Division Of Cardiac Surgery Research Articles

Long-Term Atrioventricular Block Following Valve Surgery: Electrocardiographic and Surgical Predictors.

Bradyarrhythmia requiring pacemaker implantation among patients undergoing valve surgery may occur even after several years, with unclear predictors. Our aim was to investigate the incidence of pacemaker implantation at different follow-up times and identify associated predictors. We conducted a retrospective study evaluating 1046 consecutive patients who underwent valve surgery at the Cardiac Surgery Division of Bologna University Hospital from 2005 to 2010. During 10 ± 4 years of follow-up, 11.4% of these patients required pacemaker implantation. Interventions on both atrioventricular valves independently predicted long-term pacemaker implantation (SHR 2.1, 95% CI 1.2-3.8, p = 0.014). Preoperative atrioventricular conduction disease strongly predicted long-term atrioventricular block, with right bundle branch block as the major predictor (SHR 7.0, 95% CI 3.9-12.4, p < 0.001), followed by left bundle branch block (SHR 4.9, 95% CI 2.4-10.1, p < 0.001), and left anterior fascicular block (SHR 3.9, 95% CI 1.8-8.3, p < 0.001). Patients undergoing valvular surgery have a continuing risk of atrioventricular block late after surgery until the 12-month follow-up, which was clearly superior to the rate of atrioventricular block observed at long-term. Pre-operative atrioventricular conduction disease and combined surgery on both atrioventricular valves are strong predictors of atrioventricular block requiring pacemaker implantation.

P77 A “GIANT” IN THE PANDORA’S BOX OF PARACARDIAC MASS

Abstract In this case report, we describe a giant coronary aneurysm (CAAs) of the right coronary artery occasionally found in a patient that underwent Bentall procedure 18 years earlier for acute aortic dissection. A 77–year–old man, former smoker, with type II diabetes, hypertension, dyslipidaemia, and obesity, was referred to our echo lab for echocardiography in December 2020. His medical history included anteroseptal non–Q–wave myocardial infarction (1983), type A acute aortic dissection treated with Bentall procedure and implantation of mechanical aortic valve (2002), and reparation of abdominal aortic aneurysm (2003). During the echocardiogram a paracardiac mass was incidentally found, in close contact to the right atrium and with a diameter of 60 mm in A4Ch–view, with the appearance of a cystic formation (Figure A). After a few days, a CT angiography was performed, with evidence of 61.6 mm–sized giant aneurysm located in the proximal right coronary artery, characterised by calcified walls, eccentric thrombosis, and compression of the right atrium (Figure B). The patient was subsequently evaluated by the Cardiac Surgery Division. Conservatively management with regular follow–up was performed, because of the high surgical risk of redo and the lack of symptoms. In November 2022 we performed a follow–up echocardiography with evidence of stability of the size of coronary artery aneurysm (Figure C). CAAs are defined as giant when the diameter of the vessel is greater than 20 mm. These pathological entities are extremely rare, with an incidence rate of 0.02%, and aetiologies are various. The most frequent aetiologies comprehend atherosclerosis (about 50% of cases), congenital (17%), arteritis (e.g., Kawasaki disease), connective tissue disease. Our case is characterised by the occasional diagnosis of CAA 18 years after Bentall Surgery, in absence of inflammatory vessels disease. To the best of our knowledge, It’s the largest giant CAA described in literature after Bentall cardiac surgery. Therefore, cardiologists should consider these rare entities when approaching an incidental echocardiographic finding of paracardiac mass, especially in patients with high burden of atherosclerotic disease. This case report underlines furthermore the importance of an integrated approach in the differential diagnosis of a paracardiac mass.

From Leonardo to the Valsalva graft: the physics behind valve-sparing aortic root replacement.

