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Robbie J. Foot ulcers in older people with diabetes mellitus: prevention and management. Nurs Older People 2023; 35:28-34. [PMID: 37609709 DOI: 10.7748/nop.2023.e1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 08/24/2023]
Abstract
Foot ulcers in a person with diabetes mellitus can be life-changing and threaten the viability of their lower limb. As many as one in three people with diabetes develops a foot ulcer in their lifetime. These foot ulcers are prone to fast-spreading infection and often precede lower-limb amputation. In older people with diabetes, foot ulcers can have significant negative long-term effects in terms of quality of life, morbidity and mortality. Appropriate care is crucial to prevent the development of foot ulcers and to manage them if they develop despite adequate preventive measures. Multidisciplinary team working and robust care pathways are essential. This article outlines the role of nurses in supporting older people with diabetes to maintain optimal foot health, ensuring that they undergo an annual foot assessment, assessing them for foot ulcers and referring them promptly to specialist care when required to avoid amputation.
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Affiliation(s)
- Jayne Robbie
- Birmingham City University and senior podiatrist, University Hospitals Birmingham NHS Foundation Trust, Birmingham, England
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Abstract
Hallucinogenic mushrooms have been used in religious and cultural ceremonies for centuries. Of late, psilocybin, the psychoactive compound in hallucinogenic mushrooms, has received increased public interest as a novel drug for treating mood and substance use disorders (SUDs). In addition, in recent years, some states in the United States have legalized psilocybin for medical and recreational use. Given this, clinicians need to understand the potential benefits and risks related to using psilocybin for therapeutic purposes so that they can accurately advise patients. This expert narrative review summarizes the scientific basis and clinical evidence on the safety and efficacy of psilocybin-assisted therapy for treating psychiatric disorders and SUDs. The results of this review are structured as a more extensive discussion about psilocybin's history, putative mechanisms of action, and recent legislative changes to its legal status. There is modest evidence of psilocybin-assisted therapy for treating depression and anxiety disorders. In addition, early data suggest that psilocybin-assisted therapy may effectively reduce harmful drinking in patients with alcohol use disorders. The evidence further suggests psilocybin, when administered under supervision (psilocybin-assisted therapy), the side effects experienced are mild and transient. The occurrence of severe adverse events following psilocybin administration is uncommon. Still, a recent clinical trial found that individuals in the psilocybin arm had increased suicidal ideations and non-suicidal self-injurious behaviors. Given this, further investigation into the safety and efficacy of psilocybin-assisted therapy is warranted to determine which patient subgroups are most likely to benefit and which are most likely to experience adverse outcomes related to its use.
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Affiliation(s)
- Pravesh Sharma
- Department of Psychiatry and Psychology, Mayo Clinic Health System, Eau Claire, WI, USA
- Behavioral Health Research Program, Department of Psychology and Psychiatry Research, Mayo Clinic, Rochester, MN, USA
| | - Quang Anh Nguyen
- Behavioral Health Research Program, Department of Psychology and Psychiatry Research, Mayo Clinic, Rochester, MN, USA
| | - Sadie J Matthews
- Department of Psychology, University of Wisconsin (Eau Claire), Eau Claire, WI, USA
| | | | - Douglas B Mathews
- Department of Psychology, University of Wisconsin (Eau Claire), Eau Claire, WI, USA
| | - Christi A Patten
- Behavioral Health Research Program, Department of Psychology and Psychiatry Research, Mayo Clinic, Rochester, MN, USA
| | - Christopher J Hammond
- Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Chen JF, Tan KT, Lindsay TF, Ouzounian M, Chung JCY. Surgery for complications after thoracic endovascular aortic repair with arch vessel debranching: Role of imaging in preoperative planning. J Card Surg 2022; 37:4144-4149. [PMID: 36259711 DOI: 10.1111/jocs.17051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/16/2022] [Indexed: 01/06/2023]
Abstract
We describe here a series of patients who presented with failed hybrid arch and descending thoracic aortic aneurysm repairs, while highlighting the instrumental role that advanced medical imaging played in formulating an operative plan. Each case involved persistent 1A endoleaks and aneurysm sac growth after hybrid arch repairs tackled by arch debranching followed by thoracic endovascular aortic repair. Two open cases were described as well as one endovascular case. Imaging played a key role in elucidating the site of endoleak and in operative planning. These cases highlight the importance of multidisciplinary input between cardiac surgery, vascular surgery and radiology in management of complex aortic patients.
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Affiliation(s)
- Julia F Chen
- Department of Surgery, Division of Vascular Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kong Teng Tan
- Department of Medical Imaging, Division of Interventional Radiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Thomas F Lindsay
- Department of Surgery, Division of Vascular Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Department of Surgery, Division of Cardiovascular Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer C-Y Chung
- Department of Surgery, Division of Cardiovascular Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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Nogara A, Minacapelli A, Zambelli G, V LC, Fattouch K. Functional anatomy and echocardiographic assessment in secondary mitral regurgitation. J Card Surg 2022; 37:4103-4111. [PMID: 35998280 DOI: 10.1111/jocs.16863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/02/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Mitral valve apparatus is complex and involves the mitral annulus, the leaflets, the chordae tendinae, the papillary muscles as well as the left atrial and ventricular myocardium. Secondary mitral regurgitation is a consequence of regional or global left ventricle remodeling due to an acute myocardial infarction (75% of cases) or idiopathic dilated cardiomyopathy (25% of cases). It is associated with an increase in mortality and poor outcome. There is a potential survival benefit deriving from the reduction in the degree of severity of mitral regurgitation. So the correction of the valve defect can change the clinical course and prognosis of the patient. The rationale for mitral valve treatment depends on the mitral regurgitation mechanism. Therefore, it is essential to identify and understand the pathophysiology of mitral valve regurgitation. AIM OF THE STUDY The aim of this review is to describe the crucial role of transthoracic and trans-esophageal echocardiography, in particular with three-dimensional echocardiography, for the assessment of the severity of secondary mitral regurgitation, anatomy, and hemodynamic changes in the left ventricle. Moreover, the concept that the mitral valve has no organic lesions has been abandoned. The echocardiography must allow a complete anatomical and functional evaluation of each component of the mitral valve complex, also useful to the surgeon in choosing the best surgical approach to repair the valve. CONCLUSIONS Echocardiography is the first-line imaging modality for a better selection of patients, according to geometrical modifications of mitral apparatus and left ventricle viability, especially in preoperative phase.
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Affiliation(s)
- Angela Nogara
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - Alberto Minacapelli
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - Giulia Zambelli
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - Lo Coco V
- Department of Cardiac Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
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Perri JL, Schroeder J, Fiedler AG. Computed tomography angiogram for left ventricular assist device thrombosis: When does it help? J Card Surg 2022; 37:4119-4123. [PMID: 36222261 DOI: 10.1111/jocs.16902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Jennifer L Perri
- Division of Adult Cardiothoracic Surgery, UCSF Medical Center, San Francisco, California, USA
| | - Jamie Schroeder
- Department of Radiology and Biomedical Imaging, Cardiac and Pulmonary Imaging Section, UCSF Medical Center, San Francisco, California, USA
| | - Amy G Fiedler
- Division of Adult Cardiothoracic Surgery, UCSF Medical Center, San Francisco, California, USA
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Rogers MP, DeSantis AJ, Gemayel K, Bommareddi SR, Caceres Polo M, Hooker RL. Contemporary utilization of the axillary artery in cardiac surgery. J Card Surg 2022; 37:5404-5410. [PMID: 36423262 DOI: 10.1111/jocs.17230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The axillary artery is a reliable inflow vessel when addressing pathology of the aortic root and aortic arch that may preclude standard central cannulation strategies. This narrative review examines the use of the axillary artery in cardiac surgery. Anatomy, indications for use, cannulation strategies, and potential complications will be discussed. METHODS A comprehensive review of the current literature was performed using PubMed, Cochrane Review, and authoritative committee guidelines. A narrative review incorporating current available evidence was undertaken. COMMENT Use of the axillary artery in select cardiac surgical cases is reliable, reproducible, and may be preferable in certain cases involving ascending aortic pathology, reoperative surgery, porcelain aorta, access for transcatheter valve therapies, and peripheral mechanical circulatory support.
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Affiliation(s)
- Michael P Rogers
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Anthony J DeSantis
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Kristina Gemayel
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Swaroop R Bommareddi
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Manuel Caceres Polo
- Department of Cardiac Surgery, Christus Spohn Hospital, Corpus Christi, Texas, USA
| | - Robert L Hooker
- Department of Surgery, Division of Cardiothoracic Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
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D'Onofrio A, Fiocco A, Nadali M, Gerosa G. Transapical mitral valve repair procedures: Primetime for microinvasive mitral valve surgery. J Card Surg 2022; 37:4053-4061. [PMID: 34550618 PMCID: PMC10078712 DOI: 10.1111/jocs.16011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/29/2021] [Accepted: 07/27/2021] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Nowadays micro-invasive-procedures (off-pump, beating-heart) for mitral valve repair (MVRe) are abruptly expanding with the potential to be adopted as a valuable alternative to surgery. In the present manuscript, the authors review the available technologies intended to treat mitral regurgitation (MR) through transapical approach, including annuloplasty and chordal-repair options. ANNULOPLASTY To date, Valcare Amend is the only transapical MV ring to have been implanted in patients. The device allows for stabilization of the annulus through a complete semirigid d-shaped ring. The first-in-human successful procedure was performed in 2016 by our Group and subsequent clinical experience included a total of 14 implanted patients. Currently, the technology is under clinical trial evaluation to validate the efficacy and safety profile of the device. CHORDAL REPAIR Beating-heart chordal implantation via transapical approach is a current feasible, safe and reproducible option. Neochord DS1000 is the most widely used technology in the field, with a solid procedural experience and good results in well-selected patients. Its clinical use has been validated in Europe since 2012, while it is still under clinical investigation in the United States. Harpoon MVRe system is a novel technology, recently CE-mark approved for clinical use. DISCUSSION AND CONCLUSIONS Transapical micro-invasive technologies are current viable therapies to treat MR in selected patients. Although there are still several limitations that preclude an extensive use of such procedures, their results are promising in well-selected patients. Embracing transcatheter MVRe therapies should guide the cardiac surgeon through the new revolution of micro-invasive MV tailored repair.
