Transcarotid vascular access for transcatheter aortic valve implantation: is choosing the left side always right?

BACKGROUND: The transcarotid (TC) vascular access for transcatheter aortic valve implantation (TAVI) has emerged as the first-choice alternative to the transfemoral access, in patients unsuitable for the latter. The use of both the left and right common carotid arteries (CCAs) for TC-TAVI has been described, but the optimal side is subject to debate. We conducted this pilot study to compare the level of vessel tortuosity and plaque burden from either the left CCA to the aortic annulus, or the right CCA to the aortic annulus, considering them as surrogates for technical and procedural complexity. METHODS: Consecutive patients who underwent TC-TAVI between 2018 and 2021 in our institution were included. Using three-dimensional reconstruction, pre-TAVI neck and chest computed tomography angiography exams were reviewed to assess the tortuosity index (TI), sum of angles metric, as well as plaque burden, between each CCA and the aortic annulus. RESULTS: We included 46 patients who underwent TC-TAVI. No significant difference regarding the mean TIs between the left and right sides (respectively 1.20 and 1.19, p = 0.82), the mean sum of angles (left side: 396°, right side: 384°, p = 0.27), and arterial plaque burden (arterial plaque found in 30% of left CCAs and 45% of right CCAs, p = 0.19) was found. CONCLUSIONS: We found no convincing data favoring the use of one particular access side over the other one. The choice of the CCA side in TC-TAVI should to be made on a case-by-case basis, in a multidisciplinary fashion, and may also depend on the operators' experience.

Transcaval versus Supra-Aortic Vascular Accesses for Transcatheter Aortic Valve Replacement: A Systematic Review with Meta-Analysis.

A growing body of evidence suggests that extrathoracic vascular accesses for transcatheter aortic valve replacement (TAVR) yield favorable outcomes and can be considered as primary alternatives when the gold-standard transfemoral access is contraindicated. Data comparing the transcaval (TCv) to supra-aortic (SAo) approaches (transcarotid, transsubclavian, and transaxillary) for TAVR are lacking. We aimed to compare the outcomes and safety of TCv and SAo accesses for TAVR as alternatives to transfemoral TAVR. A systematic review with meta-analysis was performed by searching PubMed/MEDLINE and EMBASE databases for all articles comparing TCv-TAVR against SAo-TAVR published until September 2023. Outcomes included in-hospital or 30-day all-cause mortality (ACM) and postoperative complications. A total of three studies with 318 TCv-TAVR and 179 SAo-TAVR patients were included. No statistically significant difference was found regarding in-hospital or 30-day ACM (relative risk [RR] 1.04, 95% confidence interval [CI] 0.47-2.34, p = 0.91), major bleeding, the need for blood transfusions, major vascular complications, and acute kidney injury. TCv-TAVR was associated with a non-statistically significant lower rate of neurovascular complications (RR 0.39, 95%CI 0.14-1.09, p = 0.07). These results suggest that both approaches may be considered as first-line alternatives to transfemoral TAVR, depending on local expertise and patients' anatomy. Additional data from long-term cohort studies are needed.

Prevalence of Pericardial Late Gadolinium Enhancement in Patients After Cardiac Surgery: Clinical and Histological Correlations.

BACKGROUND: Pericardial late gadolinium enhancement (LGE) is usually associated with active pericarditis, but it is not infrequently found in patients after cardiac surgery even a long time after the intervention. The clinical relevance of this finding and its histological correlates are unknown. We sought to determine the prevalence of chronic pericardial LGE in patients after cardiac surgery. METHODS: All consecutive patients with previous cardiac surgery, who were referred to cardiovascular magnetic resonance between January 2017 and December 2021 were enrolled in the study. Cardiovascular magnetic resonance examination protocol was adapted to clinical indication but always included standard LGE acquisitions. Two independent observers blinded to clinical data assessed the presence of pericardial enhancement on LGE sequences. Fifteen patients underwent cardiac reintervention and pericardial biopsies were obtained. The primary study end point was to assess the prevalence of pericardial enhancement after cardiac surgery and identify possible determinants. The secondary end point was to correlate pericardial enhancement with clinical symptoms and histopathology. RESULTS: Two hundred four patients were included in the study. The median time between surgery and cardiovascular magnetic resonance was 160 months (35-226 months). Pericardial LGE was observed in 90 patients (44%). All patients were asymptomatic, and no specific treatment for pericarditis was started. All patients remained asymptomatic at a 1-year clinical follow-up. Pericardial LGE was significantly correlated with the number of previous surgeries (P=0.03). Pericardial fibrosis was detected in all 15 pericardial biopsy specimens; pericardial LGE was present in 7 patients (47%) who underwent biopsy. Histological signs of low-grade inflammation were detected in 6 patients (40%) with severe, circumferential pericardial LGE but in no patient without pericardial enhancement. CONCLUSIONS: Pericardial LGE is a frequent finding even several years after cardiac surgery. Its histological correlate is a chronic subclinical post-pericardiotomy inflammation.

