Cost-Effectiveness of Total Neoadjuvant Therapy With Selective Nonoperative Management for Locally Advanced Rectal Cancer: Analysis of Data From the Organ Preservation for Rectal Adenocarcinoma Trial.

Purpose: The clinical efficacy of total neoadjuvant therapy (TNT) followed by selective nonoperative management (NOM) for locally advanced rectal cancer (LARC) was examined in the Organ Preservation for Rectal Adenocarcinoma (OPRA) trial. We investigated the cost and quality-of-life implications of adopting this treatment approach.

Methods: We analyzed clinical, cost, and quality-of-life outcomes for TNT with selective NOM in comparison with chemoradiotherapy (CRT)-surgery-adjuvant chemotherapy (standard of care [SOC]) using data from OPRA, prospective cohorts, and published studies.

Contemporary management of intracardiac thrombi: a tale of two clots.

Intracardiac thrombi such as pulmonary emboli represent a high risk of mortality. In this case study, we review two cases of intracardiac thrombi occurring within 24 h of one another and managed differently by the same cardiothoracic surgical team, highlighting the importance of an individualized approach as well as an understanding of current guidelines and contemporary management techniques.

Oral iron replacement vs. IV iron treatment in bariatric surgery patients with anemia.

Bariatric surgery has become a recognized tool to reduce weight and resolve or improve comorbid conditions associated with obesity. Patients with obesity are at risk for nutritional deficiencies because of poor-quality diets and the chronic inflammatory state of obesity. Iron deficiency is common in these patients, with incidence rates as high as 21.

Interprofessional Simulation in Cardiothoracic Surgery Improves Team Confidence.

Interest in simulation has grown substantially, as has enthusiasm for team-based approaches to surgical training. In cardiothoracic surgery, the dynamic ability of the entire team is critical to emergent events. We developed innovative, interprofessional simulation events to improve team confidence.

ECMO During COVID-19: A Society of Thoracic Surgeons/Extracorporeal Life Support Organization Survey.

Background: The Society of Thoracic Surgeons Workforce on Critical Care and the Extracorporeal Life Support Organization sought to identify how the coronavirus disease 2019 (COVID-19) pandemic has changed the practice of venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO) programs across North America.

Methods: A 26-question survey covering 6 categories (ECMO initiation, cannulation, management, anticoagulation, triage/protocols, and credentialing) was emailed to 276 North American Extracorporeal Life Support Organization centers. ECMO practices before and during the COVID-19 pandemic were compared.

Hybrid Ablation of Nonparoxysmal Atrial Fibrillation: The Convergent and Totally Thoracoscopic Approaches.

Nonparoxysmal atrial fibrillation continues to challenge electrophysiologist and surgeons alike. Stand-alone endocardial catheter ablation has resulted in less than satisfying results, and while the on-pump Cox-Maze surgery has excellent results, the invasiveness has limited its adoption amongst both referring providers and surgeons. The CONVERGE IDE trial has shed new light on this once dim problem.

2021: Perioperative and critical care year in review for the cardiothoracic surgery team.

For yet another year, our lives have been dominated by a pandemic. This year in review, we feature an expert panel opinion regarding extracorporeal support in the context of COVID-19, challenging previously held standards. We also feature survey results assessing the impact of the pandemic on cardiac surgical volume.

Surgical Triage and Timing for Patients With Coronavirus Disease: A Guidance Statement from The Society of Thoracic Surgeons.

The coronavirus disease 2019 (COVID-19) pandemic continues to disrupt the provision of cardiac procedural services due to overwhelming interval surges in COVID-19 cases and the associated crisis of cardiac intervention deferment. Despite the availability of widespread testing, highly efficacious vaccines, and intensive public health efforts, the pandemic is entering its third year, where new severe acute respiratory syndrome-coronavirus-2 variants have increased the likelihood that patients scheduled for a cardiac intervention will contract COVID-19 in the perioperative period. The Society of Thoracic Surgeons (STS) Workforce on Critical Care, the STS Workforce on Adult Cardiac and Vascular Surgery, and the Canadian Society of Cardiac Surgeons have developed this document, endorsed by the STS and affirmed by the Society of Cardiovascular Angiography and Interventions and the Canadian Association of Interventional Cardiology, to provide guidance for cardiac procedure deferment and intervention timing for preoperative patients diagnosed with COVID-19.

Characteristics of venous-venous extracorporeal membrane oxygenation related bloodstream infections.

Background: Infectious complications have been shown to increase the morbidity of venous-venous extracorporeal membrane oxygenation (VV-ECMO) population, including the use of right ventricular assist devices.

Aim: We aimed to evaluate our VV-ECMO population for ECMO related bloodstream infections (E-BSI) and characteristics that affect risk and overall outcomes.

Methods: A retrospective chart review of adult patients (>18 years of age)supported with VV ECMO was conducted.

Perioperative Coronavirus Vaccination-Timing and Implications: A Guidance Document.

Cardiothoracic surgical patients are at risk of increased coronavirus disease severity. Several important factors influence the administration of the coronavirus disease vaccine in the perioperative period. This guidance statement outlines current information regarding vaccine types, summarizes recommendations regarding appropriate timing of administration, and provides information regarding side effects in the perioperative period for cardiac and thoracic surgical patients.

Accelerated versus delayed initiation of renal-replacement strategies following cardiac surgery.

Visual representation of the impact and controversy surrounding the timing of initiation for renal-replacement therapy for acute kidney injury after cardiac surgery. On the of the image is the impact of acute kidney injury on postoperative heart surgery patients. On the are the considerations a provider must undertake when determining the appropriating timing for renal-replacement therapy for individual patients.

Performance of ultrasound for detection of transjugular intrahepatic portosystemic shunt dysfunction: a meta-analysis.

Purpose: Although ultrasound has been widely used to evaluate transjugular intrahepatic portosystemic shunts (TIPS) patency, several studies have reported conflicting data regarding its performance. Therefore, we aimed to evaluate performance of ultrasound for detection of TIPS dysfunction by performing a meta-analysis.

Methods: Literature search was performed for studies evaluating ultrasound for TIPS dysfunction, stenosis, and occlusion using PubMed, EMBASE, Scopus, and Cochrane Library through February 2019.

A novel approach to stabilize fetal cell-free DNA fraction in maternal blood samples for extended period of time.

This study was undertaken to evaluate a novel method for stabilizing and preserving the original proportion of cell-free fetal DNA (cffDNA) in maternal blood for extended periods of time without using crosslinking agents, such as formaldehyde, which compromise DNA integrity and extraction efficiency. Blood was drawn from pregnant donors into K3EDTA and Blood Exo DNA ProTeck® (ProTeck) tubes. Blood drawn into both tubes were aliquoted and stored at three different temperatures.

Accuracy of liver stiffness, spleen stiffness, and LS-spleen diameter to platelet ratio score in detection of esophageal varices: Systemic review and meta-analysis.

Background And Aim: There is increasing evidence of non-invasive measurement using elastography such liver stiffness (LS), spleen stiffness (SS), and LS-spleen diameter to platelet ratio score (LSPS) for detection of esophageal varices (EV); however, data regarding comparison between these three parameters are limited.

Methods: We performed a systemic review and meta-analysis of studies evaluating performance of LS, SS, and LSPS for detection of EV and high risk/clinically significant EV (HREV). Pooled sensitivity, specificity, log diagnostic odd ratio (LDOR), and area under the receiver operating characteristic curve (AUC) of LS, SS, and LSPS for detection of EV and HREV were analyzed and compared.