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Affiliation(s)
- Augusto D'Onofrio
- Division of Cardiac Surgery, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Veneto, Padova, Italy
| | - Alessandro Fiocco
- Division of Cardiac Surgery, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Veneto, Padova, Italy
| | - Matteo Nadali
- Division of Cardiac Surgery, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Veneto, Padova, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Veneto, Padova, Italy
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Eisenga J, Monday K, Blough B, Vandervest K, Lingle K, Espinoza O, Schwartz G. Extracorporeal membrane oxygenation support in the setting of penetrating traumatic injuries. J Card Surg 2022; 37:4359-4361. [PMID: 36150148 DOI: 10.1111/jocs.16955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/07/2022] [Accepted: 08/26/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Currently, no absolute contraindications to the use of extracorporeal membrane oxygenation (ECMO) support exist. However, the presence of penetrating traumatic injuries is often considered a relative contraindication to ECMO support. In this study, we aim to assess whether penetrating traumatic injuries should be considered a contraindication to the use of ECMO support, and how to better select patients who may benefit from this therapy. MATERIALS AND METHODS In this paper, we present the findings of a retrospective review of all patients at a large, level 1 trauma center who received ECMO support following penetrating traumatic injuries. We describe the use of ECMO in these patients along with the complications associated with this therapy. CONCLUSION In this study we show penetrating traumatic injuries should not be considered a contraindication to ECMO support, and how ECMO can be a useful treatment strategy in selected patients with these injuries.
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Affiliation(s)
- John Eisenga
- Depratment of Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - Kara Monday
- Depratment of Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - Britton Blough
- Depratment of Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | | | - Katy Lingle
- Depratment of Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - Otoniel Espinoza
- Depratment of Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - Gary Schwartz
- Depratment of Surgery, Baylor University Medical Center, Dallas, Texas, USA
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Guccione F, Moscarelli M, Sampognaro R, Salardino M, Bacarella D, Angela N, Fattouch K. Subannular procedures on papillary muscles for secondary mitral valve regurgitation repair. J Card Surg 2022; 37:5434-5438. [PMID: 36515261 DOI: 10.1111/jocs.16968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/13/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Francesco Guccione
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - Roberta Sampognaro
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - Massimo Salardino
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - Daniela Bacarella
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - Nogara Angela
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
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10
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Di Mauro M, Bonalumi G, Giambuzzi I, Messi P, Cargoni M, Paparella D, Lorusso R, Calafiore AM. Mitral valve repair with artificial chords: Tips and tricks. J Card Surg 2022; 37:4081-4087. [PMID: 36321669 PMCID: PMC10092434 DOI: 10.1111/jocs.17076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
Abstract
Mitral valve regurgitation (MR) is a common valvular disorder occurring in up to 10% of the general population. Mitral valve reconstructive strategies may address any of the components, annulus, leaflets, and chords, involved in the valvular competence. The classical repair technique involves the resection of the prolapsing tissue. Chordal replacement was introduced already in the '60, but in the mid '80, some surgeons started to use expanded polytetrafluoroethylene (ePTFE) Gore-Tex sutures. In the last years, artificial chords have been used also using transcatheter approach such as NeoChord DS 1000 (Neochord) and Harpoon TSD-5. The first step is to achieve a good exposure of the papillary muscles that before approaching the implant of the artificial chords. Then, the chords are attached to the papillary muscle, with or without the use of supportive pledgets. The techniques to correctly implant artificial chords are many and might vary considerably from one center to another, but they can be summarized into three big families of suturing techniques: single, running or loop. Regardless of how to anchor to the mitral leaflet, the real challenge that many surgeons have taken on, giving rise to some very creative solutions, has been to establish an adequate length of the chords. It can be established based on anatomically healthy chords, but it is important to bear in mind that surgeons work on the mitral valve when the heart is arrested in diastole, so this length could fail to replicate the required length in the full, beating heart. Hence, some surgeons suggested techniques to overcome this problem. Herein, we aimed to describe the current use of artificial chords in real-world surgery, summarizing all the tips and tricks.
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Affiliation(s)
- Michele Di Mauro
- Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Giorgia Bonalumi
- Department of Cardiac Surgery, IRCCS Monzino Cardiology Center, Milan, Italy.,DISCCO (Dipartimento di Scienze Cliniche e di Comunità), University of Milan, Milan, Italy
| | - Ilaria Giambuzzi
- Department of Cardiac Surgery, IRCCS Monzino Cardiology Center, Milan, Italy.,DISCCO (Dipartimento di Scienze Cliniche e di Comunità), University of Milan, Milan, Italy
| | - Pietro Messi
- DISCCO (Dipartimento di Scienze Cliniche e di Comunità), University of Milan, Milan, Italy.,Department of Cardiac Surgery, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Marco Cargoni
- Department of Cardiac Anesthesia, Mazzini Hospital, Teramo, Italy
| | - Domenico Paparella
- Department of Medical and Surgical Sciences, Division of Cardiac Surgery, University of Foggia, Foggia, Italy.,Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Tnay TD, Shell D, Lui A. Review of bioprosthetic structural valve deterioration: Patient or valve? J Card Surg 2022; 37:5243-5253. [PMID: 36317394 DOI: 10.1111/jocs.17081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/22/2022] [Accepted: 09/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND With guidelines progressively recommending bioprosthetic aortic valves in younger patients, a greater emphasis is placed on structural valve deterioration (SVD) as an important clinical endpoint for both transcatheter and surgically implanted valves. However, SVD of bioprosthetic valves is a complex entity with varying definitions in the literature and a multifaceted pathogenesis. AIM This review first aims to establish the most updated definitions of SVD as per the literature. We then explore the patient- and valve-related factors that play the greatest roles in facilitating early SVD. METHODS A PubMed literature review was conducted to identify the relevant research in this field within the past two decades. CONCLUSION Increasing rates of obesity and metabolic syndrome pose a significant risk to the longevity of bioprosthetic valves. Additionally, externally mounted valves have proven to sacrifice durability for superior haemodynamics. Bioprosthetic SVD continues to be a multifactorial issue that will require various patient- and valve-related factors to be addressed.
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Affiliation(s)
- Trevor D Tnay
- Department of Cardiothoracic Surgery, St Vincent's Hospital - Melbourne St Vincent's Health Australia, Melbourne, Australia
| | - Daniel Shell
- Department of Cardiothoracic Surgery, St Vincent's Hospital - Melbourne St Vincent's Health Australia, Melbourne, Australia
| | - Adrienne Lui
- Department of Cardiothoracic Surgery, St Vincent's Hospital - Melbourne St Vincent's Health Australia, Melbourne, Australia
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12
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Williams AM, Shah NP, Rosengart T, Povsic TJ, Williams AR. Emerging role of positron emission tomography (PET) imaging in cardiac surgery. J Card Surg 2022; 37:4158-4164. [PMID: 36345705 DOI: 10.1111/jocs.16992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/21/2022] [Indexed: 11/11/2022]
Abstract
Historically, structural and anatomical imaging has been the mainstay in the diagnosis and management of cardiovascular diseases. In recent years there has been a shift toward increased use of functional imaging studies, including positron emission tomography (PET). PET is a noninvasive nuclear medicine-imaging technique that uses radiotracers to generate images of a radionucleotide distribution by detecting the physiologic substrates that emit positron radionuclides. This article will focus on the applications of PET imaging for the cardiac surgeon and highlight the collaborative nature of using PET imaging for the management of complex heart disease. We present cases that demonstrate the value of using PET imaging in the diagnosis of coronary artery disease and management of complex endocarditis, and in targeted cardiovascular therapies.
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Affiliation(s)
- Aaron M Williams
- Department of Surgery, Duke University Hospital, Durham, North Carolina, USA
| | - Nishant P Shah
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, North Carolina, USA
| | - Todd Rosengart
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Thomas J Povsic
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, North Carolina, USA
| | - Adam R Williams
- Department of Surgery, Duke University Hospital, Durham, North Carolina, USA
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13
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Fattouch K, Calafiore AM. Mitral valve repair: Regulatory or ethical problem? J Card Surg 2022; 37:4094-4096. [PMID: 35916157 DOI: 10.1111/jocs.16823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 01/06/2023]
Abstract
The long-term outcome of patients undergoing mitral valve repair (MVr) is based on what happens during the more or less 60 min of aortic cross-clamping necessary to transform a leaking valve into a well-functioning one. As a consequence, the experience of the surgeon performing the procedure is the only determinant of the success rate that deserves to be taken into account. It is clear from the literature that the number of cases/year is inversely related to the number of early and late deaths, repair failures, and reoperations. However, there is no agreement on the minimum caseload/year that represents the threshold to identify surgeons that can perform or not MVr. This problem then cannot be regulated by specific guidelines of Scientific Societies, but only by the ethical perception, we have of our profession.
