Early outcomes of septal myectomy for obstructive hypertrophic cardiomyopathy in children with Noonan syndrome
Noonan syndrome (NS) is a genetic syndrome causing obstructive hypertrophic cardiomyopathy (HCM) in infants. Studies of cardiac surgery in pediatric HCM patients with NS (NS-HCM) are lacking. We aim to characterize the early disease course of young NS-HCM patients before adolescence and assess their complications and survival condition after septal myectomy. Pediatric obstructive HCM patients who underwent septal myectomy at age 10 years or under were enrolled consecutively between 2009 and 2019. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 26, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Shi Chen, Liang Chen, Yong Jiang, Haitao Xu, Yangxue Sun, Hao Shi, Shoujun Li, Jing Zhang, Jun Yan Tags: CONGENITAL – Original Submission Source Type: research

Maximum Standardized Uptake Value on Positron Emission Tomography is Associated with More Advanced Disease and High-risk Features in Lung Adenocarcinoma
18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) has been widely used for preoperative staging of lung adenocarcinomas. The aim of this study was to determine whether a high maximum standardized uptake value (SUVmax) could correlate with pathological characteristics in those patients. We retrospectively reviewed patients with clinical stage 0 –IA lung adenocarcinoma who underwent preoperative FDG-PET/CT followed by curative anatomical resection. To identify more advanced disease and high-risk features, representing visceral pleural involvement, pulmonary metastasis, lymph nod...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 25, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Terumoto Koike, Noriaki Sato, Yuta Hosoda, Masayuki Tazawa, Tatsuya Goto, Seijiro Sato, Motohiko Yamazaki, Shin-ichi Toyabe, Masanori Tsuchida Tags: THORACIC – Original Submission Source Type: research

Primary Pericardial Mesothelioma: A Population-Based Propensity Score-Matched Analysis
This study aimed to evaluate the clinical characteristics and survival outcomes of these patients using a US population-based cancer database. We queried the Surveillance, Epidemiology, and End Results program (1973-2015). Primary pericardial mesothelioma patients with complete follow-up data were included, and primary pleural mesothelioma patients were identified as controls. Propensity-score matching was used to balance individual characteristics. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 25, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Hilliard Brydges, Kanhua Yin, Ramkumar Balasubramaniyan, Kyle W. Lawrence, Rongkui Luo, Karl J. Karlson, David B. McAneny, Niloo M. Edwards, Michael J. Reardon, Nikola Dobrilovic Tags: THORACIC – Original Submission Source Type: research

Commentary: The Benefit of Surgery for Stage III N2 Positive Non-Small Cell Lung Cancer is Independent of Where the Okies Go
Jeon et al. recently published a retrospective study of 385 patients who underwent lobectomy and lymph node dissection (35 thoracoscopy; 350 thoracotomy) after neoadjuvant concurrent chemoradiotherapy (CRT) between 2012 and 2017 for clinical N2 positive non-small cell lung cancer (cN2+NSCLC).1 Patients with residual nodal disease (55%) were offered adjuvant chemotherapy and/or radiation therapy. Propensity matched comparison between the 2 modalities, showed significantly lower major complication rate in the thoracoscopy group (9.7% vs 30.4%, P  = 0.036). (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 25, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Abbas E. Abbas Tags: THORACIC – Commentary Source Type: research

Commentary: Making the case for a mission to Venus
Even individuals unfamiliar with popular culture are likely to recognize the title of John Gray's best-selling nonfiction book, "Men are from Mars; women are from Venus " 1 and know of its subsequent life as a meme symbolizing the contrast between the sexes. Ram and colleagues' Israeli based comparison of risk profiles and survival between 1045 men and 263 women treated with coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS) 2 attests that cardiac surgery is no exception to the rule when it comes to gender-based differences. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 25, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Jacquelyn Quin Tags: ADULT – Commentary Source Type: research

Commentary: Measurements that Matter Most
In this edition of the Journal, Smolock et al. compare long-term health-related quality of life (HRQoL) between open and hybrid thoracic aortic operations.1 We commend the authors for their work examining meaningful and long-term outcomes. While 30-day and 1-year mortality have long been used as a benchmarks for outcomes, long-term HRQoL measures provide additional insight into patient outcomes. In one series of patients who underwent elective thoracoabdominal aortic aneurysm repair, only 63% survived to live ambulatory at home one year after surgery. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 25, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Matheus P. Falasa, Thomas M. Beaver Tags: ADULT – Commentary Source Type: research

