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According to the American Cancer Society, in 2015 about 17,000 new cases of esophageal cancer will be diagnosed, and about 15,600 people will die from the disease. While the 5-year survival rate in the 1960s and 1970s was only about 5%, improvements in diagnosis, treatment, and management have led to improved survival. However, information is lacking about what happens to long-term survivors of esophageal cancer. A presentation at the AATS Annual Meeting shows that while five-year survival is up to 39%, these patients still face many health risks and should be monitored for 10 years or more.

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The National Emphysema Treatment Trial (NETT) was a multicenter, randomized, controlled clinical trial comparing the efficacy of lung volume reduction surgery (LVRS) plus medical management with rehabilitation to medical management plus rehabilitation in patients with severe emphysema. In 2003, the results of NETT demonstrated that LVRS could improve lung function in patients with emphysema, and that the procedure led to improved survival. Yet, adoption of LVRS has been very slow with concerns expressed regarding safety and long-term efficacy. In this presentation, Dr. Ginsburg will present the results of ten years of’ experience with LVRS for emphysema.

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Hospital readmission rates after major thoracic surgery can run as high as 10-17%. Alarmingly, readmission after pulmonary resection for lung cancer has been associated with worse outcomes, including higher mortality. Thus, reducing readmissions after thoracic surgery can both save lives and reduce healthcare costs. Studies in internal medicine and cardiology have shown that programs that improve the transition from hospital to post-discharge care can be effective in decreasing emergency room visits and re-hospitalization. This study from McMaster University describes for the first time the benefits of an active, post-discharge intervention that begins in the hospital for patients who have undergone thoracic surgery.

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For patients in the early stage of non-small cell lung cancer, surgical resection yields optimal outcomes. Prior investigations have shown that different resection procedures have very different outcomes, with pneumonectomy associated with three-fold higher mortality than other resection types. While it is understandable that pathological and physiological factors influence a surgeon’s choice of surgery for a particular patient, the results presented in this study suggest that physician discomfort with the operative complexities of a procedure may lead to selection of a technique associated with less favorable outcomes.

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New evidence suggests that lung cancer surgery patients are at higher risk of developing venous thromboembolism, including deep vein thrombosis (DVT) and pulmonary embolism (PE), than previously thought, with elevated risks of complications or death. When thromboemboli occur, they may be asymptomatic or attributed to post-surgical pain or complications, and may reflect both the lung cancer itself as well as compromised lung function after surgery. These incidents may also be ascribed to an inconsistent approach to prevention that currently exists among thoracic surgeons and hematologists who care for these patients. Three presentations at the 95th Annual Meeting of the American Association for Thoracic Surgery explore the problem of venous thromboembolism (VTE) after surgery for lung cancer.

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When educating medical students or residents to perform highly technical procedures, there is always a challenge to balance the educational mission with maintaining quality results and optimal patient care. This report compared outcomes of cardiac surgery residents to those of attending physicians in performing coronary artery bypass grafting. It found no differences in patient outcomes or graft patency between the residents and attending surgeons.

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Over the last 15 years, survival of children with congenital heart disease (CHD) has greatly improved, so that currently there are more adults than children living with CHD. Consequently, people with CHD of all ages are undergoing pulmonary valve replacement (PVR) with bioprosthetic valves. In this retrospective review of all patients with CHD who underwent bioprosthetic PVR over an 18-year period at Boston Children’s Hospital, investigators found that young age and small body weight predisposed patients toward re-intervention, as did the type of valve used.

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Meeting at a glance

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The American Association for Thoracic Surgery (AATS) has released new evidence-based guidelines for the prevention and treatment of perioperative and postoperative atrial fibrillation (POAF) and flutter for thoracic surgical procedures. The guidelines are published in The Journal of Thoracic and Cardiovascular Surgery.

