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Journal and News Scan
July 9, 2015
Submitted by: CTSNet Staff
Approximately 5400 patients who underwent lobectomy for non-small-cell lung cancer were analyzed. Post-discharge mortality (PDM) within 90 days came up to 1.9%. Patient-dependent risk factors were identified by multivariate logistic and Cox regression analyses. The authors consider PDM an under-reported phenomenon and suggest measures to improve it.
July 9, 2015
Submitted by: Arie Blitz
Twenty-five cardiac surgery trainees underwent randomization to learn TEE interpretation by either of two approaches: traditional teaching during cardiac surgery vs. simulation-based teaching via the Heartworks simulator. Pre- and post-testing revealed comparable improvements in both groups, but with a trend towards better learning in the simulation group.
July 6, 2015
Submitted by: Arie Blitz
This is a provocative study questioning the current practice of using blood pressure targets perioperatively to ensure adequate perfusion. Plasma levels of a brain-specific injury biomarker (GFAP) were measured in 121 patients undergoing cardiac surgery. The cerebral oximetry index, which correlates changes in mean arterial pressure (MAP) and regional cerebral oxygen saturation, was used to define individualized optimal MAPs. A comparison was made correlating the degree of cerebral injury as measured by GFAP levels and either conventional MAP targets or oximetry-based targets defining hypotension. The incidence of hypotension varied from 22-37% by conventional definitions, but the incidence was much higher at 54% when using the cerebral oximetry index. Whereas oximetry-derived hypotension correlated with GFAP levels on POD 1, conventional hypotension did not.
July 4, 2015
Submitted by: Arie Blitz
A novel social networking group has been formed and is entitled, "The Thoracic Surgery Social Media Network." It is represented on Twitter by the handle, @TSSMN. In addition, tweets are tagged with the #TSSMN hashtag. This network is a collaboration among the major cardiothoracic surgery journals as well as delegates from each cardiothoracic surgery subspecialty, as listed below:
Adult cardiac surgery
- Edward Bender @ebender001
- Arie Blitz @ArieBlitzMD
- William Harris @wharrismd
- Maral Ouzounian @OuzounianMD
Congenital cardiac surgery
- Jeff Jacobs @jeffjacobs215
- Paul Kirshbom @PaulKirshbomMD
General thoracic surgery
- Mara Antonoff @maraantonoff
- David Cooke @UCD_ChestHealth
- Brendon Stiles @BrendonStilesMD
- Tom Varghese @TomVargheseJr
CTSNet members are encouraged to subscribe to @TSSMN as well as to those delegates representing their subspecialty interests. The tweets are open to all and participation is encouraged.
July 1, 2015
Submitted by: Arie Blitz
The authors retrospectively analyzed the STS datablase for utilization of bilateral mammary artery (BIMA) grafts in patients considered at low risk for BIMA use. This group of patients were compared to a propensity matched group of single mammary artery graft (SIMA) patients. Overall, 24% of patients met criteria for "low risk"; however, only 6% of these underwent BIMA revascularization. Thus, despite the known superior outcomes of BIMA grafting in patients at low risk for BIMA harvesting, the authors conclude that BIMA grafting remains underutilized.
June 28, 2015
Submitted by: Lisa Brown
Retrospective cross-sectional cohort study using 5 years of Medicare benficiary data to determine whether post discharge mortality varies by time-to-readmission. Two of the three operations analyzed were lung resection (n=101,092) and coronary artery bypass grafting (CABG) (n=484,260). Patients were categorized as follows: no readmission within 30 days, readmitted within 1-5 days, 6-10 days, 11-15 days, 16-20 days, and 21-30 days. The main analysis examined the association between risk-adjusted mortality and the time-to-readmission categories. The secondary analysis examined whether major complications during the index hospitalization predicted mortality. The overall readmission rate for lung resection was 10.8% and for CABG was 14%. The major findings of this study are: 1) Patients who were readmitted had higher risk-adjusted mortality than nonreadmitted patients (10.8% versus 3.7%), 2) Risk-adjusted mortality decreased in a linear manner as the time-to-readmission increased, and 3) Interestingly, there was only a weak association between postoperative complications during the index hospitalization and readmission.
June 25, 2015
Submitted by: Mark Ferguson
The authors reviewed their experience with patients suffering blunt trauma who had evidence of a pneumomediastinum on CT. Among over 3,000 pts, 2.7% had pneumomediastinum. Those affected had higher injury scores and a higher mortality rate (12.5% vs 3.6%). Increased risk of mortality was associated with posterior mediastinal air, air in all mediastinal spaces, and an associated hemothorax.
June 25, 2015
Submitted by: Mark Ferguson
This study evaluated outcomes in patients undergoing resection for lung cancer who were found at surgery to have pleural carcinomatosis. 2.9% of registry patients were identified, of whom 49% had a macroscopic complete resection. 5-year survival in those without other metastatic disease was 29%. 5-year survival in those undergoing macroscopic complete resection was 37%.
June 24, 2015
Submitted by: Mark Ferguson
Patients with afib undergoing elective surgery or invasive procedure who were on coumadin were randomized to bridging with low molecular weight heparin or placebo preoperatively. The incidence of arterial thromboembolism was .03% in the bridge group and 0.4% in the placebo group, demonstrating non-inferiority of placebo. The bleeding complication rates were higher in the bridge group, 3.2% vs 1.3%. Not bridging was non-inferior to bridging and reduced the risk of bleeding complications.
Temporal Trends in Quality of Life Outcomes After Transapical Transcatheter Aortic Valve Replacement
June 24, 2015
Submitted by: Ruben Osnabrugge
The authors of this study aimed to compare the quality of life (QoL) after Transapical transcatheter aortic valve implantation (TA-TAVR) versus surgical aortic valve replacement (SAVR). They used the QoL data of 875 TA-TAVR patients from the PARTNER nonrandomized continued acces registry and compared this with the smaller randomized group of TA-TAVI and SAVR patients. They found that despite more experience in this continued access population, QoL was similar to randomized TA-TAVR patients and SAVR patients.