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
July 9, 2015
Submitted by: CTSNet Staff
The authors report on aortic arch surgery after previous type A dissection repair in 55 patients. The results with 5% perioperative deaths and 7% permanent stroke are satisfactory in this challenging patient’s group.
July 9, 2015
Submitted by: CTSNet Staff
The 600 Finnish patients who were analyzed, underwent repair of tetralogy of Fallot at the age of <15 years between 1962 and 2007. The long-term prognosis improved considerably over time. The data indicate an increased risk of death in patients who had undergone a primary palliative procedure. Further, the need of a transannular patch was associated with a higher risk of reoperation, but had no impact on late survival.
July 9, 2015
Submitted by: CTSNet Staff
A two-center prospective study on 229 patients with pulmonary lobectomy for lung cancer was conducted. Large postoperative pleural effusion (>400 ml/day) could be predicted by an aggregate score which includes age >70 years, lower lobectomy and presence of COPD.
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.