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Journal and News Scan
August 15, 2024
Submitted by: Mujtaba Mubashir
As the understanding of the natural progression of smaller peripheral lung nodules grows, the treatment options and existing paradigms continue to change. One area that is under intense study involves ground glass nodules (GGOs), which are detected by high resolution CT scans. The authors summarize the recent efforts to classify the aggressiveness of GGOs on imaging with the resulting pathology noted after surgical resection and discuss how such lesions can be over and under treated based on existing classification systems. The authors also discuss algorithms to aid in individualized patient selection for sublobar resections with such lesions.
August 8, 2024
Submitted by: Mujtaba Mubashir
While treatment of classic septal hypertrophic cardiomyopathy is well established, the treatment for long segment subaortic variant and apical hypertrophy variants are less clearly defined. The apical variant has traditionally been treated with a heart transplant, however, there is emerging experience with a transapical approach to treat this condition that may be used as an alternate to a heart transplant. The researchers reference a twenty-two-year-old patient who was successfully treated with this approach and suggest it may be used for other ventricular septal defect closures and endocardial fibroelastosis.
August 8, 2024
Submitted by: Mujtaba Mubashir
Determining the appropriate prosthetic for mitral valve replacement is an ongoing area of study. This article looked at trends at a single center over a period of 20 years and compared the use of biologic (1,658 patients) and mechanical valves (369 patients). Survival among groups was similar, however, patients with mechanical valves had significantly lower incidence for reoperation overall. The researchers discuss the established durability of mechanical valves, pitfalls of selection bias in patients of different age groups and across eras, and they share comparisons with existing data in the literature from other centers of excellence.
August 8, 2024
Submitted by: Mujtaba Mubashir
Treatment of aortic stenosis due to a bicuspid aortic valve (BAV), requires a lifetime strategy due to structural valve degeneration that necessitates redo intervention, such as surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). The researchers looked at outcomes for surgical valve replacement in patients with and without concomitant aortic aneurysms, and have reported excellent operative and reoperative outcomes, including durability at 10 years and valve function. The researchers make a case for performing surgical valve replacement versus TAVR in younger patients for several reasons, including the favorable operative and reoperative safety profile, ability to intervene on concomitant pathology (such as aneurysmal disease and atrial fibrillation), and established long-term durability profile.
August 8, 2024
Submitted by: Mujtaba Mubashir
Transcatheter aortic valve replacement (TAVR) has surpassed surgical aortic valve replacements in volume since TAVR is now approved for patients of all surgical risk categories. This article evaluated trainees and program directors to assess current training patterns and comfort levels regarding catheter-based interventions. A majority of trainees had a mean of 2.8 months on dedicated catheter-based rotations, although often serving as assistants. Only a minority of residents across the board felt comfortable performing these procedures (12 percent with dedicated rotations and 10 percent without). The authors highlight the increasing need for a more robust catheter-based intervention curriculum to aid with training the upcoming generation of cardiothoracic surgeons.
August 1, 2024
Submitted by: Mujtaba Mubashir
Post Ross procedure dilation of the pulmonary autograft (neo-aorta) is a major long-term draw back that has been dealt with in many ways, including strict blood pressure control for one year, ring and suture annuloplasty techniques, and autologous and prosthetic external graft stabilization techniques. These techniques are associated with varying technical difficulties and can add considerable time to the overall operation. The authors report their outcomes with their Seattle shawl modification of a protected Ross technique performed for bicuspid aortic valve with promising early results. This technique, described in detail, modifies the skirt of a Valsalva graft with keyholes for coronary button implantation. The authors also discuss their algorithm for choosing this technique over other conventional established approaches.
August 1, 2024
Submitted by: Mujtaba Mubashir
Button battery ingestion in children is associated with severe morbidity and mortality if not treated promptly, due to the coagulation necrosis that ensues. Formation of a tracheoesophageal fistula (TEF), due to tissue necrosis, is an exceedingly rare complication, albeit one that carries high mortality. This article reports on four cases of TEF, their presentation, perioperative management, the surgical treatment employed, and follow-up. The authors discuss the use of esophagectomy with cervical fistula, repair of the trachea with aortic homograft, and the use of latissimus dorsi pedicled interposition flaps to cover and reinforce large tracheobronchial defects. The authors also discuss their technique and rationale for using aortic homograft due to its stiffer mechanical properties compared to bovine or autologous pericardium, thus, theoretically, applying less stress to suture lines.
August 1, 2024
Submitted by: Mujtaba Mubashir
Surgical treatment of laryngotracheal stenosis remains challenging not only because of low case volumes, but also due to highly individualized approaches used, including use of different endoscopic approaches. This article discusses surgical approaches used in 45 patients, including standard cricotracheal resection (CTR) (11 percent), CTR with dorsal mucosal flap (49 percent), CTR with dorsal mucosal flap and lateral cricoplasty (24 percent) and single stage laryngotracheal reconstruction (16 percent). Although, these procedures were carried out with low morbidity, it appears that prior endoscopic approaches add to the complexity of subsequent surgical resection, and adversely affect metrics in functional evaluation. Thus, the authors make a case for earlier surgical referral in patients with laryngotracheal stenosis.
August 1, 2024
Submitted by: Mujtaba Mubashir
Surgical treatment of pleural mesothelioma remains challenging and carries high morbidity, especially in patients who develop post operative empyema. This interesting article retrospectively studied 400 patients of whom 50 developed postoperative empyema. Extrapleural pneumonectomy (EPP) was found to be the only risk factor associated with development of empyema, with an odds ratio of 2.8 after controlling for confounding factors. Of note, survival was significantly worse in patients who developed empyema compared to those who did not.
July 25, 2024
Submitted by: Mateo Marin-Cuartas
Atrial fibrillation (AF) increases the risk of stroke and systemic embolism. While oral anticoagulation is the current standard of care, there is a growing body of evidence supporting left atrial appendage closure (LAAC) as an alternative or complementary treatment approach to reduce the risk of stroke or systemic embolism in patients with AF. An increasing number of randomized clinical trials studying the efficacy and safety of catheter-based LAAC in comparison with medical noninterventional treatment are giving further insights into this topic. Furthermore, robust randomized data about surgical LAAC in patients with AF undergoing cardiac surgery showed a significant reduction of the risk of stroke on the background of continued anticoagulation therapy. In this review, the authors describe the rapidly evolving field of LAAC and discuss recent clinical data, ongoing studies, open questions, and current limitations of LAAC.