Commentary: Development of Cardiac Surgery Specialty and Training: Cultivating Talent
Rivas, et al.1 are to be congratulated on their manuscript detailing the development of the cardiac surgery specialty and training in Panama. A country of over 4 million nestled in Central America, Panama has a long-standing history of cardiac surgery. In 1967 the first cardiac surgery was performed using cardiopulmonary bypass. The field was propelled by early cardiac surgeons Moises Vicente Rios Espino and Jose Antonio Hernandez Boveda who returned to Panama in 1975 after training in the United States to practice. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 16, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Elizabeth H. Stephens, Nestor Sandoval Tags: ADULT – Commentary Source Type: research

Commentary: Bringing Back Better Backs
Cardiothoracic surgery is a physically and mentally demanding specialty. As concerns related to physician burnout remain at the forefront of broader discussions in medicine, improving the mental wellbeing of physicians has become a widely recognized priority. Despite the well-established physical demands of cardiothoracic surgery, less is understood about how this physical component of wellness can be evaluated and optimized. In this issue, Dairywala et al highlight the importance of a significant contributor to the physical health of cardiothoracic surgeons —ergonomics in the operating room. (Source: Seminars in Tho...
Source: Seminars in Thoracic and Cardiovascular Surgery - October 16, 2021 Category: Cardiovascular & Thoracic Surgery Authors: John Monu, Frederick A. Tibayan Tags: ADULT – Commentary Source Type: research

Commentary: The Ergonomic Challenge of the Cardiothoracic Surgery Operating Room
In this issue of Seminars in Thoracic and Cardiovascular Surgery, Dairywala et al.1 draw attention to the physical toll of a surgical career and ergonomic issues faced by surgeons in the modern operating room. Some common issues, such as incorrect table height and improper positioning of video monitors for thoracoscopic, laparoscopic, and hybrid procedures can be addressed with relatively minor changes to operating room setup.2,3 The caveat to this is that adjustment for one operator may lead to suboptimal positioning for their assistant. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 16, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Benjamin A. Palleiko, Leora B. Balsam Tags: ADULT – Commentary Source Type: research

Recent Articles in AATS Journals
(Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 8, 2021 Category: Cardiovascular & Thoracic Surgery Source Type: research

Cardiovascular Surgery in Panama: Evolution and Training
Cardiovascular surgery in Panama has depended on constant contributions and support from other developed countries. Although cardiac surgery has reached important milestones, cardiac surgery training is still evolving. Here, we provide a look into both the development and training of cardiac surgery in the Republic of Panama and the importance of international training. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 7, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Ubaldo E. Rivas, Eric E. Vinck, Om án P. Jiménez, Martin Vásquez Tags: ADULT – Young Surgeon's Note Source Type: research

Commentary: Fighting with atherosclerotic aortic wall
Stroke has long been a serious complication of catheterization procedures.1 The main cause is thought to be embolism, and even thoracic endovascular aortic repair (TEVAR), which has been developing remarkably recently, cannot be completely escaped. For the minimally invasive TEVAR, stroke can be called the Achilles tendon.2 (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 2, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Kenji Minatoya Tags: ADULT – Commentary Source Type: research

Commentary: Increasing Awareness of Medical Student Programs to Improve Cardiothoracic Surgery Training and Workforce Diversity
The United States has become an increasingly diverse nation.1 At present, however, our cardiothoracic (CT) surgery workforce does not reflect our racially and ethnically diverse patient population.2 Lack of medical student exposure to CT surgery may be at the forefront of this problem.2 In this issue of the Seminars, Martin and colleagues highlight current utilization of Underrepresented in Medicine Visiting Medical Student Clerkship Programs (UIM-VMSCPs).3 The authors surveyed CT surgery program director's (PD's) awareness and current utilization of general visiting medical student clerkships (VMSCs) as well as UIM-VMSCPs...
Source: Seminars in Thoracic and Cardiovascular Surgery - October 2, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Aaron M. Williams, Shu S. Lin Tags: ADULT – Commentary Source Type: research

Commentary: Awareness: The First Step to Change
The last few years have witnessed the growing awareness and need for increasing workforce diversity within the field of cardiothoracic surgery. Lack of exposure to the field of cardiothoracic surgery has been identified as a major barrier to the diversification of the field.1 In this regard Martin and colleagues conducted a survey among the Accreditation Council for Graduate Medical Education (ACGME) program directors to measure the awareness and utilization of underrepresented in medicine visiting medical student clerkship programs (UIM-VMSCPs). (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 1, 2021 Category: Cardiovascular & Thoracic Surgery Authors: T.K. Susheel Kumar Tags: ADULT – Commentary Source Type: research

