Sex differences in authorship in cardiothoracic surgery during the early coronavirus disease 2019 pandemic.

Objectives: The coronavirus disease 2019 (COVID-19) pandemic negatively impacted cardiothoracic (CT) surgery, with changes in clinical, academic, and personal responsibilities. We hypothesized that the pandemic may disproportionately impact female academic CT surgeons, accentuating preexisting sex disparities. This study assessed sex differences in authorship of 2 major CT surgery journals during the early part of the COVID-19 pandemic. Methods: All accepted submissions to The Annals of Thoracic Surgery and The Journal of Thoracic and Cardiovascular Surgery between April and August of 2019 and the same period in 2020 were reviewed. Article type and author characteristics were obtained from the journals. Author sex was predicted using a validated multinational database (Genderize.io) and verified with authors' institutional and public professional profiles. Results: In total, 1106 submissions were accepted during the 2019 period, whereas 900 articles (18.6% decrease) were accepted during the same period in 2020. Original research articles comprised 33.3% of the 2019 articles but only 4.9% of the 2020 articles. Female authors contributed to 39.3% (23.1% original research and 16.2% nonoriginal articles) and 29.4% (3.3% original research and 26.1% nonoriginal articles) of articles during the 2019 and 2020 periods, respectively. This represents a marked change in the type of articles that female authors contributed to. Conclusions: Early on during the COVID-19 pandemic, the type of articles accepted, and authorship demographic changed. There was a decrease in contribution of female-authored CT surgery articles submitted to both journals, especially for original research. Future research will elucidate the long-term impact of the pandemic on sex disparities in academic productivity.

Global Impact of Social Media on Women in Surgery.

The professional use of social media is increasingly prevalent today, particularly in medicine and surgery. Several recent movements have highlighted the strengths of this forum for networking and mentorship for females in surgery who otherwise may lack mentors locally. We sought to describe modern uses for and strengths of social media for women in surgery globally via a systematic review of the literature. Multiple efforts and avenues have promoted gender equality in surgery, while also uniting female surgeons in a collaborative virtual network of colleagues. In particular, movements on Twitter, such as #ILookLikeASurgeon and #NYerORCoverChallenge, as well as other collaborative virtual fora have brought visibility to female surgeons, while drawing the young population of students and trainees toward surgical careers. Social media provides a unique opportunity for female trainees and established surgeons alike to network and establish mentorship relationships, which may aid in fostering interest in surgery and closing the gender gap in our field.

Left Atrial Intramural Hematoma Post-Ablation of Supraventricular Tachycardia: A Rare Complication Treated Successfully.

We report successful management of left atrial hematoma after ablation of supraventricular tachycardia. A 43-year-old female patient experienced chest pain immediately after radiofrequency ablation of a symptomatic left posterolateral accessory pathway. Transthoracic echocardiography demonstrated a large mass occupying the left atrium. Computed tomography and transesophageal echocardiography results were consistent with posterolateral intramural hematoma. She became hemodynamically unstable, requiring emergent surgery. The mass resolved completely by 6 weeks. (Level of Difficulty: Beginner.).

A Rare Pulmonary Artery Sarcoma Masquerading as Pulmonary Embolus.

We present the case of a 46-year-old woman with a presumed diagnosis of multiple unprovoked pulmonary emboli. Her cardiorespiratory function continued to deteriorate despite optimal medical therapy. At surgical thrombectomy she was identified to have an intimal soft tissue lesion arising from the right pulmonary artery. This lesion was subsequently diagnosed as a pulmonary artery sarcoma, a rare neoplasm that carries a poor prognosis. It typically presents at an advanced stage with pulmonary vascular obstruction. Surgical debulking is the mainstay of therapy to restore ventilation perfusion mismatching and relieve right-sided heart strain. Median survival of these patients is 20 months with adjuvant chemoradiotherapy. At 9 months after surgery, she has undergone 6 cycles of chemotherapy and has stable disease with no metastases.

Resection of a large mycotic aneurysm of the left anterior descending coronary artery.

A 50-year-old Indigenous woman, on home haemodialysis, was found to have a large mycotic aneurysm of the proximal left anterior descending coronary artery at the site of a previous drug-eluting stent. Blood cultures grew methicillin-sensitive S taphylococcus aureus bacteraemia. She underwent a complex operation involving resection of the mycotic aneurysm, removal of the stent and a coronary artery bypass graft to the distal left anterior descending (LAD) coronary artery using the left internal mammary artery. She had a complicated intensive care unit admission with pericardial tamponade on day 1 postoperatively requiring reopening and removal of clot and type 1 respiratory failure requiring reintubation on day 10 postoperatively. Once extubated, she developed prolonged hyperactive delirium and a significant decline in mobility. Over the course of a 6-week hospital admission, she received extensive multidisciplinary care and was discharged for rehabilitation to a peripheral hospital. She was discharged home after rehabilitation with ongoing follow-up with infectious diseases.

Massive prosthetic aortic abscess: an overarching plight 7 years post-Bentall's procedure.