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Affiliation(s)
- Khalil Fattouch
- Department of Surgical, Oncologic and Stomatological Disciplines, GVM Care and Research, Maria Eleonora Hospital, University of Palermo, Palermo, Italy
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14
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Calafiore AM, Prapas S, Totaro A, Guarracini S, Cargoni M, Katsavrias K, Fattouch K, Di Mauro M. Cutting the second order chords during mitral valve repair. J Card Surg 2022; 37:4072-4078. [PMID: 36378871 DOI: 10.1111/jocs.17194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/15/2022] [Accepted: 09/04/2022] [Indexed: 11/16/2022]
Abstract
The chordae tendinae connect the papillary muscles (PMs) to the mitral valve. While the first-order chordae serve to secure the leaflets to maintain valve closure and prevent mitral valve prolapse, the second-order chordae are believed to play a role in maintaining normal left ventricle size and geometry. The PMs, from where the chordae tendinae originate, function as shock absorbers that compensate for the geometric changes of the left ventricular wall. The second-order chordae connect the PMs to both trigons under tension. The tension distributed towards the second-order chordae has been demonstrate to be more than threefold that in their first-order counterpart. Cutting the second-order chordae puts all the tension on the first-order chordae, which are then closer to their rupture point. However, it has been experimentally demonstrated that the tension at which the first-order chordae break is 6.8 newtons (N), by far higher than the maximal tension reached, that is 0.4 N. Even if the clinical reports have been favorable, the importance of cutting the second-order chordae to recover curvature of the anterior leaflet and increase the coaptation length between the mitral valve leaflets has been slowly absorbed by the surgical world. Nevertheless, there are progressive demonstrations that chordal tethering affects the anterior leaflet not only in secondary, but also in primary mitral regurgitation, having a not negligible role in the long-term outcome of mitral repair.
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Affiliation(s)
| | - Sotirios Prapas
- Division of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece
| | - Antonio Totaro
- Department of Cardiovascular Diseases, Gemelli Molise, Campobasso, Italy
| | | | - Marco Cargoni
- Department of Surgical, Oncologic and Stomatological Disciplines, GVM Care & Research, Maria Eleonora Hospital, University of Palermo, Palermo, Italy
| | - Kostas Katsavrias
- Division of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece
| | - Khalil Fattouch
- Department of Cardiac Anesthesia, Mazzini Hospital, Teramo, Italy
| | - Michele Di Mauro
- Departmente of Cardio-Thoracic and Vascular Surgery, Heart and Vascular Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
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Paparella D, Squiccimarro E, Di Mauro M, Katsavrias K, Calafiore AM. Acute iatrogenic complications after mitral valve repair. J Card Surg 2022; 37:4088-4093. [PMID: 36273407 DOI: 10.1111/jocs.17055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/04/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Mitral valve repair is the procedure of choice to correct mitral regurgitation. However, some dangerous iatrogenic complications can occur at the end of the procedure. Therefore, we sought to review the most frequent and clinically relevant acute iatrogenic complication following mitral valve repair. METHODS A thorough review of the literature has been performed. Criteria for considering studies for this non-systematic review were as follows: observational and interventional studies investigating the acute iatrogenic complications following mitral valve repair, and essential review studies pertinent to the topic. RESULTS The most frequent is the systolic anterior motion. Due to a systolic dislocation of the anterior leaflet toward the outflow tract, it causes both obstruction of the outflow tract and mitral regurgitation. Often it is due to excess of catecholamines or to reduced filling of the left ventricle but sometimes needs further surgical maneuvers, focused on moving posteriorly the coaptation line. It can be obtained by shortening the posterior leaflet or increasing the size of the ring or applying an Alfieri stitch to limit the movements of the anterior leaflet. Another complication, often underdiagnosed and potentially lethal, is the injury of the circumflex artery that happens at the level of the anterolateral commissure or P1 zone. Two mechanisms are involved. The first one is the direct injury of the artery by a stitch (roughly 25% of the patients present a distance artery-annulus <3 mm. The second one is the distortion of the artery, attracted toward the annulus by a misplaced stitch. The attraction causes kinking with stenosis of different degrees till functional occlusion. However, the artery has to be far from the annulus and the atrial tissue has to be stiff and resistant, as after an infective process, to move the circumflex artery toward the annulus without tearing. Positioning the stitches very close to the mitral leaflets in the dangerous area is the only prevention to the complication. The treatment in the operating theater is partial or total removal/reimplantation of the annular sutures or coronary artery bypass grafting to the circumflex area. If the injury is demonstrated only after coronary angiography, percutaneous revascularization can be attempted before further surgical treatment. CONCLUSIONS Acute iatrogenic complication after mitral repair exists and may compromize patient outcome. Raising awareness about these issues, the precautions to prevent them, and the manners of resolution is therefore mandatory.
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Affiliation(s)
- Domenico Paparella
- Department of Medical and Surgical Sciences, Division of Cardiac Surgery, University of Foggia, Foggia, Italy.,Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Enrico Squiccimarro
- Department of Medical and Surgical Sciences, Division of Cardiac Surgery, University of Foggia, Foggia, Italy.,Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Kostas Katsavrias
- Division of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece
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16
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Bayamin K, Power A, Chu MWA, Dubois L, Valdis M. Malperfusion syndrome in acute type A aortic dissection: Thinking beyond the proximal repair. J Card Surg 2022; 37:3827-3834. [PMID: 35989530 DOI: 10.1111/jocs.16872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/15/2022] [Accepted: 07/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Malperfusion syndrome (MPS) is associated with the highest mortality and major morbidity risk in patients with acute Type A aortic dissection (TAAD). The timing of the open proximal aortic repair in the presence of MPS remains debatable given variability in clinical presentation and different local treatment algorithms. This paper provides an up to date and comprehensive overview of published outcomes and available techniques for addressing malperfusion in the setting of acute TAAD. METHODS We have reviewed published data from the major aortic dissection registries including the International Registry of Acute Aortic Dissection, the German Registry for Acute Aortic Dissection In Type A, and the Nordic Consortium for Acute Type A Aortic Dissection, as well as the most up to date literature involving malperfusion in the setting of acute TAAD. This data highlights unique strategies that have been adopted at aortic centers internationally to address malperfusion in this setting pre-, intra-, and postoperatively, which are summarized here and may be of great clinical benefit to other centers treating this disease with more traditional methods. RESULTS The review of the available data has definitively shown an increased mortality up to 43% and morbidity in patients presenting with MPS in the setting of acute TAAD. More specifically, preoperative MPS has been shown to be an independent predictor of mortality with mesenteric malperfusion associated with the worst mortality outcomes from 70% to 100%. Addressing MPS pre or intraoperatively is associated with significantly reduced mortality outcomes down to 4%-13%. CONCLUSION Adapting a dynamic and easily accessible diagnostic method for the comprehensive assessment of different forms of malperfusion (dynamic/static) and incorporating it within the surgical plan is the first step toward early diagnosis and prevention of malperfusion related complications.
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Affiliation(s)
- Karama Bayamin
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Center, London, Ontario, Canada
| | - Adam Power
- Division of Vascular Surgery, Department of Surgery, Western University, London Health Sciences Center, London, Ontario, Canada
| | - Michael W A Chu
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Center, London, Ontario, Canada
| | - Luc Dubois
- Division of Vascular Surgery, Department of Surgery, Western University, London Health Sciences Center, London, Ontario, Canada
| | - Matthew Valdis
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Center, London, Ontario, Canada
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17
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Jones A, Olverson G, Hwang J, Bhagat R, McGann K, Bradburn K, Miller M, Louis C. The effect of tracheostomy on extracorporeal membrane oxygenation outcomes. J Card Surg 2022; 37:2543-2551. [PMID: 35662251 DOI: 10.1111/jocs.16666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/23/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The optimal timing for pursuing tracheostomy in patients with prolonged mechanical ventilation with either veno-arterial (VA) or veno-venous (VV) extracorporeal membrane oxygenation (ECMO) is a discussion of risk versus benefit. Depending on the etiology, cardiothoracic surgical patients carry some of the highest risk for respiratory failure postprocedure. Given that patients with end-stage cardiopulmonary status may be fraught with substantial comorbidities, it is critically important to manage the risk-benefit profile of performing a tracheostomy procedure on a patient requiring ECMO support. These cohorts have risk factors that may depend on each patient's inflammatory state, lung de-recruitment peri-procedure and postprocedure and bleeding requiring transfusions to name a few. We provide a descriptive analysis of ECMO patients on both VA and VV configurations who survived to hospital discharge receiving tracheostomy either during or after their ECMO course. METHODS A retrospective single-institutional study collected all consecutive patients age 18 and above who received any form of ECMO between 2016 and 2020. Five hundred forty-five patients were screened based on having received ECMO. Patients with mixed EMCO modality were excluded due to heterogeneity of disease process. A total of 521 patients received either VV or VA ECMO. A total of 54 patients received tracheostomy and had sufficiently clean data for analysis. Tracheostomy patients were compared based on survival to discharge, tracheostomy surgical complications, ECMO duration, ECMO configuration, inotrope and vasopressor use, transfusion rates, total ventilator days, total days on intravenous sedation, and history of cardiotomy or heart transplant were assessed. Baseline characteristics of race, age, gender, and body mass index (BMI) were also collected. RESULTS A total of 54 patients received tracheostomy. Twenty-nine of those patients received tracheostomy during the course of their ECMO, of whom 13 were on VV ECMO, 16 on VA ECMO. Another 25 patients underwent tracheostomy after successful ECMO explant; 8 of those were VV ECMO with the remaining 17 were on VA ECMO before explantation, with mean delay to tracheostomy, 10 and 19 days after explant between both modalities, respectively. A statistically significantly greater proportion of VV ECMO patients received a tracheostomy at any point versus VA ECMO patients (25.93% vs. 8.35%, p ≤ .0001). No statistically significant difference was noted in timing of tracheostomy when stratified by EMCO modality (VA 51.51% after explant vs. VV 38.10% after explant, p = .33). There was a greater frequency of minor tracheostomy complications in patients who were on ECMO at the time of their tracheostomy (p = .014) than in those who received their tracheostomy after being explanted. However, these minor complications did not contribute to a change in survival to hospital discharge (p = .58). Similarly, the small number of major complications (n = 13) did not impair survival to hospital discharge (p = .84). Finally, mean duration of ECMO was longer in those who received tracheostomy during ECMO versus after ECMO. (488.45 vs. 259.72 h, p < .01). CONCLUSIONS Tracheostomy is known to increase patient mobility, clinical participation, and overall decrease in sedation use. Pursuing tracheostomy during ECMO is feasible, does not result in major bleeding, and is associated with only minor complications that overall do not decrease survival. While there is an increased duration of ECMO support in the tracheostomy cohort, this may be due to existing patient conditions, and may not be causal. Research is needed to further determine the external patient factors and specific timing to optimize both VV and VA ECMO courses. CLINICAL IMPLICATIONS We hope that our analysis will pave the initial pathway for an evidence-based guideline on optimal timing of tracheostomy in ECMO patients, whether initiated during or after ECMO and taking into consideration ECMO configuration, its expected duration, and patient comorbidities.
