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Journal and News Scan
A small meta-analysis suggesting a bemefit of vascular ultrasound for access to the groin vessels in TAVI. The utility of ultrasonography may be extended in access for groin cannulation in aortovascular surgery and ECMO
A comprehensive update on the evidence on the management of acute aortic syndromes, including IMH. Of particular interest is the robust recommendation to bypass non-dedicated aortic centers even to the expense of increased transit time in order to offer management in a Comprehensive Aortic Center (CAC). The femoral cannulation appears to come gradually out of favour. The cerebral perfusion for arch work is proposed to be either ante-or retrograde. Figure 3 is particularly germane to the technical aspects. Visceral malperfusion is again heralded as a poor-outcome situation.
Pakistan has a prevalence of approximately 60,000 births with Congenital Heart Diseases (CHD) each year. With a population of 200 million and only 17 paediatric cardiac surgeons in Pakistan, the current ratio is 0.08 surgeons/milllion. This review outlines the current status and defines the need for significantly more investment in human resources and infrastructure of paediatric cardiac surgery to meet the needs ofpopulation.
There is a lack of reliable data to measure the impact of cardiovascular surgical activities in sub-Saharan Africa (SSA) and to compare with those of the other sub-regions. The Pan African Society of Cardiothoracic Surgery (PASCaTS) proposes development of an African cardiothoracic surgery database with pooled datasets similar to the practice in other continents. This would ideally serve as a working instrument to evaluate the burden of disease and to develop strategies for prevention and treatment of cardiovascular diseases and associated morbidities in these regions, ultimately with improved clincial outcomes.
Based on data of 4203 patients with acute type A dissection in the UK National Adult Cardiac Surgical Audit, Benedetto and associates have identified the following risk factors for operative mortality: age (odds ratio, OR, 1.02), malperfusion (OR 1.79), left ventricular ejection fraction (moderate: OR 1.40; poor: OR 2.83), prior cardiac surgery (OR 2.29), preoperative mechanical ventilation (OR 2.76), preoperative resuscitation (OR 3.36), and concomitant coronary artery bypass grafting (OR 2.29).
A brief but dense editorial included in a compedium on cardioplegia.
The last sentence summarises what many colleagues would think on the matter of single-shot plegia for root surgery.
The Yale database of 1162 patients with ascending aortic aneurysms was queried. Analysis suggested root dilatation was more significant in predicting adverse events than mid -ascending aortic dilatation, with short stature as a serious risk factor. Hinge points at 5.0 and 5.25 cm respectively were identified. The authors suggest these paramenters should be considered as intervention criteria.