Journal Article Accepted manuscript From Leonardo to the Valsalva graft: the physics behind valve-sparing aortic root replacement Get access Giacomo Murana, MD, PhD, Giacomo Murana, MD, PhD Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna Corresponding author: Dr. Giacomo Murana, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy. Tel: 0039 051 2143361 Fax: 0039 051 345990. e-mail: g.murana@hotmail.com; giacomo.murana@aosp.bo.it Search for other works by this author on: Oxford Academic PubMed Google Scholar Davide Pacini, MD, PhD Davide Pacini, MD, PhD Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di BolognaDepartment of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Bologna Search for other works by this author on: Oxford Academic PubMed Google Scholar European Journal of Cardio-Thoracic Surgery, ezad094, https://doi.org/10.1093/ejcts/ezad094 Published: 13 March 2023 Article history Received: 06 March 2023 Accepted: 11 March 2023 Published: 13 March 2023

Music therapy for pain and anxiety in patients after cardiac valve replacement: a randomized controlled clinical trial

ObjectiveThis study aimed to assess how listening to music after cardiac valve replacements affected patients' pain, anxiety, and vital signs.MethodIn Fuzhou, China's Fujian Medical University Union Hospital, the cardiac surgery division conducted a randomized controlled clinical experiment. 86 patients were enrolled, and 43 were assigned randomly to each group (control and experimental group). The standard treatment was given to the control group, while the experimental group was given standard treatment + a 15-min music intervention 3 times. Indicators include pain, anxiety and vital signs (respiratory rate, heart rate, and blood pressure).ResultsIn comparison to the control group, the experimental group, over time, demonstrated a statistically substantial decrease in pain, anxiety, systolic blood pressure, heart rate and respiratory rate (all P < 0.001), yet, there were no discernible variations (P > 0.05) in diastolic blood pressure.ConclusionsIn conclusion, these results provide additional proof for using music therapy to minimize cardiac postoperative pain and anxiety, as well as systolic blood pressure, heart rate and respiratory rate. Moreover, it should be regarded as a supplementary treatment for pain and anxiety after cardiac valve replacement and other medical procedures with comparable postoperative pain.

431 LONG-TERM ATRIO-VENTRICULAR BLOCK FOLLOWING VALVE SURGERY: ELECTROCARDIOGRAPHIC AND SURGICAL PREDICTORS

Abstract Background Bradyarrhythmias requiring pacemaker implantation (PM) in patients undergoing valve surgery may occur even after several years. The incidence of PM implantation after valve surgery and its predictors are unclear. Methods A retrospective, monocentric, cohort study was conducted. Consecutive patients undergoing valve surgery at the Division of Cardiac Surgery at the Bologna University Hospital from 2005 to 2010 were enrolled. The primary endpoint of the study was to evaluate the incidence of PM implantation in patients undergoing valve surgery, at different follow-up times, and to evaluate the predictors of PM implantation. Results We included 1046 patients (61.8% male, median age 63 years). Of these 735 (70%) reached a 10 year of follow-up and 11.4% required PM implantation. In single valve surgery, mitral interventions had a higher incidence of PM implantation compared to aortic ones, albeit not significantly different (11% vs 8.1%, HR 1.2, IC 95% 0.6-2.1, p=0.590). Among combined surgery, interventions on both atrioventricular valves doubled the risk compared to those performed on aortic and mitral valves (23.1% vs 12%). Moreover, interventions involving both atrioventricular valves independently predicted PM implantation in the long term (HR 2.0, IC 95% 1.1-3.7, p=0.022). Preoperative atrioventricular conduction disease strongly predicted long-term atrio-ventricular block: right bundle branch block with or without left anterior fascicular block (LAFB) was the major predictor (HR 7.2, IC 95% 2.8-19, p&amp;lt;0.001, HR 6.8, IC 95% 3.9-11.7, p&amp;lt;0.001 respectively), followed by left bundle branch block (HR 5.1, IC 95% 2.6-10.3, p&amp;lt;0.001), LAFB (HR 4.2, IC 95% 1.9-8.9, p&amp;lt;0.001) and a non-specific ventricular conduction delay (HR=3.3, IC 95% 1.3-8.4, p=0.012). Age was also predictive, PM implantation probability increasing at each year-age increase (HR 1.02, IC 95% 1.01-1.04, p=0.022) Conclusions Patients undergoing valvular surgery have a continuing risk of atrioventricular block requiring PM therapy late after surgery; combined surgery on atrio-ventricular valves carries the highest risk, while preoperative atrioventricular conduction disease have different risks of AVB at long-term.

