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Journal and News Scan

Source: Eur J Cardiothorac Surg
Author(s): Eshan L. Senanayake, Neil J. Howell, Aaron M. Ranasinghe, Nigel E. Drury, Nick Freemantle, Michael Frenneaux, Tessa Oelofse, David Green, Ian C. Wilson, Stephen J. Rooney, Jorge Mascaro, Timothy R. Graham, Sunil Bhudia, Michael Lewis, and Domenico Pagano

Perhexilene modulates cardiac metabolism and is expected to provide myocardial protection during cardiac surgery in patients with left ventricular hypertrophy. The agent was tested in a randomized clinical trial and administered per os preoperatively. The primary endpoint was use of inotropics for low cardiac output. The trial was halted after analysis of 110 of 220 planned patients due to the lack of difference between the groups for the primary and also for secondary endpoints. 

Source: MMCTS
Author(s): Jonida Bejko, Alvise Guariento, Giacomo Bortolussi, Vincenzo Tarzia, Gino Gerosa, and Tomaso Bottio

The authors describe the tricks and traps of minimally invasive approach during VAD implantation, by associating mini anterior left thoracotomy in the fifth intercostal space with a mini anterior right thoracotomy in the second intercostal space, without the aid of CPB in paravertebral block regional analgesia combined with mild general anaesthesia.

Source: Medscape
Author(s): Arthur Caplan

Arthur Caplan of the Division of Medical Ethics at NYU Langone Medical center poses a difficult ethical question: how many hearts should one child receive? Dr. Caplan presents the case of a young patient who recently received a third heart transplant. 

Source: American Journal of Surgery
Author(s): Sydne Muratore, Greg Beilman, Ranjit John, Melissa Brunsvold

No guidelines for credentialling ECMO physicians exist, so the authors surveyed ECMO programs to determine what institutional credentialling mechanisms consist of.  The survey response rate was 42%.  66% of institutions require credentialling, 57% of institutions had credentialling mechanisms, and yearly recertification was required in 16%.   

Source: American Journal of Surgery
Author(s): Elizabeth A. David, David T. Cooke, Yingjia Chen, Andrew Perry, Robert J. Canter, Rosemary Cress

Outcomes of the California Cancer Registry for patients undergoing resection for Stage I NSCLC were evaluated according to Commission on Cancer (CoC) accreditation status and lung resection procedure volume.  High volume hospitals (>50 annually) had better survival compared to medium (20-50 annually; HR 1.23) and low volume (<20 annually; 1.77) hospitals.  Survival was not associated with CoC status.

Source: American Journal of Surgery
Author(s): Haris Zahoor, James D. Luketich, Benny Weksler, Daniel G. Winger, Neil A. Christie, Ryan M. Levy, Michael K. Gibson, Jon M. Davison, Katie S. Nason email

The 6th and 7th versions of the AJCC staging system were compared for their prognostic accuracy for patients with esophagogastric adenocarcinomas using an institutional database.  The 7th edition system was significantly more accurate in groups undergoing MIE, induction therapy, and overall.

Source: Lancet
Author(s): Miklos Pless, Roger Stupp, Hans-Beat Ris, Rolf A Stahel, Walter Weder, Sandra Thierstein, Marie-Aline Gerard, Alexandros Xyrafas, Martin Früh, Richard Cathomas, Alfred Zippelius, Arnaud Roth, Milorad Bijelovic, Adrian Ochsenbein, Urs R Meier, Christoph Mamot, Daniel Rauch, Oliver Gautschi, Daniel C Betticher, René-Olivier Mirimanoff, Solange Peters on behalf of the SAKK Lung Cancer Project Group

This randomized trial compared induction therapy for pathologically-proven N2/IIIA NSCLC with 3 cycles of cisplatinum and docetaxel chemotherapy alone to chemotherapy combined with 44 Gy of radiation therapy.  232 pts in 23 centers were enrolled over a 12 year period.  No differences were identified in the chemotherapy vs chemoradiotherapy groups for event-free survival (11.6 vs 12.8 mos) or median survival (26.2 vs 37.1).

Source: Annals of Thoracic Surgery
Author(s): Elbert Heng, BA, James R. Stone, MD, PhD, Joon Bum Kim, MD∗, Hang Lee, PhD, Thomas E. MacGillivray, MD, Thoralf M. Sundt, MD

Resected aortas associated with a bicuspid aortic valve (BAV,n = 60) and trileaflet aortic valve (n = 24) in patients with aortic valve disease were compared with normal diameter aortas from patients undergoing cardiac transplantation (n = 16) by five histologic criteria.  The extent of elastic fiber loss, smooth muscle cell loss, medial fibrosis, and atherosclerosis was more severe in trileaflet aortic valve than BAV when considered across all diameters and when stratified to those between 4 and 5 cm.  This finding begs the question:  Should the guideline-recommended more aggressive threshold for replacing the aorta in BAV patients as compared to trileaflet aortic valve patients be revisited?

Source: JAMA Surgery
Author(s): Jesper Lagergren; Fredrik Mattsson; Janine Zylstra; Fuju Chang; James Gossage; Robert Mason; Pernilla Lagergren; Andrew Davies

This single institution study involving 606 patients operated 2000-2012 examined the influence of the extent of lymphadenectomy on survival.  The number of nodes resected was not related to all-cause mortality, even comparing the highest and lowest quartiles.  The number of metastatic nodes and an increasing ratio of positive to negative nodes were each related to increasing mortality rates in a dose-response relationship.

Source: Lancet
Author(s): Lancet editorial staff

The consequences of the flawed process of investigation of scientific misconduct and premature conclusions of the outcomes are discussed.

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