Infections of proximal aortic vascular grafts are a catastrophic complication of aortic surgery. Despite aggressive antimicrobial and surgical intervention, mortality and reinfection rates remain significant. Here, we describe a man aged 71 years with a medical history of bioprosthetic aortic valve with aortic arch replacement (modified Bentall's procedure), who developed a large periprosthetic abscess due to Staphylococcus aureus 7 years after his initial surgery. The patient's preference was to avoid redo surgery, however despite high-dose intravenous flucloxacillin and oral rifampicin therapy, there was rapid progression of the abscess, necessitating urgent surgery. Notwithstanding the burden of infection, the patient underwent successful surgical excision and graft re-implantation and remains independent and well, almost 2 years postoperatively.

The Thoracic Surgery Social Media Network: Early Experience and Lessons Learned.

BACKGROUND: The Thoracic Surgery Social Media Network (TSSMN) is a social media collaborative formed in 2015 by The Annals of Thoracic Surgery and The Journal of Thoracic and Cardiovascular Surgery to bring social media attention to key publications from both journals and to highlight major accomplishments in the specialty. Our aim is to describe TSSMN's preliminary experience and lessons learned. METHODS: Twitter analytics was used to obtain information regarding the @TSSMN Twitter handle and #TSSMN hashtag. TweetChat and general hashtag #TSSMN analytics were measured using Symplur (Symplur LLC, Los Angeles, CA). A TSSMN Tweeter App was created, and its use and downloads were analyzed. RESULTS: Hashtag #TSSMN has a total of 17,181 tweets, 2,100 users, and 32,226,280 impressions, with peaks in tweeting activity corresponding to TweetChats. Thirteen 1-hour TweetChats drew a total of 489 participants, 5195 total tweets, and 17,297,708 total impressions. The top demographic category of TweetChat participants included Doctors (47%), Advocates/Supports (11%), and Unknown (10%), with 3% characterized as patients. The TSSMN Tweeter iTunes App (Apple, Cupertino, CA) was downloaded 3319 times with global representation. A total of 859 articles were viewed through the App, with 450 articles from The Annals of Thoracic Surgery and 409 from The Journal of Thoracic and Cardiovascular Surgery. CONCLUSIONS: We demonstrate that TSSMN further enhances the ability for the journals to connect with their readership and the cardiothoracic community. Ongoing studies to correlate social media attention with article reads, article-level metrics, citations, and journal impact factor are eagerly awaited.

The Thoracic Surgery Social Media Network: Early experience and lessons learned.

BACKGROUND: The Thoracic Surgery Social Media Network (TSSMN) is a social media collaborative formed in 2015 by The Annals of Thoracic Surgery and The Journal of Thoracic and Cardiovascular Surgery to bring social media attention to key publications from both journals and to highlight major accomplishments in the specialty. Our aim is to describe TSSMN's preliminary experience and lessons learned. METHODS: Twitter analytics was used to obtain information regarding the @TSSMN Twitter handle and #TSSMN hashtag. TweetChat and general hashtag #TSSMN analytics were measured using Symplur (Symplur LLC, Los Angeles, Calif). A TSSMN Tweeter App was created, and its use and downloads were analyzed. RESULTS: Hashtag #TSSMN has a total of 17,181 tweets, 2100 users, and 32,226,280 impressions, with peaks in tweeting activity corresponding to TweetChats. Thirteen 1-hour TweetChats drew a total of 489 participants, 5195 total tweets, and 17,297,708 total impressions. The top demographic category of TweetChat participants included Doctors (47%), Advocates/Supports (11%), and Unknown (10%), with 3% characterized as patients. The TSSMN Tweeter iTunes App (Apple, Cupertino, Calif) was downloaded 3319 times with global representation. A total of 859 articles were viewed through the App, with 450 articles from The Annals of Thoracic Surgery and 409 from The Journal of Thoracic and Cardiovascular Surgery. CONCLUSIONS: We demonstrate that TSSMN further enhances the ability for the journals to connect with their readership and the cardiothoracic community. Ongoing studies to correlate social media attention with article reads, article-level metrics, citations, and journal impact factor are eagerly awaited.

Large air-filled intrapulmonary bronchogenic cyst associated with tension pneumothorax during air travel.

A 38-year-old woman developed a spontaneous right-sided tension pneumothorax during light aircraft travel. The aircraft was diverted to a regional centre, where emergent needle thoracostomy and chest tube insertion were performed. History suggested that this was the second episode of pneumothorax, with an untreated event with similar symptomatology during air travel 1 year ago. She was taken for surgical intervention. Intraoperative findings were of a large right middle lobe cyst of uncertain origin; the procedure was subsequently aborted. A CT chest demonstrated a large multiseptated air-filled pulmonary cystic lesion. Inpatient stay was notable for persistent right pneumothorax with interval cyst rupture. A right middle lobectomy was subsequently performed with histopathology showing a benign epithelioid bronchogenic cyst. Recovery was unremarkable with no residual pneumothorax or further episodes at 2 months postoperatively. Preventative excision of air-filled pulmonary abnormalities should be considered prior to air travel.

