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Journal and News Scan
A scholarly metanalytic review on training by surgical simulators. The authors submit that low-fidelity is acceptable, balancing affordable basic inanimate models against the higher cost (and ethics) of zootomy and cadaceric dissection.
Morimura et al. report on mechanical circulatory support bridging prior to repair of ventricular septal rupture. In eight patients, the use of intraaortic balloon pump +/- extracorporeal life support led to avoidance of emergency operation. Survival was 7/8 perioperative and 5/8 after one year. Delayed surgery of ventricular septal rupture by mechanical circulatory support bridging constitutes a safe strategy.
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.
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.
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.