Lower extremity performance predicts length of hospital stay in older candidates to elective cardiac surgery.

Prolonged hospital stay must be considered as risk factor for poor outcomes after cardiac surgery; different variables have been advocated as predictors of in-hospital stay. Nevertheless, most patients requiring prolonged hospital stay are frail older subjects; thus, we hypothesized a significant influence of pre-operative physical performance, as a frailty measure, on in-hospital stay after elective cardiac surgery. In a prospective, single-center, cohort study we enrolled patients aged 75+ years referred to our Division of Cardiac Surgery at Careggi University Hospital, for their first elective cardiac surgery. All participants were preoperatively evaluated by a team composed by a cardiac surgeon, a cardiologist, an anaesthesist, and a geriatrician to assess global cardiac surgery risk; lower extremity performance was measured with the Short Physical Performance Battery-SPPB. A total of 518 patients were included in the study. Mean age was 79.5 ± 3.3 years; 256 (49.4%) were women. Isolated coronary by pass graft was performed in 37 patients (7.1%), isolated valve surgery in 115 (22.0%), and combined cardiac surgery procedures in 366 (70,9%). In a multivariable model, SPPB score was strongly associated with hospital length of stay both as continuous, categorized and dichotomous variable (p < 0.001; p = 0.002; p = 0.002 respectively) in all study population, and in subgroup of patients candidate to cardiac surgery considered by the Society of Thoracic Surgeons calculator score (p = 0.023; p = 0.056; p = 0.013 respectively). Our findings support the use of pre-operative SPPB evaluation before elective cardiac surgery based on the independent ability to predict length of hospital stay.

Editorial introductions.

Current Opinion in Cardiology was launched in 1985. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of cardiology is divided into 14 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Subodh VermaSubodh VermaDr Subodh Verma is an internationally renowned cardiac surgeon-scientist and Professor at the University of Toronto, Canada. He is the Canada Research Chair in Cardiovascular Surgery and a past recipient of the Howard Morgan Award for Distinguished Achievements in Cardiovascular Research and the Royal College of Physicians and Surgeons of Canada Gold Medal in Surgery. He previously served as the Canada Research Chair in Atherosclerosis from 2007–2017. He is an appointee of the American Association of Thoracic Surgeons (AATS) and a member of the College of New Scholars, Artists and Scientists, Royal Society of Canada. According to Google Scholar in December 2020, Dr Verma has an h-index of 107 and his work has been cited over 58,000 times. Dr Verma has published extensively in prestigious journals like the NEJM, Lancet, Circulation, JACC, Nature, and JCI and he is currently an Associate Editor of the European Heart Journal. Dr Verma is an active contributor to Canadian clinical practice guidelines and recently co-authored the recommendations for atrial fibrillation, antiplatelet therapy, heart failure and diabetes; he was a member of the 2018 AATS consensus guidelines committee on bicuspid aortic valve-related aortopathy. Dr Verma has served in various capacities on the American Heart Association Council on Cardiovascular Surgery and Anesthesia since 2008. Dr Verma has leadership roles on seven global heart failure trials in diabetes – DAPA-HF, DELIVER, DETERMINE-A, DETERMINE-B, EMPEROR-Preserved, EMPEROR-Reduced and SOLOIST-WHF. He is also involved in the DAPA ACT HF-TIMI 68, FINEARTS-HF, STEP HFpEF, VESALIUS-CV, DARE-19, SELECT and CLEAR SYNERGY trials. He founded and oversees the CardioLink platform at St Michael's Hospital that is conducting cardiometabolic and surgically oriented RCTs and translational studies. Dr Verma leads a dynamic pre-clinical and translational research team that leverages pre-clinical disease models and clinical trial-derived data to identify novel mediators of cardiovascular and cardiometabolic disease as well as answer timely and relevant healthcare questions. His research has yielded two United States patents and is supported by several national peer-reviewed grants. Bobby YanagawaBobby YanagawaBobby Yanagawa is a surgeon in the Division of Cardiac Surgery, St Michael's Hospital, Canada. He is an Assistant Professor and Program Director, Division of Cardiac Surgery at the University of Toronto, Canada. Dr Yanagawa obtained his BSc and PhD from the University of British Columbia, Canada, and his MD degree and Cardiac Surgery Residency from the University of Toronto. He has completed research fellowships at the University of Wales College of Medicine and at St Michael's Hospital, Toronto, Canada. He completed a clinical fellowship at Mount Sinai Hospital, New York, USA. His clinical and research interests are in surgical revascularization and valvular surgery. Dr Yanagawa has published over 100 peer reviewed papers, 50 reviews and 15 book chapters. He has published in Nature Communications, Nature Medicine, Circulation, Journal of Thoracic and Cardiovascular Surgery and Annals of Thoracic Surgery. He was the AATS 13th Annual C. Walton Lillehei Award winner in 2010.