Surgeon Strength: Ergonomics and Strength Training in Cardiothoracic Surgery
With the high prevalence of musculoskeletal pain in surgeons and interventionalists, it is critical to analyze the impact of ergonomics on cardiothoracic surgeon health. Here, we review the existing literature and propose recommendations to improve physical preparedness for surgery both in and outside the operating room. For decades, cardiothoracic surgeons have suffered from musculoskeletal pain, most commonly in the neck and back due to a lack of proper ergonomics during surgery. A lack of dedicated ergonomics curriculum during training may leave surgeons at a high predisposition for work-related musculoskeletal disorder...
Source: Seminars in Thoracic and Cardiovascular Surgery - September 28, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Mohammed I. Dairywala, Saurabh Gupta, Michael Salna, Tom C. Nguyen Tags: ADULT – Original Submission Source Type: research

Commentary: Which aortic valve prosthesis to choose in end-stage renal failure.
In the present study the authors retrospectively evaluated the longitudinal hemodynamic changes of bioprosthetic aortic valves implanted in hemodialysis patients in an effort to document the frequency of structural valvular deterioration (SVD), as detected by echocardiography.1 When compared to propensity matched non-HD patients they discovered early onset and accelerated progression of SVD as evidenced by significant per annum decrements in effective orifice area and increases in mean pressure gradient and peak velocity that started as early as two years post implant. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 28, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Eddie W. Manning, Thomas M. Beaver Tags: ADULT – Commentary Source Type: research

Commentary: What happens to the aorta in bicuspid aortic valve disease?
Bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly and is characterized by genetic and hemodynamic factors that predispose affected individuals to aortic valve disease and aortopathies.1 Over half of patients with BAV will develop significant valvular dysfunction within 25 years of their initial diagnosis, for which the primary treatment is aortic valve replacement (AVR) for non-repairable valves.2 The past decade has brought forth significant changes to bicuspid AVR, with a shift towards concomitant aortic surgery. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 28, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Grace Lee, Maral Ouzounian, Derrick Y. Tam Tags: ADULT – Commentary Source Type: research

Commentary: Choice of prosthesis in the hemodialysis patient: Everything old is new again
Valvular heart disease is particularly prevalent in the hemodialysis population, affecting 19.1% of end-stage renal disease (ESRD) patients, most commonly involving the aortic valve and usually presenting as aortic stenosis.1 Valve selection in this population is particularly challenging. Mechanical valves are less vulnerable to the accelerated structural valve deterioration (SVD) observed in the bioprostheses of ESRD patients and were, in fact, the recommendation of the 1998 American College of Cardiology/American Heart Association Guidelines. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 27, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Takuya Ogami, Paul Kurlansky Source Type: research

Commentary: Quizzes, midterms, and finals: considerations in aortic root replacement
In this issue of Seminars in Thoracic and Cardiovascular Surgery, the aortic surgery group from the University of Pittsburgh presents comparative results of aortic root replacement (ARR) using either stentless or stented bioprostheses.1 Briefly summarized, the authors found that larger stentless aortic root prostheses were able to be implanted, and that across all sizes implanted (not just with smaller sizes), statistically significant superior prosthetic valve physiology (as assessed non-invasively) was observed. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 24, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Faisal H. Cheema, Shuab Omer, Keshava Rajagopal Tags: ADULT – Commentary Source Type: research

Commentary: Scratching the surface
Cardiovascular diseases (CVD) are a leading cause of death worldwide. In high-income countries, the etiology is primarily lifestyle and aging-related comorbidities, while in low- and middle-income (LMIC) countries they are often a sequela of communicable diseases. Alarmingly, industrialization and urbanization have altered the profile and burden of CVD in LMICs. The consequent lifestyle changes, such as tobacco use and physical inactivity, have led to increasing non-communicable risk factor prevalence. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 23, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Dawn S. Hui Tags: ADULT – Commentary Source Type: research

