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
In RCTs comparing TAVR and SAVR in low-risk patients, early mortality and stroke were lower in TAVR, but did not differ at 1 year. There was no difference in mortality and stroke in intermediate-risk patients. The Multidisciplinary Heart Team must consider individual patient characteristics and preferences when recommending TAVR or SAVR. The decision must consider the long-term management of each patient’s aortic valve disease.
Malaria and the Heart: JACC State-of-the-Art Review
Although there is a paucity of data regarding cardiac manifestations of malaria, an algorithm for appropriate use of diagnostic tools to assess cardiac involvement has been developed in this paper. Furthermore, it is important to note that typical antimalarial treatment regimens can have fatal cardiac side-effects.
Effect of Hematocrit on the CO2 Removal Rate of Artificial Lungs
In conclusion, the hematocrit level significantly affects vCO2 and should be taken into account when interpreting changes in the vCO2 of an ECCO2R device.
Improving Hemocompatibility: How Can Smart Surfaces Direct Blood To Fight against Thrombi
Our work demonstrates the first report of a coating that self-regulates its fibrinolytic activity depending on the conditions of blood.
Intraoperative Cell Salvage
By reading this article you should be able to:
•Discuss why it may be beneficial to avoid allogeneic (donor) transfusion.
•List the benefits that intraoperative cell salvage (ICS) can provide.
•Identify when ICS usage is both appropriate and safe.
•Explain the complications of ICS.
•Describe areas of controversy relating to the use of ICS.
Computer Vision in the Operating Room: Opportunities and Caveats
Leveraging computer vision approaches through interdisciplinary collaboration and advanced approaches to data acquisition, modeling, interpretation, and integration promises a powerful impact on patient safety, public health, and financial costs.
Viscoelastic Coagulation Monitor as a Novel Device to Assess Coagulation at the Bedside. A Single-Center Experience During the COVID-19 Pandemic
In conclusion, VCM provided reliable results in COVID-19 patients and was easy to perform with minimal training at the bedside.
Impact of Single versus Double Clamp Technique on Blood Lactate Levels and Postoperative Complications in Coronary Artery Bypass Surgery
CPB time, cross-clamp time and numbers of proximal saphenous graft and distal anastomosis showed a significant positive correlation with the postoperative lactate level. In the regression analysis, CPB time emerged as the only independent predictor of PHL (OR 1.04, CI 95% 1.01-1.07, P=0.011). There was no difference in postoperative blood lactate levels between SCT and DCT groups.
Cardiopulmonary Bypass Preparation Is Mandatory in Cardiac Exploration for Blunt Cardiac Injury Patients
This report introduces how such decision was made based on what supporting evidence and the diagnostic process leading to the initiation of surgical intervention. This report may help with decision-making process when confronted by blunt cardiac injury patients who need cardiac exploration.
Feasibility of Healthcare Providers’ Autonomic Activation Recognition in Real-Life Cardiac Surgery Using Noninvasive Sensors
This work supports the possibility to detect real-time SNS activation, which could enable interventions to proactively mitigate errors. Additional studies on our large database of surgical cases are underway to confirm this observation.
Professionalism: Microaggression In the Healthcare Setting
This review offers education on the correlation of microaggression and unconscious bias to health disparities, provides tools to address microaggressions as a bystander, and outlines processes for institutional improvement.
Argatroban Anticoagulation for Adult Extracorporeal Membrane Oxygenation: A Systematic Review
Argatroban infusion rates and anticoagulation target ranges showed substantial variations. The rational for divergent dosing and monitoring approaches are discussed in this paper. Argatroban appears to be a potential alternative to UFH in patients requiring ECMO. To definitively establish its safety, efficacy and ideal dosing strategy, larger prospective studies on well-defined patient populations are warranted.
Cardiopulmonary Bypass in A Child with Severe Factor XII Deficiency
We report the case of a 14.7 kg girl undergoing CPB with a pre-admission FXII concentration of <1% and aPTT >200 seconds. The child was transfused with fresh-frozen plasma to replenish FXII, allowing safe ACT monitoring of heparin anticoagulation throughout CPB.
