Heart Transplantation for Uhl Anomaly in an Adult

Uhl anomaly is characterized by the morphologic absence of right ventricular myocardium and is an exceedingly rare cause of nonischemic cardiomyopathy. We report the first case of a successful heart transplantation in a 41-year-old patient who presented in cardiogenic shock from Uhl anomaly causing decompensated right ventricular failure.

Researchers propose ice 3D printing as a method to create internal channels in artificial organs

By freezing water droplets into smooth, even columns, researchers from Carnegie Mellon University created complex internal channels that may eventually render viable complex artificial tissue.

Engineers use a porcine heart scaffold to create a bio-robotic model of the right ventricle

The simulator can provide a dynamic and sophisticated platform to further aid in the study of the right heart in an era where numerous technologies are rapidly emerging in this space.

Can Artificial Intelligence Improve the Readability of Patient Education Materials on Aortic Stenosis? A Pilot Study

INTRODUCTION

The advent of generative artificial intelligence (AI) dialogue platforms and large language models (LLMs) may help facilitate ongoing efforts to improve health literacy. Additionally, recent studies have highlighted inadequate health literacy among patients with cardiac disease. The aim of the present study was to ascertain whether two freely available generative AI dialogue platforms could rewrite online aortic stenosis (AS) patient education materials (PEMs) to meet recommended reading skill levels for the public.

METHODS

Online PEMs were gathered from a professional cardiothoracic surgical society and academic institutions in the USA. PEMs were then inputted into two AI-powered LLMs, ChatGPT-3.5 and Bard, with the prompt "translate to 5th-grade reading level". Readability of PEMs before and after AI conversion was measured using the validated Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook Index (SMOGI), and Gunning-Fog Index (GFI) scores.

RESULTS

Overall, 21 PEMs on AS were gathered. Original readability measures indicated difficult readability at the 10th-12th grade reading level. ChatGPT-3.5 successfully improved readability across all four measures (p < 0.001) to the approximately 6th-7th grade reading level. Bard successfully improved readability across all measures (p < 0.001) except for SMOGI (p = 0.729) to the approximately 8th-9th grade level. Neither platform generated PEMs written below the recommended 6th-grade reading level. ChatGPT-3.5 demonstrated significantly more favorable post-conversion readability scores, percentage change in readability scores, and conversion time compared to Bard (all p < 0.001).

CONCLUSION

AI dialogue platforms can enhance the readability of PEMs for patients with AS but may not fully meet recommended reading skill levels, highlighting potential tools to help strengthen cardiac health literacy in the future.

Finding the Right Mentor

Quality mentorship is essential for a successful career in cardiothoracic surgery. From the premedical phase to the position of senior faculty, there are many benefits to having mentors who can provide insight, promote career advancement and facilitate professional opportunities. It is important to distinguish between a mentor and sponsor in seeking this career guidance because both are beneficial but serve different purposes. By being clear about one's professional goals, the mentor-mentee relationship can be optimized and lead to a fulfilling and productive career.

"Choose Your Own Threat"-A Modern Paradigm for Academic Surgery

This Viewpoint discusses a potential shift from academic surgery’s triple-threat paradigm (provide high-quality clinical care, perform primary research, and train residents and students) to defining success in ways that allow individual surgeons to focus on their own path based on intrinsic motivation and curiosity.

An early artificial implantable kidney prototype demonstrates short-term viability in a porcine model without immunosuppression

Dialysis remains an imperfect treatment for over two million patients with renal failure worldwide. This bioreactor may lead to the completely implantable, continuous filtration system they need.

Global cardiothoracic surgery: A survey of trainees' interests and barriers

Background

More than 5 billion people lack access to surgical care, disproportionately in low- and middle-income countries. The emerging literature demonstrates high interest in global surgery across specialties; however, participation in global cardiothoracic surgical care remains low. To date, there has been no research quantifying the attitudes of cardiothoracic surgeons about global surgery. Our study aimed to acquire a broader understanding of cardiothoracic surgical trainees' interest in global surgery to address barriers and promote cardiac healthcare worldwide.