Increased patency with comparable mortality and revascularization risk: Is the case for no-touch vein harvesting open and shut?

Journal of Cardiac SurgeryVolume 36, Issue 11 p. 4376-4377 COMMENTARY Increased patency with comparable mortality and revascularization risk: Is the case for no-touch vein harvesting open and shut? Makoto Hibino MD, MPH, PhD, Corresponding Author Makoto Hibino MD, MPH, PhD [email protected] orcid.org/0000-0002-0017-8744 Division of Cardiac Surgery, The Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Canada CorrespondenceMakoto Hibino, MD, MPH, PhD, Division of Cardiac Surgery, The Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, 30 Bond St., Toronto, ON M5B 1W8, Canada. Email: [email protected]Search for more papers by this authorNitish K. Dhingra BHSc, Nitish K. Dhingra BHSc Division of Cardiac Surgery, The Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, CanadaSearch for more papers by this authorSubodh Verma MD, PhD, Subodh Verma MD, PhD Division of Cardiac Surgery, The Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, CanadaSearch for more papers by this author Makoto Hibino MD, MPH, PhD, Corresponding Author Makoto Hibino MD, MPH, PhD [email protected] orcid.org/0000-0002-0017-8744 Division of Cardiac Surgery, The Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Canada CorrespondenceMakoto Hibino, MD, MPH, PhD, Division of Cardiac Surgery, The Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, 30 Bond St., Toronto, ON M5B 1W8, Canada. Email: [email protected]Search for more papers by this authorNitish K. Dhingra BHSc, Nitish K. Dhingra BHSc Division of Cardiac Surgery, The Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, CanadaSearch for more papers by this authorSubodh Verma MD, PhD, Subodh Verma MD, PhD Division of Cardiac Surgery, The Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, CanadaSearch for more papers by this author First published: 03 September 2021 https://doi.org/10.1111/jocs.15973Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume36, Issue11November 2021Pages 4376-4377 RelatedInformation

Association of hospital performance measures with readmissions for patients with heart failure: A report from JROAD-DPC study

BackgroundMeasuring quality of care is central to quality improvement. Improving outcomes for heart failure (HF) may relate to hospital care delivery. However, there is limited nationwide data on the relationship between hospital-level HF performance measures and clinical outcomes. MethodsFrom the Japanese Registry of All cardiac and vascular Diseases (JROAD-DPC) database, 83,567 HF patients hospitalised in 731 certificated hospitals in 2014 by the Japanese Circulation Society were analysed. Five performance measures were prescription rate of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, and mineralocorticoid receptor antagonist and measurement rate of echocardiography and B-type natriuretic peptide during hospitalisation. Relationships between these measures and 1-year readmission due to HF were analysed. Composite performance score (CPS) obtained from the five performance measures and outcomes were also analysed. We also investigated the relationships between CPS and hospital structural factors. ResultsFrom the cohort (mean age; 78.2 years, woman 48.4%), HF readmission rate at 1 year was 19.6% (n = 16,368). Readmission rate decreased with higher quartiles of prescription rate in each medication and diagnostic performance rates. The highest CPS group was associated with a 15% risk reduction in HF readmission compared with the lowest CPS group (hazard ratio, 0.85, 95% confidence interval [0.80–0.89], p < 0.001) after covariate adjustment. Several structural factors such as number of cardiology specialists, hospital case volume for HF, and presence of cardiac surgery division were associated with high CPS. ConclusionHigher hospital performance measures for HF were inversely associated with HF readmissions.

