Left Ventricular Re-training: Feasibility and Effectiveness-What Are the Limits?

The concept of 're-training' the morphologic left ventricle (mLV) is based on the crude principle of applying a fixed afterload by means of pulmonary artery banding. The complex physiological, molecular and structural responses to banding are poorly understood, and complicated by the fact that re-training is undertaken in a variety of different morphological settings and age-groups. This article reviews the evidence for re-training in different situations with particular focus on the age at banding and on the best ways to assess suitability for subsequent repair. Particular importance is placed on the role of re-training in congenitally corrected transposition as this is the commonest current indication - looking at better ways to train the mLV, the role of combined pressure and volume loading, and more sophisticated ways of assessing the adequacy of training. Current evidence suggests that age at banding has a fundamental impact on ability to re-train and long-term mLV function with the best results being achieved in infancy and concerns at any attempt beyond 2 years of age.

The key questions in rehabilitation in thoracic surgery.

Enhancing the recovery of patients undergoing Thoracic Surgery is the raison d'être of a pulmonary rehabilitation (PR) process. Benefits of a PR program have been shown to include reduced postoperative complications, hospital length of stay (LOS) and improved exercise and lung function parameters. Identifying which groups of patients benefit most and the constituency of the perfect PR program is subject to ongoing research. Providing PR to patients in a manner acceptable to their lifestyle and disease timeline within economic limitations is the challenge.

Incidental abnormal CT scan findings during transcatheter aortic valve implantation assessment: incidence and implications.

Objectives: The aim of this retrospective series is to describe the prevalence and clinical significance of the incidental findings found during pre-transcatheter aortic valve implantation (TAVI) work-up and to ascertain the clinical course of such patients. Methods: Consecutive patients undergoing TAVI from 2013 to 2015 where a TAVI CT assessment was performed (n=138) were included in the study. All incidental findings that were not expected from the patient's history were discussed at the TAVI multidisciplinary meeting in order to ascertain the clinical significance of said findings and whether they would alter the proposed course of treatment. Mortality data were determined by careful retrospective case note and follow-up appointment analysis. Results: Seventy-eight patients (57%) were found to have incidental findings on pre-TAVI CT scan. The majority of patients had benign pathology with high incidence in particular of diverticular disease, pleural effusions, gallstones, hiatus hernia and degenerative spinal disease. Vascular pathology such as superior mesenteric, renal and iliac artery stenoses and abdominal aortic aneurysm was detected in seven patients. In terms of long-term mortality data, we found no significant difference between those with incidental findings and those without (p=0.48). Survival as assessed by Kaplan-Meier analysis showed no significant difference between those with and without incidental abnormal CT scan findings (p=0.98). Conclusions: Incidental findings with potential for malignancy are common in an elderly, comorbid population. Ultimately, clinical correlation and prognosis must be swiftly ascertained in order to streamline the patients down the appropriate management pathway while avoiding unnecessary delay for treatment of their aortic stenosis.