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Journal and News Scan
November 3, 2015
Submitted by: Joel Dunning
It turns out that marriage may actually mend broken hearts.
A new study published in the Journal of the American Medical Association found that married patients recovered better after heart surgery than single or divorced patients.
After studying 1,576 adults over age 50 who had serious cardiac surgery, the researchers found that unmarried patients had a 40% greater chance of dying or developing complications two years after the surgery.
October 29, 2015
Submitted by: Mark Ferguson
Using University of Michigan Health and Retirement Study data, the authors evaluated marital status at the time of cardiac surgery and subsequent survival or deterioration in the ability to perform activities of daily living (ADLs) independently. At follow-up, those who were married had a 19.4% incidence of death or new disability, which was similar to outcomes for never married individuals. In contrast, those who were divorced, separated, or widowed had a 32% incidence of adverse outcomes.
Initial Surgical versus Conservative Strategies in Patients with Asymptomatic Severe Aortic Stenosis
October 19, 2015
Submitted by: Ruben Osnabrugge
The investigators in this registry study enrolled 3815 patients with asymptomatic aortic stenosis. Patients underwent either surgical aortic valve replacement (AVR) or conservative therapy. In order to increase comparability, they used propensity score matching to create two more similar groups. The cumulative 5-year incidences of all-cause death and heart failure hospitalization were significantly lower in the initial AVR group compared to the conservative group (15.4% vs. 26.4%, p=0.009 and 3.8% vs. 19.9%, p<0.001). Moreover, 41% of the patients in the conservative treatment group received AVR during follow-up. These results indicate that initial AVR in patients asymptomic severe aortic stenosis might be substantially improved by initial AVR.
October 19, 2015
Submitted by: Joel Dunning
Download the 5 year plan for workforce planning across the whole of the UK here. This is probably a template also for workforce planning internationally for Cardiac Surgery, Thoracic Surgery, Congenital Heart surgery and Transplantation as it discusses future surgical requirements, age demographics of surgeons and many other issues that are all key factors in planning for numbers in these specialties for the future.
This is a very high quality document that the many authors should be phenomenally proud of
October 18, 2015
Submitted by: J. Rafael Sadaba
In this manuscript the authors report on the results of a retrospective propensity score analysis in 102 matched pairs of patients, considered to be in a “grey zone” of surgical risk for either TAVI (Edwards Sapiens, Medtronic CoreValve or Symetis Acurate TA prosthesis) or aortic valve replacement (AVR) with a sutureless prosthesis (Sorin Perceal). There were no significant differences in intra-procedural complications, postoperative renal, neurological or respiratory complications and the need for pacemaker between the patients undergoing TAVI and sutureless AVR. Patients receiving TAVI had shorter ICU and hospital stay, and required less blood transfusion, but suffered vascular complications significantly more frequently than patients receiving a sutureless prosthesis. There was no significant difference in hospital mortality. At follow up, paravalvular leak was more frequent in the TAVI group. Survival rate was significantly better in the sutureless AVR group. Outcomes regarding the cost associated to the two procedures showed than when the cost of the device was included, sutureless AVR resulted as a cost-saving treatment compared with TAVI.
October 16, 2015
Submitted by: Mark Ferguson
Using an anonymous survey, surgeons at a single institution were asked to rate the impact of 9 stressors on performance and outcomes. Complex cases, rarely performed cases, and lack of adequate assistance were assocated with the most stress. A stress-related intraoperative complication occurrence was reported by 40%. More than 80% indicated that training in stress management would be useful.
October 14, 2015
Submitted by: Arie Blitz
During the 2013 In-Training Exam for cardiothoracic surgery residents, 312 residents were surveyed regarding their training. Residents self-reported that only 70-75% of the cases they claimed 'surgeon' credit met the ABTS definition for 'surgeon'--i.e., the resident performs "those technical manipulations that constituted the essential parts of the procedure itself" and has substantial involvement in preoperative and postoperative care. What are the reasons that residents feel they need to 'over-report' their cases? What are the implications of this study?
October 14, 2015
Submitted by: Arie Blitz
The authors retrospectively reviewed the postoperative TEEs on patients undergoing DCCV within 30 days after cardiac surgery that included LAA closure (n=93 patients). The presence of a residual communication between the LAA and the left atrium was 37% overall. The LAA patency rates according to LAA technique were as follows: amputation, 0%; suture closure, 51%; staple exclusion, 29%. These results beg the question: should the appendage always be amputated?
October 13, 2015
Submitted by: Joel Dunning
This is an anterior approach to the station 7 lymph node after a left upper lobectomy. I have certainly never seen the lymph node from this direction. very interesting
October 12, 2015
Submitted by: Mark Ferguson
This single institution study evaluated compliance with NCCN guidelines in the management of stage II-III esophageal cancer. Overall compliance was 81%, and was related to younger age, white race, and higher education level. Compliance was associated with improved survival.