Topical skin adhesive PRINEO as the ideal wound closure system in cardiac surgery to limit surgical site infection.

OBJECTIVE: Surgical site infections (SSIs) are a major source of morbidity after cardiac surgery, involving prolonged hospitalisation. Among the numerous techniques of skin closure and dressings available, the optimal method remains undetermined. The DERMABOND-PRINEO (PRINEO) (PRINEO, Ethicon, J&J) is the only skin closure system which combines a topical skin adhesive with a mesh. Other surgical disciplines have highlighted remarkable results with PRINEO. The aim of this study was to evaluate the effects of PRINEO, used as the final layer in sternotomy closure, in the incidence of postoperative SSIs. METHOD: This was a retrospective single-centre cohort study including adult patients who underwent cardiac surgery between January 2015 and December 2018. Patients who had undergone heart transplantation or ventricular assist surgery were excluded. Included patients were divided into two groups depending on the type of post-operative wound care technique used. Group 1 consisted of patients who had their sternotomy closed with a standard dressing and group 2 consisted of patients who were treated with PRINEO. The primary endpoint of our study was the occurrence of SSIs and secondary outcomes were the length of hospitalisation and mortality. RESULTS: A total of 1603 patients were reviewed with the occurrence of 44 SSIs. Both groups were homogeneous in terms of risk factors. The incidence of SSIs was significantly lower in group 2 (PRINEO) than in group 1 (standard dressing) (n=29, 3.8% vs n=15, 1.8%, respectively; p=0.042). However, there was no significant difference in the duration of hospitalisation and mortality. CONCLUSION: In our practice, PRINEO has proven to be a safe wound closure system after sternotomy, with a reduced SSI rate compared to conventional wound care techniques.

Case report: Acute pericarditis following hepatic microwave ablation for liver metastasis.

Hepatic microwave ablation (MWA) is a growing treatment modality in the field of primary and secondary liver cancer. One potential side effect is thermal damage to adjacent structures, including the pericardium if the hepatic lesion is located near the diaphragm. Hemorrhagic cardiac tamponade is known to be a rare but potentially life-threatening complication. Here we present the first case of cardiac complication following MWA treatment in a 55-year-old man who presented with late cardiac tamponade. Adequate and timely management is essential, and clinicians should be fully aware of the need to perform early transthoracic echocardiography to detect signs of pericardial effusion when cardiac involvement is suspected.

Transcatheter Aortic Valve Implantation Using the Transcervical Vascular Access (from a 7-Year Experience from a Swiss Tertiary Center).