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Investigators from the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) have successfully transplanted hearts from genetically engineered piglets into baboons’ abdomens and had the hearts survive for more than one year, twice as long as previously reported. This was achieved by using genetically engineered porcine donors and a more focused immunosuppression regimen in the baboon recipients, according to a study published in The Journal of Thoracic and Cardiovascular Surgery, an official publication of the American Association for Thoracic Surgery.

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Less aggressive anticoagulation therapy, combined with low-dose aspirin, can be used safely in conjunction with a newer generation mechanical heart valve. These findings from the first phase of a randomized clinical trial are published in The Journal of Thoracic and Cardiovascular Surgery, an official publication of the American Association for Thoracic Surgery.

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A new technique that brings CT imaging into the operating room will allow surgeons to precisely demarcate and remove small sub-centimeter lung nodules, leaving as much healthy tissue as possible, according to Raphael Bueno, MD, of Brigham and Women’s Hospital in Boston. His team is presenting the results of this late-breaking research at the 94th AATS Annual Meeting in Toronto, ON, Canada on April 30, 2014.

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A new study presenting data from 17 cardiac surgical centers in Virginia, representing 100 surgeons and 99% of cardiac operations performed in the state, demonstrates that, even today, significant variations – among surgeons and hospitals - still exist in the performance of mitral valve repair vs replacement for moderate to severe mitral regurgitation. Significant associations were observed between the propensity for MV repair and both institutional and surgeon annual volume, although increasing surgeon volume appears to be the much stronger predictor.

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Researchers at the University of Louisville School of Medicine are using breath analysis to detect the presence of lung cancer. Preliminary data indicate that this promising noninvasive tool offers the sensitivity of PET scanning, and has almost twice the specificity of PET for distinguishing patients with benign lung disease from those with early stage cancer. Michael Bousamra II, MD, Associate Professor, Department of Cardiovascular and Thoracic Surgery, is presenting the results of the study at the AATS 2014 Conference on April 29, 2014.

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Children with a heart defect called transposition of great arteries (TGA) are born with the two major blood vessels (aorta and the main lung artery) arising from the wrong sides of the heart. Consequently, blood is pumping inappropriately between the lungs and the rest of the body, a fatal condition unless surgically treated. The surgery of choice, the arterial switch operation (ASO), is usually performed within the first few weeks of life. In a retrospective analysis of 30 years of experience performing ASOs, Hanna A. Jensen, MD, PhD, and the rest of the team led by Victor Tsang, MD, FRCS, from the Great Ormond Street Hospital for Children NHS Foundation Trust in London, suggest that 90-day outcomes may give a more revealing picture than the traditional reliance on 30-day data. She is presenting the results of this research at the 94th AATS Annual Meeting in Toronto.

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High-risk operable lung cancer patients have poorer quality of life scores than the normal U.S. population. However surgery can still be undertaken safely: Low global quality of life scores were not associated with lower survival, recurrence-free rate, or for higher risk for adverse events following sublobar resection, a major surgical procedure.

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A major new study using data from the National Cancer Data Base details the impact of annual hospital volume on 30- and 90-day mortality rates. Investigators found that major lung surgery has become progressively safer over the last few decades, although higher death rates at low-volume hospitals and an unexpected increase in mortality at 90 days compared to 30 days were observed. The study further suggests that choosing a center that performs major lung surgery regularly can have a strong impact on survival.

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The use of transplant organs from animals (xenotransplantation) could help to compensate for the shortage of human organs available for transplant. NIH researchers have demonstrated that by using hearts from genetically engineered pigs in combination with target-specific immunosuppression of recipient baboons, organ survival can be significantly prolonged. This has potential for paving the way for the use of animal organs for transplantation into humans.

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Investigators propose that NASA’s “threat and error model” – derived from analyzing >30,000 commercial flights and which explains >90% of crashes – is directly applicable to pediatric cardiac surgery.

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A quick overview of the 94th AATS Annual Meeting, Toronto, April 26-30, 2014 plus 8 featured presentations.