Commentary: Outcomes of Surgical Aortic Valve or Root Replacement in Patients on Hemodialysis: Lessons Learned and Remaining Challenges
End-stage renal disease (ESRD) patients undergoing hemodialysis (HD) are at high-risk when undergoing surgical aortic valve replacement (SAVR). After SAVR, the cardiovascular disease and renal comorbidities in these HD patients increase the risk of 30-day mortality by up to 15-17%, approximately 40% at 3 years, and 60% at 5 years.1 –3 Thus, it is essential to carefully assess preoperative comorbidities of each patient and to optimize prosthetic valve selection and surgical procedure. This will minimize the deleterious effect of cardiopulmonary bypass (CPB) and HD-associated postoperative morbidities and increase surv...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 25, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Ko Bando Tags: ADULT – Commentary Source Type: research

Commentary: A “watch”ful eye on the future
It is a well-accepted concept that experiences early in life help to shape individuals ’ future career interests and choices. For example, having a surgical mentor in medical school significantly increases the chances a student will pursue a surgical specialty.1 With the impending reality of health care workforce shortages,2,3 creative strategies to recruit the younger population in to the field of nursing, medicine and surgery are necessary. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 25, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Christine E. Alvarado, Stephanie G. Worrell Tags: THORACIC – Commentary Source Type: research

Commentary: Ephemeral Versus Long-Lived Surgical Metrics: Time for A Change
Dr. Yun and colleagues have presented an article that again shows that pneumonectomy is a disease. The authors report a 5-year survival of patients who had a pneumonectomy of approximately 50%, worse than many cancers or diseases.1 In addition, the author show that not only is pneumonectomy itself an independent predictor of non-cancerous deaths (non-oncologic mortality) but so are age and postoperative predicted DLCO percent. The authors are to be congratulated for this article and its findings. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 22, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Robert J. Cerfolio Tags: THORACIC – Commentary Source Type: research

Commentary: Is surgical aortic valve replacement for older patients still justified in the current era?
Surgical aortic valve replacement is a safe and well-established technique offering low mortality and excellent postoperative patient outcome. The first aortic valve replacement using a mechanical prosthesis was performed by D. Harken in 1960.1 Since then the prostheses underwent an evolution: better flow conditions could be established and biological valves were developed making a life-long anticoagulation redundant, hereby reducing the risk of bleeding complications. A meta-analysis of studies conducted in Europe, the USA and Taiwan revealed a 12.4 % prevalence of aortic valve stenosis (AS), and a 3.4 % prevalence of sev...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 22, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Manfred Richter, Oliver J. Liakopoulos Tags: ADULT – Commentary Source Type: research

Commentary: Life with a New Aorta
With advancements in cerebral perfusion, spinal cord protection, and endovascular technology, outcomes of thoracic aortic replacement have improved considerably over the past decades.1,2 Nevertheless, such operations can still carry substantial morbidity when extensive aortic reconstruction is performed. The impact of postoperative complications on quality of life (QoL) is becoming increasingly important in surgical decision-making as lesser invasive strategies for the aorta are taking center stage. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 22, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Sarah Yousef, Ibrahim Sultan Tags: ADULT – Commentary Source Type: research

Midterm Results and Predictors for the Postoperative Vascular Stenosis of Supravalvular Aortic Stenosis
This study reviewed the midterm outcomes of supravalvular aortic stenosis (SVAS) repair and determined the risk factors associated with postoperative aortic or pulmonary stenosis. We retrospectively reviewed 225 patients who underwent surgical correction of SVAS from 2010 to 2019. 178 (79.1%), 44 (19.6%) and 3 (1.3%) patients underwent McGoon, Doty, and Brom repair, respectively. The median age at surgery was 2.2 years (interquartile range, 1.2-4.4). The median follow-up time was 3.7 years (interquartile range, 1.9-5.7). (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 17, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Jie Hu, Hao Chen, Wei Dong, Renjie Hu, Wen Zhang, Qi Jiang, Haibo Zhang Tags: CONGENITAL – Original Submission Source Type: research

Nononcologic Mortality after Pneumonectomy Compared to Lobectomy
This study aimed to compare long-term nononcologic mortality between pneumonectomy and lobectomy patients and investigate factors associated with nononcologic mortality. Medical records of 337 patients who underwent pneumonectomy and 7545 patients who underwent lobectomy from 2009 to 2018 were reviewed. Postoperative morbidity, mortality, and cause of death were investigated. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 17, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Jeonghee Yun, Yong Soo Choi, Tae Hee Hong, Min Soo Kim, Sumin Shin, Jong Ho Cho, Hong Kwan Kim, Jhingook Kim, Jae Il Zo, Young Mog Shim Tags: THORACIC – Original Submission Source Type: research