Methods

An online survey was sent to all North American cardiothoracic surgical residents via the Thoracic Surgery Residents Association email listserv. The survey was designed in the REDCap database and administered twice, in 2021 and 2022. Data were analyzed by descriptive and chi-square analysis using Stata.

Results

Seventy-three cardiothoracic surgical trainees responded to our survey, of whom 95.3% considered increasing cardiothoracic surgical access to be important, and 67.2% identified this as a future career priority. Most respondents (82.8%) would participate in global surgery if opportunities were available through their home institution. Lack of opportunities (70.0%) and finances (66.7%) were the primary barriers to participation. Respondents identified funding (85%) and institutional support (83.3%) as the most significant incentives to increase involvement.

Conclusions

There is strong interest in global surgery among cardiothoracic trainees; however, involvement remains low. A consensus among the North American cardiothoracic surgical community is needed to address barriers to global volunteerism within surgical residency and improve access to cardiac surgery worldwide.

Researchers successfully engineer endovascular probes for brain recording at a microscopic scale

A neural probe capable of recording single-cell resolution was implanted using an endovascular approach through micrometer-scale vasculature. Overall, this, among other developments, are enabling safer and more specific targeting of neurologic conditions, but their overall ethical implications remain to be further discussed.

The convergence between artificial organ technology and simulation in surgery

Scientists are creating high-fidelity, physiologic simulation platforms that enable the testing of various artificial organs, which may offer a valuable alternative to animal testing in the future.

Three-dimensional bioprinting of artificial organs-How close are we to its clinical application?

A patient recently received a 3D-printed outer ear made out of her own cells. An endoscopic 3D bioprinter was able to print biomaterials in situ. In this decade, we may at last see the application of 3D bioprinters in the creation of complex, clinically viable artificial organs.

Risk of Stroke and Major Bleeding With Vitamin K Antagonist Use After Mitral Valve Repair

BACKGROUND

Guidelines are discordant on the use of a vitamin K antagonist (VKA) after mitral valve repair (MVr) to reduce the risk of cerebral embolic events. We performed an observational study among patients who underwent a MVr, without perioperative atrial fibrillation, to determine the risk of cerebral ischemic and major bleeding events with or without VKA.

METHODS

From 2004 to 2016, we included patients who underwent MVr, using a national administrative claims database. Those with preoperative atrial fibrillation and anticoagulant use were excluded. Patients were stratified based on the presence of a VKA. Inverse probability weighting with a Cox proportional hazard model was used.

RESULTS

After MVr, 754 patients were discharged on VKA and 1462 on no-VKA. We found no difference in the cumulative incidence for embolic stroke at 180 days (VKA: 2.21% vs no-VKA: 1.50%; hazard ratio, 1.35; P = .38). However, VKA patients had a significantly increased risk for any-cause major bleeding events at 180 days (VKA: 8.58% vs no-VKA: 4.21%; hazard ratio, 2.09; P < .001). VKA patients also had increased need for a pericardiocentesis/pericardial window at 30 days after discharge (VKA: 1.13% vs no-VKA: 0.37%; hazard ratio, 3.88; P = .025).

CONCLUSIONS

Our study suggests that VKA after MVr does not reduce the risk of cerebral embolic events but is associated with an increased risk of major bleeding events.

A multimillion‐dollar DARPA grant awarded to a team developing artificial whole blood product

Each year, countless individual die from not having immediate access to life-saving blood products. A multi-institutional team was awarded a $46.4 million grant to create an artificial alternative.

Demographics of Current and Aspiring Integrated Six-year Cardiothoracic Surgery Trainees

BACKGROUND

The integrated 6-year thoracic surgery (I-6) residency model was developed in part to promote early interest in cardiothoracic surgery in diverse trainees. To determine gaps in and opportunities for recruitment of women and minority groups in the pipeline for I-6 residency, we quantified rates of progression at each training level and trends over time.

