The anatomy of enjoyment: the flow experience and cardiac surgery.

PURPOSE OF REVIEW: In a time of record levels of physician burnout coupled with a global pandemic, protecting physician wellness is critical. The experience of cognitive flow has been found to enhance both wellness and performance. Although flow has been vastly explored in other fields including elite sport, it has not been deeply investigated or applied in cardiac surgery. Here we discuss flow and flow-promoting techniques employed in other fields that may be beneficial within cardiac surgery. RECENT FINDINGS: Flow is a prevalent experience among surgeons, amplified during operations. Possible strategies to cultivate flow may be separated into individual skills training, such as mindfulness practice and stress management, institutional changes, such as ensuring adequate resources and protected spaces, and strategies targeting the intersectionality of individuals and systems, such as how workplace culture shapes an individual's experience. These techniques may be applicable within cardiac surgery, especially in training. SUMMARY: Flow has been identified as a key component of a happy and meaningful life, and a potential protector against burnout. Harnessing the benefits of flow may help promote flourishing, particularly in demanding fields, such as cardiac surgery.

Lung transplantation and concomitant cardiac surgical procedures: A systematic review and meta-analysis.

BACKGROUND: Lung transplantation is an effective treatment option for end-stage lung diseases. In some cases, these patients may also have underlying cardiac disease which may require surgical intervention before or during transplantation. Concomitant cardiac surgery may often be preferred, as reduced lung function precludes these patients from pre-transplant surgery. Our meta-analysis sought to examine the impact of lung transplantation paired with concomitant cardiac surgery on long-term mortality. METHODS: We conducted a systematic review of the MEDLINE, Embase, and Cochrane databases. Our primary outcome was overall mortality. Secondary outcomes included length of stay (LOS) in hospital and serious postoperative complication rates. We used a meta-analytic model to determine the differences in the above outcomes between patients who underwent lung transplantation with or without concomitant cardiac surgery. RESULTS: Out of the 1876 articles screened, 7 met our pre-determined inclusion criteria. Lung transplantation with concomitant cardiac surgery was not associated with increased mortality compared to lung transplantation alone (hazard ratio = 1.02; 95% confidence interval [CI] = 0.80-1.31; I2 = 0%; p = .99). LOS in hospital was not significantly different between groups (standardized mean difference = 0.32; 95% CI = -0.91 to 1.55). Postoperative complication rates were also reported but not analyzed due to missing data. CONCLUSIONS: There was no significant difference in mortality rates in patients undergoing lung transplantation with or without concomitant cardiac surgery at 1, 3, and 5 years. However, postoperative complication rates were higher in the concomitant group. The decision to perform concomitant procedures should be tailored to each patient's clinical condition.

Zone 0 frozen elephant trunk for type A retrograde acute aortic dissection following endovascular stenting of the arch.

A 70-year-old man underwent the frozen elephant trunk (FET) procedure with zone 0 debranching following a failed endovascular repair for type B aortic dissection and a stent-graft deployment in zone 1 for a retrograde type A aortic dissection. Zone 0 deployment is a novel approach that is valuable as a bailout strategy in urgent cases and it can potentially improve the technical feasibility of the FET while minimizing its ischemic complications.

Recurrent Catatonia and Demyelinating Disorders.

Catatonia, a neuropsychiatric syndrome characterized by psychomotor and behavioral symptoms, can be associated with various underlying conditions, including demyelinating diseases such as multiple sclerosis. This paper presents a case study of a 47-year-old female with recurrent catatonic relapses and an underlying demyelinating disease. The patient exhibited symptoms of confusion, decreased oral intake, and difficulty with movement and speech. Neurological examinations, brain imaging, and laboratory tests were conducted to evaluate the etiology and guide treatment. The patient showed improvement with lorazepam and electroconvulsive therapy (ECT). However, relapses occurred after the abrupt withdrawal of medication. The case study highlights the potential connection between demyelinating diseases and catatonia and emphasizes the importance of considering demyelinating diseases in the workup, treatment, and relapse prevention of catatonia. Further research is needed to explore the mechanisms underlying the relationship between demyelination and catatonia and to investigate how different etiologies may impact the recurrence rates of catatonic episodes.

CABG in patients with liver cirrhosis: to pump or not to pump?

INTRODUCTION: Coronary artery bypass grafting in patients with established liver cirrhosis is generally associated with poor outcomes. Avoiding cardiopulmonary bypass (CPB) in these patients has not demonstrated any advantage over the use of CPB. We review the current available literature that compared the outcome of both on-pump (ONCABG) and off-pump (OPCAB) techniques in cirrhotic patients in terms of morbidity and mortality. AREAS COVERED: A comprehensive search was conducted in the PubMed/MEDLINE and EMBASE databases in January 2021. Articles that reported outcomes of OPCAB and/or ONCABG in cirrhotic patients with no concomitant surgical procedures were included. 829 unique abstracts were retrieved with title and abstract screening completed independently by two reviewers. Two case studies and six retrospective cohort studies were included. The largest study comprised more than 98% of the total population, showing some survival benefit for OPCAB over ONCABG. However, it was population-based and did not report the severity of liver. The remaining studies reported no clear difference in outcome between the two techniques. EXPERT OPINION: Surgical myocardial revascularisation carries high perioperative risk in patients with liver cirrhosis irrespective of the surgical technique. There is a lack of evidence to suggest that avoiding CPB in these patients may be beneficial.