Coronary Artery Bypass Grafting Following Acute Coronary Syndrome: Impact of Gender
The impact of gender on clinical outcomes after coronary artery bypass grafting (CABG) has generated conflicting results. We investigated the impact of gender, on 30-day mortality, complications and late survival in patients with acute coronary syndrome (ACS) undergoing CABG. The study included 1308 patients enrolled from the biennial Acute Coronary Syndrome Israeli Survey between 2000 and 2016, who were hospitalized for ACS and underwent CABG. Of them, 1045 (80%) were men and 263 (20%) women. While women were older and had more hypertension and hyperlipidemia, they demonstrated less diabetes mellitus, previous ischemic he...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 17, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Eilon Ram, Leonid Sternik, Yaron Moshkovitz, Zaza Iakobishvili, Elchanan Zuroff, Yael Peled, Romana Herscovici, Ehud Raanani Tags: ADULT – Original Submission Source Type: research

CHEST Watch: A High School Outreach Program
We describe an outreach program aimed at exposing high school students to health care as a career choice while emphasizing science courses and prevention of tobacco use. High school students were invited to participate in CHEST Watch, a structured educational program based on thoracic pathology. Before students attended the program, parental consent was collected. Students engaged in a discussion with multiple professionals (physicians, nurses, smoking cessation counselors, social workers, basic science researchers) who presented their personal motivation and information about the corresponding career. (Source: Seminars in...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 17, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Leah C. Horslen, Svetlana Kotova, Virginia Hankins, Julanne Sandoz, Mansen Wang, Robert M. Sade, Jr John R. Handy Tags: THORACIC – Original Submission Source Type: research

Commentary: Surgical embolectomy for massive pulmonary embolism revisited: A contemporary tribute to Trendelenburg procedure
Despite all contributions of modern medicine, intensive care and surgery, pulmonary embolism remains one of the most important cause of cardiovascular death. In the most recent guidelines of the European Society of Cardiology (ESC), patients with acute pulmonary embolism are classified according to the PESI score (pulmonary embolism severity index) into high risk, intermediate risk and low risk patients.1 The score includes vital signs as well as patient associated factors like age, sex and comorbidities and predicts 30-day mortality. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 15, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Thierry Carrel Tags: ADULT – Commentary Source Type: research

Commentary: Is simpler better?
It is critical to understand the anatomy of the aortic root in aortic valve repair for aortic insufficiency. There are ten structure in the aortic root: one anatomic crown-shaped aortic annulus, two coronary ostia, three aortic sinuses/three cusps/three interleaflet triangles, and four rings: virtual basal ring (functional aortic annulus), ventriculo-aortic junction (VAJ), ring of the aortic sinuses (largest diameter of the aortic root), and sinotubular junction (STJ). Among the ten structures, three structures are critical for the competency of AV, including the functional aortic annulus (basal ring), the cusps and the ST...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 13, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Bo Yang Tags: ADULT – Commentary Source Type: research

Commentary: A simplified treatment algorithm for late presenting d-TGA combines clinical success with insights into the potential of the morphologic LV
The concept of staged and rapid-staged training of the deconditioned left ventricle in a late presenting d-transposition of the great arteries with intact ventricular septum (d-TGA IVS) is well established.1,2 This experience reported by giants of the field more than forty years ago has informed our contemporary understanding of the regenerative potential of myocardium and how this can be triggered by acute alteration of loading conditions. More recently, a one stage procedure with short-duration provocative pulmonary artery banding on the operation table immediately followed by an arterial switch operation (ASO) in select...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 13, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Gananjay G. Salve, David S. Winlaw Tags: CONGENITAL – Commentary Source Type: research

Commentary: SARS-CoV-2 and Esophagectomy for Esophageal Cancer: Timely Operations and Good Outcomes
The novel coronavirus SARS-CoV-2, commonly known as COVID-19, presented a challenge for all medical professionals. Many hospitals and health systems were overwhelmed with sick infected patients. Lack of protective equipment and fully occupied emergency rooms and intensive care units caused a delay in treating other conditions, often with deleterious effects on patients' health. Another important issue during the pandemic was the unknown consequence of COVID-19 infection in the perioperative period. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 13, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Benny Weksler Tags: THORACIC – Commentary Source Type: research

Beyond the third dimension: combined functional and anatomical assessment of anomalous origin of coronary arteries
Anomalous aortic origin of a coronary artery (AAOCA) is one of the commonest causes of sudden cardiac death in healthy children and young adults.1 Although surgery is effective in relieving ischemia related to AAOCA, it remains unclear which patients benefit from surgery, and which would remain asymptomatic for their entire lifetime. When there is evidence of ischemia, there is consensus that surgery is reasonable.2 However, in the case of asymptomatic AAOCA of the right coronary artery (AAORCA) the optimal approach remains unknown. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 13, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Edward Buratto, Igor E. Konstantinov Tags: CONGENITAL – Commentary Source Type: research

