Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Aug 2021
Female and Country Representation on Editorial Boards of Cardiothoracic Surgery Journals.
Editorial board positions are prestigious and have important implications as gatekeepers for the advancement of academic surgeons. We assessed the composition of editorial boards of cardiothoracic surgery journals to identify female and low- and middle-income country (LMIC) representation. Journals listed as "Cardiac and Cardiovascular Systems" in the 2019 InCites Journal Citation Reports (JCR) directory by Clarivate Analytics were manually searched to identify journals pertaining to cardiothoracic surgery. ⋯ Our findings suggest editorial boards of cardiothoracic surgery journals remain highly imbalanced in terms of sex and country income group. Disparities in editorial boards may further result in less inclusive review processes, which may lead to fewer publications and slower academic advancement by underrepresented groups. Societies should partake in active assessment and reporting of disparities across their editorial boards as well as assessment of implicit biases and barriers impeding female and LMIC researchers from joining their boards.
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Semin. Thorac. Cardiovasc. Surg. · May 2021
Pseudo heparin resistance after pulmonary endarterectomy: Role of thrombus production of Factor VIII.
Pulmonary endarterectomy (PEA) is the main treatment for chronic thromboembolic pulmonary hypertension (CTEPH). Postoperative unfractionated heparin dosing can be monitored by activated partial thromboplastin time (APTT) or by anti-factor Xa activity (anti-Xa). In pseudo heparin resistance, APTT response to heparin is blunted due to elevated Factor VIII (FVIII) which can underestimate anticoagulation. ⋯ Single-cell RNA sequencing showed FVIII gene expression in PEA specimen endothelial cells. Pseudo heparin resistance is common after PEA likely due to highly elevated postoperative FVIII levels indicating that anti-Xa reflects postoperative heparinization better than APTT in these patients. FVIII production by the pulmonary artery endothelium may participate in local prothrombotic processes important for CTEPH pathogenesis.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2020
Meta AnalysisThyroid Hormone (Triiodothyronine) Therapy in Children After Congenital Heart Surgery: A Meta-Analysis.
Thyroid hormone modifies metabolic, immune and cardiovascular functions and has been administered perioperatively to treat a relative reduction of thyroid function in children following cardiopulmonary bypass (CPB) for correction of congenital heart disease. However, it remains unclear whether its use is associated with improved outcomes. We performed a meta-analysis of studies that evaluated the impact of thyroid hormone supplementation on clinical outcomes in children undergoing repair of congenital heart disease using CPB. ⋯ There was no difference in duration of mechanical ventilation, duration of ICU stay, duration of hospital stay, cardiac index, and mortality between groups. In this meta-analysis, routine thyroid hormone replacement with approximately 1-5 μg/kg administered over 24 hours does not significantly alter the postoperative course in children following CPB. However, given a clinically small but significant difference in respect to lower inotrope score and shorter duration of ICU and hospital stays with higher thyroid replacement additional studies are warranted.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2020
Comparative StudyOutcomes of Uniportal vs Multiportal Video-Assisted Thoracoscopic Lobectomy.
The optimal number of incisions for video-assisted thoracoscopic surgery (VATS) lobectomy, the standard treatment for early-stage nonsmall cell lung cancer (NSCLC), is still a matter of great debate. To compare single-incision (uniportal) VATS (U-VATS) with traditional multiportal VATS (M-VATS), we retrospectively reviewed the surgical outcomes of a large cohort of patients. Our prospectively maintained institutional database was queried retrospectively. ⋯ Mediastinal lymph node dissection and complete resection were accomplished similarly using U-VATS and M-VATS. When the 2 approaches were compared through propensity matching, U-VATS was associated with fewer pneumonias (P = 0.012), as well as decreased intraoperative bleeding (P < 0.001), faster surgery (P < 0.001), shorter duration of chest tube drainage (P = 0.001), and shorter hospital stay (P < 0.001). At our institution, in the hands of an experienced surgeon, U-VATS lobectomy is safe, feasible, and can result in similar short-term outcomes for early-stage NSCLC as compared with M-VATS.