Commentary: Walking the tightrope
Achieving the best possible outcomes for our patients and teaching the next generation are obligations fundamental to experienced cardiothoracic surgeons since the earliest years of the field, but balancing the two may be harder than ever. Patient populations get older with more comorbidities, improved transcatheter therapies reduce surgical volume and raise expectations for excellent surgical results, and scrutiny on resource utilization increases each year. In this issue, Chaban and co-authors1 demonstrate how they have walked this tight rope at their institution. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 23, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Frederick A. Tibayan Tags: ADULT – Commentary Source Type: research

Commentary: Rooting for the Best Root Prosthesis
Brown and colleagues compared the outcomes of stented versus stentless bioprosthetic root replacement in 455 patients.1 Mean patient age was 70 years and the study excluded mechanical prostheses. Medtronic Freestyle porcine bioprosthesis (Medtronic, Minneapolis, MN) was used for all stentless valve implants. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 23, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Faisal G. Bakaeen, Shinya Unai, Lars G. Svensson Tags: ADULT – Commentary Source Type: research

Short and Long-term Outcomes Among High-Volume vs Low-Volume Esophagectomy Surgeons at a High-Volume Center
To determine associations between surgeon volume and esophagectomy outcomes at a high-volume institution. All esophagectomies for esophageal cancer at our institution from August 2005 to August 2019 were reviewed. Cases were divided by surgeon into low, (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 20, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Daniel Dolan, Abby White, Daniel N. Lee, Emanuele Mazzola, Emily Polhemus, Suden Kucukak, Jon O Wee, Scott J Swanson Tags: THORACIC – Original Submission Source Type: research

Short and Long-term Outcomes Among High-Volume Versus Low-Volume Esophagectomy Surgeons at A High-Volume Center
To determine associations between surgeon volume and esophagectomy outcomes at a high-volume institution. All esophagectomies for esophageal cancer at our institution from August 2005-August 2019 were reviewed. Cases were divided by surgeon into low, (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 20, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Daniel Dolan, Abby White, Daniel N. Lee, Emanuele Mazzola, Emily Polhemus, Suden Kucukak, Jon O Wee, Scott J Swanson Tags: THORACIC – Original Submission Source Type: research

Postoperative Aortic Regurgitation in Outflow Ventricular Septal Defect: Determinants of Outcome
Aortic cusp prolapse is an acquired complication and usually precedes the development of aortic regurgitation (AR) in unoperated outflow ventricular septal defect (VSD). However, its impact on postoperative AR-progression is unknown. 161 patients with outflow-VSD and AR who underwent surgery between 2006 and 2012 were studied retrospectively. 31 patients without prolapse (group-I), 87 with only right coronary cusp (RCC) (group-II), 43 with noncoronary cusp (NCC) prolapse (group-III: 23 only NCC (IIIa), 20 both NCC-RCC (IIIb)) were followed postoperatively for a mean 6.05+/-2.4 years (range 3-12 years). (Source: Seminars in...
Source: Seminars in Thoracic and Cardiovascular Surgery - September 20, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Priya Giridhara, Amitabh Poonia, Deepa S Kumar, Anoop Ayyappan, Kavassery M. Krishnamoorthy, Sivasankaran Sivasubramonian, Ajitkumar Valaparambil Tags: CONGENITAL – Original Submission Source Type: research

Cardiothoracic Surgery Training Program Director Awareness of Available Visiting Medical Student Clerkships for the Underrepresented in Medicine
A diversity gap exists within cardiothoracic (CT) surgery that might be addressed with currently available medical student pipeline programs. We sought to assess CT surgery residency/fellowship program directors ’ (PD) awareness of and participation in underrepresented in medicine visiting medical student clerkship programs (UIM-VMSCPs). We reviewed the ACGME program finder database and medical school websites to identify thoracic surgery training programs that: 1) offer visiting student clerkships (VSCs) , 2) are affiliated with an institution offering a UIM-VMSCP, 3) are at an institution where the existing UIM-VMS...
Source: Seminars in Thoracic and Cardiovascular Surgery - September 17, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Angelica C. Martin, Luis A. Godoy, Lisa M. Brown, David T. Cooke Tags: ADULT - Brief Research Report Source Type: research