Showcasing the lateral approach for robotic aortic and mitral valve surgery: Does one approach fit it all?

Journal of Cardiac SurgeryVolume 36, Issue 10 p. 3860-3861 COMMENTARY Showcasing the lateral approach for robotic aortic and mitral valve surgery: Does one approach fit it all? Andrea Amabile MD, Department of Surgery, Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USASearch for more papers by this authorCaroline M. Komlo MD, Department of Surgery, Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USASearch for more papers by this authorThomas Sloane Guy MD, MBA, Corresponding Author sloane.guy@jefferson.edu orcid.org/0000-0003-0543-306X Department of Surgery, Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA Correspondence Thomas Sloane Guy, MD, MBA, Department of Surgery, Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. Email: sloane.guy@jefferson.eduSearch for more papers by this author Andrea Amabile MD, Department of Surgery, Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USASearch for more papers by this authorCaroline M. Komlo MD, Department of Surgery, Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USASearch for more papers by this authorThomas Sloane Guy MD, MBA, Corresponding Author sloane.guy@jefferson.edu orcid.org/0000-0003-0543-306X Department of Surgery, Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA Correspondence Thomas Sloane Guy, MD, MBA, Department of Surgery, Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. Email: sloane.guy@jefferson.eduSearch for more papers by this author First published: 30 June 2021 https://doi.org/10.1111/jocs.15782Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume36, Issue10October 2021Pages 3860-3861 RelatedInformation

Ultrasound-Guided Long-Axis Versus Short-Axis Femoral Artery Catheterization in Neonates and Infants Undergoing Cardiac Surgery: A Randomized Controlled Study

The objective of the present study was to compare ultrasound-guided long-axis (LAX) and short-axis (SAX) femoral artery catheterization in neonates and infants undergoing cardiac surgery. A single-center, prospective, randomized, single-blinded, controlled study. This study was conducted in the operating room and intensive care unit of the division of cardiac surgery, Mansoura University Children's Hospital, Egypt. Ninety neonates and infants undergoing elective cardiac surgery were enrolled in this study and randomly allocated to ultrasound-guided LAX and SAX groups. Ultrasound-guided femoral artery catheterization was done using either LAX (in-plane) or SAX (out-of-plane) technique. The primary outcome measure was the rate of a successful first puncture. The secondary outcome measures were the rates of mechanical complications, failure rate, time to a successful first, second, and third puncture, total time of catheterization, and imaging time. The first puncture success rate was significantly higher (p=0.048) in the LAX group (34 of 41, 82.9%) than in the SAX group (25 of 41, 60.9%). The mean time to a successful first puncture was significantly shorter (p < 0.001) in the LAX group (153.1 ± 30.1 seconds) than in the SAX group (227.2 ± 48.8 seconds). The total catheterization time was significantly shorter in the LAX group than in the SAX group. There was no significant difference in the rate of complication. With a single experienced operator performing the ultrasound-guided femoral artery cannulation, the LAX technique resulted in a higher first puncture success rate and shorter time to cannulation than the SAX technique.

Leveraging Remote Physiologic Monitoring in the COVID-19 Pandemic to Improve Care After Cardiovascular Hospitalizations.

Leveraging Remote Physiologic Monitoring in the COVID-19 Pandemic to Improve Care After Cardiovascular Hospitalizations.

Surgery for aortic dissection: An international case for universal coverage?

