Effective pain control is crucial in the management of thoracic surgical patients since it reduces postoperative morbidity and promotes recovery. These patients have co-existing respiratory diseases and impaired pulmonary function, which may be further impaired by surgery. With the adoption of minimally invasive surgical techniques and an emphasis on enhancing recovery after surgery, multimodal analgesia has gained popularity as a way to reduce perioperative opioid use and its associated adverse events such as respiratory depression. The literature related to opioid-sparing analgesia in thoracic surgery is still evolving. This review summarizes the latest research related to the use of various intravenous, oral, and perineural pharmacological agents as a part of multimodal analgesic regimen for pain relief in patients undergoing thoracic surgery and provides a summary for their application in clinical practice.
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http://dx.doi.org/10.1016/j.bpa.2024.01.002 | DOI Listing |
J Am Coll Cardiol
December 2024
Division of Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Background: There are no contemporary reports that highlight the national outcomes for children with congenital heart disease (CHD) undergoing ventricular assist device (VAD) implantation.
Objectives: This study sought to evaluate differences in VAD outcomes for children with CHD to those with non-CHD as well as those with univentricular CHD to those with biventricular CHD.
Methods: Data for CHD and non-CHD patients from the multicenter ACTION (Advanced Cardiac Therapies Improving Outcomes Network) undergoing VAD implantation from April 2018 to February 2023 were included.
J Am Coll Cardiol
November 2024
Elite Centre for Individualized Medicine in Arterial Disease, Odense University Hospital, Odense, Denmark; Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Background: Prospective data on the clinical course of the ascending thoracic aorta are lacking.
Objectives: This study sought to estimate growth rates of the ascending aorta and to evaluate occurrences of adverse aortic events (AAEs)-that is, thoracic aortic ruptures, type A aortic dissections, and thoracic aortic-related deaths.
Methods: In this prospective cohort study from the population-based, multicenter, randomized DANCAVAS (Danish Cardiovascular Screening trials) I and II, participants underwent cardiovascular risk assessments including electrocardiogram-gated, noncontrast computed tomography (CT) scans.
J Am Coll Cardiol
December 2024
Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom.
Background: Hypertrophic cardiomyopathy (HCM) is a leading cause of sudden cardiac death. Current diagnosis emphasizes the detection of left ventricular hypertrophy (LVH) using a fixed threshold of ≥15-mm maximum wall thickness (MWT). This study proposes a method that considers individual demographics to adjust LVH thresholds as an alternative to a 1-size-fits-all approach.
View Article and Find Full Text PDFJ Am Coll Cardiol
December 2024
Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Sydney Adventist Hospital, Sydney, New South Wales, Australia; Maquarie University Hospital, Sydney, New South Wales, Australia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
J Thorac Oncol
January 2025
Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York. Electronic address:
Introduction: The phase 3 randomized controlled trial of extended pleurectomy decortication and chemotherapy versus chemotherapy alone for pleural mesothelioma (PM) (MARS2) reported "extended pleurectomy decortication was associated with worse survival to 2 years, and more serious adverse events for individuals with resectable PM, compared with chemotherapy alone." These results have led to considerable discourse regarding the future role of surgery for PM, and there has not been unanimity in the mesothelioma surgical community regarding the trial interpretation. This "perspective" evaluates MARS2 using internationally renowned PM experts who either agreed with the trial interpretation or who found issues with its conduct which may have influenced the results.
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