Heart Transplantation Following Donation After Cardiac Death: History, Current Techniques, And Future
An increasing number of transplant programs use hearts donated after cardiac death. Here we consider the history of donation after cardiac death heart transplantation with the surrounding ethical controversies, outline the different surgical techniques that were developed and conclude with a look into the future.
Lessons Learned From the First Pilot Study of the Compensatory Reserve Index After Congenital Heart Surgery Requiring Cardiopulmonary Bypass
Compensatory Reserve Index monitoring after CHS with CPB seems feasible and safe. Early changes in CRI may precede meaningful clinical outcomes, but this requires further study.
ECMO Combined with Prone Positioning Strategies In COVID-19 Respiratory Distress Syndrome
Previous evidence from similar patient populations proved that carefully selected patients with severe ARDS who did not benefit from conventional treatment might be successfully supported with Veno-Venous extracorporeal membrane oxygenation (V-V ECMO). We now share the case reports of COVID-19 patients with ECMO combined prone position strategies.
Redo Surgery for A Type A Aortic Dissection in A Pregnant Woman with Marfan Syndrome: A Complex Clinical Case
The diagnosis and the treatment of this case, given the mid-term gestational age combined with an increased surgical risk due to the reintervention, required a particular effort by our team. A multidisciplinary approach to the management of this patient was the key to achieve a favorable outcome both for the mother and for the baby.
Red Blood Cell Transfusion Requirements for Patients on Extracorporeal Membrane Oxygenation
Patients without clinical bleeding still required transfusion, with higher rates observed with VA- than VV-ECMO. Transfusion requirements dramatically increased when patients developed various bleeding complications and had a significant impact on 30-day mortality rate.
Reducing Delirium and Cognitive Dysfunction After Off-Pump Coronary Bypass: A Randomized Trial
Performing ANA significantly decreases the incidence of PD and ePOCD compared with “conventional” OPCAB with vein grafts, whereas CO2FF is inconsequential in this regard. These results, which probably reflect decreased delivery of embolic load to the brain in ANA, may have practical applicability in daily practice to improve clinical outcomes.
Updating an Empirically Based Tool for Analyzing Congenital Heart Surgery Mortality
The updated STAT metrics reflect contemporary practice and outcomes. New empirically based STAT 2020 Scores and Category designations are assigned to a larger set of procedure codes, while accounting for risk associated with multiple component operations. Updating STAT metrics based on contemporary outcomes facilitates accurate assessment of case mix.
Prevalence and Nature of Sexist and Racial/Ethnic Microaggressions Against Surgeons and Anesthesiologists
The prevalence of sexist and racial/ethnic microaggressions against female and racial/ethnic–minority surgeons and anesthesiologists was high and associated with physician burnout. This study provides a valuable response to the increasing call for evidence-based data on surgical workplace mistreatment.
Minimal Invasive Extracorporeal Circulation Preserves Coagulation Integrity
MiECC preserves clot quality throughout surgery acting in both key determinants of clot strength; fibrinogen and platelets. This is clinically translated into minimal postoperative bleeding and restricted use of blood products and coagulation factors.
Temperature Management on Cardiopulmonary Bypass: Is It Standardised Across Great Britain And Ireland?
To conclude, the practice of temperature management is changing with the awareness of new research. Lower target temperatures are recommended for rewarming, ensuring a lower temperature gradient and a longer mean rewarming time.
Using A Roller Pump for Establishing Extra-Corporal Membrane Oxygenation (ECMO) – Technical Considerations for Times of Crisis
Roller pumps with silicone tubing but not PVC tubing may be used for running ECMO circuits. Silicone tubing may endure the roller pump shear forces for up to 1 week. Thus, repeated tubing repositioning may be a solution. Circuit heating and substantial limitations in flow detection should increase attention if clinical use in situations of crisis is considered.