Impacto de la pandemia por COVID-19 en un programa de cirugía cardiovascular pediátrica de un hospital público de Argentina / Impact of the COVID-19 pandemic on a pediatric cardiovascular surgery program of a public hospital from Argentina

Objetivo. Describir el impacto de la pandemia por COVID-19 en el programa de cirugía cardiovascular pediátrica y estimar el tiempo para reducir la lista de espera quirúrgica. Métodos. Estudio descriptivo y retrospectivo. Se compararon resultados quirúrgicos del período preCOVID versus el período COVID. Se utilizó un modelo matemático para estimar el tiempo para reducir la lista de espera. Resultados. Entre el 23 de marzo y el 31 de agosto de 2020 se operaron 83 pacientes, que representan una reducción del 60 %, respecto al período preCOVID. La mediana de edad fue de 6 meses (rango intercuartílico [RIC]: 25-75, 1,8 meses a 2,9 años; p = 0,0023. El tiempo para eliminar la lista de espera varía entre 10 y 19 meses. Conclusiones. El programa tuvo una reducción del 60 %. El tiempo de resolución de la lista de espera puede ser al menos 10 a 19 meses

Objective. To describe the impact of the COVID-19 pandemic on a pediatric cardiovascular surgery program and estimate the necessary time to reduce the surgery waiting list. Methods. Retrospective, descriptive study. Surgical outcomes from the pre-COVID-19 period and COVID-19 period were compared. A mathematical model was used to estimate the time necessary to reduce the waiting list. Results. Between March 23rd and August 31st, 2020, 83 patients underwent surgery, accounting for a 60 % reduction compared to the pre-COVID-19 period. Their median age was 6 months (interquartile range [IQR]: 25-75, 1.8 months to 2.9 years; p = 0.0023). The time necessary to eliminate the waiting list ranges from 10 to 19 months. Conclusions. There was a 60 % reduction in the program. The time required to clear the backlog of cases may range from, at least, 10 to 19 month

Impact of the COVID-19 pandemic on a pediatric cardiovascular surgery program of a public hospital from Argentina. / Impacto de la pandemia por COVID-19 en un programa de cirugía cardiovascular pediátrica de un hospital público de Argentina.

OBJECTIVE: To describe the impact of the COVID-19 pandemic on a pediatric cardiovascular surgery program and estimate the necessary time to reduce the surgery waiting list. METHODS: Retrospective, descriptive study. Surgical outcomes from the pre-COVID-19 period and COVID-19 period were compared. A mathematical model was used to estimate the time necessary to reduce the waiting list. RESULTS: Between March 23rd and August 31st, 2020, 83 patients underwent surgery, accounting for a 60 % reduction compared to the pre-COVID-19 period. Their median age was 6 months (interquartile range [IQR]: 25-75, 1.8 months to 2.9 years; p = 0.0023). The time necessary to eliminate the waiting list ranges from 10 to 19 months. CONCLUSIONS: There was a 60 % reduction in the program. The time required to clear the backlog of cases may range from, at least, 10 to 19 months.

Objetivo. Describir el impacto de la pandemia por COVID-19 en el programa de cirugía cardiovascular pediátrica y estimar el tiempo para reducir la lista de espera quirúrgica. Métodos. Estudio descriptivo y retrospectivo. Se compararon resultados quirúrgicos del período preCOVID versus el período COVID. Se utilizó un modelo matemático para estimar el tiempo para reducir la lista de espera. Resultados. Entre el 23 de marzo y el 31 de agosto de 2020 se operaron 83 pacientes, que representan una reducción del 60 %, respecto al período preCOVID. La mediana de edad fue de 6 meses (rango intercuartílico [RIC]: 25-75, 1,8 meses a 2,9 años; p = 0,0023. El tiempo para eliminar la lista de espera varía entre 10 y 19 meses. Conclusiones. El programa tuvo una reducción del 60 %. El tiempo de resolución de la lista de espera puede ser al menos 10 a 19 meses.

Burden of Infective Endocarditis in Homeless Patients in the United States: A National Perspective.

BACKGROUND: Earlier studies have shown disparate cardiovascular care in homeless patients. Limited data exist on burden of infective endocarditis (IE) in homeless patients and in this study, we aimed to analyze it using a nationally representative United States population sample. METHODS: Data were extracted from National Inpatient Sample database from January 2000 to December 2017. Patients with endocarditis were sampled using International Classification of Diseases, 9th Revision, Clinical Modification codes of 421.0, 421.1 or 421.9 and International Classification of Diseases, 10th Revision, Clinical Modification codes of I33.0 or I33.9. Homeless patients were identified using codes of V60 and Z59. Linear regression was used for trend analysis and logistic regression was utilized to identify predictors of mortality. 1:1 propensity score (PS) matching was also done to balance confounders and outcomes were assessed in both unmatched and matched cohorts. RESULTS: We found an increase in proportion of homeless patients admitted with endocarditis from 0.2% in year 2000 to 2.4% in year 2017. Mortality was not statistically significant in PS matched homeless and non-homeless cohorts (4.7% vs 6.6%, p = 0.072). There was a trend towards increased mortality in homeless endocarditis patients over our study years with lower utilization of valvular surgeries. Advanced age, alcohol abuse and admission to large hospitals were independently associated with mortality in homeless endocarditis patients. CONCLUSION: Homeless patients have rising trend of IE and IE related mortality and also found to have low utilization of life saving valvular surgeries when compared to general population.

