days after surgery was 7.7 percent for MV repair and 14.0 percent for MV repair with tricuspid annuloplasty. PPM was associated with reduced long-term survival among MV repair patients (HR: 1.96; 95 percent CI: 1.75-2.19; P < 0.001) and MV repair with tricuspid annuloplasty patients (HR: 1.65; 95 percent CI: 1.28-2.14; P < 0.001). In both surgical groups, PPM was also associated with an increased risk of heart failure hospitalizations (HR: 1.56; 95 percent CI: 1.27-1.90; P < 0.001) and endocarditis (HR: 1.95; 95 percent CI: 1.52-2.51; P < 0.001), but not with stroke or reoperation.
June 13, 2024
Submitted by: Mujtaba Mubashir
This paper reports the interim findings from the clinical registry that was initiated after FDA approval to validate the findings of the 386 PROACT trial for the On-X aortic valve. The original trial showed that low dose warfarin (INR range 1.5-2.0) and aspirin were safe starting at least three months after On-X aortic valve implantation. This interim report validates the findings of the trial in a real-world setting and explores outcomes (e.g., bleeding and thromboembolic events) among various subgroups of INR monitoring methods in patients.
June 13, 2024
Submitted by: Polychronis Antonitsis
The COMICS trial is the largest randomized trial of minimally invasive extracorporeal circulation (MiECC) compared to conventional ECC (CECC). MiECC reduced the frequency of SAEs prespecified to qualify for the primary outcome. This finding was of borderline significance due to stopping recruitment early, but is consistent with the results of large-scale, published meta-analyses. MiECC improved a visual analogue quality-of-life measure. MiECC was safe with respect to other SAEs and adverse events that were reported. It did not reduce mortality, any SAE not included in the primary outcome, time to ICU or hospital discharge or transfusion of any red cells or any other blood product. However, all treatment effect estimates for these outcomes, except for hospital stay, favored MiECC; and the magnitude of the reductions in mortality and risk of any SAE not included in the primary outcome were consistent with the reduction in risk observed for the primary outcome.
June 13, 2024
Submitted by: Mujtaba Mubashir
This editorial summarizes the landscape that led to the founding of the Thoracic Surgical Oncology Group in 2017, in an era when, due to various oncology group reorganizations, a need developed for a focused committee to conduct thoracic surgery oncology-based clinical trials. The group has expanded over the years to include 32 hospitals. It has completed two clinical trials, with three more actively recruiting patients, and four new studies planned in the near future. There remain multiple challenges, however, with increasing interest, there are more opportunities going forward.