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Journal and News Scan
Holmgren et al. report the long-term outcome of aortic valve replacement patients for bicuspid or tricuspid aortic valve pathologies within a Swedish cohort. In their analysis, patients with bicuspid valve morphology showed an independent association with improved outcome, even matching the general population´s prognosis.
Amirghofran et al. present a cohort of 21 patients receiving repair of tetralogy of Fallot (ToF) by a new surgical technique using autologous right atrial appendage tissue as a pulmonary valve substitute. This technique was proven feasible with good mid-term results and valve function in patients undergoing ToF repair requiring a PA valve substitute.
This study compared outcomes of mechanical valves, bioprostheses, and homografts patients undergoing an operation for active complex aortic endocarditis.
STAT Mortality Categories (developed 2009) stratify congenital heart surgery procedures into groups of increasing mortality risk to characterize case mix of congenital heart surgery providers. This update of the STAT Mortality Score and Categories is empirically based for all procedures and reflects contemporary outcomes. Cardiovascular surgical operations in the Society of Thoracic Surgeons Congenital Heart Surgery Database (January 1, 2010 – June 30, 2017) were analyzed. In this STAT 2020 Update of the STAT Mortality Score and Categories, the risk associated with a specific combination of procedures was estimated under the assumption that risk is determined by the highest risk individual component procedure. Operations composed of multiple component procedures were eligible for unique STAT Scores when the statistically estimated mortality risk differed from that of the highest risk component procedure. Bayesian modeling accounted for small denominators.
A brief editorial with a clear message on the importance of genomics in tailoring aortic surgery to individual patients' long-term outlook.in bicuspid aortic valve disease in the absence of arch dilatation
The authors conducted a systematic literature review for evidence regarding prone positioning during cardiopulmonary resuscitation (CPR). Three observational or experimental studies determined that systolic blood pressure generated in the prone position was over 20 mmHg higher than supine, tidal volumes were within the recommended range of 6 mL/kg, and a majority of compressions met standard criteria. An additional CT study led to the recommendation for hand positioning at the T7-T9 level in the midline, where the anatomy of the left ventricle is widest. Fourteen case reviews revealed that return of spontaneous circulation was achieved in all cases after a median of 5 minutes, without repositioning the patient. Recommended placement of defibrillator pads are illustrated as bilaterally under the axilla or alternatively, one midline under the left axilla and another above the right scapula. This evidence suggests that prone CPR may generate superior blood flow due the relative stiffness of the costovertebral joint which allows greater exertional force, displacement of the diaphragm and abdominal viscera, but may be more strenuous for the rescuer. It should be noted that all patients in the case reports experienced a witnessed arrest with a secured airway, and CPR was initiated rapidly. While acknowledging that publication bias is likely, the authors conclude it is reasonable to perform CPR in the prone position for several minutes before repositioning. Given the recent increase in prone positioning due to COVID, this report is a timely review that is of great interest to OR and ICU providers.
This article describes midterm results of the Dissected Aorta Repair Through Stent Implantation trial.
This study looks at the relationship between failure to rescue and patient frailty after cardiovascular surgery.
An editorial that may herald the decrease in aspirinization and the rise of ticagrelor monotherapy in Percutaneous stenting of coronary arteries. There might be a peripheral relevance to the group of our patients undergoing urgent surgical revascularisation after failed PCI: the balance of protecting the angioplasty versus minimising peri and postoperative heamorrhage is yet to be achieved.
In this article, Thourani et al present the International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on transcatheter and surgical aortic valve replacement in low- and intermediate-risk patients: A meta-analysis of randomized and propensity-matched studies. The authors conclude with the importance of a multidisciplinary heart team in taking into account each patient and their characteristics and weighing the risk and benefits of TAVR vs. SAVR.