Abstract
OBJECTIVES
We introduced statistical twin as aggregates of multiple virtual patients’ data throughout the treatment at any chosen time point. The goal of this manuscript was to provide the ...proof of concept of statistical twin by evaluating the feasibility of detection of distinctive aggregates of patients throughout the perioperative trajectory (prerequisite for development of statistical twin).
METHODS
We used a retrospective validated cohort of all comers with mitral valve disease treated (2014–2020) at a tertiary academic hospital. The end point was overall survival based on the decision of the heart team. We applied two-step cluster analysis to detect distinct aggregated virtual patients throughout the process of care.
RESULTS
The cluster procedure resulted in 5 distant clusters with relatively equal numbers of patients. Effects of the treatment (surgery, transcatheter or optimal medical therapy) on survival were as follows: For optimal medical therapy, the expected survival ranged from 95% to 96% in 30 days to 58% to 75% in 10 years independent of baseline characteristics. However, for transcatheter interventions, the 5-year survival was 60–92% and was dependant on the initial characteristics of the virtual patient. Furthermore, survival following an uncomplicated operation of normal duration was higher through all observation periods. The aggregated virtual patients of cluster 5 would have a better survival rate at all times if the intervention were done by a dedicated surgeon.
CONCLUSIONS
It is possible to detect distinctive aggregates of virtual patients based on baseline characteristics and to capture the impact of perioperative events and external and other factors at multiple time points throughout the postoperative phase.
The guiding principle in the allocation of treatment for cardiovascular interventions is risk assessment, which is based primarily on the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the Society of Thoracic Surgeons (STS) score 1, 2.
Background
The management of concomitant valvular lesions in patients undergoing left ventricular assist device (LVAD) implantation remains a topic of debate. This systematic review and meta‐analysis ...aimed to evaluate the existing evidence on postoperative outcomes following LVAD implantation, with and without concomitant MV surgery.
Methods
A systematic database search was conducted as per PRISMA guidelines, of original articles comparing LVAD alone to LVAD plus concomitant MV surgery up to February 2023. The primary outcomes assessed were overall mortality and early mortality, while secondary outcomes included stroke, need for right ventricular assist device (RVAD) implantation, postoperative mitral valve regurgitation, major bleeding, and renal dysfunction.
Results
The meta‐analysis included 10 studies comprising 32 184 patients. It revealed that concomitant MV surgery during LVAD implantation did not significantly affect overall mortality (OR:0.83; 95% CI: 0.53 to 1.29; p = 0.40), early mortality (OR:1.17; 95% CI: 0.63 to 2.17; p = 0.63), stroke, need for RVAD implantation, postoperative mitral valve regurgitation, major bleeding, or renal dysfunction. These findings suggest that concomitant MV surgery appears not to confer additional benefits in terms of these clinical outcomes.
Conclusion
Based on the available evidence, concomitant MV surgery during LVAD implantation does not appear to have a significant impact on postoperative outcomes. However, decision‐making regarding MV surgery should be individualized, considering patient‐specific factors and characteristics. Further research with prospective studies focusing on specific patient populations and newer LVAD devices is warranted to provide more robust evidence and guide clinical practice in the management of valvular lesions in LVAD recipients.
Concomitant MV surgery during LVAD implantation did not significantly affect overall mortality or other clinical outcomes. Decision‐making regarding MV surgery should be individualized, considering patient‐specific factors and characteristics.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Abstract
OBJECTIVES
The increase in the complexity of operations, the rising quest for improved outcomes and the scrutiny of surgical practice and its associated complications have led to a decreased ...educational value of in-patient surgical training within cardiac surgery. Simulation-based training has emerged as an adjunct to the apprenticeship model. In the following review, we aimed to evaluate the currently available evidence regarding simulation-based training in cardiac surgery.
METHODS
A systematic database search was conducted as per PRISMA guidelines, of original articles that explored the use of simulation-based training in adult cardiac surgery programs in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to 2022. Data extraction covered the study characteristics, simulation modality, main methodology and main outcomes.
RESULTS
Our search yielded 341 articles, of which 28 studies were included in this review. Three main areas of focus were identified: (i) validity testing of the models; (ii) impact on surgeons’ skills; and (iii) impact on clinical practice. Fouteen studies reported animal-based models and 14 reported on non-tissue-based models covering a wide spectrum of surgical operations. The results of the included studies suggest that validity assessment is scarce within the field, being carried out for only 4 of the models. Nonetheless, all studies reported improvement in trainees’ confidence, clinical knowledge and surgical skills (including accuracy, speed, dexterity) of trainees both at senior and junior levels. The direct clinical impact included initiation of minimally invasive programmes and improved board exam pass rates, and creating positive behavioural changes to minimize further cardiovascular risk.
CONCLUSIONS
Surgical simulation has been shown to provide substantial benefits to trainees. Further evidence is needed to explore its direct impact on clinical practice.
Traditionally, cardiac surgeons have been acquiring their surgical skills through a practical apprentice model, basing their training on patients in the operating room.
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