METHODS

We obtained 2015 to 2019 medical student, I-6 applicant, and I-6 resident gender and race/ethnicity demographic data from the American Association of Medical Colleges and Electronic Residency Application Service public databases and Accreditation Council for Graduate Medical Education Data Resource Books. We performed χ², Fisher exact, and Cochran-Armitage tests for trend to compare 2015 and 2019.

RESULTS

Our cross-sectional analysis found increased representation of women and all non-White races/ethnicities, except Native American, at each training level from 2015 to 2019 (P < .001 for all). The greatest trends in increases were seen in the proportions of women (28% vs 22%, P = .46) and Asian/Pacific Islander (25% vs 15%, P = .08) applicants. There was also an increase in the proportions of women (28% vs 24%, P = .024) and White (61% vs 58%, P = .007) I-6 residents, with a trend for Asian/Pacific Islanders (20% vs 17%, P = .08). The proportions of Hispanic (5%) and Black/African American (2%) I-6 residents in 2019 remained low.

CONCLUSIONS

I-6 residency matriculation is not representative of medical student demographics and spotlights a need to foster early interest in cardiothoracic surgery among all groups underrepresented in medicine while ensuring that we mitigate bias in residency recruitment.

Communicating Cardiac Pathology and Procedures: Patient and Medical Perspective

This article, co-authored by a family member of a patient with atrial fibrillation and a cardiothoracic surgeon, discusses the challenges of communicating cardiac diagnoses and treatment options from both the patient and clinician perspective.

FDA Modernization Act 2.0 allows for alternatives to animal testing

On December 29, 2022, President Biden signed into law the FDA Modernization Act 2.0. The bill essentially refutes the Federal Food, Drug, and Cosmetics Act of 1938, which mandated animal testing for every new drug development protocol. While for the past century, the mandate was intended to ensure certain quality and safety standards for drugs and medical devices, recent advancements in science have begun to offer increasingly viable alternatives to animal testing. For certain areas such as organ replacement therapies, non-animal testing may not prove to be an adequate alternative in the foreseeable future.

Higher Rates of Dialysis and Subsequent Mortality in the New Allocation Era for Heart Transplants

BACKGROUND

In 2018, a United Network for Organ Sharing (UNOS) policy change increased prioritization of patients bridged with temporary mechanical circulatory support devices, such as venoarterial ECMO, for cardiac transplantation. Considering increased waitlist acuity, we sought to characterize whether this was associated with an increased risk for development of postoperative acute renal failure requiring dialysis (AKI-D) and risk of death after transplantation.

METHODS

Dialysis-naive adults receiving single-organ heart transplant between November 2009 and February 2020 were stratified by receipt of AKI-D. Era 1 and era 2 were defined by the periods of UNOS allocation before and after policy change, respectively. Multivariable logistic regression was performed to determine risk factors for AKI-D. Rates of AKI-D were compared by propensity score-matched cohorts. Survival was compared by Kaplan-Meier analysis.

RESULTS

A total of 20 698 patients were included. Venoarterial ECMO use significantly increased in era 2 (5.6% vs 0.58%; P < .01). Overall prevalence of AKI-D was greater in era 2 (13.5% vs 10.2%; P < .01). Use of preoperative ECMO, intra-aortic balloon pump, and ventilators and longer ischemia times were identified as independent risk factors for development of AKI-D. Five- and 10-year survival rates were significantly decreased for patients with AKI-D. There was no short-term survival difference of patients with AKI-D between era 2 and the more contemporary era 1.

CONCLUSIONS

Patients in whom AKI-D develops after transplantation have significantly worse short- and long-term outcomes. Preoperative use of ECMO, preoperative ventilator support, and longer ischemia times are risk factors for development of AKI-D, and their prevalence has increased since the allocation policy change.