Journal of Cardiac SurgeryVolume 36, Issue 6 p. 2044-2044 INVITED COMMENTARY Surgery for aortic dissection: An international case for universal coverage? Matthew Pichert MD, Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USASearch for more papers by this authorArnar Geirsson MD, orcid.org/0000-0002-8943-9962 Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USASearch for more papers by this authorRoland Assi MD, MMS, Corresponding Author Roland.assi@yale.edu Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USA Correspondence Roland Assi, MD, MMS, Division of Cardiac Surgery, Yale University School of Medicine, 330 Cedar St, Boardman Bldg 225, New Haven, CT 06510, USA. Email: Roland.assi@yale.eduSearch for more papers by this author Matthew Pichert MD, Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USASearch for more papers by this authorArnar Geirsson MD, orcid.org/0000-0002-8943-9962 Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USASearch for more papers by this authorRoland Assi MD, MMS, Corresponding Author Roland.assi@yale.edu Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USA Correspondence Roland Assi, MD, MMS, Division of Cardiac Surgery, Yale University School of Medicine, 330 Cedar St, Boardman Bldg 225, New Haven, CT 06510, USA. Email: Roland.assi@yale.eduSearch for more papers by this author First published: 08 March 2021 https://doi.org/10.1111/jocs.15455Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume36, Issue6June 2021Pages 2044-2044 RelatedInformation

DAMPening Mortality in COVID-19: Therapeutic Insights From Basic Cardiometabolic Studies on S100A8/A9.

DAMPening Mortality in COVID-19: Therapeutic Insights From Basic Cardiometabolic Studies on S100A8/A9.

Teamwork in the time of coronavirus: An MGH experience.

The global pandemic of coronavirus 2019 (COVID‐19) caused by coronavirus has had a profound impact on the delivery of health care in the United States and globally. Boston was among the earliest hit cities in the United States, and within Boston, the Massachusetts General Hospital provided care for more patients with COVID‐19 than any other hospital in the region. This necessitated a massive reallocation of resources and priorities, with a near doubling of intensive care bed capacity and a halt in all deferrable surgical cases. During this crisis, the Division of Cardiac Surgery responded in a unified manner, dealing honestly with the necessity to reduce Intensive Care Unit resource utilization for the benefit of both the institution and our community by deferring nonemergent cases while also continuing to efficiently care for those patients in urgent or emergent need of surgery. Many of the interventions that we instituted have continued to support teamwork as we adapt to the remarkably fluid changes in resource availability during the recovery phase. We believe that the culture of our division and the structure of our practice facilitated our ability to contribute to the mission of our hospital to support the community in this crisis, and now to its recovery. We describe here the challenge we faced in Boston and some of the details of the structure and function of our division.

Blood stream infection and outcomes in recipients of a left ventricular assist device.

Our aim was to investigate associations between blood stream infection [≥1 positive blood culture (BC)] and outcomes in recipients of a left ventricular assist device (LVAD). We retrospectively analysed all adult recipients of a continuous-flow LVAD between 2006 and 2016 at the Division of Cardiac Surgery, Medical University of Vienna (n = 257; devices: Medtronic HeartWare® HVAD®, Abbott HeartMate II®, Abbott HeartMate 3™). The primary outcome was all-cause mortality during follow-up. Secondary outcomes included the risk of stroke and pump thrombus during follow-up as well as the probability of heart transplantation (HTx). Risk factors for the development of ≥1 positive BC were evaluated additionally. The incidence of ≥1 positive BC during the first year of LVAD support was 32.1% [95% confidence interval (CI) 26.4-37.9]. Multivariable Cox proportional cause-specific hazards regression analysis showed that a positive BC was associated with significantly increased all-cause mortality [hazard ratio (HR) 5.51, 95% CI 3.57-8.51; P < 0.001]. Moreover, a positive BC was associated with a significantly increased risk of stroke (HR 2.41, 95% CI 1.24-4.68; P = 0.010). There was no association with the risk of pump thrombus or the probability of HTx. Independent risk factors for a positive BC included preoperative albumin and extracorporeal membrane oxygenation/intra-aortic balloon pump support. Blood stream infection is common and associated with a significantly increased risk of all-cause mortality and stroke at any given time during LVAD support. Effective strategies of prevention and treatment are necessary.