Toll-like Receptor 4 Mediates Reflux-Induced Inflammation in a Murine Reflux Model
Dysregulation of toll-like receptor (TLR) signaling within the gastrointestinal epithelium has been associated with uncontrolled inflammation and tumorigenesis. We sought to evaluate the role of TLR4 in the development of gastroesophageal reflux-mediated inflammation and mucosal changes of the distal esophagus. Verified human esophageal Barrett's cells with high grade dysplasia (CPB) and esophageal adenocarcinoma cells (OE33) were treated with deoxycholic acid for 24 hours. Cells were pretreated with a TLR4-specific inhibitor peptide 2 hours prior to deoxycholic acid treatment. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 14, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Anna K. Gergen, Michael J. Jarrett, Anqi Li, Xianzhong Meng, Akshay Pratap, David A. Fullerton, Michael J. Weyant Tags: THORACIC – Original Submission Source Type: research

Commentary: Choosing the Right Model for Bile Reflux Induced Esophageal Disease Research
Esophageal cancer has a high mortality and poor prognosis. The incidence of esophageal adenocarcinoma (EAC), the most common form of this cancer in the United States, has dramatically risen in recent years.1 Chronic exposure of the esophagus to gastroduodenal intestinal fluid is an important determinant factor in the development of Barrett's esophagus (BE), which is closely associated with the development of EAC.2 Although the close relationship between bile reflux and EAC has been well established, little is known about the mechanisms that link bile acids to esophageal carcinogenesis due to a lack of reliable models. (Sou...
Source: Seminars in Thoracic and Cardiovascular Surgery - September 12, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Yuan Xu Tags: THORACIC – Commentary Source Type: research

Commentary: Does Toll Play the Sole Role?
Gastro esophageal reflux has been associated with esophageal cancer as well as benign complications such as peptic strictures. With new concerns being raised about the safety of long term use high dose PPI as well as limited longevity of anti-reflux procedures, investigation into alternative pathways to mitigate the deleterious effect of gastro-esophageal reflux is most welcome. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 12, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Andrew Tang, Siva Raja Tags: THORACIC – Commentary Source Type: research

Commentary: Is minimally invasive mitral approach after a previous sternotomy still competitive?
In the setting of previous cardiac operations, minimally invasive mitral valve surgery (MIMVS) combines the advantage of less invasiveness (i.e. less chest trauma and fast recovery) with the less risks associated with resternotomy.1 Specifically, right minithoracotomy approach has shown to reduce the risk of damaging major structures such as patent left internal mammary artery (LIMA), right ventricle and aorta, requires less dissection of pericardial adehesions and consequently associated with less bleeding and blood transfusion when compared to re-sternotomy. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 12, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Igor Belluschi, Mattia Glauber, Antonio Miceli Tags: ADULT – Commentary Source Type: research

Midterm Outcomes of Stented versus Stentless Bioprosthetic Valves after Aortic Root Replacement
To determine the impact of aortic root replacement (ARR) with a stentless bioprosthetic valve on midterm outcomes compared to a stented bioprosthetic valve-graft conduit. This was an observational study of aortic root operations from 2010-2018. All patients with a complete ARR for non-endocarditis reasons were included, while patients undergoing valve-sparing root replacements or primary aortic valve replacement or repair were excluded. Of the patients with a complete ARR, bioprosthetic valve implants were included, while mechanical valve implants were excluded. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 11, 2021 Category: Cardiovascular & Thoracic Surgery Authors: James A. Brown, Derek Serna-Gallegos, Arman Kilic, Yancheng Dai, Danny Chu, Forozan Navid, Courtenay Dunn-Lewis, Ibrahim Sultan Tags: ADULT – Original Submission Source Type: research

Commentary: Changing concepts in predicting morbidity following arterial switch operation
There is little doubt that the arterial switch operation (ASO) is one of the greatest achievements in pediatric cardiac surgery and it is currently performed with excellent early and late outcomes.1 Nowadays it is essential to characterize long-term sequelae, provide counseling for parents and guide appropriate patient screening and surveillance. Salve and coworkers elegantly evaluated a simplified approach to better estimate the risk of re-intervention following ASO.2 In their study, some of the conventional criteria for classifying complex TGA (such as abnormal coronary pattern, low birth weight, malaligned commisures, a...
Source: Seminars in Thoracic and Cardiovascular Surgery - September 9, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Matteo Trezzi Tags: CONGENITAL – Commentary Source Type: research