Explant of a transcatheter valve-in-transcatheter valve with pericardial patch repair of the aortic root

Surgically explanting a failed transcatheter aortic valve can be challenging due to substantial neoendothelialization and may require concomitant and often unanticipated repairs of the aortic root and ascending aorta. We describe the explant of a failed transcatheter aortic valve-in-transcatheter aortic valve with surgical aortic valve replacement and pericardial patch repair of the aortic root. This case report illustrates that appropriate patient selection is essential for transcatheter aortic valve replacement, especially as transcatheter technology expands to lower-risk and younger patients.

Impella RP Flex with SmartAssist receives FDA pre-market approval

This approval follows an ongoing trend toward less invasive and more versatile mechanical circulatory support platforms.

[Enterostomy based on abdominal wall tension and fascial locking: a theory of preventing stoma complications and parahernia]

No consensus on standardized technique of enterostomy creation has been made meanwhile high heterogeneity of surgical procedure exists in 'stoma creation' chapters of textbooks or atlases of colorectal surgery. The present article reviews the anatomy of tendinous aponeurotic fibers which is crucial for abdominal wall tension and integrity. Through empirical practice we hypothesize a procedure of enterostomy creation basied on abdominal wall tension plus anchor suture for fascia fixation which could theoretically decrease short-term stoma complication rates and long-term parastomal hernia rates. Surgical techniques are as followed: (1) preoperative stoma site mark for de-functioning ileostomy should be positioned at the lateral border of rectus abdominis muscle (RAM) to decrease the difficulty of stoma reversal and for permanent colostomy should be placed overlying the RAM to promote adhesion; (2)Optimal circular removal or lineal opening of skin, and avoid dissection of subcutaneous tissue; (3) Lineal dissection of natural strong fascia (rectus sheath) at stoma site and blunt separation of muscular fibers. The tunnel of the fascia should be made with appropriate size without undue tension. To prevent the formation of dead space, additional suturing at fascia layer is unnecessary. (4) Anchor suture for fascia fixation at two ends of fascia opening could be considered to avoid delayed fascia disruption and parastomal hernia. (5) After pull-through of ileum or colon loop, 4-8 interrupted seromuscular sutures could be placed to attach loop to skin. For ileostomy, self-eversion of mucosa can be successful in vast majority of cases and a Brooke ileostomy is not necessary. The efficacy and safety of this procedure should be tested in future trials.

Researchers succeed in growing mouse embryos ex utero solely from stem cells

Synthetic mouse embryos grew ex utero to 8.5 days and showed early stages of organogenesis.

The utilization of educational resources published by the Thoracic Surgery Residents Association

OBJECTIVE

The Thoracic Surgery Residents Association (TSRA) is a trainee-led cardiothoracic surgery organization in North America that has published a multitude of educational resources. However, the utilization of these resources remains unknown.

METHODS

Surveys were constructed, pilot-tested, and emailed to 527 current cardiothoracic trainees (12 questions) and 780 former trainees who graduated between 2012 and 2019 (16 questions). The surveys assessed the utilization of TSRA educational resources in preparing for clinical practice as well as in-training and American Board of Thoracic Surgery (ABTS) certification examinations.

RESULTS

A total of 143 (27%) current trainees and 180 (23%) recent graduates responded. A higher proportion of recent graduates compared with current trainees identified as male (84% vs 66%; P = .001) and graduated from 2- or 3-year traditional training programs (81% vs 41%; P < .001), compared with integrated 6-year (8% vs 49%; P < .001) or 4 + 3 (11% vs 10%; P = .82) pathways. Current trainees most commonly used TSRA resources to prepare for the in-training exam (75%) and operations (73%). Recent graduates most commonly used them to prepare for Oral and/or Written Board Exams (92%) and the in-training exam (89%). Among recent graduates who passed the ABTS Oral Board Exam on the first attempt, 82% (97/118) used TSRA resources to prepare, versus only 48% (25/52) of recent graduates who passed after multiple attempts, failed, have not taken the exam, or preferred not to answer (P < .001).

