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Journal and News Scan
A cohort of 2145 patients from the International Registry of Acute Aortic Dissection were compared according to whether they had axillary (1106 [52 percent]) or femoral (1039 [48 percent]) arterial cannulation. Patients with axillary cannulation had more total arch (15 percent versus 11 percent, P < .02) and valve-sparing root replacements (22 percent versus 12 percent, P < .001), but in-hospital mortality (15 percent versus 14 percent, respectively; P = .7) and stroke rates were similar compared with femoral cannulation.
In a single-center series of 502 patients who underwent thoracoscopic ablation and left atrial appendage closure, of whom 333 had preoperative and postoperative computed tomographic imaging, complete left atrial appendage closure (defined as residual stump <1 cm on computed tomography one year postoperatively) was lower with the stapled resection (83 percent) compared with a clip (96 percent), and the residual left atrial appendage stump depth was greater (5.3 vs 2.9 mm, respectively). Two patients with a residual stump experienced an ischemic stroke during follow-up.
In this paper, the authors completed a propensity matched retrospective observational study to compare long-term outcomes of isolated mechanical versus bioprosthetic mitral valves in different age groups. After propensity matching, analysis was completed in two age groups: < 65 and 65–75 years. Ten-year survival and freedom from reintervention were superior in those less than 65 years and receiving mechanical valves. In patients aged between 65–75, there was no difference in survival or freedom from reintervention between valve prosthesis.
The authors report the results of their randomized controlled trial (RCT) exploring the use of preoperative CT three-dimensional (3D) reconstruction and its impact on operative time and outcomes in thoracoscopic segmentectomy. The authors conducted a multicenter (three hospitals) RCT between 2019 and 2023, randomizing patients 1:1 to either 3D reconstruction CT or standard chest CT. The primary endpoint was operative time. Overall, 191 patients with small peripheral tumors were randomized. There was no statistically significant difference in operative time or clinical outcomes between the groups.
Of 1,579 patients undergoing esophagectomy for esophageal cancer, 60 patients underwent up-front surgery for cT2 N0 M0 esophageal cancer, of whom 8 (13 percent) were found to have pathologic T2 N0 M0, 16 (27 percent) were pathologically downstaged, and 36 (60 percent) were upstaged, 7 (19 percent) on the basis of pathologic T stage, 14 (39 percent) on pathologic N stage, and 15 (42 percent) had upstaging of T and N stages. Dysphagia and high maximum standardized uptake value of the tumor were predictive of more advanced underlying disease.
This study evaluated the outcomes after the use of cardiac shockwave therapy (SWT) combined with coronary artery bypass surgery (CABG) in patients with reduced left ventricular ejection fraction (LVEF) due to ischemic cardiomyopathy. Patients with LVEF ≤ 40 percent requiring CABG were enrolled in this single-blind, parallel-group, sham-controlled trial. Patients were randomly assigned to undergo direct cardiac SWT or sham treatment in addition to CABG. The primary efficacy endpoint was the improvement in LVEF measured by cardiac magnetic resonance imaging from baseline to 360 days. A total of 63 patients were randomized, 30 patients in the SWT group and 28 patients in the sham group. A greater improvement in LVEF was observed in the SWT group (Δ from baseline to 360 days: SWT 11.3 percent; Sham 6.3 percent, SD 7.4, P = 0.0146). Furthermore, patients in the SWT group significantly improved in the six minute walking test 360 days after randomization. The authors conclude that direct cardiac SWT, in addition to CABG, improves LVEF and physical capacity in patients with ischemic heart failure.
This video is a balanced, gripping presentation on an increasingly common emergency problem for the on-call cardiac surgeon. Professor Oo discusses the evolving landscape of surgery for acute De Bakey I and II pathologies of the aortic organ. He discusses device use for malperfusion and juxtaposes it with FET and more simple, traditional options to treat acute type A aortic dissections.
This consensus paper released by the AATS puts forth 17 recommendations regarding subsolid lung nodules. These consensus statements relate to the radiological and pathological definitions of subsolid nodules, growth rate, recommendations for diagnosis of these nodules, initial and long-term surveillance based on their appearance and type, as well as timing and type of surgical intervention. Several recommendations are also laid forth regarding management of multiple subsolid lung nodules.
In this phase three national, multicenter, UK randomized controlled trial, the authors seek to compare outcomes after extended pleurectomy decortication plus chemotherapy versus chemotherapy alone. The trial recruited patients between 2015 and 2021 from 26 UK hospitals, recruiting and randomly assigning patients with a 1:1 allocation ratio. In total 335 patients were randomized, 87 percent of which were male. The authors concluded that extended pleurectomy decortication was associated with a worse survival up to two years.
The prevalence of anomalous aortic origin of a coronary artery is 0.4 percent to 0.8 percent. The decision to operate and choice of procedure can be challenging. This invited expert review by a panel of congenital cardiac surgeons, cardiologists, and imaging practitioners summarizes a systematic survey of publications since 2010, providing practical advice for surgical management.