Early Intraluminal Frozen Elephant Trunk Stent Graft Thrombosis After Aortic Arch Surgery.

BACKGROUND: Partial intraluminal thrombosis of the frozen elephant trunk (FET) stent graft is a poorly described but not infrequent complication after aortic arch surgery. This study aims to describe and analyze the occurrence of early FET stent graft thrombosis. METHODS: Retrospective single-center analysis including patients who underwent aortic arch replacement with FET technique between 2006 and 2020. Stent graft thrombosis was diagnosed through computed tomography scan. Several computed tomography scan parameters and clinical variables were analyzed as predictors of this event. RESULTS: A total of 125 patients were included for analysis. Among these, 21 (16.8%) patients developed early postoperative FET stent graft thrombosis. Mean volumetric size of the aorta was 12.2 ± 2.0 mL in patients with FET stent graft thrombosis and 10.1 ± 2.8 mL in patients without thrombosis (P < .01). Thrombosis occurred more frequently among patients requiring thoracic endovascular aortic repair completion (15 of 21 [71.4%] patients) than in patients with completely excluded aneurysms (6 of 21 [28.6%] patients) (P = .01). Mean stent-to-aneurysm diameter ratio was 0.8 ± 0.2 among patients with thrombosis and 1.0 ± 0.2 among patients without thrombosis (P < .01). Thrombosis was more frequently observed among patients with conservative management of postoperative bleeding (P = .04). Patients with early FET thrombosis had a nonsignificantly higher in-hospital all-cause mortality than patients without thrombosis (19.0% vs 8.7%; P = .3). CONCLUSIONS: Early postoperative intraluminal thrombosis is a frequent complication post FET surgery. Smaller stent graft sizes, larger or partially covered aneurysms, and major bleeding are associated with early thrombosis. Slight FET oversizing, prompt thoracic endovascular aortic repair completion, and early reintervention for major bleeding may prevent early thrombosis.

Perioperative temporary mechanical circulatory support with Impella in cardiac surgery patients.

BACKGROUND: The benefits of perioperative mechanical circulatory support (MCS) in cardiac surgery patients are still uncertain. This study aims to review early outcomes of perioperative temporary MCS using the Impella device in cardiac surgery patients. METHODS: Retrospective, single-center analysis in cardiac surgery patients presenting with cardiogenic shock (CS) in whom Impella was used for perioperative temporary MCS, either as single device therapy or as left ventricular (LV) venting strategy for concomitant extracorporeal membrane oxygenation (ECPELLA). Study outcomes were 30-day mortality and occurrence of complication composite outcome. RESULTS: Between 2016 and 2019, a total of 33 consecutive patients were supported with Impella (single-device therapy in 19 [57.6%] patients and ECPELLA in 14 [42.4%] patients). The 30-day mortality of Impella-alone and ECPELLA groups was 15.8% and 50.0% (P=0.03). The 30-day mortality according to pre-, intra-, and postoperative implantation was 12.5%, 60.0%, and 28.6% (P=0.04), and it was significantly lower in those patients in whom a left ventricular assist device was implanted in comparison to all other surgical procedures (P<0.01). The complication composite outcome occurred more frequently after axillary implantation compared to femoral Impella (P=0.05) due to higher stroke rates (P=0.03). Bleeding requiring surgical re-exploration was more frequent in the ECPELLA than in the Impella-alone group (1 [3.0%] vs. 5 [15.1%]; P=0.03). CONCLUSIONS: Temporary MCS with Impella is associated with high complication and mortality rates. However, preoperative use of Impella as single-device temporary MCS is associated with lower mortality rates and is a reasonable alternative as a bridge-to-decision strategy for acutely decompensated patients.

Neurobiological origins of individual differences in mathematical ability.

Mathematical ability is heritable and related to several genes expressing proteins in the brain. It is unknown, however, which intermediate neural phenotypes could explain how these genes relate to mathematical ability. Here, we examined genetic effects on cerebral cortical volume of 3-6-year-old children without mathematical training to predict mathematical ability in school at 7-9 years of age. To this end, we followed an exploration sample (n = 101) and an independent replication sample (n = 77). We found that ROBO1, a gene known to regulate prenatal growth of cerebral cortical layers, is associated with the volume of the right parietal cortex, a key region for quantity representation. Individual volume differences in this region predicted up to a fifth of the behavioral variance in mathematical ability. Our findings indicate that a fundamental genetic component of the quantity processing system is rooted in the early development of the parietal cortex.

Incidental Learning: A Systematic Review of Its Effect on Episodic Memory Performance in Older Age.

Episodic memory is the capacity to encode, store, and retrieve information of specific past events. Several studies have shown that the decline in episodic memory accompanies aging, but most of these studies assessed memory performance through intentional learning. In this approach, the individuals deliberately acquire knowledge. Yet, another method to evaluate episodic memory performance-receiving less attention by the research community-is incidental learning. Here, participants do not explicitly intent to learn. Incidental learning becomes increasingly important over the lifespan, since people spend less time in institutions where intentional learning is required (e.g., school, university, or at work). Yet, we know little how incidental learning impacts episodic memory performance in advanced age. Likewise, the neural mechanisms underlying incidental learning in older age remain largely unknown. Thus, the immediate goal of this review was to summarize the existing literature on how incidental learning changes with age and how neural mechanisms map onto these age-related changes. We considered behavioral as well as neuroimaging studies using incidental learning paradigms (alone or in combination with intentional learning) to assess episodic memory performance in elderly adults. We conducted a systematic literature search on the Medline/PubMed, Cochrane, and OVID SP databases and searched the reference lists of articles. The search yielded 245 studies, of which 34 concerned incidental learning and episodic memory in older adults. In sum, these studies suggest that aging particularly affects episodic memory after incidental learning for cognitively demanding tasks. Monitoring deficits in older adults might account for these findings since cognitively demanding tasks need increased attentional resources. On a neuronal level, dysregulation of the default-mode-network mirrors monitoring deficits, with an attempt to compensate through increased frontal activity. Future (neuroimaging) studies should systematically evaluate retrieval tasks with diverging cognitive load and consider the influence of attention and executive functions in more detail.