In cardiac arrest survivors treated with hypothermia at temperatures between 33 and 36 °C, low NPi values were associated with other predictors of poor outcomes, implying that abnormal NPi may be ...indicative of brain injury within this range of body temperatures 4. Quantitative versus standard pupillary light reflex for early prognostication in comatose cardiac arrest patients: an international prospective multicenter double-blinded study. Neurological pupil index and its association with other prognostic tools after cardiac arrest: a post hoc analysis.
Background
Aortic stenosis is the most common valvular disease and has a dismal prognosis without surgical treatment. The aim of this meta‐analysis was to quantitatively assess the comparative ...effectiveness of the Perceval (LivaNova) valve versus conventional aortic bioprostheses.
Methods and Results
A total of 6 comparative studies were identified, including 639 and 760 patients who underwent, respectively, aortic valve replacement with the Perceval sutureless valve (P group) and with a conventional bioprosthesis (C group). Aortic cross‐clamping and cardiopulmonary bypass duration were significantly lower in the P group. No difference in postoperative mortality was shown for the P and C groups (2.8% versus 2.7%, respectively; odds ratio OR: 0.99 95% confidence interval (CI), 0.52–1.88; P=0.98). Incidence of postoperative renal failure was lower in the P group compared with the C group (2.7% versus 5.5%; OR: 0.45 95% CI, 0.25–0.80; P=0.007). Incidence of stroke (2.3% versus 1.7%; OR: 1.34 95% CI, 0.56–3.21; P=0.51) and paravalvular leak (3.1% versus 1.6%; OR: 2.52 95% CI, 0.60–1.06; P=0.21) was similar, whereas P group patients received fewer blood transfusions than C group patients (1.16±1.2 versus 2.13±2.2; mean difference: 0.99 95% CI, −1.22 to −0.75; P=0.001). The incidence of pacemaker implantation was higher in the P than the C group (7.9% versus 3.1%; OR: 2.45 95% CI, 1.44–4.17; P=0.001), whereas hemodynamic Perceval performance was better (transvalvular gradient 23.42±1.73 versus 22.8±1.86; mean difference: 0.90 95% CI, 0.62–1.18; P=0.001), even during follow‐up (10.98±5.7 versus 13.06±6.2; mean difference: −2.08 95% CI, −3.96 to −0.21; P=0.030). We found no difference in 1‐year mortality.
Conclusions
The Perceval bioprosthesis improves the postoperative course compared with conventional bioprostheses and is an option for high‐risk patients.
A 63-year-old woman was admitted because of sudden ischemic hemyplegia promptly cleared up by intravenous (IV) recombinant tissue plasminogen activator. On subsequent 2-dimensional echocardiogram, we ...observed an extremely mobile homogeneous mass attached by a short stalk to ventricular insertion of anterolateral papillary muscle chordae tendineae. The mass was surgically removed. Gross anatomy showed a mass with a gelatinoids appearance formed on histology by a lining of hyperplastic endocardial cells covering a hypocellular stroma consistent with papillary fibroelastoma. Given the prompt clinical improvement with IV thrombolytic therapy, we postulate that cerebral artery occlusion was at least in part because of thrombotic material.
Postoperative hemorrhage in cardiac surgery is a significant cause of morbidity and mortality. Standard laboratory tests fail as predictors for bleeding in the surgical setting. The use of ...viscoelastic (VE) hemostatic assays thromboelastography (TEG) and rotational thromboelastometry (ROTEM) could be an advantage in patients undergoing cardiac surgery. The objective of this meta-analysis was to analyze the effects (benefits and harms) of VE-guided transfusion practice in cardiac surgery patients.
A meta-analysis of randomized trials.
For this study, PubMed, EMBASE, Scopus, and the Cochrane Collaboration database were searched, and only randomized controlled trials were included. A systematic review and meta-analysis were performed in accordance with the standards set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, using a random-effects model.
The study comprised adult cardiac surgery patients.
VE-hemostatic assays transfusion algorithm compared with transfusion algorithms based on clinicians’ discretion.
Seven comparative randomized controlled trials were considered, including a total of 1,035 patients (522 patients in whom a TEG- or ROTEM-based transfusion algorithm was used). In patients treated according to VE-guided algorithms, red blood cell (odds ratio 0.61; 95% confidence interval CI: 0.37-0.99; p: 0.04; I2: 66%) and fresh frozen plasma transfusions (risk difference 0.22; 95% CI: 0.11-0.33; p < 0.0001; I2: 79%) use was reduced; platelets transfusion was not reduced (odds ratio 0.61; 95% CI: 0.32-1.15; p: 0.12; I2 74%).
