ALERT!
This site is not optimized for Internet Explorer 8 (or older).
Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.
Journal and News Scan
This large-scale analysis of the National Cancer Database (NCDB) highlights some interesting trends in the current use of systemic therapy in patients with NSCLC who undergo pneumonectomy. Current practice patterns show only 12 percent of patients undergoing pneumonectomy for pathologic stage IB to IIIA received neoadjuvant therapy, 43 percent received adjuvant therapy, and 45 percent underwent surgery alone. Although this retrospective study is subject to limitations of large database analysis, including selection bias reporting only patients who received a particular therapy without reasons identified, this large difference in treatment patterns is certainly an area of potential research. In an era of rapid oncological advances with targeted therapy and immunotherapy, there seems to be a role for further systemic therapy in patients who require pneumonectomy, as the authors highlight survival benefits and downstaging of tumors to perhaps allow a lesser resection to be performed.
This free-access report raises a number of research questions in light of a relatively unsatisfactory response of 55 percent that may reflect unrecorded deaths and should be addressed in future research.
A further analysis of the subgroup of connective tissue aortopathies, possibly differentiating between Marfan and less common pathology, may generate further information in order to understand the patients’ journey in acute aortic syndrome. This would help to guide allocation of resources, counseling, and most importantly, manage the expectations of the public from the aortic service.
The apparent equipoise of conservative treatment and intervention is alarming, to an extent. The key to understand that is, perhaps, the 45 percent of nonresponders.
This paper explores the application of a novel aortic valve visualization and pressurization device to inspect the valve under physiological conditions following aortic repair. The authors report their results in a cohort of twenty-four patients.This paper explores the application of a novel aortic valve visualization and pressurization device to inspect the valve under physiological conditions following aortic repair. The authors report their results in a cohort of twenty-four patients.
This is the newly published latest version of Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection developed by the Japanese Circulation Society, Japanese Society for Cardiovascular Surgery, Japanese Association for Thoracic Surgery, and Japanese Society for Vascular Surgery. Compared to the 2022 ACC/AHA Guidelines on Aortic Disease, the Japanese document discusses the following topics in more detail, along with 86 figures and 1,943 references, which may warrant careful study. Topics included definition, pathogenesis, and epidemiology; pathology; symptoms, examinations, and diagnosis; selection of treatment; treatment for aortic aneurysm; treatment for aortic dissection, issues associated with aortic surgery, other aortic diseases; rehabilitation; and various issues of medical treatment for aortic diseases.
This is an open access genomic study of carotid atheroma in Viennese patients with a useful extensive discussion on potential translational value of the signature of calcification, juxtaposed to sonographic diagnostics and in the quest to manage the risk of rupture of carotid atheromatous plaque. The article also has gravitas in the light of the updated ESVS guidelines in carotid disease.
The authors reported the prognostic impact of donor transmitted coronary artery disease in heart transplantation in their retrospective multicenter cohort study. They found that TCAD was not associated with reduced survival. However, TCAD patients showed increased risk of cardiovascular death.The authors reported the prognostic impact of donor transmitted coronary artery disease in heart transplantation in their retrospective multicenter cohort study. They found that TCAD was not associated with reduced survival. However, TCAD patients showed increased risk of cardiovascular death.
Survival of diabetics after single or multiple coronary artery bypass grafting was compared in a national database over twenty years with 69,224 patients. End points were long-term all-cause mortality and thirty-day clinical outcomes. 17,474 nondiabetic and 10,989 diabetic matched pairs were generated. At a median of 5.9 years after grafting, mortality was statistically significantly lower after multiple arterial grafting in both diabetic and nondiabetic cohorts. The incidence of myocardial infarction was significantly higher in single rather than multiple grafting for both cohorts. Multiple arterial grafting was associated with improved survival for both diabetic and nondiabetic patients.
While much research is ongoing regarding the safety of transcatheter aortic valve replacement (TAVR) compared to surgical aortic valve replacement (SAVR) after prior coronary artery bypass (CABG), there is limited data on morbidity outcomes and discharge locations among these two procedures. This article looked into a single center experience over fifteen years and found shorter length of stay, less new-onset atrial fibrillation, and more discharges home in the TAVR group compared to the SAVR group, with an overall improved morbidity profile.
During some transcatheter aortic valve implant (TAVI) procedures, complications require conversion to emergency open heart surgery (E-OHS). This study evaluated early and midterm outcomes in a large center over fifteen years. Patients were grouped by surgical risk and the study time was divided into three five-year periods. In the entire study period, 1.1 percent of TAVI patients (74/6903) required E-OHS. The rate of E-OHS decreased over the three periods, from 3.5 percent to 0.4 percent. However, the proportion of patients from the study with low or intermediate risk increased considerably, from 1 percent to 26 percent. In-hospital mortality was 62 percent in high-risk and 12.5 percent in low and intermediate-risk patients. One-year survival was 31.8 percent in high-risk and 87.5 percent in low/intermediate risk patients.
This study reports outcomes of protocolized management of chest drain removal on-table for patients undergoing wedge resections and minor thoracic procedures. Chest drains were removed at the end of the operation if air leak was < 20 ml/min. Between 2016 and 2021, 107 patients underwent on-table chest drain removal with a 0.9 percent reintervention rate. Safe on-table chest drain removal using digital drainage in select cases challenges the need for routine drain insertion in thoracic surgery.