Journal and News Scan

Although video assisted thoracoscopic surgery (VATS) is associated with less pain than open surgery, there are still several complications that arise due to poor postoperative control with VATS. Epidural analgesia has traditionally been considered the gold standard for pain control, however regional analgesia like paravertebral blocks (PVB) are increasingly being used. The authors explore the use of patient controlled PVB analgesia compared to epidural analgesia as part of a randomized controlled trial. Interestingly, with the PVB, the authors found no additional puncture pain, shorter time duration for catheter placement, and overall reduced failure rate of catheter placement. Hence, PVB is another viable and effective tool that clinicians have at their disposal to optimize pain control after VATS.

The elderly population is exponentially increasing worldwide, leading to a higher incidence of coronary artery disease. The growing number of elderly patients is closely related to a higher incidence of frailty. Despite frailty being a known predictor of increased mortality and morbidity, there is a lack of evidence regarding the outcomes of coronary artery bypass grafting (CABG) in frail patients.

The FRAGILE trial is a Brazilian multicenter, randomized, controlled clinical trial that analyzed 169 patients aged over sixty years who underwent on-pump and off-pump CABG. In this subanalysis of the FRAGILE trial, patients were divided into two groups for statistical comparisons: off-pump (n= 87) and on-pump CABG (n= 82). Based on the Fried's frailty criteria, patients were classified as frail, pre-frail, and non-frail. Unintentional weight loss, self-reported fatigue, physical activity level, grip strength, and gait speed before and after surgery were compared between the off-pump and on-pump study groups. Patients who were non-frail before surgery were excluded from the analysis.

Patients' frailty was positively impacted by CABG six months following surgery. Overall, more than 50 percent of frail patients became pre-frail after CABG, and only 3 percent of the total patients were classified as frail six months following surgery. Patients reported more total time of physical activity, less fatigue, and an improved gait speed after surgery. Moreover, patients from the off-pump CABG group improved their grip strength and presented with less unintentional weight loss.

The authors of this study conducted a systematic review of clinical outcomes after pediatric aortic valve repair (AVr) and examined life expectancy and risk of reintervention using microsimulation. The study included forty-one publications including 2,636 patients with 17,217 years of follow-up (median follow up was 7.3. years). Pooled early mortality rates after AVr in children (<18 years), infants (<1 year), and neonates (<30 days) were, respectively, 3.5 percent, 7.4 percent, and 10.7 percent. The pooled late reintervention rates in children, infants and neonates were 3.3 percent per year, 6.8 percent per year, and 6.32 percent per year. Microsimulation-based mean life expectancy in the first twenty years was 18.4 years. Despite a high hazard of reintervention for valve dysfunction and slightly impaired survival compared with the general population, AVr has low valve-related event occurrences and should always be considered.

This paper looks to explore the outcomes in obese patients with non-small cell lung cancer following VATS or open lobectomy. The authors utilized data from the European Society of Thoracic Surgeons Database to assess morbidity and postoperative length of stay in 78,018 patients across a fourteen-year period. An intention-to-treat analysis was used, with assessment performed using univariable, multivariable-adjusted, and propensity-score-matched analyses. VATS lobectomy was found to be associated with improved postoperative outcomes.