This study demonstrated that the use of VE assays in cardiac surgical patients is effective in reducing allogenic blood products exposure, postoperative bleeding at 12 and 24 hours after surgery, and the need for redo surgery unrelated to surgical bleeding.
Minimally invasive mitral valve surgery leads to shorter postoperative recovery time, cosmetic advantages and significant pain reduction compared with the standard sternotomy approach. Both an ...external aortic clamp and an endoaortic balloon occlusion can be used to manage the ascending aorta and the myocardial protection. In this study, we aimed to compare these two strategies in terms of effectiveness of myocardial protection and associated early postoperative outcomes.
We investigated the retrospective records of prospectively collected data of patients treated by minimally invasive mitral valve surgery from March 2014 to June 2019. A total of 180 cases (78 in the external aortic clamp group and 102 in the endoaortic balloon clamp group) were collected. A propensity weighting analysis was adopted to adjust for baseline variables.
The endoaortic balloon clamp presented higher EuroSCORE II (higher reoperative surgery rate). The intra- and postoperative data were similar between the two groups: the postoperative troponin-I levels, peak of serum lactates and rate of myocardial infarction were also comparable. The endoaortic clamp group recorded longer operative, cardiopulmonary bypass and cross-clamp times. The external clamp group showed a higher rate of postoperative atrial fibrillation and conduction block.
In experienced centers, the use of the endoaortic balloon clamp is safe, reproducible and comparable to the external aortic clamp regarding the effectiveness of myocardial protection: its employment might facilitate minimally invasive mitral valve surgery.
Background and Aim of the Study
The aim of this meta‐analysis was to compare short‐ and long‐term outcomes of patients undergoing mitral annuloplasty (MA) with or without papillary muscle surgery ...(PMS) for the treatment of ischemic mitral regurgitation (IMR).
Methods
A systematic review and meta‐analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement were performed.
Results
Nine studies met the inclusion criteria. This meta‐analysis identified 478 patients: 228 patients underwent MA alone and 250 patients underwent concomitant PMS. Early mortality was similar between two groups (odds ratio OR 1.14, 95% confidence interval CI, 0.51‐2.53; P = .75). PMS was associated at follow‐up with a higher freedom from cardiac‐related events (P = .050); moreover, although both surgical techniques had a positive impact on ventricular remodeling, the PMS group showed a significant higher reduction of left ventricle end‐diastolic diameter (OR, 4.89, 95% CI, 2.77‐7.01; P < .001) and left ventricle end‐systolic diameter values (OR, 4.11, 95% CI, 1.98‐6.24; P < .001). Finally, PMS compared with MA alone was associated with a significant reduction of recurrent mitral regurgitation at follow‐up (OR, 3.25, 95% CI, 1.60‐6.59; P = .001).
Conclusions
This meta‐analysis demonstrated superiority in terms of ventricular remodeling of a combined approach encompassing PMS and MA over MA alone in IMR. Moreover, the association of subvalvular surgery with restrictive MA decreases the incidence of mitral regurgitation recurrence and cardiac‐related events at follow‐up.
About one-third of candidates for transcatheter aortic valve implantation (TAVI) suffer from severe peripheral artery disease, making the routine femoral approach difficult or impossible. The aim was ...to compare the transaxillary (TAx) and the transaortic (TAo) route for TAVI with Medtronic CoreValve Revalving System (CRS).
Out of 1049 consecutive TAVI with 18F CRS, 242 (23%) were treated in 4 high-volume Italian Centre through TAx (61%) and TAo (39%).
The devices success was similar (P=0.16) with a trend to a lower incidence of significant paravalvular leak (6% vs. 14%, P=0.07) and a significant reduction of permanent pacemaker (PPM) implantation (13% vs. 34%, P=0.017) in the TAo. However, this route showed a higher incidence of acute kidney injury (P=0.016) and a longer hospital stay after the index procedure (days 10 8-14 vs. 8 7-12, P=0.001). By a multivariate analysis the vascular access is an independent predictor for a longer hospital stay (TAo route; OR=0.37, 95% CI: 0.18-0.75; P=0.006) and for PPM implantation (TAx route; OR=3.7, 95% CI: 1.2-10.8; P=0.017).
Although the higher clinical risk profile of transaortic population, the TAo approach showed an equally high device success with similar 30-day safety and 1year efficacy, compared to TAx route. However, due to non-procedure-specific complications post-TAo TAVI, this route requires a specialized postoperative care and the treatment of patients in highly specialized and experienced centers.
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