Association of ongoing cerebral oxygen extraction during deep hypothermic circulatory arrest with post-operative brain injury
Cardiac surgery utilizing circulatory arrest is most commonly performed under deep hypothermia ( ∼18°C) to suppress tissue oxygen demand and provide neuroprotection during operative circulatory arrest. Studies investigating the effects of deep hypothermic circulatory arrest (DHCA) on neurodevelopmental outcomes of patients with congenital heart disease give conflicting results. Here, we addr ess these issues by quantifying changes in cerebral oxygen saturation, blood flow, and oxygen metabolism in neonates during DHCA and investigating the association of these changes with post-operative brain injury. (Source: Semi...
Source: Seminars in Thoracic and Cardiovascular Surgery - September 8, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Jennifer M. Lynch, Constantine D. Mavroudis, Tiffany S. Ko, Marin Jacobwitz, David R. Busch, Rui Xiao, Susan C. Nicolson, Lisa M. Montenegro, J. William Gaynor, Arjun G. Yodh, Daniel J. Licht Tags: CONGENITAL – Original Submission Source Type: research

Longitudinal Hemodynamics of Aortic Bioprosthetic Valve in Hemodialysis Patients
We examined the hemodynamic profile of bioprosthetic aortic valves in patients on hemodialysis (HD), longitudinally, and assess the incidence of adverse changes detected by echocardiography. Of 1,146 consecutive patients with severe aortic stenosis who underwent bioprosthetic aortic valve replacement (AVR), 148 patients had end-stage renal disease requiring HD. Each patient on HD was matched one-to-one with a non-HD patient on the basis of propensity scores. The mean follow-up period was 3.3 years for the HD group and 5.9 years for the non-HD group. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 8, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Takeshi Kinoshita, Kumi Yoshida, Tomoaki Suzuki, Tohru Asai Tags: ADULT – Original Submission Source Type: research

A simplified approach to predicting reintervention in the arterial switch operation
We investigated patients with transposition anatomy suitable for the arterial switch operation (ASO) to evaluate a simplified approach to prediction of reintervention. A retrospective review was performed of 180 consecutive patients who underwent ASO from 2009 to 2018. Patients were classified as Category I (n=122) d-transposition of great arteries (dTGA)  + intact ventricular septum, Category II (n=28) dTGA + ventricular septal defect (VSD) and Category III (n=30) dTGA + Aortic arch obstruction (AAO) +/- VSD or Taussig-Bing Anomaly (TBA) +/- AAO. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 8, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Gananjay G. Salve, Kim S. Betts, Julian G. Ayer, Richard B. Chard, Ian A. Nicholson, Yishay Orr, David S. Winlaw Tags: CONGENITAL – Original Submission Source Type: research

Mitral Valve Repair vs Replacement in Patients with Previous Mediastinal Irradiation
Long-term outcomes of mitral valve surgery after mediastinal radiation therapy (MRT) are not well characterized. We analyzed long-term survival in patients who underwent mitral valve repair or replacement after MRT. From 2001 to 2018, 148 patients underwent mitral valve surgery at our institution after MRT for cancer. The association between surgery group and survival was assessed using Cox proportional hazards modeling, with propensity score adjustment to control for clinical and operative differences between groups. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 7, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Siddharth Pahwa, Juan Crestanello, Annalisa Bernabei, Hartzell Schaff, Joseph Dearani, Brian Lahr, Kevin Greason Tags: ADULT – Original Submission Source Type: research

Commentary: A guiding light in the night?: Maximum standardized uptake value associated with high-risk features in lung adenocarcinoma
Positron emission tomography (PET) scans have become a key part of the staging work up for non-small cell lung carcinoma. In the current issue, Koike et al. performed a retrospective study of 297 patients who underwent resection for stage 0-IA lung adenocarcinoma and found that the maximum standardized uptake value (SUVmax) was associated with high-risk features including visceral pleural involvement, pulmonary metastasis, nodal disease, and lymphovascular invasion.1 While this is a potentially important finding since many patients, even those with early stage lung cancer, will develop recurrent disease, there are some wea...
Source: Seminars in Thoracic and Cardiovascular Surgery - September 6, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Jules Lin Tags: THORACIC – Commentary Source Type: research

Commentary: The Shrinking Role of the Freestyle Aortic Bioprostheses in Younger Patients
In this issue of Seminars in Thoracic and Cardiovascular Surgery, Khazaal and colleagues from Grand Rapids present their single center long-term experience with the Freestyle porcine bioprosthesis (Medtronic Inc., Minneapolis MN) in younger patients.1 Since its FDA-approval in 1997, the Freestyle bioprosthesis has become part of the armamentarium for aortic valve and aortic root replacement. Like other stentless bioprostheses, the main advantage it offers is favorable hemodynamics due to larger effective orifice area. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 6, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Leora B. Balsam Tags: ADULT – Commentary Source Type: research