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Affiliation(s)
- Andrew Jones
- School of Medicine & Dentistry, University of Rochester Medical Center, Rochester, New York, USA
| | - George Olverson
- School of Medicine & Dentistry, University of Rochester Medical Center, Rochester, New York, USA
| | - Jason Hwang
- Division of Pathology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Rohun Bhagat
- School of Medicine & Dentistry, University of Rochester Medical Center, Rochester, New York, USA
| | - Kevin McGann
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathryn Bradburn
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York, USA
| | - Matthew Miller
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York, USA
| | - Clauden Louis
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
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18
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Ikonomidis JS. The recurring theme of gender difference in cardiac surgical outcomes. J Card Surg 2022; 37:2661-2662. [PMID: 35652890 DOI: 10.1111/jocs.16657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- John S Ikonomidis
- Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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19
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Copeland H, Westfall S, Morton J, Mohammed A. Successful recovery with venovenous ECMO for ARDS after LVAD HeartMate 3 implantation: A case report. J Card Surg 2022; 37:2450-2452. [PMID: 35650659 DOI: 10.1111/jocs.16624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022]
Abstract
Acute respiratory distress syndrome (ARDS) following left ventricular assist device (LVAD) implantation is a rare complication. Venovenous (VV) extracorporeal membrane oxygenation (ECMO) is used as a treatment for severe ARDS and pneumonia. We report the successful use of VV ECMO for ARDS Klebsiella pneumonia following urgent LVAD HeartMate 3 implantation.
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Affiliation(s)
- Hannah Copeland
- Department of Cardiovascular and Thoracic Surgery, Lutheran Hospital, Fort Wayne, Indiana, USA.,Indiana University School of Medicine, Fort Wayne, Indiana, USA
| | - S Westfall
- Department of Cardiology, Advanced Heart Failure, Heart Transplant and Ventricular Assist Devices, Lutheran Hospital, Fort Wayne, Indiana, USA
| | - John Morton
- Department of Perfusion, Lutheran Hospital, Fort Wayne, Indiana, USA
| | - Asim Mohammed
- Department of Cardiology, Advanced Heart Failure, Heart Transplant and Ventricular Assist Devices, Lutheran Hospital, Fort Wayne, Indiana, USA
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20
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Lattouf OM. Impact of digital transformation on the future of medical education and practice. J Card Surg 2022; 37:2799-2808. [PMID: 35612355 DOI: 10.1111/jocs.16642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/28/2022]
Abstract
In this article, the author provides synopses of the factors that have finally propelled health-care education and practice to join, at times reluctantly, the overarching digital transformative process that has been swept other industries over the last few decades. The key contributors and driving forces that have energized the entry of health-care education and practices are mentioned. The roles of major universities, large technology companies, and the expanding roles of Artificial Intelligence and Machine Learning are described. The projected future developments are predicted to continue to be substantial, sweeping, and forcing changes that are unprecedented. Thus, academicians and practitioners should be alerted to what the rapidly changing landscape is likely to become and accordingly take steps to manage and preserve their roles or risk be left behind or worse be forced out.
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Affiliation(s)
- Omar M Lattouf
- Department of Cardiovascular Surgery, Icahn School of Medicine, Professor Emeritus, New York, New York, USA.,Emory University, Atlanta, Georgia, USA
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21
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Aranda-Domene R, Minano-Frutos C, Arribas-Leal JM, Pérez-Andreu J, Taboada-Martín R, Alfonso-Colomer L, Moreno-Moreno J, Canovas S. Accessory left atrial cords: A case report and literature review. J Card Surg 2022; 37:2437-2439. [PMID: 35578332 DOI: 10.1111/jocs.16608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Accessory left atrial cords are fibroelastic structures found in the left atrium. Left atrial cords may be associated with mitral valve disease, atrial fibrillation, stroke, and other congenital left-side anomalies. METHODS We presented the case of a man with severe Mitral Regurgitation and two accessories left atrial cords attached to P2 scallop by a single tendon and performed a literature review using PUBMED/MEDLINE, Web of Science, and EMBASE databases on December 4, 2021. RESULTS According to our review, accessory left atrial cords were found more frequently in women (36 patients, 62%), more frequently attached to the mitral valve (66% of reports) and mitral regurgitation was the most frequently reported pattern of mitral valve disease (64.2%). No other cases of double left atrial cords attached to P2 segment were found. CONCLUSION Accessory left atrial chords may be related to mitral valve disease and other left-side congenital abnormalities. These structures were found more frequently in females and A2 insertion was the most frequently observed pattern in the review.
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Affiliation(s)
- Ramón Aranda-Domene
- Cardiovascular Surgery Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
| | - Celia Minano-Frutos
- Anesthesiology and Reanimation Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
| | - José M Arribas-Leal
- Cardiovascular Surgery Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
| | - Joaquín Pérez-Andreu
- Cardiovascular Surgery Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
| | - Rubén Taboada-Martín
- Cardiovascular Surgery Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
| | - Laura Alfonso-Colomer
- Cardiovascular Surgery Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
| | - José Moreno-Moreno
- Cardiovascular Surgery Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
| | - Sergio Canovas
- Cardiovascular Surgery Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
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22
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Zhu T, Dufendach KA, Hong Y, Thoma FW, Kilic A. Infectious complications following contemporary left ventricular assist device implantation. J Card Surg 2022; 37:2297-2306. [PMID: 35502490 DOI: 10.1111/jocs.16545] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/21/2022] [Accepted: 03/10/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The aim of this study is to evaluate the source of infectious complications following contemporary left ventricular assist device (LVAD) implantation and to determine the impact of infections on patient outcomes. METHODS All patients who underwent centrifugal LVAD implantation between 2014 and 2020 at a single center were retrospectively reviewed. Postimplant infections were categorized as VAD-specific, VAD-related, or non-VAD according to previously published definitions. Postoperative survival and freedom from readmission were assessed using Kaplan-Meier analysis. Univariable and multivariable analyses were performed to determine the risk factors for postoperative infectious complications. RESULTS A total of 212 patients underwent centrifugal LVAD implantation (70 HeartMate 3, 142 HeartWare HVAD) during the study period. One hundred and two patients (48.1%) developed an infection, including 34 VAD-specific, 11 VAD-related, and 57 non-VAD. Staphylococcus species were the most common source of postoperative infection (n = 57, 33.7%). In multivariable analysis, diabetes significantly impacted overall postoperative infection rate. At 12 and 24 months, respectively, Kaplan-Meier survival was 81.1% and 61.6% in the infection group and 83.4% and 78.1% in the noninfection group (p = 0.006). Within the total cohort, 12- and 24-month freedom from infection were 46.2% and 31.9%, respectively. Patients with infectious complication had significantly lower rate of transplantation (16.4% vs. 43.6%; p < 0.001), increased overall mortality (46.3% vs. 17.3%, p < 0.001), and increased rates of noncardiac readmission (58.2% vs. 37.3%, p = 0.007). CONCLUSIONS Infections are common following contemporary LVAD implantation and are most commonly non-VAD related. Patients with postoperative infectious complications have significantly reduced rates of transplantation, survival, and freedom from noncardiac readmission.
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Affiliation(s)
- Toby Zhu
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pennsylvania, Pittsburgh, USA
| | - Keith A Dufendach
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pennsylvania, Pittsburgh, USA
| | - Yeahwa Hong
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pennsylvania, Pittsburgh, USA
| | - Floyd W Thoma
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pennsylvania, Pittsburgh, USA
| | - Arman Kilic
- Division of Cardiac Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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23
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Kumar A, Satija S. The choice of palliative arterial switch operation as an alternative for selected cases in a single center: Experience and midterm results. J Card Surg 2022; 37:2502. [PMID: 35488782 DOI: 10.1111/jocs.16566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Arun Kumar
- Ghulam Muhammad Mahar Medical College, Sukkur, Pakistan
| | - Sapna Satija
- Ghulam Muhammad Mahar Medical College, Sukkur, Pakistan
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24
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Satija S, Kumar A. Association between time to therapeutic INR and length of stay following mechanical heart valve surgery. J Card Surg 2022; 37:2501. [PMID: 35488788 DOI: 10.1111/jocs.16562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 04/18/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Sapna Satija
- Ghulam Muhammad Mahar Medical College, Sukkur, Pakistan
| | - Arun Kumar
- Ghulam Muhammad Mahar Medical College, Sukkur, Pakistan
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25
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Djouani A, Smith A, Choi J, Lall K, Ambekar S. Cardiac surgery in the morbidly obese. J Card Surg 2022; 37:2060-2071. [PMID: 35470870 DOI: 10.1111/jocs.16537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/28/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obesity rates globally continue to rise and in turn the body mass index (BMI) of patients undergoing cardiac surgery is set to mirror this. Patients who are Class III obese (BMI ≥ 40) pose significant challenges to the surgical teams responsible for their care and are also at high risk of complications from surgery and even death. To improve outcomes in this population, interventions carried out in the preoperative, operative, and postoperative periods have shown promise. Despite this, there are no defined best practice national guidelines for perioperative management of obese patients undergoing cardiac surgery. AIM This review is aimed at clinicians and researchers in the field of cardiac surgery and aims to form a basis for the future development of clinical guidelines for the management of obese cardiac surgery patients. METHODS The PubMed database was utilized to identify relevant literature and strategies employed at various stages of the surgical journey were analyzed. CONCLUSIONS Data presented identified the benefits of preoperative respiratory muscle training, off-pump coronary artery bypass grafting where possible, and early extubation. Further randomized controlled trials are required to identify optimal operative and perioperative management strategies before the introduction of such guidance into clinical practice.
