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Journal and News Scan

Source: Journal of Thoracic Oncology
Author(s): Koshy, Matthew; Malik, Renuka; Spiotto, Mike; Mahmood, Usama; Weichselbaum, Ralph; Sher, David

This analysis of nearly 40,000 patients with inoperable early stage lung cancer explored factors associated with delivery of potentially curative conventional radiotherapy (ConvRT) or SBRT.  Treatment was less likely in blacks and hispanics.  SBRT was more likely than ConvRT in high volume and academic centers.  Overall use of SBRT, ConvRT, and no treatment was 68%, 11%, and 21% in academic centers compared to 25%, 28%, and 46% in community centers.

Source: Annals of Oncology
Author(s): B. A. Mahal, G. Inverso, A. A. Aizer, D. R. Ziehr, A. S. Hyatt, T. K. Choueiri, K. E. Hoffman, J. C. Hu, C. J. Beard, A. V. D'Amico, N. E. Martin, P. F. Orio III, Q.-D. Trinh and P. L. Nguyen

There is growing recognition that hospital mortality is not an accurate metric for surgery-related mortality after cancer operations.  This article evaluated SEER data for 1-month mortality after cancer surgery in nearly 54,000 patients.  4.8% died within 1 month of surgery.  Favorable factors included being married, being insured, having an above-median income, and having an above-median educational status.  Eliminating such adverse outcomes in those with socioeconomic disparities provides the opportunity to substantially improve cancer survival.

Source: Annals of Oncology
Author(s): D. Schmid and M. F. Leitzmann

This meta-analysis evaluated 6 published studies involving over 71,000 cancer patients who experienced 2002 instances of cancer mortality.  Compared to patients with low fitness, those with high levels of cardiorespiratory fitness had a 50% reduction in their cancer mortality risk.

Source: Journal of the American Medical Association
Author(s): Marjorie Podraza Stiegler

The author recounts the posttraumatic distress that Captain Scully and other crewmembers experienced after the emergency landing of US Airways Flight 1549 on the Hudson River in New York City.  She describes the counseling this team required after executing a nearly perfect recovery from a potentially disastrous aviation event.  The author wonders why, when physicians experience similarly traumatic experiences with their patients (especially those with fatal outcomes), they are expected to resume work immediately, without counseling and without regard for any potential disability.

Source: Journal of Cardiac Surgery
Author(s): Tomoyuki Minami, Yasuko Uranaka, Makoto Tanaka, Koji Negishi, Keiji Uchida and Munetaka Masuda

Coronary subclavian steal syndrome is a concern in hemodialysis patients with an upper extremity arteriovenous fistula (AVF) who are undergoing ipsilateral IMA harvest for revascularization.  In this case report, the authors describe the intraoperative documentation of reversal of flow in the LIMA to LAD graft that improved with occlusion of the AVF.  This finding prompted taking the LIMA off the Aorta as a free graft, which led to improvement of flow characteristics.

Source: Alcoholism: Clinical and Experimental Research
Author(s): Erin M. Lowery, Erica A. Kuhlmann, Erin L. Mahoney, Daniel F. Dilling, Stephanie A. Kliethermes and Elizabeth J. Kovacs

In this retrospective study of 173 lung transplants performed at Loyola University, investigators found a correlation between heavy alcohol use in lung transplant donors and risk of developing severe primary graft dysfunction.  Those recipients had  an 8.7 times higher risk than patients who received lungs from donors who did not drink.

Source: JACC Cardiovascular Interventions
Author(s): M Pasic, A Unbehaun, S Buz, T Drews, R Hetzer

This manuscript offers a comprehensive and easy to read review of annular rupture during TAVI. The authors explain the pathophysiology of this complication and classify it according to the anatomical location. They also discuss the management options in terms of diagnosis and treatment.

Source: Boston Herald
Author(s): Herald Staff

Dear Colleagues,

I am heartbroken to inform you that Dr. Michael J. Davidson, director of Endovascular Cardiac Surgery at Brigham and Women’s Hospital, has tragically died this evening after sustaining gunshot wounds this morning during the shooting event at the Shapiro Cardiovascular Center.

Dr. Davidson was a wonderful and inspiring bright light and an outstanding cardiac surgeon who devoted his career to saving lives and improving the quality of life of every patient he cared for. It is truly devastating that his own life was taken in this horrible manner.

Dr. Davidson was kind, compassionate and beloved by his colleagues and his patients. He was deeply dedicated to the Brigham. In 2010, he ran the Boston Marathon with Team Brigham to celebrate his 40th birthday. He stated at the time, “There is no better way to commemorate a birthday, run the marathon to achieve a personal goal and, in the process, support Team Brigham and its mission to help so many people.”

He was part of the remarkable team that performed the hospital’s first tricuspid “valve-in-valve” procedure and was involved in establishing the hybrid OR at BWH, once of the most advanced operating rooms in the country. Dr. Davidson graduated from Yale University School of Medicine and then trained at Duke University and Brigham and Women’s Hospital, joining our Brigham family in 2006.

The world is a better place because of Dr. Davidson. Let us honor our dear colleague’s memory and legacy by treating each other with kindness and providing the best possible care to those who come to us in need. If you need support, the Employee Assistance Program staff are available for any employees who wish to contact them. The telephone number is 617-732-6017.

Our thoughts and prayers are with his family at this time. More information on a memorial service will be forthcoming.

Source: Journal of the American College of Cardiology
Author(s): Diana C. Canseco, Wataru Kimura, Sonia Garg, Shibani Mukherjee, Souparno Bhattacharya, Salim Abdisalaam, Sandeep Das, Aroumougame Asaithamby, Pradeep P.A. Mammen, Hesham A. Sadek

This study from the University of Texas Southwestern sought to analyze the effects of mechanical unloading during prolonged LVAD support on mitochondrial mass, DNA damage response (DDR), and cardiomyocyte proliferation.  Ten matched human samples of LV myocardium were analyzed before and after mechanical circulatory support. Among its interesting findings, the study found that prolonged mechanical unloading induces adult human cardiomyocyte proliferation, hypothesized to occur through prevention of mitochondria-mediated activation of DDR.  How do we optimize LVAD myocardial recovery regimens to leverage this important finding?

 

 

 

Source: Annals of Thoracic Surgery
Author(s): Kan Kajimoto, Taira Yamamoto, Atsushi Amano

This systematic review and meta-analysis explores the literature to determine the relative advantages and disadvantages of using bilateral IMAs over single IMAs on outcomes after CABG in diabetic patients.   In their analysis, the group found that patients who underwent bilateral IMA grafting using skeletonized IMAs had no greater incidence of sternal wound infection than those undergoing unilateral IMA harvesting; however, if the mammaries were harvested on a pedicle, an increased incidence of sternal wound infection was noted in the bilateral harvest group.  In addition, the meta-analysis demonstrated better long-term survival in the bilateral IMA group, regardless of harvesting method, over the unilateral IMA group.  Is it time to reconsider bilateral IMA usage in diabetics?  If bilateral IMAs are indeed used, should they be harvested only in skeletonized fashion?

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