Low hematocrit levels: a risk factor for long-term outcomes in patients requiring prolonged mechanical ventilation after cardiovascular surgery. A retrospective study.

While low-risk patients who undergo elective surgery can tolerate low hematocrit levels, the benefits of higher hematocrit levels might outweigh the risk of transfusion in high-risk patients. Therefore, this study aimed to evaluate the effects of perioperative hematocrit levels on mortality in patients requiring prolonged mechanical ventilation (PMV) after a cardiovascular surgery. This single-center retrospective cohort study was conducted on 172 patients who underwent cardiovascular surgery with cardiopulmonary bypass or off-pump coronary artery bypass grafting and required PMV for ≥72 hours in the intensive care unit (ICU) from 2008 to 2012 at the Yokohama City University Medical Center in Yokohama, Japan. Patients were classified according to hematocrit levels on ICU admission: high (≥30%) and low (<30%) groups. Of 172 patients, 86 were included to each of the low-hematocrit and high-hematocrit groups, with median hematocrit levels (first to third quartiles) of 27.4% (25.4%-28.7%) and 33.0% (31.3%-35.5%), respectively. The difference in survival rates was significant between the two groups using the log-rank test (HR 0.55, 95% CI 0.32 to 0.95, p=0.033). Cox regression analysis revealed that ≥30% increase in hematocrit levels on ICU admission was significantly associated with decreased long-term mortality (HR 0.40, 95% CI 0.20 to 0.80, p=0.0095). Lower hematocrit levels on ICU admission was a risk factor for increased long-term mortality, and higher hematocrit levels might outweigh the risk of transfusion in patients requiring PMV after a cardiovascular surgery.

The relationship of preoperative estimated glomerular filtration rate and outcomes after cardiovascular surgery in patients with normal serum creatinine: a retrospective cohort study.

BACKGROUND: Although serum creatinine concentration has been traditionally used as an index of renal function in clinical practice, it is considered relatively inaccurate, especially in patients with mild renal dysfunction. This study investigated the usefulness of preoperative estimated glomerular filtration rate (eGFR) in predicting complications after cardiovascular surgery in patients with normal serum creatinine concentrations. METHODS: This study included 2208 adults undergoing elective cardiovascular surgery. Preoperative eGFR was calculated using Chronic Kidney Disease Epidemiology Collaboration equations. The relationships between preoperative eGFR and 90 day postoperative composite major complications were analyzed, including 90 day all-cause mortality, major adverse cardiac and cerebrovascular events, severe acute kidney injury, respiratory and gastrointestinal complications, wound infection, sepsis, and multi-organ failure. RESULTS: Of the 2208 included patients, 185 (8.4%) had preoperative eGFR < 60 mL/min/1.73 m2 and 328 (14.9%) experienced postoperative major complications. Multivariable logistic regression analyses showed that preoperatively decreased eGFR was independently associated with an increased risk of composite 90 day major postoperative complications (adjusted odds ratio: 1.232; 95% confidence interval [CI]: 1.148-1.322; P <  0.001). eGFR was a better discriminator of composite 90 day major postoperative complications than serum creatinine, with estimated c-statistics of 0.724 (95% CI: 0.694-0.754) for eGFR and 0.712 (95% CI: 0.680-0.744) for serum creatinine (P = 0.008). CONCLUSIONS: Decreased eGFR was significantly associated with an increased risk of major complications after cardiovascular surgery in patients with preoperatively normal serum creatinine concentrations.

Perioperative rupture risk of unruptured intracranial aneurysms in cardiovascular surgery.

Although unruptured intracranial aneurysms are increasingly being diagnosed incidentally, perioperative rupture risk of unruptured intracranial aneurysm in patients undergoing cardiovascular surgery remains unclear. Therefore, we conducted an observational study to assess the prevalence and perioperative rupture risk of unruptured intracranial aneurysm in patients undergoing cardiovascular surgery. Adult patients (n = 4864) who underwent cardiovascular surgery between January 2010 and December 2016 were included. We assessed the prevalence of unruptured intracranial aneurysms in these patients using preoperative neurovascular imaging. The incidence of postoperative 30-day subarachnoid haemorrhage from aneurysmal rupture was investigated in patients undergoing cardiovascular surgery with unruptured intracranial aneurysm. Postoperative outcomes were compared between patients with unruptured intracranial aneurysm and those without unruptured intracranial aneurysm. Of the 4864 patients (39.6% females; mean ± standard deviation age, 62.3 ± 11.3 years), 353 patients had unruptured intracranial aneurysms (prevalence rate, 7.26%; 95% confidence interval, 6.52-8.06%). Of these, eight patients received surgical or endovascular treatment before surgery and 345 patients underwent cardiovascular surgery with unruptured intracranial aneurysms. Within 30 days postoperatively, subarachnoid haemorrhage occurred only in one patient, and the cumulative postoperative 30-day subarachnoid haemorrhage incidence was 0.29% (95% confidence interval, 0.01% to 1.61%). The Kaplan-Meier estimated subarachnoid haemorrhage probabilities according to the unruptured intracranial aneurysm rupture risk scores were not higher than the previously reported risk in the general population. There were no significant differences in postoperative subarachnoid haemorrhage-free survival, haemorrhagic stroke-free survival, in-hospital mortality, and hospital length of stay between patients with unruptured intracranial aneurysm and those without unruptured intracranial aneurysm. In conclusion, the prevalence of unruptured intracranial aneurysm in patients undergoing cardiovascular surgery is higher than in the general population. However, incidentally detected unruptured intracranial aneurysms are not linked to an increased risk of subarachnoid haemorrhage or adverse postoperative outcomes. These findings may help determine the optimal management of unruptured intracranial aneurysms before cardiovascular surgery.