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Affiliation(s)
- Adam Djouani
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Alexander Smith
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Jeesoo Choi
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Kulvinder Lall
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Shirish Ambekar
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
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26
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Anumolu AR, Panakala S, Kumar S. Letter to the Editor: Outcomes of minimally invasive aortic valve replacement in patients with obese body mass indices. J Card Surg 2022; 37:2503. [PMID: 35471585 DOI: 10.1111/jocs.16568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Akhil R Anumolu
- Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
| | | | - Satesh Kumar
- Shaheed Mohtarma Benazir Bhutto Medical College Liyari, Karachi, Pakistan
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27
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Ku L, Lv H, Ma X. An abscess of mitral aortic intervalvular fibrosa mimicking an intracardiac mass. J Card Surg 2022; 37:2138-2141. [PMID: 35397124 DOI: 10.1111/jocs.16507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Abscess of the mitral-aortic intervalvular fibrosa (MAIVF) is a rare occurrence, with its most frequently described causative associations being active or prior endocarditis, prosthetic valves, or native valves with anomalies. We report a case of infective endocarditis (IE) complicated by an abscess of the MAIVF without valvular involvement. This case highlights the importance of this rare clinical entity and of the multimodality imaging approach in reaching an accurate diagnosis and differential diagnosis. METHODS AND RESULTS A 35-year-old male presented with fatigue and intermittent high-grade fever for a 2-week duration. IE was suspected based on a clinical exam. Transthoracic echocardiography (TTE) demonstrated heterogeneous mass with a size of about 2.9 cm × 2.3 cm coming from the MAIVF, mimicking an intracardiac mass. Color Doppler flow Imaging showed the mass without communication with the surrounding cardiovascular cavities. Cardiac computed tomography angiography (CCTA) revealed a large low-density mass without any enhancement, which was situated adjacent to the left ventricular tract with a severely compressed left atrial chamber. The patient underwent cardiac mass removal under extracorporeal circulation. During the procedure, a large abscess was found to be located in MAIVF. The postoperative course was uneventful. DISCUSSION The abscess of MAIVF is a rare entity with a high risk of developing the pseudoaneurysm of MAIVF (p-MAIVF). The periaortic spread of the abscess is a dynamic process in which the inflammation of the deep tissue causes, in the first stage, a MAIVF thickening, which eventually progresses with the formation of an abscess, and subsequently, a pseudoaneurysm. Complications of p-MAIVF include rupture into the left atrium, aorta, or pericardial space leading to hemopericardium, tamponade, and death. The major differential diagnosis for abscess of MAIVF includes p-MAIVF an intracardiac mass. TTE plays a key role in the diagnosis and differential diagnosis of abscesses of MAIVF. CCTA can be a useful adjunct to further characterize abscess spread, three-dimensional spatial relationships with other cardiac structures for preoperative planning, as well as in the evaluation of potential complications such as coronary artery compromise and communication with the aorta, left atrium, or pericardial space. Surgical management is recommended in complicated, symptomatic patients to prevent further expansion of abscesses or pseudoaneurysms. CONCLUSION The abscess of MAIVF is a rare complication of endocarditis and surgical trauma in the MAIVF area, TTE remains a first-line imaging modality for clinically suspected periaortic abscess or other IE complications. CCTA has a complementary role to echocardiography in identification, characterization, and preoperative planning.
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Affiliation(s)
- Leizhi Ku
- Department of Radiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Hang Lv
- Department of Cardiac Function, Wuhan Asia General Hospital, Wuhan, China
| | - Xiaojing Ma
- Department of Echocardiography, Wuhan Asia Heart Hospital, Wuhan, China
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28
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Bansal A, Akhtar F, Desai S, Velasco-Gonzalez C, Bansal A, Teagle A, Shridhar A, Webre K, Ostrow S, Fary D, Parrino PE. Six-month outcomes in postapproval HeartMate3 patients: A single-center US experience. J Card Surg 2022; 37:1907-1914. [PMID: 35385586 PMCID: PMC9320844 DOI: 10.1111/jocs.16452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The European CE Mark approval study and the MOMENTUM 3 trial demonstrated safety and a reduction in hemocompatibility-related adverse events with the use of HeartMate 3 (HM3) device. This single-center study investigated the real-world experience in HM3 patients since FDA approval. METHODS This retrospective, observational study included patients implanted with the HM3 LVAD as a primary implant between October 2017 and March 2020. Patients were divided into trial group and postapproval group. The primary endpoint was survival at 6 months. Secondary endpoints were adverse events including pump thrombosis (requiring pump exchange), stroke, renal failure, acute limb ischemia, re-exploratory for bleeding, gastrointestinal bleeding, right ventricular failure, and driveline infection. RESULTS A total of 189 patients were implanted with HM3 device during the study period. 174 patients met the inclusion criteria: 82 patients in the trial group and 92 patients in the postapproval group. The postapproval group had younger patients, higher preoperative mean international normalized ratio, and greater numbers of patients with bridge to transplant (BTT) indications, IINTERMACS profile 1, and use of mechanical assist devices (other than IABP) than the trial group. Other characteristics between the two groups were comparable. Overall survival at 6 months in the postapproval group was 93.3% versus 93.8% (p = .88). The postapproval group demonstrated a statistically significant lower incidence of re-explorative surgery for bleeding (10.9% vs. 46.3, p = .01) than the trial group. CONCLUSION In this single-center study, the real-world 6-month survival in the postapproval group was comparable to the trial results. Further studies are needed to monitor long-term outcomes.
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Affiliation(s)
- Aditya Bansal
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA.,Faculty of Medicine, Ochsner Clinical School, The University of Queensland, New Orleans, Louisiana, USA
| | - Faisal Akhtar
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Sapna Desai
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Cruz Velasco-Gonzalez
- Center for Applied Health Services Research, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Anirudh Bansal
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Angie Teagle
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Avni Shridhar
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Karen Webre
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Sheila Ostrow
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - David Fary
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Patrick Eugene Parrino
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA.,Faculty of Medicine, Ochsner Clinical School, The University of Queensland, New Orleans, Louisiana, USA
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Velastegui S, Teran A, Raja R. Letter to the Editor: Extracorporeal membrane oxygenation (ECMO) for critically ill patients with coronavirus disease 2019 (COVID-19): A retrospective cohort study. J Card Surg 2022; 37:1800. [PMID: 35338711 PMCID: PMC9115256 DOI: 10.1111/jocs.16436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 12/05/2022]
Affiliation(s)
| | - Ana Teran
- Universidad de las Américas-Ecuador, Quito, Ecuador
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Sainathan S, Agala CB, Said SM, Mulinari L, Sharma MS. National Fontan Operation short-term outcomes at or below 2-years-of-age compared to older than 2-years-of-age. J Card Surg 2022; 37:1567-1573. [PMID: 35324033 DOI: 10.1111/jocs.16424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/20/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Opinion is divided about optimal early timing of the Fontan Operation (FO). While some studies have suggested 3 years-of-age, others have shown good outcomes below 2 years-of-age. We analyzed the impact of age ≤2 years as compared age >2 years on short-term outcome of the FO using a large national database. METHODS A retrospective analysis of the Kids Inpatient Database (2009-16) for the FO was done. The groups were divided into those who underwent FO at age ≤2 years (Early FO [EF]) as compared to age >2 years (Late FO [LF]). The data was abstracted for demographics, clinical characteristics, and operative outcomes. Standard statistical tests were used. RESULTS A total of 3381 patients underwent FO during this period of which 1482 (44%) were EF. The mean ages of the EF and LF were 1.6 and 4.3, respectively (p < .001). LF were more likely to be non-White, female, and have Heterotaxy syndrome. HLHS was more common in EF. There was no difference in the discharge mortality, length of stay, disposition (majority went home), and mean total charges incurred. The overall discharge mortality was low at 0.7% (24/3381). In multivariate analysis: cardiac arrest, acute kidney injury, mechanical ventilation >96 h, endocardial cushion defect and non-White ethnicity were predictors of a mortality and not age. CONCLUSION Contemporary outcomes for FO are excellent with equivalent short-term outcomes in both the age groups. Occurrence of postoperative complications, non-White ethnicity and endocardial cushion defect diagnosis were predictive of a negative outcome.
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Affiliation(s)
- Sandeep Sainathan
- Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of Miami, Coral Gables, Florida, USA.,Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Chris B Agala
- Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sameh M Said
- Department of Surgery, Division of Pediatric Cardiothoracic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Leonardo Mulinari
- Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of Miami, Coral Gables, Florida, USA
| | - Mahesh S Sharma
- Department of Surgery, Section of Pediatric Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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31
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Nadeem B. Letter to the Editor: Utilization and outcomes of postcardiotomy mechanical circulatory support. J Card Surg 2022; 37:1808. [PMID: 35274758 DOI: 10.1111/jocs.16395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 12/01/2022]
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Amabile A, Fereydooni S, Mori M, Hameed I, Jung J, Krane M, Geirsson A. Variable definitions and treatment approaches for atrial functional mitral regurgitation: A scoping review of the literature. J Card Surg 2022; 37:1182-1191. [PMID: 35179258 DOI: 10.1111/jocs.16312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Atrial functional mitral regurgitation (AFMR) is a subtype of functional mitral regurgitation due to longstanding atrial fibrillation (AF) or heart failure with preserved ejection fraction. The variation in AFMR' definition and the common mode of treatment described in the literature remain unknown. METHODS We performed a scoping review of studies that surgically treated AFMR to characterize the existing variability in the definition of AFMR, the type of operations performed for AFMR valvulopathy, and the treatment for the chronic AF. We searched Medline, EMBASE, Cochrane Library, Scopus, and Web of Science since their inceptions for studies of patients affected by AFMR and surgically treated for their valvulopathy. RESULTS Twelve studies (n = 494 patients) met eligibility criteria. All studies excluded patients with signs of left ventricular (LV) dysfunction, but the way additional parameters were used to define AFMR at a more granular level varied across studies: nine studies (75%) used the presence of AF to define their AFMR cohorts, with five (41.2%) requiring a history of AF of >1 year; additionally, the threshold values for the LV ejection fraction differed (45%-55%). Isolated mitral annuloplasty was performed in 96.2% of patients. Broad variability was detected in the proportion of patients undergoing the Cox-Maze procedure (range, 17.8%-79.5%), pulmonary vein isolation (0.0%-66.7%), and left atrial appendage ligation (0.0%-100.0%). CONCLUSIONS AFMR remains variably defined in surgical studies, making comparisons across studies difficult. Mitral annuloplasty was most commonly performed. The proportion of AFMR patients undergoing concomitant procedures for AF varied substantially.