Commentary: Providing the same treatment will not lead to different outcomes
Radiation therapy (RT) is the mainstem treatment of different types of malignant chest wall and mediastinal tumors, providing improved survival. However, RT-associated cardiac diseases may occur, leading to complex clinical presentations, requiring unique management strategies, and leading to increased morbidity and mortality. It may take years, or even decades after RT, for the development of first symptoms. Valvular abnormalities, resulting from RT, range from 7% to 39% at 10 years, and 12% to 60% at 20 years. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 6, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Leonardo A Mulinari, Tomas A. Salerno Tags: ADULT – Commentary Source Type: research

Commentary: Is there a second chance to treat mitral disease after irradiation?
Mediastinal radiation therapy (MRT), along with chemotherapy and surgery, has been widely used in the past decades for the treatment of breast cancer and thoracic lymphomas, improving patients mid- and long-term survival.1 (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 6, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Igor Belluschi, Antonio Miceli Tags: ADULT – Commentary Source Type: research

Discussion
Presenter: Dr Dale S. Deas (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 1, 2021 Category: Cardiovascular & Thoracic Surgery Source Type: research

Association Officers
(Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 1, 2021 Category: Cardiovascular & Thoracic Surgery Source Type: research

Contents
(Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 1, 2021 Category: Cardiovascular & Thoracic Surgery Source Type: research

Masthead (copyright and information page)
(Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 1, 2021 Category: Cardiovascular & Thoracic Surgery Source Type: research

Recent Articles in AATS Journals
(Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 1, 2021 Category: Cardiovascular & Thoracic Surgery Source Type: research

Commentary: Using the National Cancer Database to Create a Surgical Outcomes Composite Index. Is this Textbook or Cliffs Notes?
The term “textbook outcome” (TO) was coined in 2012 by Kolfschoten and colleagues to describe a summarizing measure for short-term outcomes after colon cancer resections.1 This measure is binary, awarded only when 6 distinct “desirable” measures are all accomplished (30 day survival, R0 resection, no reintervention, no colostomy, no complications and hospitalization of 14 days or less). The name choice for this index is, however, misleading. A textbook provides a comprehensive analysis of a problem and does not abbreviate. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 1, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Abbas E. Abbas Tags: THORACIC – Commentary Source Type: research

Commentary: Why do stage I patients die from lung cancer?
Why is survival for stage IA non-small cell lung cancer (NSCLC) so variable and can we do more to predict who will do well (and who will not)? Cai and colleagues used the Surveillance, Epidemiology, and End Results (SEER) database to derive a prognostic nomogram for lung cancer-specific survival then validated it in another SEER cohort and externally within a dataset from their own institution.1 While the models are predictive, there is still room for improvement, and the bigger question of what to do with higher risk stage IA NSCLC patients is left unanswered. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 1, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Andrea S. Wolf Tags: THORACIC – Commentary Source Type: research

Commentary: Lighting the way forward for clinical decision making in pectus excavatum
Patient selection for corrective surgery for pectus excavatum varies nationally and regionally. However, the most widely agreed upon standards have typically included a radiographic measurement to quantify the degree of defect. Since first being described in 1987, the Haller Index (HI) ≥ 3.25 has largely remained the requisite measurement standard for surgical correction.1 More recently, this has been occasionally supplemented by the Pectus Corrective Index (PCI).2 Both indices rely on radiographic measurements derived from either plain radiography or computed chest tomography w hich may unnecessarily expose children to...
Source: Seminars in Thoracic and Cardiovascular Surgery - August 31, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Stephanie D. Chao Tags: THORACIC – Commentary Source Type: research

Commentary: Reducing resection of benign pulmonary nodules – A laudable goal, but how and at what cost?
The most recent United States Preventive Services Task Force Recommendations have expanded lung cancer screening with annual low dose computed tomography (CT) scan to adults from 50 to 80 years old with a 20 pack-year smoking history within the past 15 years.1 These guidelines are based on the National Lung Screening Trial (NLST) and the Dutch-Belgian lung cancer screening trial (Nederlands-Leuvens Longkanker Screenings Onderzoek [NELSON]), performed within the last decade.2,3 To standardize the interpretation of these screening CT scans, the American College of Radiology developed the Lung Imaging Reporting and Data Syste...
Source: Seminars in Thoracic and Cardiovascular Surgery - August 31, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Lillian L. Tsai, Stephen R. Broderick Tags: THORACIC – Commentary Source Type: research