CONCLUSIONS

Current cardiothoracic trainees and recent graduates have utilized TSRA educational resources extensively, including to prepare for in-training and ABTS Board examinations.

Surgeon who implanted the world's first artificial trachea found guilty of causing bodily harm

Dr. Paolo Macchiarini was a celebrated researcher for his development of an artificial trachea until his integrity and outcomes came under the medico-legal spotlight.

Interaction between donor obesity and prolonged donor ischemic time in heart transplantation

BACKGROUND

The purpose of the study was to determine the impact of donor obesity on outcomes following heart transplantation in the setting of routine (<4 h) and prolonged (≥4 h) organ ischemic times.

METHODS

Retrospective review of the 2000-2020 United Network for Organ Sharing Database was performed to identify adult heart transplant recipients and donors. Nearest-neighbor propensity score matching by donor obesity was performed separately among routine and prolonged cohorts, with Kaplan-Meier survival estimates used to assess survival at 5 years following transplantation.

RESULTS

A total of 43,304 heart transplant recipients were included in analysis, with 15,925 (36.8 %) receiving obese donor hearts. After propensity-score matching, 30-day mortality and 5-year survival following transplantation were not statistically different between recipients of obese and non-obese donor hearts when organ ischemic times were routine. In the setting of prolonged organ ischemic times, those receiving obese donor hearts experienced lower 30-day mortality (5.1 % vs 6.7 %, p = 0.04) and improved 5-year survival (74.9 % vs 71.2 %, p < 0.01) compared to non-obese donor hearts.

CONCLUSIONS

Recipients of obese donor hearts experienced improved outcomes compared to those receiving non-obese donor hearts when organ ischemic times exceeded 4 h. These findings suggest that the detrimental impact of prolonged organ ischemic time may be attenuated by donor obesity.

Development of a Modular and Equitable Surgical Simulator

Current trends in surgical simulation favor high-fidelity, costly models that are often limited to high-income academic centers. The GlobalSurgBox overcomes many of the barriers to routine implementation and use of surgical simulators in low-income countries by circumventing the often prohibitive financial, time, and personnel investments required of current simulation prototypes.

There is a tremendous need for affordable and accessible surgical simulators in the United States and abroad. Our group developed a portable, modular, inexpensive surgical simulator designed for all levels of surgical trainees, from medical students to cardiothoracic surgery fellows, and adaptable to a variety of surgical specialties. Our goal is to provide a platform for innovative surgery simulation that applies to any learner or resource setting. We describe the development, assembly, and future directions for this simulator.

Considerations for a Holistic Model in Evaluating Medical Students for Cardiothoracic Surgical Residency

Program directors are tasked with selecting whom they think will be the best fit for residency and the next leaders of the field. While numerical metrics have played a vital role in this process, recent changes to student evaluation are reducing the availability of these metrics. This poses unique challenges for both applicants and program directors. Here we discuss how this will likely shift the focus on other parts of the application and the consequences (good and bad) of doing so.

Individualized human physiology modeled in the first multi-organ chip of engineered human tissue

A team of researchers succeeded in modeling complex human physiology using the first multi-organ chip of human tissue derived from induced pluripotent stem cells. The platform may help more accurately predict various disease and pharmacologic processes.

How Should ECMO Be Used Under Conditions of Severe Scarcity? A Population Study of Public Perception

OBJECTIVE

To assess societal preferences regarding allocation of extracorporeal membrane oxygenation (ECMO) as a rescue option for select patients with coronavirus disease 2019 (COVID-19).

DESIGN

Cross-sectional survey of a nationally representative sample.

SETTING

Amazon Mechanical Turk platform.

PARTICIPANTS

In total, responses from 1,041 members of Amazon Mechanical Turk crowd-sourcing platform were included. Participants were 37.9 ± 12.6 years old, generally white (65%), and college-educated (66.1%). Many reported working in a healthcare setting (22.5%) and having a friend or family member who was admitted to the hospital (43.8%) or died from COVID-19 (29.9%).

