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Journal and News Scan
Benedetto et al. looked into machine learning as a tool to predict mortality after cardiac surgery. They analyzed single-center data using prediction models, which were developed based on a neural network technique. They demonstrated in their cohort of more than 28.000 surgeries that machine learning methods did not result in improved prediction of mortality following cardiac surgery.
Mortality in Low-Risk Patients With Aortic Stenosis Undergoing Transcatheter or Surgical Aortic Valve Replacement: A Reconstructed Individual Patient Data Meta-Analysis
Celik et al. present a meta-analysis regarding the outcome of TAVI implantation with respect to the survival six years after the implantation and compared it to the outcome of surgical aortic valve replacement. In their reconstructed individual patient data analysis, they found a significant higher 5-year mortality rate in TAVI patients compared to surgical aortic valve replacement.
This is brief informative review that aids in decision making and provides criteria for early surgery for infective endocarditis in the setting of a neurologic event.
Chemtob et al. present data from the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD). They database out of eight hospitals the recorded data of 1,128 patients. This analysis focused on perioperative stroke, which occurred in 15.7% of all patients and was higher in patients with preoperative cerebral malperfusion, impaired hemodynamics, and in patients who underwent arch replacement. However, as many patients with prior cerebral malperfusion did not develop stroke, this should never be judged as contra-indication for surgery.
Early Infant Symptomatic Patients With Tetralogy of Fallot With Absent Pulmonary Valve: Pulmonary Artery Management and Airway Stabilization
This retrospective observational study of patients undergoing surgical repair for TOF-APV between 2006 and 2018 evaluated the safety of pulmonary artery replacement and aggressive direct airway management at initial definitive repair of cardiac TOF-APV.
An ad hoc interim analysis pursuant to previous publications raising concerns on Paclitaxel DCS in chronic critical and not-critical lower limb ischaemia. The short manuscript requires careful reading to form an individual opinion beyond the relatively simple arithmetics: slightly more deaths in the intervention group. The vasculopathic cohort had a 75% crude overall survival after only 2.5 years.
A brief and readable editorial on the United Kingdom prespective on the global impact of the pandemic to the delivery of cardiovascular care, attempting a semi-quantitative economic appraisal of the problem.
A large RCT with results somewhat supportive of considering a NOAC in the place of warfarin for post operative surgical patients. The study will be weighed against healthcare economical aspects. One question will arise: Why, if there was a subgroup ( the cohort had an average age below 60 years) eceiving lifelong warfarin or equivalent anticoagulation prior to surgery, they did not have a mechanical prosthesis? It is of course possible that local financial constrains impede access to such devices, and bioprostheses were more affordable.
Commentary: Lack of Screening Makes Primary Prevention Most Effective to Reduce the Mortality of Aortic Dissection
A relatively recent, open-access, brief viewpoint on the utility of screening for thoracic aortic pathologies. Although the negative opinion expressed by the author may not be universally accepted, a debate fuelled by data and especially patient-centered cerebrospinal outcomes will certainly be of benefit; evem more so with the spreading of metrics for prediction of acute complications of aortic disease.
This is a comprehensive review of current strategies for monitoring and protection of the brain during aortic arch surgery under hypothermic circulatory arrest.