The gold-standard transfemoral (TF) access for transcatheter aortic valve implantation (TAVI) is not suitable in 10% to 15% of patients, and alternative accesses are needed. Studies have suggested that the transcervical (TC) access might yield outcomes comparable to the TF access. In our center, TC-TAVI is the first-line alternative to TF-TAVI. We herein present our 7-year experience regarding the use of the TC access in TAVI. We included all consecutive patients referred for TC-TAVI between January 1, 2016 and December 31, 2022. Data regarding the patients' characteristics,perioperative and 30-day outcomes were prospectively collected. Patients were separated into 2 temporal groups (group 1: January 1, 2016 to June 30, 2019; group 2: July 1, 2019 to December 31, 2022) to assess the changes of their characteristics and outcomes over time. A total of 95 patients were included, with more belonging to group 2 (n = 56 vs n = 39 in group 1). Patients in group 2 were significantly younger (81.0 [interquartile range 77.0 to 87.0] vs 89.0 [interquartile range 83.0 to 92.0] years, p <0.001) and had a higher prevalence of hypertension (87.5% vs 66.7%, p = 0.028) and chronic pulmonary disease (35.7% vs 15.4%, p = 0.029). There was no significant difference regarding other co-morbidities or surgical scores. All-cause mortality and the risk of stroke at 30 days were low and similar (group 2 vs group 1, 3.6% vs 2.5%, p = 0.787 and 1.8% vs 0%, p = 0.397, respectively), as were the risks of permanent pacemaker implantation, postoperative acute kidney injury, cardiac tamponade, life-threatening bleeding, and major vascular complications. In conclusion, the use of the TC access increased over time. The rates of adverse events did not change, despite patients from mid-2019 onward having slightly more co-morbidities.

Complete atrioventricular septal defect: Modified 2-patch technique.

Complete atrioventricular septal defect is a common congenital malformation. Various surgical corrections coexist. This video tutorial describes a correction that preserves the height of the leaflets by splitting both the anterior and the posterior bridging leaflets and using two patches to close the ventricular septal defect and the atrial septal defect separately.

Temporary Right Ventricular Assist Device After Redo Aortic Valve Replacement And Heartmate 3tm Implantation - A Case Report.

The implantation of the left ventricular assist device Abbott HeartMate 3TM is being increasingly performed for management of end-stage heart failure. LVAD implantation might be associated with early or late right ventricular dysfunction. When severe, a temporary right ventricular support device may need to be implanted. However, these situations are associated with higher mortality. We report a successful case of temporary right ventricular support following HeartMate 3 implantation.

Evaluation of Pesticide Residues Occurrence in Random Samples of Organic Fruits and Vegetables Marketed in Poland.

In recent years, organic food, produced with the use of natural means and production methods, has been gaining more and more popularity among consumers. This is due, inter alia, to their belief that it is more abundant in health-promoting bioactive compounds and safer than conventional food. Consumers are increasingly aware of the harmfulness of plant protection products used in intensive agriculture, which are not allowed in organic production. At the same time, it is reported that a certain share of organic products on the EU market are contaminated with pesticide residues, which may raise consumer concerns and lead to a loss of trust in organic food. The aim of the present study was to investigate the problem of pesticide residues occurrence in random samples of organically produced fruits and vegetables (apples, potatoes, carrots, and beetroots) commonly used in the Polish households, and which are available directly from the organic producers in open markets in Poland. For simultaneous analysis of 375 pesticides, an LC-MS/MS system consisting of an Eksigent expert ultraLC 100-XL coupled to a triple quadrupole mass spectrometer QTRAP 6500 and GC Agilent 6890 N equipped with ECD/NPD system were used. Among the 96 vegetable and fruit samples studied, 89 samples (92.7%) were free from detectable pesticide residues, 7 samples (7.3%) of carrot (5) and potato (2) were contaminated, and in 1 of them (1.0%) the detected residues exceeded the maximum residue limit (MRL). None of the tested apple and beetroot samples were found to contain detectable residues. These findings are important for Polish consumers who look for high-quality organic food. However, the presence of detectable residues in a small proportion of the organic samples indicates a need to strengthen the monitoring of pesticides in organic crops, to educate farmers and to raise their awareness regarding the risks of unauthorized use of pesticides banned in organic farming, which can damage the reputation of the whole organic sector.

Comparison of the Design of 3-Pole BLDC Actuators/Motors with a Rotor Based on a Single Permanent Magnet.

