Outcomes in techniques of valve sparing aortic root replacement: A systematic review and meta-analysis.

OBJECTIVE: To compare clinical outcomes of reimplantation versus remodeling in patients undergoing valve-sparing aortic root replacement (VSRR) surgery. METHOD: Electronic database search at PubMed, Scopus, Embase, Ovid, and Google scholar was performed from inception to January 2020. Primary outcomes were aortic valve (AV) reintervention and postoperative grade of aortic insufficiency (AI) while secondary outcomes were 30-day mortality, reoperation for bleeding, and operative times. RESULTS: A total of 21 articles met the inclusion criteria. A total of 1283 patients had reimplantation while 1150 had remodeling. No difference in preoperative demographics was noted except reimplantation patients were younger (48 ± 16 vs. 56 ± 15 years; p < .00001). The cardiopulmonary bypass and aortic cross-clamp times were shorter in the remodeling cohort (168 ± 38 vs. 150 ± 37 min; p = .0001 and 133 ± 31 vs. 112 ± 30 min; p = .0002, respectively). No difference in concomitant total arch surgery (14% in reimplantation vs. 15% in remodeling; p = .53). Postoperatively, there were similar stroke rates (3% in both cohorts; p = .54), rates of reoperation for bleeding (9% in reimplantation vs. 12% in remodeling; p = .88), and 30-day mortality (3% in reimplantation vs. 4% in remodeling; p = .96). No difference in early AV reintervention (1% in reimplantation vs. 2% in remodeling; p = .07), and late AV reintervention (4% in reimplantation vs. 7% in remodeling; p = .07). The AI of +2 grade was significantly lower in the reimplantation cohort (5% vs. 8%; p = .01). CONCLUSION: Our study shows comparable clinical outcomes between both techniques. The practice of each technique is largely center and surgeon dependent. Larger sample size cohorts with minimal confounding factors are required to confirm the above findings.

Myocardial protection in cardiac surgery: how limited are the options? A comprehensive literature review.

For patients undergoing cardiopulmonary bypass, myocardial protection is a key for successful recovery and improved outcomes following cardiac surgery that requires cardiac arrest. Different solutions, components and modes of delivery have evolved over the last few decades to optimise myocardial protection. These include cold and warm and blood and crystalloid solution through antegrade, retrograde or combined cardioplegia delivery approach. However, each method has its own advantages and disadvantages, posing a challenge to establish a gold-standard cardioplegic solution with an optimised mode of delivery for enhanced myocardial protection during cardiac surgery. The aim of this review is to provide a brief history of the development of cardioplegia, explain the electrophysiological concepts behind myocardial protection in cardioplegia, analyse the current literature and summarise existing evidence that warrants the use of varying cardioplegic techniques. We provide a comprehensive and comparative overview of the effectiveness of each technique in achieving optimal cardioprotection and propose novel techniques for optimising myocardial protection in the future.

The role of imaging and other diagnostic approaches in COVID-19.

As the COVID 19 pandemic develops across the globe, a large amount of literature has been written about the different ways in which we can diagnose and investigate someone suspected of being infected with the new coronavirus. Many approaches highlight the importance of using reverse transcriptase polymerase chain reaction (RT-PCR) used in conjunction with computed tomography (CT) scans. Whilst CT scans have been shown to be useful, there are multiple risks associated with them, for example radiation exposure and the transmission risk associated with repeated use of a CT suite. Therefore, it is important to analyse their diagnostic ability and limitations and to consider other methods of diagnosing COVID 19. Additionally, RT-PCR testing can have significant rates of false negatives, indicating the importance of taking a more comprehensive diagnostic approach. Here, we aim to review and analyse this literature to compare RT-PCR, serum inflammatory biomarkers, chest radiographs, ultrasound and chest CT scanning as methods of diagnosing COVID 19, particularly in asymptomatic patients.