Commentary: Acute Type A Aortic Dissection Presenting with Neurologic Dysfunction: A Clinical Conundrum?
The International Registry of Acute Aortic Dissection (IRAD) continues to enrich our knowledge and understanding of the medical and surgical management of acute type A aortic dissection (ATAAD). Over the last two decades, IRAD investigators have systematically interrogated their registry database to help us understand various clinical presentations of ATAAD and their natural history with medical management compared with surgery.1,2 In this issue of Seminars, Angleitner and colleagues present another IRAD registry analysis investigating patients with ATAAD aged 70 years or older and look specifically at those presenting wit...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 13, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Ali Hage, Fadi Hage, Francois Dagenais, Michael C. Moon, Linrui Guo, Michael W.A. Chu, Canadian Thoracic Aortic Collaborative (CTAC) Tags: ADULT – Commentary Source Type: research

Health-Related Quality of Life after Extensive Aortic Replacement
To assess and compare patient-reported long-term health-related quality of life (HRQoL) after combined proximal aortic (arch ± ascending, root) and distal aortic (descending thoracic ± abdominal) replacement using open vs. multimodal/endovascular (hybrid) approaches. From 2010 to 2016, 146 adults underwent single- or multi-stage aortic arch plus descending thoracic aorta replacement, 31 open and 115 hybrid. The two surg ical approach groups had similar preoperative characteristics and extent of surgery. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 13, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Christopher J. Smolock, Fei Xiang, Eric E. Roselli, Eugene H. Blackstone, Lars G. Svensson, Amanda S. Artis, Huan Liu, Michael Z. Tong, the Aorta Umbrella Working Group (see Acknowledgement) Tags: ADULT – Original Submission Source Type: research

Commentary: Cancer Cannot Wait – Esophagectomy During the COVID-19 Pandemic
During the height of the pandemic, elective healthcare was cancelled to preserve hospital resources for the influx of patients suffering from COVID-19. Many centers continued to offer cancer care; however, resource limitations affected care in ways that have yet to be fully described. Healthcare teams were “learning on the go” to design processes that would allow for continued treatment of cancer, while battling a contagious virus that threatened patients and providers alike. It was unknown at the time if laparoscopy would endanger the esophagectomy team present in the operating room. (Source: Seminars in Thora...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 13, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Caitlin A. Harrington, Daniela Molena Tags: THORACIC – Commentary Source Type: research

Commentary: Cognitive Dysfunction after Coronary Revascularization in Older Adults- An Unsolved Mystery
Postoperative cognitive dysfunction (POCD) can be a significant concern in older patients undergoing surgical coronary revascularization. This is believed to be associated with hypo-perfusion, embolism and neuro inflammation. Increased Carotid intima media thickness(C-IMT) has been associated with increased risk of cognitive dysfunction. Bora Lee et al have pursued this single institutional prospective clinical trial studying the association of increased C-IMT with POCD in older patients who underwent off pump Coronary Artery Bypass Graft(CABG). (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 13, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Sashi K. Inkollu, Vipul Khetarpaul Tags: ADULT – Commentary Source Type: research

Commentary: Back to the future: The re-emergence of non-anatomic lung resection for cancer Be very, very careful
The manuscript 1 in this issue of Seminars, Wedge Resection Offers Similar Survival To Segmentectomy For Typical Carcinoid Tumors, uses a large database (National Cancer Database) to examine the outcomes for patients with typical carcinoid tumor who had either a wedge resection or a segmentectomy between 2010 and 2016. The cohort included over 800 patients comprised of 677 who had a wedge resection and 144 who had a segmentectomy. The conclusion was that a wedge resection offers similar survival to segmentectomy. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 12, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Scott J. Swanson Tags: THORACIC – Commentary Source Type: research

Commentary: Is it time to Change Management Guidelines and Referral Patterns for PE?
Massive pulmonary embolism (MPE) is defined as hemodynamically significant acute PE leading to sustained hypotension (systolic blood pressure15 min or requiring inotropic support) or circulatory collapse. Sub-massive PE are more common (x6). Compared to sub-massive PE, the reported 90- day mortality rates for MPE are 3.3-fold higher, exceeding 40% with 80% of deaths occur at initial hospitalization.1 Evidence or RV dilatation on the CT scan and of RV strain on echocardiography along with elevated biomarkers of troponin and BNP levels have been highlighted as important prognostic indicators of MPE. (Source: Seminars in Thor...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 9, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Maziar Khorsandi, Gabriel Aldea Tags: ADULT – Commentary Source Type: research