Permanent Magnet (PM) Brushless Direct Current (BLDC) actuators/motors have many advantages over conventional machines, including high efficiency, easy controllability over a wide range of operating speeds, etc. There are many prototypes for such motors; some of them have a very complicated construction, and this ensures their high efficiency. However, in the case of household appliances, the most important thing is simplicity, and, thus, the lowest price of the design and production. This article presents a comparison of computer models of different design solutions for a small PM BLDC motor that uses a rotor in the form of a single ferrite magnet. The analyses were performed by using the finite element method. This paper presents unique self-defined parts of basic PM BLDC actuators. With their help, various design solutions were compared with the PM BLDC motor used in household appliances. The authors proved that the reference device is the lightest one and has a lower cogging torque compared to other actuators, but also has a slightly lower driving torque.

Influence of Zirconia and Organic Additives on Mechanical and Electrochemical Properties of Silica Sol-Gel Coatings.

This paper presents the result of the investigation of organically modified silica (ORMOSIL)-zirconia coatings used to enhance their protective properties, namely corrosion and scratch resistance. Two different materials, i.e., SiO2/ZrO2 and SiO2/GPTMS/ZrO2, were synthesized, measured, and analyzed to find the difference in the used organosilane precursor (dimethyldiethoxysilane and (3-glycidoxypropyl)trimethoxysilane, respectively). SiO2/ZrO2 coatings showed higher hardness than SiO2/GPTMS/ZrO2. Moreover, the value of polarization resistance (Rp) for SiO2/GPTMS/ZrO2 coated 316L steel relative to the uncoated one was obtained. It was nearly 84 times higher. The coating delamination was observed with load 16N. Additionally, the corrosion mitigation for 316L coated by SiO2/GPTMS/ZrO2 was observed even after extended exposure to corrosion agents.

Hand Areas Which Are Commonly Missed during Hand Disinfection by Nursing Students Who Completed a Basic Educational Course in Hand Hygiene.

BACKGROUND: Teaching nursing students how to correctly perform hand hygiene procedures may guarantee a reduction in transmitting pathogens through direct contact and, thus, it may lead to a decrease in the number of hospital infections. The aim of the study, which was conducted in low fidelity simulation conditions, was to assess the performance and the efficiency of a hand-rubbing disinfection technique among nursing students on the last day of their course. MATERIALS AND METHODS: The study was conducted in a group of 190 nursing students studying at the Jagiellonian University and it focused on the performed hand-rubbing disinfection procedure. The accuracy of the task performance was assessed by measuring the percentage of the amount of Fluo-Rub (B. Braun) fluorescent alcohol-based gel remaining on students' hands after disinfection. The gel was rubbed into particular hand parts including four surfaces (left palm, right palm, left back and right back) divided into thirteen areas (I-XIII) and each surface was examined separately. The results were then dichotomized based on the cut-off point of 10% and two categories: "clean" and "dirty" were established. Additionally, the range of negligence in the disinfection procedure was assessed by counting the total number of the areas classified as "dirty". The comparison of continuous and categorical variables was conducted by means of Friedman's and Cochrane's tests, respectively. RESULTS: It was found out that the palm surfaces that were commonly missed during hand disinfection included the whole thumb (I and VI), the fingertip of the little finger (V) and the midpalm (XIII), whereas in the case of back surfaces (on both right and left hand) the most commonly missed areas were the fingertips and the whole thumb I-VI. Only 30 students (13%) had all 52 areas of both hands completely clean, whereas more than one third-66 students (33%)-failed to disinfect properly more than 10 areas out of all assessed ones on the surfaces of both hands. CONCLUSIONS: In the examined group of nursing students, a significant lack of compliance with hand disinfection procedures was observed and it was related mainly to thumbs and back parts of both hands. Therefore, it is essential to conduct systematic training sessions and assessment of hand hygiene procedures for nursing students at the end of every educational stage as it can lead to their developing these skills properly.

Cobalt(II) Bipyrazolate Metal-Organic Frameworks as Heterogeneous Catalysts in Cumene Aerobic Oxidation: A Tag-Dependent Selectivity.