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Affiliation(s)
- Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Soraya Fereydooni
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Makoto Mori
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Irbaz Hameed
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jeenah Jung
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Markus Krane
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Arnar Geirsson
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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33
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Holcomb RM, Ündar A. Are outcomes in congenital cardiac surgery better than ever? J Card Surg 2022; 37:656-663. [PMID: 35023592 DOI: 10.1111/jocs.16225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/06/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Congenital heart disease is the most common congenital defect among infants born in the United States. Within the first year of life, 1 in 4 of these infants will need surgery. Only one generation removed from an overall mortality of 14%, many changes have been introduced into the field. Have these changes measurably improved outcomes? METHODS The literature search was conducted through PubMed MEDLINE and Google Scholar from inception to October 31, 2021. Ultimately, 78 publications were chosen for inclusion. RESULTS The outcome of overall mortality has experienced continuous improvements in the modern era of the specialty despite the performance of more technically demanding surgeries on patients with complex comorbidities. This modality does not account for case-mix, however. In turn, clinical outcomes have not been consistent from center to center. Furthermore, variation in practice between institutions has also been documented. A recurring theme in the literature is a movement toward standardization and universalization. Examples include mortality risk-stratification that has allowed direct comparison of outcomes between programs and improved definitions of morbidities which provide an enhanced framework for diagnosis and management. CONCLUSIONS Overall mortality is now below 3%, which suggests that more patients are surviving their interventions than in any previous era in congenital cardiac surgery. Focus has transitioned from survival to improving the quality of life in the survivors by decreasing the incidence of morbidity and associated long-term effects. With the transformation toward standardization and interinstitutional collaboration, future advancements are expected.
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Affiliation(s)
- Ryan M Holcomb
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA.,Surgery, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA
| | - Akif Ündar
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA.,Biomedical Engineering, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA
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34
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Pahwa S. Pericardiectomy for constrictive pericarditis after mediastinal irradiation-Need for functional assessment. J Card Surg 2022; 37:706. [PMID: 34997779 DOI: 10.1111/jocs.16218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Siddharth Pahwa
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky, USA
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35
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Masiello P, Mastrogiovanni G, Presutto O, Chivasso P, Bruno VD, Colombino M, Miele M, Cafarelli F, Leone R, Triggiani D, Iesu S. Frozen elephant trunk procedure for complex aortic arch surgery: The Salerno experience with Thoraflex hybrid. J Card Surg 2021; 37:107-114. [PMID: 34662451 PMCID: PMC9297964 DOI: 10.1111/jocs.16086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/06/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022]
Abstract
Background and Aim of the Study To report early clinical outcomes of the frozen elephant trunk (FET) technique for the treatment of complex aortic diseases after transition from conventional elephant trunk. Methods A single‐center, retrospective study of patients who underwent hybrid aortic arch and FET repair for aortic arch and/or proximal descending aortic aneurysms, acute and chronic Stanford type A aortic dissection with arch and/or proximal descending involvement, Stanford type B acute and chronic aortic dissections with retrograde aortic arch involvement. Results Between December 2017 and May 2020, 70 consecutive patients (62.7 ± 10.6 years, 59 male) were treated: 41 (58.6%) for emergent conditions and 29 (41.4%) for elective. Technical success was 100%. In‐hospital mortality was 14.2% (n = 12, 17.1% emergent vs. 10.3% elective, P = NS); 2 (2.9%) major strokes; 1 (1.4%) spinal cord injury. Mean follow‐up was 12.5 months (interquartile range, 3.7–22.3). Overall survival at 3, 6, 12, and 24 months was 90% (95% confidence interval [CI], 83.2—97.3), 85.6% (95% CI, 77.7–94.3), 79.1% (95% CI, 69.9–89.5), 75.6% (95% CI, 65.8–86.9) and 73.5% (95% CI, 63.3–85.3). There were no aortic re‐interventions and no distal stent graft‐induced new entry (dSINE); 5 patients with residual type B dissection underwent TEVAR completion. Conclusions In a real‐world setting, FET with Thoraflex Hybrid demonstrated feasibility and good clinical outcomes, even in emergent setting. Our implant technique optimize cerebral perfusion reporting good results in terms of neurological complications. Techniques to perfect the procedure and to reduce remaining risks, and consensus on considerations such as standardized cerebral protection need to be reported.
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Affiliation(s)
- Paolo Masiello
- Department of Emergency Cardiac Surgery, Cardio-Thoracic-Vascular, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Generoso Mastrogiovanni
- Department of Emergency Cardiac Surgery, Cardio-Thoracic-Vascular, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Oreste Presutto
- Department of Emergency Cardiac Surgery, Cardio-Thoracic-Vascular, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Pierpaolo Chivasso
- Department of Emergency Cardiac Surgery, Cardio-Thoracic-Vascular, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | | | - Mario Colombino
- Department of Emergency Cardiac Surgery, Cardio-Thoracic-Vascular, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Mario Miele
- Department of Emergency Cardiac Surgery, Cardio-Thoracic-Vascular, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Francesco Cafarelli
- Department of Emergency Cardiac Surgery, Cardio-Thoracic-Vascular, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Rocco Leone
- Department of Emergency Cardiac Surgery, Cardio-Thoracic-Vascular, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Donato Triggiani
- Department of Emergency Cardiac Surgery, Cardio-Thoracic-Vascular, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Severino Iesu
- Department of Emergency Cardiac Surgery, Cardio-Thoracic-Vascular, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
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36
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Head WT, Paladugu N, Kwon JH, Gerry B, Hill MA, Brennan EA, Kavarana MN, Rajab TK. Adhesion barriers in cardiac surgery: A systematic review of efficacy. J Card Surg 2021; 37:176-185. [PMID: 34661944 DOI: 10.1111/jocs.16062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/03/2021] [Accepted: 10/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Postoperative pericardial adhesions have been associated with increased morbidity, mortality, and surgical difficulty. Barriers exist to limit adhesion formation, yet little is known about their use in cardiac surgery. The study presented here provides the first major systematic review of adhesion barriers in cardiac surgery. METHODS Scopus and PubMed were assessed on November 20, 2020. Inclusion criteria were clinical studies on human subjects, and exclusion criteria were studies not published in English and case reports. Risk of bias was evaluated with the Cochrane Risk of Bias Tool. Barrier efficacy data was assessed with Excel and GraphPad Prism 5. RESULTS Twenty-five studies were identified with a total of 13 barriers and 2928 patients. Polytetrafluoroethylene (PTFE) was the most frequently evaluated barrier (13 studies, 67% of patients) with adhesion formation rate of 37.31% and standardized tenacity score of 26.50. Several barriers had improved efficacy. In particular, Cova CARD had a standardized tenacity score of 15.00. CONCLUSIONS Overall, the data varied considerably in terms of study design and reporting bias. The amount of data was also limited for the non-PTFE studies. PTFE has historically been effective in preventing adhesions. More recent barriers may be superior, yet the current data is nonconfirmatory. No ideal adhesion barrier currently exists, and future barriers must focus on the requirements unique to operating in and around the heart.
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Affiliation(s)
- William T Head
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Namrata Paladugu
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jennie H Kwon
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brielle Gerry
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Morgan A Hill
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily A Brennan
- Department of Research & Education Services (Libraries), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Minoo N Kavarana
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Taufiek K Rajab
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Degner BC, Akhter SA, Allman RD, Rogers AL, Popowicz P, Fang X, Bell RA, Bates MJ. Response to Letter to the Editor-Analysis of racial disparities in acute type A aortic dissection repair at a rural tertiary academic medical center. J Card Surg 2021; 37:263-264. [PMID: 34643291 DOI: 10.1111/jocs.16071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Benjamin C Degner
- Department of Cardiothoracic Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
| | - Shahab A Akhter
- Department of Cardiothoracic Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
| | - Robert D Allman
- Department of Cardiothoracic Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
| | - Austin L Rogers
- Department of Cardiothoracic Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
| | - Patrycja Popowicz
- Department of Cardiothoracic Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
| | - Xiangming Fang
- Department of Biostatistics, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
| | - Ronny A Bell
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael J Bates
- Department of Cardiothoracic Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
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Allman RD, Rogers AL, Popowicz P, Fang X, Bell RA, Bates MJ, Akhter SA, Degner BC. Analysis of racial disparities in acute type A aortic dissection repair at a rural tertiary academic medical center. J Card Surg 2021; 36:4238-4242. [PMID: 34499373 DOI: 10.1111/jocs.15971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/04/2021] [Accepted: 08/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND To determine if racial disparities exist between African Americans (AA) and Non-Hispanic Whites (NHW) for patients undergoing repair of acute type A aortic dissection (ATAAD) at a rural tertiary academic medical center. METHODS There were 215 consecutive AA and NHW patients who underwent ATAAD repair at our institution from 1999 to 2019 included in a retrospective analysis of our Society of Thoracic Surgeons Adult Cardiac Surgery Database. Statistical analysis was performed with a p value of less than .05 considered statistically significant. RESULTS Patients undergoing ATAAD repair were 47% AA despite comprising only 27% of the total population in our region. AAs were significantly younger (54.0 vs. 61.2 years), were more likely to be hypertensive (94.1% vs. 79.7%), had higher creatinine levels (1.7 vs. 1.1 mg/dL), and higher body mass index (30.8 vs. 28.1 kg/m2 ) (all p values < .006). There were no significant differences in type of repair or intraoperative variables. A logistic regression analysis showed AAs had an increased rate of postoperative acute renal failure not requiring hemodialysis when compared to NHWs (20.8% vs. 10.6%, p value = .042). Thirty-day mortality was not significantly different (15.7% vs. 13.4%) nor was 1-year survival (78% vs. 79%) in AAs and NHWs, respectively. CONCLUSIONS Despite AAs having more medical comorbidities at presentation, there were no differences in short- and intermediate-term survival. In our catchment of 1.8 million people, AAs appear to undergo ATAAD repair at a disproportionate rate versus NHWs. These findings may alter strategies for surveillance and prevention of aortic disease in this high-risk population.
