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Title: Mechanical Ventilation and Pulmonary Perfusion During Cardiopulmonary Bypass: A Mechanistic Lung-Protective Intervention in Cardiac Surgery
Authors: Dolly Munlemvo Matondo, Marco Echeverria-Villalobos, Juan Fiorda-Diaz, Michael K. Essandoh
Affiliations: Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA 43210
Abstract: Postoperative pulmonary dysfunction (POPD) is a common multifactorial complication after cardiopulmonary bypass (CPB) [1, 2], abnormal systemic inflammatory response being the major cause of lung injury during CPB [2, 3]. CPB-related POPD has been associated with increased hospital mortality and length of hospital stay . Protective mechanical ventilation (PMV) during CPB is one of the strategies oriented to mitigate the CPB-induced pulmonary changes. Recent evidence suggests that PMV is more effective than continuous positive airway pressure on preventing post-CPB pulmonary dysfunction [1, 2]. A comprehensive review describing the physiopathology and lung protective strategies for post-CPB POPD will be conducted
Title: Why and how to achieve total arterial revascularisation in coronary surgery
Authors: Alistair Royse et al
Affiliations: Royal Melbourne Hospital, The University of Melbourne, Parkville VIC 3010, Australia
Abstract: Single internal mammary artery and supplementary saphenous vein grafts (SVG) continues to be used in approximately 95% of coronary surgery as of 2019. The late failure of SVG is very well documented yet remains the predominant conduit used – why? The left internal mammary artery almost never fails, and late angiography of patent radial artery grafts also appear entirely normal. Logic would suggest that avoiding the conduit known to progressively fail would lead to improved late outcome. Our studies have demonstrated such findings in large single centre and national registry datasets. We describe strategies to achievement of total arterial coronary revascularisation.
Title: Transcatheter aortic valve implantation in the elderly: an umbrella review
Authors: Giuseppe Biondi Zoccai et al
Affiliations: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185 Roma RM, Italy
Abstract: The management of aortic stenosis has seen momentous changes in the last decades thanks to the introduction of transcatheter aortic valve implantation. While initially reserved for sick patients deemed inoperable or at high risk of surgical complications, indications to this intervention have expanded progressively to intermediate and low risk patients. Intriguingly, concomitant trends in prolonged life expectancy have lead to an increase in the population of elderly but fit patients with aortic stenosis. We thus aimed to review the current evidence base on transcatheter aortic valve implantation in the elderly by conducting a comprehensive umbrella review (i.e. overview of systematic reviews). Findings of this exercise in evidence synthesis will prove important to guide the current use of transcatheter aortic valve implantation, as well as to inform future research efforts.
Title: Impact of Advances in Percutaneous Catheter Interventions on Redo Cardiac Surgery
Authors: Venkat R. Machiraju et al
Affiliations: Department of Thoracic surgery, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA
Abstract: During the end of 20th century, 15-20% of cardiac surgical volume was redo cardiac surgery. Young age at the time of surgery, vein graft atherosclerosis, malfunctioning of mechanical valves and degeneration of bioprosthetic valves were the leading indications. Infective endocarditis, native as well as prosthetic valves also contributed to the surgical volume. Aneurysmal formation of the aorta following surgery for aortic dissection or for aneurysms resulted in repeat operative procedures. In the 21st century, improvements came tackling vein graft atherosclerosis and advances in coronary stenting eliminated the majority of redo coronary artery surgical procedures. TAVR was approved for high risk patients and elderly patients who developed calcific aortic stenosis after previous CABG fit into the criteria perfectly. Valve in valve, aortic stenting for residual and recurrent aneurysms and mitral clip to correct mitral regurgitation in high risk patients are rapidly developing and obviating the need for redo cardiac surgery. Our intent is to review these advances and their impact on re-do cardiac surgery.