Three metal-organic frameworks with the general formula Co(BPZX) (BPZX2- = 3-X-4,4'-bipyrazolate, X = H, NH2, NO2) constructed with ligands having different functional groups on the same skeleton have been employed as heterogeneous catalysts for aerobic liquid-phase oxidation of cumene with O2 as oxidant. O2 adsorption isotherms collected at pO2 = 1 atm and T = 195 and 273 K have cast light on the relative affinity of these catalysts for dioxygen. The highest gas uptake at 195 K is found for Co(BPZ) (3.2 mmol/g (10.1 wt % O2)), in line with its highest BET specific surface area (926 m2/g) in comparison with those of Co(BPZNH2) (317 m2/g) and Co(BPZNO2) (645 m2/g). The O2 isosteric heat of adsorption (Qst) trend follows the order Co(BPZ) > Co(BPZNH2) > Co(BPZNO2). Interestingly, the selectivity in the cumene oxidation products was found to be dependent on the tag present in the catalyst linker: while cumene hydroperoxide (CHP) is the main product obtained with Co(BPZ) (84% selectivity to CHP after 7 h, pO2 = 4 bar, and T = 363 K), further oxidation to 2-phenyl-2-propanol (PP) is observed in the presence of Co(BPZNH2) as the catalyst (69% selectivity to PP under the same experimental conditions).

Short-term single-centre experience with the HeartMate 3 left ventricular assist device for advanced heart failure.

OBJECTIVES: The objective of this study was to analyse clinical characteristics, survival and adverse events of patients with advanced heart failure supported using the Abbott HeartMate 3 left ventricular assist device (LVAD). METHODS: We retrospectively reviewed 42 consecutive HeartMate 3 recipients implanted in our centre between 1 November 2015 and 31 October 2019. RESULTS: Our series comprised 39 males, aged 56.7 ± 11.8 years. Eleven (26%) patients had preimplant INTERMACS clinical profiles of 1 or 2. The mean duration support was 14.0 ± 10.6 months (range 0.69-44 months). During follow-up, 4 (10%) patients died while on support, 13 (35%) patients received a heart transplant and 25 patients are still ongoing. Actuarial survival after LVAD implantation was 88.4 ± 5.5% and 84.4 ± 6.6% at 1 and 2 years, respectively. There were no cases of pump thrombosis or technical malfunction. Seven (17%) patients required post-implant temporary right ventricular support. Adverse events included bleeding requiring surgery in 13 (31%) patients, gastrointestinal bleeding in 6 (14%) patients, LVAD-specific infections in 19 (45%) patients and non-disabling ischaemic stroke in 5 (12%) patients. The incidence of ischaemic stroke was significantly higher in patients where the outflow graft was anastomosed to the descending aorta as compared to those where it was anastomosed to the ascending aorta (P < 0.003). CONCLUSIONS: We have observed satisfactory survival rates using the HeartMate 3 LVAD for long-term mechanical circulatory support. The absence of technical failure, pump thrombosis, haemolysis or need for pump exchange during our 4-year experience confirms its technical reliability and improved haemocompatibility, but bleeding complications and infections remain a concern.

Muscle-sparing aortic coarctation repair.

OBJECTIVE: Surgery for aortic coarctation repair provides excellent hemodynamic results but may be complicated by musculoskeletal issues. The purpose of the study was to determine the midterm results of a muscle-sparing surgical approach to aortic coarctation repair, with special emphasis on the repair and on the musculoskeletal changes associated with a posterior thoracotomy. METHODS: We included all children with aortic coarctation operated on with our minimally invasive approach between June 2002 and October 2004, with a follow-up of ≥4.5 years. Patients were assessed clinically and echocardiographically. The spine, left chest, and shoulder were assessed clinically and radiographically. RESULTS: Thirty-one children were included. The age at operation ranged from 1 day to 15 months and weight ranged from 980 g to 10 kg. All patients underwent an extended end-to-end anastomosis coarctation repair through a minimal (n = 19) or total-muscle sparing (n = 12) or extrapleural (n = 18) approach. Five patients had an additional enlargement procedure on the aortic arch. 27 patients had no residual or recurrent gradient. Four patients exhibited restenosis, for which 1 underwent a percutaneous angioplasty and 2 underwent surgical reintervention. All patients were free of hypertension. One patient had borderline values. The musculoskeletal assessment was normal in all but 3 patients. Two patients who underwent other subsequent thoracic surgeries developed thoracogenic scoliosis of moderate severity. A third patient had a left winged scapula. No rib fusion or intercostal space enlargement was found. CONCLUSIONS: Compared with a conventional approach, our minimally invasive surgical approach led to excellent musculoskeletal outcomes without compromising the hemodynamic results.

