Journal and News Scan

This study evaluated the safety of low-dose warfarin (target INR 1.8) combined with daily aspirin (75 100 mg) after On-X mechanical aortic valve implantation. The results showed that the composite rate of major bleeding, valve thrombosis, and thromboembolism was significantly lower in the low-dose warfarin group (1.83 percent) compared to the standard-dose warfarin group (5.39 percent), with reductions in major bleeding and total bleeding by 87 percent and 71 percent, respectively. There was no increase in thromboembolic events, and the outcomes were consistent regardless of home or clinic monitoring. These interim findings support the continued safe use of low-dose warfarin and aspirin as a safe anticoagulation strategy for patients with an On-X valve at five years. 

This study investigated the initial experience of two cardiac centers starting their robotic programs evaluating the impact of previous minimally invasive mitral valve surgery (MIMVS) experience on the learning curve. A retrospective analysis was performed on the first consecutive cases using the robotic surgical platform at two European centers, with Center 1 transitioning from conventional surgery and Center 2 transitioning from minithoracotomy MIMVS. The learning process was evaluated using surgical times and a combined primary outcome that included relevant intra- and postoperative results, with the first 62 patients from each center included in the analysis. The turning point at the end of the learning phase was detected at the 60th case in Center 1 and at the 50th in Center 2. Regarding surgical time, the learning curve was steeper in Center 1, with both cardiopulmonary bypass and cross-clamp times overcoming the learning phase after 32 cases, as compared to 16 cases in Center 2. 

The authors aimed to explore the applicability of the benefits of early mobility and ambulation for patients receiving extracorporeal membrane oxygenation (ECMO). This single-center preintervention, post-intervention review, performed at a high-volume center found that 13 out of 46 (28 percent) patients who met safety criteria ambulated from January through March 2021, compared to 14 out of 147 (10 percent) in historical controls. The authors note important considerations for devising similar protocols given the limited evidence available to date. Strategies employed by the interprofessional team included mobility discussions during rounds, the development of an ambulation safety checklist, clear expectations for providers during ambulation, and documentation to evaluate tolerance. Through standardized assessment and protocol intervention, progressive ambulation can be safely offered to some patients receiving ECMO. 

This prospective randomized trial assessed whether noninvasive ventilation (NIV) before and after cardiac surgery reduces the incidence of acute pulmonary and cardiac failure in high-risk patients. A total of 216 adult patients at risk of postoperative complications were assigned to either NIV for five days pre- and post-surgery or to standard care alone. The primary outcome was the occurrence of cardio-respiratory failure within one month post-surgery. Results showed that 55.1 percent of the NIV group experienced cardiopulmonary failure, compared to 79.8 percent in the standard care group, with NIV significantly reducing the risk (RR 0.69, p<0.001). The benefit persisted at three months; however, there was no difference in intubation rates or ICU stay duration between the two groups. The use of NIV before and after cardiac surgery could effectively lower the rate of cardiopulmonary failure in high-risk patients.