Editorial introductions

Current Opinion in Cardiology was launched in 1985. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of cardiology is divided into 14 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Alan BravermanAlan BravermanDr Braverman is a graduate of the University of Missouri-Kansas City School of Medicine, USA. He completed a residency in internal medicine and cardiology fellowship at Brigham and Women's Hospital and Harvard Medical School, USA, and served as Chief Medical Resident. In 1991, Dr Braverman joined the faculty at Washington University School of Medicine in St. Louis, USA, where he is currently the Alumni Endowed Professor in Cardiovascular Diseases. Dr Braverman is actively involved in the education of students, house staff and fellows at Washington University and serves as a Director of the Inpatient Cardiology Firm at Barnes-Jewish Hospital, USA. He has been awarded Teacher of the Year Award by the internal medicine residents on five occasions, the Clinical Teacher of the Year Award by the Washington University Medical Students Class of 2004, and the Benico Barzilai Teaching Award by the cardiology fellows in 2016, and the Hugh McCullough Award from the American Heart Association. In 2010, Dr Braverman was bestowed the E. Grey Dimond Take Wing Award from the University of Missouri-Kansas City. He is a Clinical Cardiologist and has a particular interest in diseases of the aorta, Marfan syndrome and hereditary aneurysm conditions. He is the Director of the Marfan Syndrome Clinic at Washington University in St. Louis and serves on the Professional Advisory Board and the Board of Directors of the Marfan Foundation. He has been awarded the Antoine Marfan Award from the Marfan Foundation in 2003. Dr Braverman is actively involved in clinical research on Marfan syndrome and related aortic diseases, including genetically triggered aortopathy, aortic dissection, and bicuspid aortic valve aortopathy. Marc RuelMarc RuelDr Marc Ruel is the Michael Pitfield Professor and Chair of the Division of Cardiac Surgery at the University of Ottawa Heart Institute, Canada. His areas of predilection include minimally invasive coronary and valve surgeries, heart transplantation, as well as complex and repeat cardiac operations. He co-developed and taught in several countries minimally invasive multivessel coronary bypass grafting -now frequently performed around the world- and introduced other novel cardiac surgical techniques on the international scene. Dr Ruel established a successful regenerative medicine research program in Ottawa, which has been continuously funded by national funding agencies for over 15 years. He was the recipient of many awards, including the Medal in Surgery from the Royal College of Physicians and Surgeons of Canada, and the Queen Elizabeth II Diamond Jubilee Medal. He led numerous studies and clinical trials on the outcomes of valve and coronary surgery. Dr Ruel has authored more than 300 publications, and written textbooks on Cardiac Surgery Techniques and on Cardiac Regeneration. He is the President-Elect of the Canadian Cardiovascular Society, the Canadian Director of the Society of Thoracic Surgeons, the past-Chairman of the Council on Cardio-Vascular Surgery and Anesthesia at the American Heart Association, and the Surgery Theme Editor for the journal Circulation. Peter H. StonePeter H. StonePeter H. Stone, MD, is a Professor of Medicine at Harvard Medical School, USA, Director of the Vascular Profiling Research Group, a Co-Director of the Center for Clinical Investigation, and Senior Physician at Brigham & Women's Hospital, USA. Dr Stone's research interests are in evaluating and managing patients with acute and chronic coronary artery disease. He is using new in-vivo methodologies to identify areas where human coronary disease will progress to determine if pre-emptive therapeutic strategies may avert adverse cardiac events. He received his undergraduate degree from Princeton University, USA, and his Medical Degree from Cornell University, USA. He completed internal medicine training at the University of California, San Francisco, USA, and then did a clinical cardiology fellowship at Pacific Medical Center in San Francisco, USA. He came to the Peter Bent Brigham Hospital as a Cardiology Research Fellow and he has remained at Brigham and Women's Hospital. He is past President of the Boston Chapter of the American Heart Association, past President of the International Society for Holter and Noninvasive Electrocardiology, and is a Fellow of the American College of Cardiology and the American Heart Association.