Commentary: In with the new: three-dimensional surface imaging for pectus excavatum
Patients with pectus excavatum have historically been evaluated with computed tomography (CT) scans, from which a Haller index may be calculated.1 It is traditionally thought that a Haller index of>3.25 constitutes a significant pectus excavatum deformity, although one limitation of using this parameter is that it can overestimate or underestimate the distortion of the chest wall in individuals because of the overall shape of the thoracic cavity. The correction index, which takes into account whether or not patients are built “thin” or “deep” in an anteroposterior dimension, can be utilized to co...
Source: Seminars in Thoracic and Cardiovascular Surgery - August 31, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Benjamin Wei, Frank Gleason Tags: THORACIC – Commentary Source Type: research

Commentary: Limitations of Data for Primary Pericardial Mesothelioma
Brydges and colleagues present a propensity-matched study of patients with primary pericardial mesothelioma (PCM) compared to patients with malignant pleural mesothelioma (MPM) based on SEER database from 1973 – 2015.1 Prior to matching, 41 patients with PCM were identified. The overall survivals (OS) were terrible with 22% and 12% surviving one and two years, respectively. With 1:2 propensity-matching, the authors found that patients with PCM were less likely to receive chemotherapy and had worse OS (2 versus 10 months). (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - August 29, 2021 Category: Cardiovascular & Thoracic Surgery Authors: R. Taylor Ripley Tags: THORACIC – Commentary Source Type: research

Commentary: Can patients with bicuspid aortopathy be ultimately cured?
In this issue of Seminars, Sun et al.1 analyzed mortality and late aortic adverse events in 1204 patients with bicuspid (n=454) versus tricuspid (n=750) aortic valves after isolated aortic valve replacement (AVR) at a single center in Beijing, China, between 2002 and 2009. The authors used propensity score matching and included 318 propensity score-matched patient-pairs. During a mean follow-up of ten years, the authors found no difference in mortality or aortic adverse events between the two groups. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - August 29, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Natalie Glaser Tags: ADULT – Commentary Source Type: research

Mitral valve repair versus replacement in the elderly
This study aims to evaluate whether mitral valve replacement in the elderly is associated with similar outcome compared to repair in the short- and long-term. All patients aged 70 years and older undergoing minimally invasive mitral valve surgery were studied retrospectively. Primary outcome was 30-day complication rate, secondary outcome was long-term survival and freedom from re-operation. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - August 29, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Kinsing Ko, Thom L. de Kroon, Karen F. Schut, Johannes C. Kelder, Nabil Saouti, Bart P. van Putte Tags: ADULT – Original Submission Source Type: research

Commentary: Quality vs. conformity
A prevailing metric of surgical quality within healthcare systems striving for recognition as highly reliable organizations is conformity to established pathways of care delivery. Deviation from the agreed upon standards raises concern for suboptimal or potentially unsafe medical care. A common example is adherence to early recovery after surgery (ERAS) protocols with the understanding that complications are reduced corresponding with shorter lengths of stay. On a grander scale, establishment of textbook surgeries for common operations extrapolates similar concepts throughout the country. (Source: Seminars in Thoracic and ...
Source: Seminars in Thoracic and Cardiovascular Surgery - August 29, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Chadrick E. Denlinger Tags: THORACIC – Commentary Source Type: research

Female and Country Representation on Editorial Boards of Cardiothoracic Surgery Journals
Inequities remain pervasive in academic cardiothoracic surgery. In the United States, only one in twenty practicing cardiothoracic surgeons is female.1 Systemic sex-based disparities have contributed to achievement gaps, with women being promoted later and less often than men, and holding fewer leadership positions at academic institutions and professional societies.2 The cardiac surgical workforce is also unevenly distributed globally, with high-income countries having a 180 times higher density of cardiac surgeons compared to low-income countries. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - August 25, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Camila R. Guetter, Dominique Vervoort, Jessica G.Y. Luc, Maral Ouzounian Tags: ADULT - Brief Research Report Source Type: research