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Visiting Medical Student Clerkships: Call to Action for Program Directors, Faculty, and the Thoracic Surgery Medical Student Association
A workforce reflective of the patient population is critical for a successful and clinically effective specialty.1 Recent efforts such as the formation of the Society of Thoracic Surgeons Workforce on Diversity and Inclusion and the American Association of Thoracic Surgeons Medical Student Diversity Scholarship have attempted to address the gap in diversity within our specialty by targeting barriers to entry.1 In a recent survey, 36.9% of aspiring cardiothoracic surgeons cited financial constraints including application fees and additional costs of ‘away’ rotations as barriers to the field. (Source: Seminars in Thoraci...
Source: Seminars in Thoracic and Cardiovascular Surgery - February 5, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Lin Chen, Paola Barrios, Tara Karamlou Tags: ADULT – Letter to the Editor Source Type: research

Recent Articles in AATS Journals
(Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - February 1, 2022 Category: Cardiovascular & Thoracic Surgery Source Type: research

Male-Female Differences In Ascending Aortic Aneurysm Surgery: 25-Year Single Center Results
The aim of this study was to improve insight into male-female differences in patients undergoing ascending aortic aneurysm surgery. Consecutive patients that underwent ascending aortic aneurysm surgery between 01/1991-12/2016 were retrospectively analyzed. Patient and procedural characteristics, 30-day mortality, and survival were compared between male and female patients. Multivariable Cox-regression analysis was performed to explore differences in factors associated with longt-term mortality. Of 631 included patients, 36% were female patients. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - January 26, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Kelly R. Voigt, Arjen L. G ökalp, Grigorios Papageorgiou, Ad J.J.C. Bogers, Johanna J.M. Takkenberg, Mostafa M. Mokhles, Jos A. Bekkers Tags: ADULT – Original Submission Source Type: research

Survival Analyses: A Statistical Review for Surgeons
Survival analyses are a group of statistical principles applied to accurately analyze the length of time until a previously defined event occurs. Increasing survival is the underlying goal for most medical interventions, and is particularly critical in oncology-related surgical fields. In order to justify the application of a novel surgical intervention or other cancer therapy, one must first definitively show improvements in patient survival compared to the existing method of treatment. In order to definitively recommend one treatment option over another, it is paramount to design a study that addresses and minimizes sour...
Source: Seminars in Thoracic and Cardiovascular Surgery - January 26, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Ryan J. Rebernick, Hannah N. Bell, Elliot Wakeam Tags: THORACIC – State of the Art Source Type: research

Relation Between Pulmonary Artery Pressures Measured Intraoperatively and at One-Year Catheterization After Unifocalization and Repair of Tetralogy with Major Aortopulmonary Collateral Arteries
To assess the relationships between pulmonary artery (PA) pressure and the PA:aortic systolic pressure ratio measured intraoperatively and at surveillance catheterization in patients achieving complete unifocalization and repair for tetralogy of Fallot with major aortopulmonary collateral arteries (TOF/MAPCAs). This was a single-center retrospective cohort analysis of all patients who underwent complete repair of TOF/MAPCAs from 2002-2019 and received a postoperative surveillance catheterization at our center 6-24 months after surgery. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - January 26, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Michael Ma, Lynn F Peng, Yulin Zhang, Lisa Wise-Faberowski, Elisabeth Martin, Frank L. Hanley, Doff B. McElhinney Tags: CONGENITAL – Original Submission Source Type: research

Triiodothyronine Supplementation in Infants Undergoing Cardiopulmonary Bypass: A Randomized Controlled Trial
Cardiopulmonary bypass (CPB) profoundly suppresses circulating thyroid hormone levels in infants. We performed a multicenter randomized placebo controlled trial to determine if triiodothyronine (T3) supplementation improves reduces time to extubation (TTE) in infants after CPB. Infants (n  = 220) undergoing cardiac surgery with CPB and stratified into two age cohorts: ≤30 days and> 30 days to (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - January 26, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Michael A. Portman, April E. Slee, Stephen J. Roth, Monique Radman, Aaron K. Olson, Richard D. Mainwaring, Asavari Kamerkar, Muhammad Nuri, Laura Hastings, TRICC Investigators Tags: CONGENITAL – Original Submission Source Type: research

Stroke Following Thoracic Endovascular Aortic Repair: Determinants, Short and Long Term Impact
We performed a contemporary assessment of clinical and radiographic factors of stroke after thoracic endovascular aortic repair (TEVAR). Patients undergoing TEVAR from 2006-2017 were identified. We assessed clinical and radiographic data, including preoperative head and neck computed tomography, Doppler ultrasonography and intraoperative angiography. Our primary outcome was stroke after TEVAR. 479 patients underwent TEVAR, mean age 68.1 ±19.5 years, 52.6% male. Indications for TEVAR included aneurysms (n=238, 49.7%) or dissections (n=152, 31.7%). (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - January 25, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Arnoud V. Kamman, Pieter A.J. van Bakel, Bo Yang, David M. Williams, Karen M. Kim, Minhaj S. Khaja, Frans L. Moll, Joost A. van Herwaarden, Santi Trimarchi, Kim A. Eagle, Jonathan L. Eliason, Himanshu J. Patel Tags: ADULT – Original Submission Source Type: research