Commentary: Analytic morphomics and LVRS – a story of frailty and fibrosis
Lung volume reduction surgery (LVRS) is a known therapeutic approach for the management of emphysematous disease. Much information about selection criteria and outcomes after LVRS derives from the National Emphysema Treatment Trial (NETT)1. Although LVRS is an accepted operation for severe emphysema, this operation is arguably underutilized, which may be secondary to limited access to specialized centers, lack of awareness of NETT results or misinterpretation of LVRS benefits, perceptions of LVRS assessment being too complex and related to higher costs, and limited availability of pulmonary rehabilitation programs2. (Sourc...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 6, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Juan A. Mu ñoz-Largacha, Benjamin Wei Tags: THORACIC – Commentary Source Type: research

Commentary: Stentless AVR in Dialysis Patients – Another Hand on the Elephant.
There is a parable from the Indian subcontinent that a group of blind men approach an elephant and each of them has a dramatically different appreciation depending on which part of the elephant they are touching (tusk, ear, tail, trunk etc.). In the present report the authors make a valiant effort to understand the performance of the Medtronic Freestyle heterograft (Medtronic, Minneapolis MN) in the setting of Hemodialysis (HD) patients at their center and found excellent durability.1 Anecdotally, at our center we have also found the Freestyle valve a durable option for root replacement; and a recent review of Medicare rec...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 6, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Thomas M. Beaver, Eddie W. Manning Tags: ADULT – Commentary Source Type: research

Commentary: First-Mover Advantage in the Quest for Cavopulmonary Circulatory Support
Dr. Francis Fontan's operation1 – and its subsequent modifications over the 50 years since – revolutionized the care and lifespan of patients with single-ventricle heart disease. The total cavopulmonary connection engineers a palliative circulation which is inefficient owing to absence of a subpulmonary ventricle. This ineffic iency leads to elevated systemic venous pressures and reduced cardiac output, a paradox which progresses to late Fontan failure. Despite an increasing number of patients palliated with Fontan physiology, extensive research has yet to identify a solution to prevent or reverse this circulat...
Source: Seminars in Thoracic and Cardiovascular Surgery - July 6, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Andrew B. Goldstone, Katsuhide Maeda Tags: CONGENITAL – Commentary Source Type: research

Commentary: Can Kicking and Rip Currents
In a cohort of 314 young adults with congenital heart disease (ACHD) who underwent bioprosthetic aortic valve replacement (b-AVR), Fuller et al. report surgical valve reintervention in 11% of patients at a median follow-up of 2.5 years and an actuarial survival of only 85% at 5 years.1 Young age, smaller valve, and one particular type of valve were associated with shorter time to reintervention – not too surprising.2 Apparently, echocardiographic discharge data was available for only approximately half the cohort. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 6, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Ronald K. Woods Tags: CONGENITAL – Commentary Source Type: research

Esophagectomy for Esophageal Cancer Performed During the Early Phase of the COVID-19 Pandemic
Delay in time to esophagectomy for esophageal cancer has been shown to have worse peri-operative and long-term outcomes. We hypothesized that COVID-19 would cause a delay to surgery, with worse perioperative outcomes, compared to standard operations. All esophagectomies for esophageal cancer at a single institution from March-June 2020, COVID-19 group, and from 2019 were reviewed and peri-operative details were compared between groups. Ninety-six esophagectomies were performed in 2019 vs 37 during March-June 2020 (COVID-19 group). (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - July 1, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Daniel P. Dolan, Scott J. Swanson, Daniel N. Lee, Emily Polhemus, Suden Kucukak, Daniel C. Wiener, Raphael Bueno, Jon O. Wee, Abby White Tags: THORACIC – Original Submission Source Type: research

Nomogram to Predict Cancer Specific Survival in Patients with Pathological Stage IA Non-small Cell Lung Cancer
We identified the prognostic factors of resected stage IA non-small cell lung cancer (NSCLC) and developed a nomogram, with purpose of defining the high-risk population who may need closer follow-up or more intensive care. Eligible stage IA NSCLC cases from the Surveillance, Epidemiology, and End Results (SEER) database and the Sun Yat-sen University Cancer Center (SYSUCC) were included. Stage IB NSCLCs were also included for evaluating the risk stratification efficacy. Cancer specific survival (CSS) was compared between groups. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - June 30, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Jing-Sheng Cai, Xiao-Meng Dou, Ji-Bin Li, Mu-Zi Yang, Chu-Long Xie, Xue Hou, Hao-Xian Yang Tags: THORACIC – Original Submission Source Type: research