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Affiliation(s)
- Robert D Allman
- Department of Cardiothoracic Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
| | - Austin L Rogers
- Department of Cardiothoracic Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
| | - Patrycja Popowicz
- Department of Cardiothoracic Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
| | - Xiangming Fang
- Department of Biostatistics, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
| | - Ronny A Bell
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael J Bates
- Department of Cardiothoracic Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
| | - Shahab A Akhter
- Department of Cardiothoracic Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
| | - Benjamin C Degner
- Department of Cardiothoracic Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
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McGiffin DC, Cumming G, Myles PS. The frequent insignificance of a "significant" p-value. J Card Surg 2021; 36:4322-4331. [PMID: 34477260 DOI: 10.1111/jocs.15960] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
Null hypothesis significance testing (NHST) and p-values are widespread in the cardiac surgical literature but are frequently misunderstood and misused. The purpose of the review is to discuss major disadvantages of p-values and suggest alternatives. We describe diagnostic tests, the prosecutor's fallacy in the courtroom, and NHST, which involve inter-related conditional probabilities, to help clarify the meaning of p-values, and discuss the enormous sampling variability, or unreliability, of p-values. Finally, we use a cardiac surgical database and simulations to explore further issues involving p-values. In clinical studies, p-values provide a poor summary of the observed treatment effect, whereas the three-number summary provided by effect estimates and confidence intervals is more informative and minimizes over-interpretation of a "significant" result. p-values are an unreliable measure of the strength of evidence; if used at all they give only, at best, a very rough guide to decision making. Researchers should adopt Open Science practices to improve the trustworthiness of research and, where possible, use estimation (three-number summaries) or other better techniques.
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Affiliation(s)
- David C McGiffin
- Department of Cardiothoracic Surgery, Alfred Hospital, Monash University, Melbourne, Australia
| | - Geoff Cumming
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Paul S Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Monash University, Melbourne, Australia
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Sweeney JC, Smith SA, Avula D, Trivedi JR, Slaughter MS, Ganzel BL. Aortic root replacement with Medtronic Freestyle bioprosthesis: 25-year experience. J Card Surg 2021; 36:4038-4042. [PMID: 34386993 DOI: 10.1111/jocs.15910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Stentless porcine bioprothesis is a surgical strategy to treat aortic root disease. Use has been limited due to the concern for long-term valve degeneration. This study evaluated the perioperative and late outcomes of patients with aortic root disease requiring root replacement. METHODS A total of 409 patients underwent aortic root replacement by a single surgeon using a stentless porcine bioroot between February 1996 and May 2020. The cohort was divided into two groups (age ≤65 and >65 years). Descriptive statistics were used to analyze the data and Kaplan-Meier curves used to evaluate long-term outcomes. RESULTS Patients age >65 years were more likely to be female (p = .01), have hypertension (p = .01), require circulatory arrest (p = .01), and have concomitant coronary artery bypass grafting (CABG) (p = .04). Baseline creatinine >1.8 (p = .20), diabetes (p = .06), and ejection fraction (p = .20) were similar between groups. The 1-, 5-, and 10-year survival for patients age ≤65 years were 92%, 87%, and 69%, respectively, significantly better than patients age >65 (88%, 73%, and 43%, respectively) (p < .01, Figure 1). The 1-, 5-, and 10-year freedom from reoperation for patients ≤65 years were 99%, 97%, and 93% versus 99%, 98%, and 96% in patients age >65 years, respectively (p = .24). CONCLUSION Patients with aortic root disease can be treated with acceptable perioperative outcomes, long-term survival, and low reoperation rates using a stentless porcine bioprothesis. It should be considered irrespective of age due to its excellent durability and freedom from anti-coagulation requirement.
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Affiliation(s)
- Joseph C Sweeney
- Department of General Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Susan A Smith
- Department of General Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Divya Avula
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Jaimin R Trivedi
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Mark S Slaughter
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Brian L Ganzel
- Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky, USA
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41
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Garcia LR, Brito FDS, Felicio ML, Garzesi AM, Tardivo MT, Polegato BF, Minicucci MF, Zornoff LAM. Clinical trials in cardiac xenotransplantation: Are we ready to overcome barriers? J Card Surg 2021; 36:3796-3801. [PMID: 34137071 DOI: 10.1111/jocs.15747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/25/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
Heart allotransplantation has become one of the methods of choice in the treatment of severe heart failure. In the face of its difficulties, such as the unmet balance between organ supply and demand, the use of xenotransplantation (XTx) might be an attractive option shortly, even more with the ongoing progress achieved regarding the avoidance of hyperacute rejection and primary organ disfunction, maintenance of xenograft function and control of xenograft growth. To make possible this translational challenge, some points must be taken into account indeed, and they are the equipoise of human benefit and animal suffering, the risk of unknown infections, a well prepared informed consent, ethical and religious beliefs, and the role of cardiac XTx in a ventricular assistance device era.
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Affiliation(s)
- Leonardo Rufino Garcia
- Department of Surgery, Universidade Estadual Paulista-UNESP, SP, São Paulo, São Paulo, Brazil
| | - Flavio de Souza Brito
- Department of Surgery, Universidade Estadual Paulista-UNESP, SP, São Paulo, São Paulo, Brazil
| | - Marcello Laneza Felicio
- Department of Surgery, Universidade Estadual Paulista-UNESP, SP, São Paulo, São Paulo, Brazil
| | - André Monti Garzesi
- Department of Surgery, Universidade Estadual Paulista-UNESP, SP, São Paulo, São Paulo, Brazil
| | - Márcia Terezinha Tardivo
- Department of Internal Medicine, Universidade Estadual Paulista-UNESP, SP, São Paulo, São Paulo, Brazil
| | - Bertha Furlan Polegato
- Department of Internal Medicine, Universidade Estadual Paulista-UNESP, SP, São Paulo, São Paulo, Brazil
| | - Marcos Ferreira Minicucci
- Department of Internal Medicine, Universidade Estadual Paulista-UNESP, SP, São Paulo, São Paulo, Brazil
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Gazendam AM, Popovic S, Munir S, Parasu N, Wilson D, Ghert M. Synovial Sarcoma: A Clinical Review. ACTA ACUST UNITED AC 2021; 28:1909-20. [PMID: 34069748 DOI: 10.3390/curroncol28030177] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 01/26/2023]
Abstract
Synovial sarcomas (SS) represent a unique subset of soft tissue sarcomas (STS) and account for 5–10% of all STS. Synovial sarcoma differs from other STS by the relatively young age at diagnosis and clinical presentation. Synovial sarcomas have unique genomic characteristics and are driven by a pathognomonic t(X;18) chromosomal translocation and subsequent formation of the SS18:SSX fusion oncogenes. Similar to other STS, diagnosis can be obtained from a combination of history, physical examination, magnetic resonance imaging, biopsy and subsequent pathology, immunohistochemistry and molecular analysis. Increasing size, age and tumor grade have been demonstrated to be negative predictive factors for both local disease recurrence and metastasis. Wide surgical excision remains the standard of care for definitive treatment with adjuvant radiation utilized for larger and deeper lesions. There remains controversy surrounding the role of chemotherapy in the treatment of SS and there appears to be survival benefit in certain populations. As the understanding of the molecular and immunologic characteristics of SS evolve, several potential systematic therapies have been proposed.
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Smith A, Balmforth D, Treibel TA, Lall K, Oo A, Ambekar S. Cardiac amyloidosis in non-transplant cardiac surgery. J Card Surg 2021; 36:2901-2910. [PMID: 33993535 DOI: 10.1111/jocs.15629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/30/2022]
Abstract
Cardiac amyloidosis is a rare infiltrative cardiomyopathy that portends a poor prognosis. There is a growing recognition of co-existent aortic valve stenosis and transthyretin cardiac amyloidosis, with some studies suggesting that dual pathology may be associated increased risk of complication and mortality during surgical intervention. This review aims to evaluate the available literature on non-transplant cardiac surgical interventions in patients with cardiac amyloidosis, with particular focus on diagnosis, high surgical risk and areas of uncertainty that require further research.
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Affiliation(s)
- Alex Smith
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK.,Queen Mary University of London, London, UK
| | - D Balmforth
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - T A Treibel
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK.,Institute for Cardiovascular Sciences, University College London, London, UK
| | - Kulvinder Lall
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Aung Oo
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Shirish Ambekar
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
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Balmforth D, Dimagli A, Benedetto U, Uppal R. Fifty years of the pericardial valve: Long-term results in the aortic position. J Card Surg 2021; 36:2865-2875. [PMID: 33982282 DOI: 10.1111/jocs.15604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/23/2021] [Accepted: 04/18/2021] [Indexed: 11/26/2022]
Abstract
It is now 50 years since the development of the first pericardial valve in 1971. In this time significant progress has been made in refining valve design aimed at improving the longevity of the prostheses. This article reviews the current literature regarding the longevity of pericardial heart valves in the aortic position. Side by side comparisons of freedom from structural valve degeneration are made for the valves most commonly used in clinical practice today, including stented, stentless, and sutureless valves. Strategies to reduce structural valve degeneration are also discussed including methods of tissue fixation and anti-calcification, ways to minimise mechanical stress on the valve, and the role of patient prosthesis mismatch.