Bilateral or unilateral antegrade cerebral perfusion during surgery for acute type A dissection

ObjectiveThe study objective was to investigate outcomes associated with the application of bilateral or unilateral antegrade cerebral perfusion during surgery for acute type A dissection. MethodsPatients who underwent surgery for type A dissection with the application of antegrade cerebral perfusion between 2009 and 2017 at the Division of Cardiac Surgery, Medical University of Vienna were analyzed retrospectively (bilateral antegrade cerebral perfusion: n = 91, 49.5%; unilateral antegrade cerebral perfusion: n = 93, 50.5%). The primary outcome variable was overall survival. Subgroup analyses were performed in patients requiring antegrade cerebral perfusion durations of 50 minutes or more and less than 50 minutes. Secondary outcome variables were 30-day mortality, adverse outcome, permanent and temporary neurologic deficits, renal replacement therapy, prolonged ventilation, intensive care unit stay, and hospital stay. ResultsMultivariable Cox proportional hazards analysis demonstrated no significant association of bilateral antegrade cerebral perfusion with overall survival (hazard ratio, 0.63; 95% confidence interval, 0.34-1.14, P = .126). Propensity score modeling using the method of inverse probability of treatment weighting confirmed this result (hazard ratio, 0.73; 95% confidence interval, 0.33-1.60, P = .428). Bilateral antegrade cerebral perfusion was associated with significantly improved overall survival in patients requiring antegrade cerebral perfusion durations of 50 minutes or more (P = .017). The bilateral antegrade cerebral perfusion and unilateral antegrade cerebral perfusion groups showed comparable rates of secondary outcome variables. ConclusionsIn the present study, bilateral antegrade cerebral perfusion and unilateral antegrade cerebral perfusion are associated with comparable outcomes after surgery for type A dissection. Subgroup analyses suggest that bilateral antegrade cerebral perfusion is associated with superior overall survival in patients requiring antegrade cerebral perfusion durations of 50 minutes or more. An adequately powered prospective randomized controlled trial is required to validate these results.

On the Voyage from Anatomic to Physiologic Guidelines for Coronary Intervention

On the Voyage from Anatomic to Physiologic Guidelines for Coronary Intervention

Role of comprehensive geriatric assessment in low surgical risk older patients with aortic stenosis.

Among elderly with severe aortic stenosis (AS), Comprehensive Geriatric Assessment (CGA) originally contributed to address to transcatheter aortic valve implantation (TAVI) patients not suitable to surgical aortic valve replacement(SAVR). Nevertheless, TAVI has recently been proposed also in lower surgical risk patients. To evaluate predictors of TAVI procedure and clinical outcomes among these patients. For each patient ≥ 65years with severe AS referring to our Cardiac Surgery Division, CGA was performed, including functional and cognitive status, comorbidity burden, frailty, nutritional status, gait speed, hand-grip strength and number of medications. Surgical risk was evaluated according to the Society of Thoracic Surgeons (STS) score (low-risk < 4%). Post-procedural outcomes (30-day survival and post-procedural complications) were obtained by medical records and a one-year follow-up assessed survival, and functional and cognitive performance. Among 154 subjects (mean age 82.9years), 52 were at low-risk according to STS score. 32 patients were addressed to TAVI, 20 to SAVR. Variables significantly associated with TAVI-approach were lower gait speed (p 0.030) and higher number of medications (p 0.015). Short and long-term outcomes did not differ between groups. Among CGA variables, gait speed and number of medications were associated with the decision to perform TAVI instead of SAVR, even in patients at low surgical risk. 30-day and one-year survival and one-year functional and cognitive decline were similar between groups, despite a relevant prevalence of frailty in the TAVI group. We suggest that gait speed and number of medications should be considered in selecting appropriate candidates to TAVI among low surgical risk patients.