Decreasing Prevalence of Benign Etiology in Resected Lung Nodules Suspicious for Lung Cancer over the Last Decade
This study investigated treatment strategy for suspicious lung cancer with postoperatively proven benign etiology. In this retrospective study, we collected patients who underwent pulmonary resection for radiologically suspected lung cancer from 2010 to 2019 at Department of Thoracic Surgery, Fudan University Shanghai Cancer Center (FUSCC). Radiological features, preoperative follow-up time, preoperative pathology and postoperative pathology of these patients were documented. We classified resected benign lesions based on paraffin section and compared the therapy management performed on indeterminate lung nodules of 2 time...
Source: Seminars in Thoracic and Cardiovascular Surgery - June 30, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Zelin Ma, Yang Zhang, Qingyuan Huang, Fangqiu Fu, Chaoqiang Deng, Shengping Wang, Yuan Li, Haiquan Chen Tags: THORACIC – Original Submission Source Type: research

Commentary: Get Better Soon
I recently saw a card that said “Get Better Soon!” on the front and when I opened it, it read, “I know you're not sick. You could just get better.” I was tempted to buy a few of them, but realized that most people who needed one probably would not appreciate it! I was reminded of that card as I read the report from Dr. Lib erman's group in this month's issue of Seminars,1 because it makes me think I could get better. The authors describe their 10-year, single center experience using a combination of endobronchial ultrasound- (EBUS) and endoscopic ultrasound- (EUS) guided biopsies for the diagnosis o...
Source: Seminars in Thoracic and Cardiovascular Surgery - June 30, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Christopher W. Seder Tags: THORACIC – Commentary Source Type: research

Root reimplantation and aortic annuloplasty with external ring in bicuspid aortic valve: an anatomical comparison
Aortic annuloplasty has demonstrated to be a protective factor in valve-sparing root replacement and aortic valve repair. Both reimplantation for aortic root aneurysms and external ring annuloplasty for isolated aortic regurgitation have demonstrated good long-term results. The aim of this anatomical study is to compare aortic reimplantation with Valsalva graft with aortic external ring annuloplasty in bicuspid aortic valves, analyzing their morphological features with CT scan. We selected 56 patients with bicuspid aortic valve who underwent reimplantation procedure with Valsalva graft or external ring annuloplasty; after ...
Source: Seminars in Thoracic and Cardiovascular Surgery - June 30, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Ilaria Chirichilli, Francesco Giosu è Irace, Andrea Salica, Salvatore D'Aleo, Lorenzo Guerrieri Wolf, Luigi Garufi, Ruggero De Paulis Tags: ADULT – Original Submission Source Type: research

Commentary: Desperately seeking data
The more I try to understand pectus excavatum, the less I realize I know. Pectus excavatum frustratingly persists as an orphan disorder due partly to the relative rarity of the disorder but more to the relative lack of understanding of the physiologic consequences of the abnormality as well as lack of health industry interest in research on the topic. Many patients are told that it is simply a cosmetic problem yet many physicians, including myself, believe there is significant physiologic impairment based on the severity of the abnormality. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - June 30, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Daniel P. Raymond Tags: THORACIC – Commentary Source Type: research

Repair of Isolated Native Mitral Valve Endocarditis: A Propensity Matched Study
In the setting of chronic primary mitral regurgitation, the benefit of mitral valve repair over replacement is well established. However, data comparing outcomes for mitral valve surgery for endocarditis is limited. We sought to determine whether mitral valve repair offers traditional advantages over replacement in the endocarditis population. Retrospective review of our institutional mitral valve database (N=8,181) was performed between 1998 and 2019 for all adult patients undergoing isolated mitral valve surgery for endocarditis. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - June 28, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Mark R. Helmers, Cody Fowler, Samuel T. Kim, Max Shin, Jason J. Han, Gabriel Arguelles, Mitchel Bryski, W. Clark Hargrove, Pavan Atluri Tags: ADULT – Original Submission Source Type: research

Commentary: Indication Creep: Rebranding the Alfieri Stitch During Aortic Surgery
Significant mitral regurgitation (MR), frequently seen in the presence of severe aortic stenosis (AS), results in an association that negatively affects prognosis and imposes particular challenges for both the assessment of valvular lesions severity and decisions on treatment. Significant MR (grade ≥ 2) is present in ∼25-30% of patients treated for AS, while severe MR (grade 4) is seen ∼ 2-5%.1 The need for additional mitral valve (MV) surgery concomitant to surgical aortic valve replacement (SAVR) has shown perioperative mortality almost three-fold higher (9.4%) compared with isolated A VR (3.2 %). (Source: Sem...
Source: Seminars in Thoracic and Cardiovascular Surgery - June 27, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Jessica Forcillo, Vinod H. Thourani Tags: ADULT – Commentary Source Type: research

