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Journal and News Scan
June 25, 2021
Submitted by: Mark Ferguson
Data from the Esodata project used more than 8,000 patients undergoing esophagectomy for cancer to develop a risk prediction score for 90-day mortality. Development and validation groups were used. There were 10 variables that emerged as significant predictors, and weighted values were developed into the model. The model identified 5 risk levels for 90-day mortality, which may help in patient selection and in informed discussions.
June 25, 2021
Submitted by: Catherine Joyce
This retrospective, single-center analysis reviewed 142 consecutive patients with cardiac arrest treated with veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and targeted temperature management (TTM) to determine the impact of enteral feeding on clinical outcomes and survival. The authors propose that feeding may lead to redistribution of blood flow from the brain to the gut, thus decreasing brain perfusion at a vulnerable time. In contrast to other studies which demonstrate benefits with early feeding in critically ill patients, this study included a population that was presumably well nourished and ambulatory prior to admission. Additionally, TTM was used for all patients and may have contributed to reduced gut motility. Despite limitations that include a non-randomized, single-center design, this study provides important cautions about early enteral feeding in this “ultra-sick” population that warrant further study.
June 15, 2021
Submitted by: Aristotle Protopapas
Fascinating confirmation of null hypotheses including bleeding complications and survival in a Pennsylvanian cohort study, despite the easily predictable previous PCI, hock, and IABP prevalence in the emergency group. The statistical model is elaborate and complex. Perhaps a randomized trial could now be justified!
June 11, 2021
Submitted by: Aristotle Protopapas
A useful detailed review (or state-of-the-art article) on revascularisation in extracardiac vascular stenoocclusive atheromatosis.
June 11, 2021
Submitted by: Aristotle Protopapas
A glimpse of what could be a future for surgery..........
June 10, 2021
Submitted by: Mark Ferguson
This examination of readmission rates is based on data from nearly 40,000 patients from the STS Database having undergone elective pulmonary lobectomy. Readmission was driven by complications during the index operation, notably pulmonary embolism, empyema, pleural effusion, and pneumothorax. Improved pleural space management may offer a means to mitigate readmission rates.
June 10, 2021
Submitted by: Mark Ferguson
Over 30% of lung resection patients in the STS Database had prior exposure to opioid use. They experienced longer length of postoperative stay, more frequent visits to the ED, and a higher incidence of readmission within 90 days. Athough there is growing interest in standardized enhanced recovery pathways after lung resection, this challenging subset of patients appears to require unique targeted postoperative interventions.
June 10, 2021
Submitted by: Mark Ferguson
Chyle leak remains a challenging postoperative complication to manage, and avoidance is always easier than mitigation. The only predisposing factor identified in this study was low BMI. Although ICU stay was longer in affected patients, operative mortality, hospital LOS, and survival were not negatively impacted by the presence of a leak.
June 4, 2021
Submitted by: Saurabh Gupta
A good discussion on the concepts of:
1. aortic true lumen and false lumen behavior after repair of acute Type A aortic dissection
2. distal anastomotic new entry tear after hemiarch repair
3. impact of above on clinical outcomes
4. strategies on preventing distal anastomotic entry tear
The authors communicate that improved understanding of these hemodynamic conditions may serve to improve surgical technique, guide creation of novel devices toward new therapeutic targets, reduce surgical risk, and ultimately improve patient outcomes.
June 4, 2021
Submitted by: Wei-Guo Ma
On May 25, 2021, Dr. David Heimansohn successfully performed the first surgical implantation of biopolymer Tria™ heart valve in a patient with mitral valve disease at Ascension St. Vincent Hospital, Indianapolis, IN.
Foldax’s Tria valve is fabricated with a polymeric, silicone-rich polyurethane material intended to resist calcification, improve valve durability, and, most importantly, avoid the need for lifelong anticoagulation.