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Journal and News Scan
In this paper, the objective was to find out the echocardiographic predictors of reoperation for subaortic stenosis. Among 82 patients who initially underwent subaortic stenosis corrective surgery, 30 patients required reoperation. The risk factors were young age, unfavorable left ventricular geometry, interrupted aortic arch, and higher residual left ventricular outflow tract gradient.
An interesting pilot experiment on attempting to quantify the optimum disposition of neochordae in transapical intervention for severe mitral regurgitation.
The authors address appropriate use of the transcatheter clip to treat degenerative mitral regurgitation in elderly low to moderate risk patients. Their analysis shows that the transcatheter approach had slightly higher one year survival (97.6% vs 95.3%) than the surgical group but long-term survival was much worse than the surgical group at five years (34.5% vs 82.2%). This is likely related to a much higher incidence of recurrent >3+ mitral regurgitation in the clip group, 36.9% vs 3.9%. The one caveat was that the STS PROM (interquartile range) was higher in the clip group, 2.99 (2.29 to 4.38) vs 1.64(1.3 to 2.41), which has been shown to correlate with long-term survival.
An important and recent consensus update.
In this systemic review and meta-analysis, the authors compared outcomes of valve-sparing root replacement vs. the Bentall procedure in patients with acute aortic dissection type A. Valve-sparing root replacement was associated with lower risk of early and late mortality compared with the Bentall procedure. However, there was an increased risk of reintervention after valve-sparing root replacement. The authors concluded that valve-sparing root replacement can be performed safely in experienced centers and should be performed especially in young active patients.
Abnormal pulmonary artery bending in the setting of the Lecompte maneuver may affect right ventricular afterload in the absence of stenosis. The authors identified novel measurements related to the curvature of the pulmonary artery branches, and found that they correlated with right ventricular systolic pressures, as measured by contributions of curvature in the pulmonary arteries.
The Hugo system includes a tower, surgeon console, surgical end effectors, and robotic arm carts.
Key aspects of the Hugo system include:
- Modularity — The arms and other parts of the system are modular — and they’re on wheels — allowing for flexibility when it comes to placement and swapping around parts of the system. A surgeon could complete a procedure with an arm, push it out of the way, and start a laparoscopic procedure still using the tower, for example. After the surgery, hospital staff could undrape the system and roll it into a second sterilized and prepped OR so that the surgeon could quickly start a new surgery after a break. Because the arms are modular, a hospital could split up the arms for use in different procedures at the same time.
- Universal use — The tower and its visualization system, generator, processors and endoscope are meant to support both robot-assisted surgery and laparoscopic applications, and even open surgery. The endoscope, for example, is a standard length. The FT10 generator powering the robotic system is the same type of generator powering laparoscopic and open surgery devices.
- Upgradeable — Medtronic designed the system so that health providers can swap in new systems, generators, etc. as they become available, without having to buy an entirely new system. The company also has a pipeline of software applications and features that it will continually roll out.
- An open console — The surgical console design boasts an open architecture with foot pedals so that surgeons can still interact with the patient and OR staff during procedures. At the same time, three-dimensional, high-definition glasses provide an immersive situation.
- Drawing on existing surgical tool expertise — Medtronic is taking advantage of the expertise, know-how, and IP from its existing surgical instrumentation portfolio, which makes sense because the system’s instruments could be a big revenue source for the company. Doctors consulting for the company said today that they also like that the surgical tools are familiar.
Interesting to see the long term curative results of this randomized controlled trial.
Patients undergoing elective or urgent cardiac surgery who were anemic at the time of surgery were compared to a matched population who were not anemic. Anemia was associated with increased mortality during follow-up, but blood transfusion was not associated with mortality.
Open distal anastomosis in the frozen elephant trunk operation is usually performed in aortic arch zone 2 or 3. The authors compared outcomes in patients who underwent zone 2 versus 3 open distal anastomosis. They found that proximallization of the anastomosis simplifies the arch replacement, reducing the visceral ischaemia time.