Mortality and reoperation risk after bioprosthetic aortic valve replacement in young adults with congenital heart disease
Bioprosthetic aortic valve replacement (bAVR) in patients with congenital heart disease is challenging due to age, size and complexity. Our objective was to assess survival and identify predictors of re-operation. Data were retrospectively collected for 314 patients undergoing bAVR at 8 centers from 2000-2014. Kaplan-Meier estimation of time to re-operation and Cox regression were utilized. Average age was 45.2 years (IQR 17.8-71.1) and 30% were (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - June 23, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Stephanie M. Fuller, Michele J. Borisuk, Lynn A. Sleeper, Emile Bacha, Luke Burchill, Kristine Guleserian, Michel Ilbawi, Anees Razzouk, Takeshi Shinkawa, Minmin Lu, Christopher W. Baird Source Type: research

Commentary: Look before you leap
Lung transplantation (LTx) is a last-line treatment option for end-stage respiratory insufficiency. Despite improved postoperative outcomes, the prognosis of LTx is worse than that of other solid organ transplantations, mainly because of chronic lung allograft dysfunction.1 Gastrointestinal complications after LTx are not uncommon and may be serious.2 Esophageal aperistalsis is considered a relative contraindication for LTx due to a higher risk of allograft dysfunction secondary to reflux and aspiration induced by poor esophageal clearance. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - June 22, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Koichi Fukumoto, Toyofumi Fengshi Chen-Yoshikawa Tags: ADULT – Commentary Source Type: research

Commentary: Is Resternotomy Proximal Aortic Repair Still a High-Risk Procedure?
The number of proximal aortic repairs in patients with previous cardiac or proximal aortic repairs has been increasing 1 due to improved surgical techniques and perioperative care. Recent reports have shown that 8-26% of patients undergoing proximal aortic repair were redo sternotomy cases.2,3 In the modern era, approximately 10% of patients who had acute type A aortic repair with hemiarch repair require distal reoperation, due to the improved survival rate.4 In the current issue of Seminars in Thoracic and Cardiovascular Surgery, Lou et al. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - June 22, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Akiko Tanaka, Anthony L. Estrera Tags: ADULT – Commentary Source Type: research

Analytic Morphomics Are Related to Outcomes After Lung Volume Reduction Surgery
This study evaluated the association between analytic morphomics on chest computed tomography scans and outcomes after lung volume reduction surgery. In a retrospective review of 85 lung volume reduction surgery patients from 1998-2013, dorsal muscle group area, subcutaneous and visceral fat area, and bone mineral density were assessed using analytic morphomics. Lung density was divided into five levels of increasing density (Lung density 1, emphysema; 2, normal lung; 4-5, scarring). (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - June 21, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Jules Lin, William B. Weir, Tyler Grenda, Peng Zhang, Brian A. Derstine, Binu Enchakalody, Joshua Underhill, Rishindra M. Reddy, Andrew C. Chang, Stewart C. Wang Tags: THORACIC – Original Submission Source Type: research

A Cavopulmonary Assist Device for long-term Therapy of Fontan Patients
This study aimed at translating clinical objectives towards a functional CPAD with preclinical proof regarding hydraulic performance, hemocompatibility and electric power consumption. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - June 21, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Andreas Escher, Carsten Strauch, Emanuel J. Hubmann, Prof. Michael H übler, Dominik Bortis, Bente Thamsen, Marc Mueller, Ulrich Kertzscher, Prof. Paul U. Thamsen, Prof. Johann W. Kolar, Prof. Daniel Zimpfer, Marcus Granegger Tags: CONGENITAL – Original Submission Source Type: research

Commentary: Surgical treatment for atrial fibrillation at the time of cardiac surgery: just do it
In this issue of Seminars in Thoracic and Cardiovascular Surgery, Pyo and colleagues address the question “Does surgical ablation of atrial fibrillation benefit patients undergoing bioprosthetic valve replacement?” 1 They conclude that adding surgical ablation for atrial fibrillation reduces the prevalence of atrial fibrillation, decreases the need for anticoagulation, and improves long-term surviva l at the expense of an increased pacemaker requirement. There are reasons to question these conclusions, chiefly that the risk profiles were far more favorable in those who underwent ablation when compared to those ...
Source: Seminars in Thoracic and Cardiovascular Surgery - June 20, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Kevin Hodges, Daniel Burns, A. Marc Gillinov, Rakesh Suri Tags: ADULT – Commentary Source Type: research