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Affiliation(s)
| | | | | | - Rakesh Uppal
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
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45
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Rushakoff JA, Polyak A, Caron J, Parrinella K, Salabat R, Wong M, Emerson D. A case of a pregnant patient with COVID-19 infection treated with emergency c-section and extracorporeal membrane oxygenation. J Card Surg 2021; 36:2982-2985. [PMID: 33974311 PMCID: PMC8242885 DOI: 10.1111/jocs.15623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/29/2021] [Accepted: 05/01/2021] [Indexed: 12/25/2022]
Abstract
Coronavirus disease 2019 (COVID‐19) causes the development of severe acute respiratory distress syndrome. Pregnant women may be at increased risk for the development of severe disease. We present the case of a pregnant patient who developed respiratory failure due to COVID‐19 and rapidly decompensated requiring intubation. Despite mechanical ventilation, the patient's respiratory status continued to worsen. At bedside, cardiothoracic surgeons, obstetricians, intensivists, and neonatologists discussed balancing the risk of COVID‐19 and respiratory failure to the patient, premature delivery to the neonate, potential coagulopathy associated with COVID‐19, and the need for anticoagulation with mechanical circulatory support. Ultimately, the decision was to proceed with emergency cesarean section delivery in the intensive care unit followed by peri‐partum veno‐venous extracorporeal membrane oxygenation initiation. The patient and neonate were both discharged home in stable condition.
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Affiliation(s)
- Joshua A Rushakoff
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Alexander Polyak
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jayne Caron
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kristin Parrinella
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Reza Salabat
- Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Melissa Wong
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dominic Emerson
- Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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46
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Jiang Y, Wang C, Jiang X, Chen S. Is surgery necessary for adults with isolated interrupted aortic arch?: Case series with literature review. J Card Surg 2021; 36:2467-2475. [PMID: 33844339 DOI: 10.1111/jocs.15525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/31/2021] [Accepted: 02/10/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIM Interrupted aortic arch (IAA) is defined as a complete interruption of aortic lumen between the ascending and descending aorta. It is an uncommon and complicated congenital heart disease. It is rare for patients with isolated IAA to survive to adulthood without operation. Here we present three rare cases with isolated IAA together with a review of the literature of IAA. Besides, we reviewed reported adult cases with isolated IAA in the last 20 years and summarized the relevant data of the isolated type. METHODS We retrospectively searched the hospital databases for adult patients with isolated IAA diagnosed at the Wuhan Union Hospital over the past 10 years. Cases related to adult isolated IAA published in last 20 years were identified by searching Pubmed. RESULTS Three adult patients with isolated IAA were identified. Two were referred to us for hypertension management and were diagnosed with IAA. They declined surgical treatments and took antihypertensive medications. One patient was referred to our hospital for further treatment options after diagnosed with IAA at another hospital. He received an extra-anatomic bypass surgery. But his hypertension did not well resolve after surgery, and was subsequently managed by anti-hypertensives medications. 25 published adult patients with isolated IAA were identified in Pubmed and relevant details were summarized. CONCLUSIONS Adult patients with isolated IAA usually have extensive collateral vessels joining the descending aorta. Anti-hypertensives medical management with long-term follow-up appears to be a reasonable treatment option for these patients, although surgical intervention is a good choice.
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Affiliation(s)
- Yefan Jiang
- Department of Cardiovascular Surgery and Heart Transplantation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chen Wang
- Department of Cardiovascular Surgery and Heart Transplantation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xionggang Jiang
- Department of Cardiovascular Surgery and Heart Transplantation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Si Chen
- Department of Cardiovascular Surgery and Heart Transplantation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Abstract
BACKGROUND Although aortic valve replacement (AVR) has been the standard of treatment for severe aortic stenosis, a small aortic annulus (SAA) poses significant challenges. Improvements in valve designs and evolution in surgical techniques have led to improved outcomes, however, the ideal prosthetic valve remains elusive. METHODS We performed a comprehensive literature review to discuss the surgical management of aortic stenosis, with a special focus on patients with SAA. RESULTS Stentless valves and root replacement techniques have been shown to overcome the hemodynamic challenges associated with conventional stented bioprostheses, but are technically challenging and require longer cross-clamp times. Sutureless and rapid deployment valves mitigate the long operative time while maintaining the hemodynamic advantages. The use of transcatheter AVR has emerged as another reasonable alternative and has shown promise among patients with SAA, however, long-term outcomes are awaited. CONCLUSION There is no consensus regarding the type of valve prosthesis or replacement technique among patients with SAA. Consideration of patient comorbidities and valvular anatomy is paramount in planning the optimal strategy for AVR. Further long-term clinical trials are necessary to assess outcomes and achieve progress toward the development of the ideal prosthesis.
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Affiliation(s)
- Yash P Vaidya
- Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Shaelyn M Cavanaugh
- Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Aqeel A Sandhu
- Department of Cardiothoracic Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
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48
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Resch JC, Said SM, Steiner ME, Somani A. Hirudotherapy for neonatal limb ischemia during ECMO support: A word of caution. J Card Surg 2021; 36:2549-2557. [PMID: 33811665 DOI: 10.1111/jocs.15539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Disordered coagulation, clot formation and distal limb ischemia are complications of extracorporeal membrane oxygenation (ECMO) with significant morbidity and mortality. Medicinal leech therapy (hirudotherapy) has been attempted in plastic and orthopedic surgeries to improve venous congestion and salvage ischemic flaps. To our knowledge this has not been reported in pediatric cardiac surgery or during ECMO support. We present a complex neonate whose ECMO course was complicated by distal limb ischemia for whom leech therapy was attempted. PATIENT AND INTERVENTION A 2-week-old 2.7 kg infant required ECMO support secondary to perioperative multiorgan system dysfunction following repair of critical coarctation and ventricular septal defect. Despite systemic anticoagulation, his clinical course was complicated by arterial thrombus, vasopressor-induced vascular spasm and bilateral distal limb ischemia. Medicinal leech therapy was tried after initially failing conventional measures. RESULT Following the third leech application, this patient developed significant hemorrhage from the web space adjacent to the left great toe. An estimated 450 ml of blood loss occurred and more than 300 ml of blood product transfusions were required. He ultimately progressed to irreversible systemic end organ dysfunction and comfort care was provided. CONCLUSION The use of medicinal leech therapy in pediatric cardiac surgery may be considered to minimize the consequences of advanced limb ischemia and venous congestion. However, this should be used with caution while patients are systemically anticoagulated during ECMO support. A directed review is presented here to assist in determining optimal application and potential course of therapy.
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Affiliation(s)
- Joseph C Resch
- Department of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Sameh M Said
- Department of Pediatric Cardiac Surgery, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Marie E Steiner
- Department of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Arif Somani
- Department of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
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Ahmed A, Levy KH. Valve-in-valve transcatheter aortic valve replacement versus redo surgical aortic valve replacement: A systematic review and meta-analysis. J Card Surg 2021; 36:2486-2495. [PMID: 33797799 DOI: 10.1111/jocs.15546] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/09/2021] [Accepted: 03/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND/AIM With the growing contemporary use of bioprosthetic valves, whose limited long-term durability has been well-documented, an increase in the need for reintervention is expected. We perform a meta-analysis to compare the current standard of care, redo surgical aortic valve replacement (Redo SAVR) with the less invasive alternative, valve-in-valve transcatheter aortic valve replacement (ViV TAVR) for treating structural valve deterioration. METHODS After a comprehensive literature search, studies comparing ViV TAVR to Redo SAVR were pooled to perform a pairwise meta-analysis using the random-effects model. Primary outcomes were 30-day and follow-up mortality. RESULTS A total of nine studies including 9127 patients were included. ViV TAVR patients were significantly older (mean difference [MD], 5.82; p = .0002) and more frequently had hypercholesterolemia (59.7 vs. 60.0%; p = .0006), coronary artery disease (16.1 vs. 16.1%; p = .04), periphery artery disease (15.4 vs. 5.7%; p = .004), chronic obstructive pulmonary disease (29.3 vs. 26.2%; p = .04), renal failure (30.2 vs. 24.0%; p = .009), and >1 previous cardiac surgery (23.6 vs. 15.9%; p = .004). Despite this, ViV TAVR was associated with decreased 30-day mortality (OR, 0.56; p < .0001). Conversely, Redo SAVR had lower 30-day paravalvular leak (OR, 6.82; p = .04), severe patient-prosthesis mismatch (OR, 3.77; p < .0001), and postoperative aortic valve gradients (MD, 5.37; p < .0001). There was no difference in follow-up mortality (HR, 1.02; p = .86). CONCLUSIONS Despite having patients with an increased baseline risk, ViV TAVR was associated with lower 30-day mortality, while Redo SAVR had lower paravalvular leak, severe patient-prosthesis mismatch, and postoperative gradients. Although ViV TAVR remains a feasible treatment option in high-risk patients, randomized trials are necessary to elucidate its efficacy over Redo SAVR.
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Affiliation(s)
- Adham Ahmed
- CUNY School of Medicine, New York, New York, USA
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50
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Myatt R. How to take a patient's temperature. Nurs Stand 2021; 36:77-82. [PMID: 33554487 DOI: 10.7748/ns.2021.e11679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
Being able to accurately assess and record a patient's temperature is an essential nursing skill, and should be undertaken as part of a wider systematic assessment of the patient. Any concerns regarding individual recordings or trends should be escalated to other members of the healthcare team as appropriate. REFLECTIVE ACTIVITY: 'How to' articles can support you to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect and write a short account of.
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Affiliation(s)
- Rebecca Myatt
- Guy's and St Thomas' NHS Foundation Trust, London, England
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