Muscle-sparing extrapleural repair of neonatal aortic coarctation.

The goal of surgical treatment of aortic coarctation is to relieve the pressure gradient on the aorta and to allow for subsequent growth of the repaired aorta. In this regard, coarctation resection and extended end-to-end anastomosis has become the surgical gold standard. Early and long-term results have been reported to be excellent. In this tutorial, we present our technique for correction of aortic coarctation using a muscle-sparing, extrapleural approach.

Selected Socio-Demographic and Occupational Factors of Burnout Syndrome in Nurses Employed in Medical Facilities in Malopolska-Preliminary Results.

The study examined the relationship between socio-demographic and occupational factors and the level of occupational burnout using the dimensions of emotional exhaustion (EE), depersonalization (DEP), and personal accomplishment (PA). It examined 560 nurses working in hospitals and primary healthcare units. We used: Maslach Burnout Inventory and a questionnaire including socio-demographic (sex, age, marital status, education, parental status) and occupational (period of employment, workplace, managerial functions, additional employment) factors. An average respondent was 38.13 (SD = 10.16) and had a BA degree (56.0%). The respondents reported average values of the EE (22.8), a low level of DEP (Me = 6), and a low PA (27.63). Nurses working on the intensive care unit had a chance of a high level of DEP that was 75% lower (OR = 0.25, 95% CI = 0.13⁻0.50) than nurses working in conservative treatment units. Additional employment increased the risk of a high level of DEP (OR = 2.86, 95% CI = 1.70⁻4.84). The chance of low PA was 64% lower in the case of nurse managers (OR = 0.36, 95% CI = 0.13⁻0.998) than other nurses. Education, period of employment, additional employment, and managerial position had a significant influence on the level of occupational burnout. An analysis of nurses' work overload and additional employment can be an interesting research area.

The role of Heart Failure Team in managing Mechanical Circulatory Support in a Swiss low-volume institution.

BACKGROUND: Outcomes after VAD implantation may be dependent on institutional procedural volume. Specifically, it is claimed that high volumes are associated to better clinical results. This study aims to determine if this procedure is safe even in low-volume center. METHODS: Single center, retrospective cohort study, including Heart Failure consecutive patients who received long-term VAD from 2007 to 2017. Primary outcome was survival to transplant or ongoing MCS at 1-year. Survival analysis was performed using Kaplan-Meier method. RESULTS: Data concerning 50 adult patients were examined; 35 male (70%), mean age 49+/- 8 years. VAD was implanted as BTT in 48 and DT in 2. Devices implanted were: HeartMate II in 18 (36%), HeartWare in 20 (40%), HeartMate III in 12 (24%). Outcomes were: Death in 16 (32%), heart transplant in 24 (48%), uneventful ongoing support 10 (20%). Data were analysed according to pre and post-heart team creation and 2 groups of 25 patients were identified: 2007-2013 (mean INTERMACS level 3.1) and 2014-2017 (mean INTERMACS level 3.9) showing 1-year survival of 56% and 80% respectively. According to the type of device implanted, 3 groups were identified: HMII = 18 (mean INT. level 2.7), HW=20 (mean INT. level 3.3) and HMIII=12 (mean INT. level 3.7), showing survival of 52%, 78% and 91% respectively. CONCLUSIONS: Long term MCS can be implanted at low-volume centers with survival rate not inferior to high volume centers. A Heart team specifically trained in heart failure is probably more important than institutional volume in determining outcomes after VAD implantation.

Early stenosis of bioprosthetic mitral valve during venoarterial extracorporeal life support successfully treated using isolated percutaneous balloon valvuloplasty: a case report.

We present the case of a 58-year-old man who had complex reoperative bioprosthetic mitral valve replacement under femorofemoral venoarterial extracorporeal life support. The patient experienced early bioprosthetic valve failure due to leaflet fusion. This complication could be treated successfully using isolated percutaneous balloon valvuloplasty that allowed restoration of full leaflet mobility.