Endosonography-Guided Biopsy as a First Test in the Diagnosis of Lymphoma
To evaluate the diagnostic accuracy of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) and Endoscopic Ultrasound-guided Fine Needle Aspiration (EUS-FNA) in the diagnosis of lymphoma. A retrospective analysis of patients with suspected mediastinal lymphoproliferative disorders who underwent EBUS-TBNA, EUS-FNA or combined procedures from 2009 to 2019 was conducted using a prospectively maintained interventional thoracic endoscopy database. Demographic data, imaging, needle size, surgical biopsy, complications rate and pathology reports were reviewed. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - June 19, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Gabriel Dayan, Stephan Soder, Anny Godin, Antonio Maietta, Philippe Stephenson, Bernard Lemieux, Moishe Liberman Tags: THORACIC – Original Submission Source Type: research

Comparison of Surgical Embolectomy and Veno-arterial Extracorporeal Membrane Oxygenation for Massive Pulmonary Embolism
Massive pulmonary embolism (MPE) is associated with a 20-50% mortality rate with guideline directed therapy. MPE treatment with surgical embolectomy (SE) or venoarterial extracorporeal membrane oxygenation (VA-ECMO) have shown promising results. In the context of a surgical management strategy for MPE, a comparison of outcomes associated with VA-ECMO or SE was performed. A retrospective review of a single institution cardiac surgery database was performed, identifying MPE treated with SE or VA-ECMO between 2005-2020. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - June 19, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Joshua B. Goldberg, Daniel M. Spevack, Syed Ahsan, Yogita Rochlani, Suguru Ohira, Philip Spencer, Masashi Kai, Ramin Malekan, David Spielvogel, Steven Lansman Tags: ADULT – Original Submission Source Type: research

Commentary: We should be uncomfortable with being comfortable
Ralph Waldo Emerson is credited with the quote, “Life is a journey, not a destination”. Yet a significant amount of our early formative surgical years is spent thinking about the light at the end of the tunnel – becoming a board-certified cardiothoracic surgeon. Only when we reflect back on this momentous milestone do we really understand w hat arriving at this destination really means. It is the certification of sound judgement in the fundamentals of cardiothoracic surgery, not a mastery of the vast intricacies of our field nor the achievement of technical perfection. (Source: Seminars in Thoracic and Ca...
Source: Seminars in Thoracic and Cardiovascular Surgery - June 19, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Ahmet Kilic Tags: ADULT – Commentary Source Type: research

Commentary: Do surgeons believe treating atrial fibrillation improves survival yet?
The published evidence on the impact of atrial fibrillation (AF) on cardiac surgery patients is growing with a consistent message: untreated AF is a significant source of long-term morbidity and mortality that can be reduced when treated at the time of cardiac surgery, likely due to successful restoration of sinus rhythm.1 In this issue, Pyo et al. present a retrospective study of 426 patients with AF that underwent left-sided valve replacement with bioprosthetic valves. 297 patients underwent surgical ablation during the index procedure while 129 patients did not undergo ablation and served as matched controls. (Source: S...
Source: Seminars in Thoracic and Cardiovascular Surgery - June 19, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Peter D. Drevets, Richard Lee Tags: ADULT – Commentary Source Type: research

Commentary: “The Attending Case”: The Height of Hypocrisy for Academic Surgery?
During my daily commute on I-95 North towards Johns Hopkins Hospital in November 2011, I was informed that my seemingly healthy newborn son, Christopher, was diagnosed with Tetralogy of Fallot. After a 60 second trip through all five Kubler-Ross stages, I called upon whom I considered Hopkins ’ greatest technical surgeon to repair him with the unstated expectation that Christopher's corrective operation was not going to be a “resident case”. I was troubled that, despite having dedicated my entire career to resident education and a steadfast practice to allow residents to perform as primary surgeon in all ...
Source: Seminars in Thoracic and Cardiovascular Surgery - June 18, 2021 Category: Cardiovascular & Thoracic Surgery Authors: David D. Yuh Tags: ADULT – Commentary Source Type: research

Type a acute aortic dissection presenting with cerebrovascular accident at advanced age
Our aim was to analyze outcomes of patients aged 70 years or above presenting with type A acute aortic dissection (TAAAD) and cerebrovascular accident (CVA). A retrospective analysis of the International Registry of Acute Aortic Dissection (IRAD) was conducted. Patients aged 70 years or above (n  = 1449) were stratified according to presence or absence of CVA before surgery (CVA: n = 110, 7.6%). In-hospital outcomes and mortality up to 5 years were analyzed. Additionally, in-hospital outcomes of patients who received medical management were described. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - June 16, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Philipp ANGLEITNER, Derek R. BRINSTER, Thomas G. GLEASON, Kevin M. HARRIS, Arturo EVANGELISTA, Raffi BEKEREDJIAN, Daniel G. MONTGOMERY, Harleen K. SANDHU, George J. ARNAOUTAKIS, Marco DI EUSANIO, Santi TRIMARCHI, Christoph A. NIENABER, Eric M. ISSELBACHER Source Type: research