Social media as a tool to rewrite the narrative for women in cardiothoracic surgery.

To deliver the best possible care, the global surgical workforce should mirror the diverse society it is entrusted to serve. Cardiothoracic surgery remains amongst the most under-represented of the surgical specialties for women. Herein, we describe the role of social media in the cardiothoracic surgery community and its potential to rewrite the narrative for women in cardiothoracic surgery.

Cardiac Prehabilitation.

The care of patients undergoing cardiac surgery is becoming more complex, in part owing to the increasing burden of comorbid disease, frailty, and psychosocial issues. Many risk factors for postoperative morbidity and mortality are potentially modifiable if identified and treated in a timely fashion before surgery. Cardiac prehabilitation, draws from strategies currently undertaken in cardiac rehabilitation but implements them proactively rather than reactively. There is substantial evidence that in multiple domains, including aerobic conditioning, respiratory muscle training, lifestyle modification, diabetic control, sleep, and psychoeducation, selected interventions before cardiac surgery may improve outcomes. However, the optimal preoperative program remains unclear and there is an unmet need for a comprehensive evaluation of the range of interventions specifically targeted at modifiable perioperative risk factors that may reduce adverse outcomes after cardiac surgery.

Social Media as a Means of Networking and Mentorship: Role for Women in Cardiothoracic Surgery.

As women represent <5% of practicing cardiothoracic (CT) surgeons, networking and mentorship is pivotal to support the growth of women in this field. With widespread use of social media in the healthcare domain, its role in enhancing mentorship for CT surgeons who lack access to same-sex mentors remains unknown. Methods: A 35-item survey investigating CT trainee and surgeon social media use was designed using online survey software and distributed via social media and email. Responses were analyzed using descriptive statistics. One hundred fifty-six respondents who completed the survey reported careers in surgery, among whom 27 (17.3%) were in CT surgery. Despite expressing value for the role of same-sex mentorship in their careers more than those in other surgical specialties (P = 0.044), respondents in CT surgery were more likely to lack exposure to same-sex mentors at their own institution (P = 0.028). Compared to other surgical specialties, CT surgery respondents more frequently engaged with mentors of the same sex by viewing social media sites (P = 0.041) to discuss topics regarding surviving a career in the field (P = 0.049) and promotion of scholarship opportunities (P < 0.001). CT surgery respondents reported a trend towards a greater likelihood of using social media to build a network of same-sex mentorship compared to other surgical specialties (P = 0.077). Conclusions: Social media serves as a valuable tool to enhance the networking and mentorship of surgeons, particularly for women in CT surgery who may lack exposure to same-sex mentors at their own institution. Longitudinal studies surrounding the effectiveness of mentorship by social media are warranted.

The academic tweet: Twitter as a tool to advance academic surgery.

Social media, Twitter in particular, has emerged as an essential tool for surgeons. In the realm of academic surgery, it enables surgeons to advance the core values of academic surgery, as outlined by the Association for Academic Surgery: inclusion, leadership, innovation, scholarship, and mentorship. This article details the ways in which surgeons are using Twitter to embody these values and how the Twitter account for the Association of Academic Surgeons accomplishes its goal of inspiring and developing young academic surgeons.

Social media in the mentorship and networking of physicians: Important role for women in surgical specialties.

BACKGROUND: Social media may be a useful supplement to physician and trainee interactions; however, its role in enhancing mentorship has not been described. METHODS: A 35-item survey investigating trainee and physician social media use was distributed. Responses were analyzed using descriptive statistics. RESULTS: 282 respondents completed the survey, among whom 136 (48.2%) reported careers in surgical specialties. Women in surgical specialties were more likely to describe the specialty as being dominated by the opposite sex (p < 0.001) and to be mentored by the opposite sex though wish to be mentored by individuals of the same sex (p < 0.001). Respondents in surgical specialties were also more likely to report using social media to build a network of same-sex mentorship (p = 0.031). CONCLUSIONS: Social media serves as a valuable tool to enhance the networking and mentorship of surgeons, particularly for women in surgical specialties who may lack exposure to same-sex mentors at their own institution.

Patch Repair of Anomalous Origin of Left Anterior Descending Artery From the Right Coronary Artery.

Coronary artery anomalies occur in an estimated 1.3% of the population. We present the case of a 52-year-old man who had a less common anomaly of a left anterior descending artery arising from the right coronary ostium, causing ischemia and chest pain, demonstrated by perfusion scan. The usual options for management of coronary anomalies were not suitable for this anatomy, and therefore we present a case of patch augmentation of the arteries.

Modern cardiac surgery: the future of cardiac surgery in Australia.

Cardiac surgery is a relatively young specialty and is undergoing many changes presently. The advent of catheter-based technology, minimally invasive surgery and better information regarding the roles of cardiac surgery in the management of common cardiac disease is changing the way we provide services. In Australia, attention must be turned to the way cardiac surgical services are provided to enable delivery of modern procedures. This has implications for the provision of training. We explore the face of modern cardiac surgery and how this may be taken up in Australia.