Novel valve choices for pulmonary valve replacement
Among the 40,000 children born every year in the USA with a congenital heart disease, more than 16,400 will need the implantation of a valve or a valved conduit to replace the pulmonary valve (PV) or the right ventricular outflow tract (RVOT) at least once during their lifetime.1 Devices currently used to replace PVs in children include biological valves, mechanical valves, cryopreserved homografts, stented heterografts, stentless heterografts and transcatheter valves. All these prostheses come with significant drawbacks, including high reoperation rate, need for anticoagulation, pannus formation, thrombo-embolic complicat...
Source: Seminars in Thoracic and Cardiovascular Surgery - January 12, 2022 Category: Cardiovascular & Thoracic Surgery Authors: David Kalfa Tags: CONGENITAL - Invited Expert Opinion Source Type: research

Ketamine Mitigates Neurobehavioral Deficits in a Canine Model of Hypothermic Circulatory Arrest
Hypothermic circulatory arrest is a protective technique used when complete cessation of circulation is required during cardiac surgery. Prior efforts to decrease neurologic injury with the NMDA receptor antagonist MK801 were limited by unacceptable side effects. We hypothesized that ketamine would provide neuroprotection without dose-limiting side effects. Canines were peripherally cannulated for cardiopulmonary bypass, cooled to 18 °C, and underwent 90 minutes of circulatory arrest. Ketamine-treated canines (n=5; total dose 2.85 mg/kg) were compared to untreated controls (n=10). (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - January 4, 2022 Category: Cardiovascular & Thoracic Surgery Authors: Katherine Giuliano, Eric Etchill, Ana K. Velez, Mary Ann Wilson, Mary E. Blue, Juan C. Troncoso, William A. Baumgartner, Jennifer S. Lawton Tags: ADULT – Original Submission Source Type: research

Commentary: Are we any closer to understanding the influence of shunt type in the Norwood procedure?
Piber and colleagues from Munich present a single-center retrospective review of Sano right ventricle (RV) to pulmonary artery (PA) shunts vs modified Blalock-Taussig (BT) shunts in the Norwood procedure for hypoplastic left heart syndrome (HLHS) and aortic atresia.1 146 neonates with HLHS who underwent the Norwood between 2001 and 2020 were compared according to shunt type. Sano was performed in 103 patients and BT shunt in 43. There were no statistically significant differences in 30 day mortality or after Stage 2. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - December 31, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Paul J. Chai Tags: CONGENITAL – Commentary Source Type: research

Commentary: Peak VO2 after acute aortic dissection: Is it worth the effort?
Cardiorespiratory fitness, despite being a powerful measure of overall health, is poorly understood in the population of patients who have undergone proximal aortic surgery. In this issue, Norton and colleagues have taken the important step of making direct assessments of cardiorespiratory fitness, using state-of-the-art measures of peak oxygen consumption (VO2) at two time points: 3 and 15 months postoperatively.1 (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - December 28, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Harleen K Sandhu, Anthony L Estrera Tags: ADULT – Commentary Source Type: research

Commentary: No-Touch Saphenous Vein: Adding More Fuel to the Flame?
Optimal conduit selection and harvesting technique remains an ongoing source of controversy in surgical coronary revascularization. The no-touch saphenous vein graft (SVG) harvesting technique was introduced in the late 1990s in hope of prolonging SVG longevity.1 Theoretical advantages of this technique include improved endothelial integrity through atraumatic handling of the conduit and preservation of adventitial blood supply.2 (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - December 26, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Kenza Rahmouni, Fraser D. Rubens Tags: ADULT – Commentary Source Type: research

Commentary: Neuroprotection in Hypothermic Circulatory Arrest – is ketamine a magic bullet?
Although hypothermic circulatory arrest remains an essential technique in contemporary cardiac surgery, it carries a significant risk of neurological injury.1-2 The quest for neuroprotection in this setting has been multimodal, including cerebral perfusion adjuncts and neuroprotective agents such as ketamine.3-4 The neuroprotective effects of ketamine are, however, dependent on clinical context.3-5 Consequently, clinical controversy has persisted about whether ketamine is truly neuroprotective after cardiac surgery. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - December 21, 2021 Category: Cardiovascular & Thoracic Surgery Authors: John G. Augoustides Tags: ADULT – Commentary Source Type: research

Commentary: Neuroprotection in Hypothermic Circulatory Arrest – is ketamine a magic bullet?
Although hypothermic circulatory arrest remains an essential technique in contemporary cardiac surgery, it carries a significant risk of neurological injury.1-2 The quest for neuroprotection in this setting has been multimodal, including cerebral perfusion adjuncts and neuroprotective agents such as ketamine.3-4 The neuroprotective effects of ketamine are, however, dependent on clinical context.3-5 Consequently, clinical controversy has persisted about whether ketamine is truly neuroprotective after cardiac surgery. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - December 21, 2021 Category: Cardiovascular & Thoracic Surgery Authors: John G. Augoustides Tags: ADULT – Commentary Source Type: research

Commentary: Improving Surgical Outcomes for Pulmonary Artery Sarcoma: The Challenge Remains
Primary pulmonary artery sarcoma (PAS) is a rare thoracic tumor with a dismal prognosis.1 Since the report of Mandelstramm in 1923,2 there have been very few case series with more than 10 patients.3,4 Because of this, the clinical features, diagnostic modalities, surgical approaches, and chemotherapy/radiotherapy remain controversial.5,6 (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - December 21, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Michio Yoshitake, Ko Bando Tags: ADULT – Commentary Source Type: research