MEASUREMENTS AND MAIN RESULTS

Although most reported an unwillingness to stay on ECMO for >one week without signs of recovery, participants were highly supportive of ECMO utilization as a life-preserving technique on a policy level. The majority (96.7%) advocated for continued use of ECMO to treat COVID patients during periods of resource scarcity but would prioritize those with highest likelihood of recovery (50%) followed by those who were sickest regardless of survival chances (31.7%). Patients >40 years old were more likely to prefer distributing ECMO on a first-come first-served basis (21.5% v 13.3%, p < 0.05).

CONCLUSION

Even though participants expressed hesitation regarding ECMO in personal circumstances, they were uniformly in support of using ECMO to treat COVID patients at a policy level for others who might need it, even in the setting of severe scarcity.

Populational Perceptions Regarding Decision to Visit the Emergency Room with Chest Pain During COVID-19

INTRODUCTION

A significant decrease in emergency presentations of acute cardiac conditions has been observed during the COVID-19 pandemic. We aimed to understand perceptions that influence people's decisions whether to present to the emergency department (ED) with symptoms related to acute cardiovascular events to inform necessary medical communication.

METHODS

We recruited users of Amazon Mechanical Turk (Seattle, WA) to participate in a survey to elucidate perceptions of COVID-19 risk associated with a visit to the ED. A conjoint analysis was designed based on commonly reported factors associated with people's decisions to present to the ED during the pandemic to calculate preference utilities.

RESULTS

After exclusions, 1003 participants completed the survey between 12/5/2020 and 12/6/2020. Participants ranked the perceived risk of contracting COVID-19 at the ED as one of the highest, only second to that at bars and restaurants. Only 68% (685/1003) were willing to present to the ED immediately with severe chest pain. Fear of further transmitting the virus to loved ones was the most frequently cited reason for not presenting. Conjoint analysis demonstrated severe chest pain to be the dominant factor in the decision to present to the ED.

CONCLUSIONS

The risk of contracting COVID-19 while presenting to the ED for a life-threatening cardiovascular symptom is overestimated and is strongly affected by social factors.

The Aveir Leadless Pacing System receives FDA approval

The Aveir leadless system is now the second device on the market in the United States to offer safe and reliable pacemaking capabilities to patients who experience significant bradycardia and arrhythmias.

A man in a completely locked-in state produces intelligible sentences using a brain-computer interface

Patients with amyotrophic lateral sclerosis may enter into a completely locked-in state without any capability for communication using neuromuscular output. Using an auditory-guided neurofeedback-based strategy with implantable sensors in the motor cortex, scientists were able to help a patient in this state produce intelligible sentences.

A man with severed spine is able to walk again following implantation of electrical stimulation device

Patients with devastating spinal cord injuries regained the ability to stand, walk, and perform even more complex motor functions after receiving implants that deliver epidural electrical stimulation.

Pioneer interview: Lyle D. Joyce, MD, PhD

Lyle D. Joyce, MD, PhD is an adult cardiac surgeon who helped pioneer the artificial heart technology throughout his career. In 1982, he and Dr. William DeVries implanted Jarvik-7 total artificial heart (TAH) in a patient named Barney Clark, which was the first ever destination therapy TAH. Artificial Organs discussed with Dr. Joyce how he came to embark on this career path, his experiences in the operating room during these early days, and what advice he has for the future generation.

First successful porcine to human heart transplantation performed in the United States

In an 8-h operation, the cardiac surgery team at the University of Maryland Medical Center made history by performing the first porcine-to-human heart transplant without signs of early rejection. Xenotransplantation offers a potential solution to the thousands of patients worldwide who die annually while waiting for donor organs.

The FDA expands indications for the Vercise™ deep brain stimulation systems

Deep brain stimulation technology offers symptomatic relief to patients with intractable tremor as an adjunct to traditional medical therapy. Their expanding indications signify the devices' growing potential and versatility.