Gender Disparities in Cardiovascular Fellowship Training Among 3 Specialties From 2007 to 2017.

Despite women accounting for nearly half of all U.S. medical school graduates, this balanced representation is lacking in the cardiovascular specialties. To explore this question further, gender-based trends in the selection of cardiovascular subspecialty fellowship training were investigated among three core specialties: anesthesiology, medicine, and surgery. Using enrollment and workforce data from the Accreditation Council for Graduate Medical Education (ACGME), the Association of American Medical Colleges (AAMC), and the Journal of the American Medical Association Annual Report on Graduate Medical Education, trends in cardiovascular fellowship selection among women were examined over a 10-year period (2007-2017). An attempt was also made to better understand barriers that might contribute to any discrepancies, as well as factors that might influence women's choices of cardiovascular specialties over other fields.

Galeno y Vesalius y la revolución científica en la circulación sanguínea: historia y epistemología para la educación / Galen and Vesalius and the scientific revolution in blood circulation: History and epistemology for education

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Overview of the 82nd Annual Scientific Meeting of the Japanese Circulation Society　- Futurability: Pioneering the Future of Circulatory Medicine.

The 82nd Annual Scientific Meeting of the Japanese Circulation Society was held in Osaka, Japan, on March 23-25, 2018, when the cherry blossoms were just opening everywhere around the venue. This was the 5th Annual Scientific Meeting of JCS in which a cardiovascular surgeon served as Congress Chairperson. The main theme of this meeting was "Futurability: Pioneering the Future of Circulatory Medicine". The word, futurability, is a neologism of future ability, because we now have to contemplate what constitutes the essence of cardiovascular medicine, how it should develop as medicine for future generations, and how its ability should be displayed. The meeting was favored by splendid weather and the number of participants was recorded as being higher than 18,700. There were heated and profound discussions about the "futurability" of cardiology, cardiovascular surgery, and heart team medical care as well, in every session. The meeting was successfully completed and we sincerely appreciate the great cooperation and support from all affiliates.

[Modern polyurethanes in cardiovascular surgery]. / Sovremennye poliuretany v serdechno-sosudistoi khirurgii.

Currently, there is great clinical demand for synthetic tissue-engineered cardiovascular prostheses with good long-term patency. Polyurethanes belong to the class of polymers with excellent bio- and hemocompatibility. They are known to possess good mechanical properties, but are prone to processes of degradation in conditions of functioning in living organisms. Attempts at solving this problem have resulted in the development of various new subclasses of polyurethanes such as thermoplastic polyether polyurethanes, polyurethanes with a silicone segment, polycarbonate polyurethanes and nanocomposite polyurethanes. This was accompanied and followed by offering a series of new technologies of production of implantable medical devices such as vascular grafts, heart valves and others. In the presented review, we discuss biological and mechanical properties of modern subclasses of polyurethanes, as well as modern methods of manufacturing implantable medical devices made of polyurethanes, especially small-diameter vascular prostheses.

Future of transcatheter aortic valve implantation - evolving clinical indications.

Accumulating clinical experience and technological improvements have provided the basis for transcatheter aortic valve implantation (TAVI) to emerge as a well-established means for treating patients with severe symptomatic aortic stenosis at high or prohibitive surgical risk. During this decade, TAVI has emerged as a valid alternative to surgical aortic valve replacement in patients at intermediate surgical risk, and several studies are currently being performed to evaluate the role of TAVI in patients at low surgical risk. Furthermore, promising, but preliminary, data are emerging on the efficacy of TAVI for treating patients with bicuspid aortic valve disease, as well as patients with pure aortic regurgitation. In this Perspectives article, we summarize the evolving indications for TAVI, and give our opinion on the future perspectives for this procedure.

Evaluating the Effect on Mortality of a No-Tranexamic acid (TXA) Policy for Cardiovascular Surgery.

OBJECTIVES: The authors stopped using tranexamic acid (TXA) in April 2013. The present study aimed to examine the impact of a "no-TXA-use" policy by comparing the adverse effects of TXA and clinical outcomes before and after the policy change in patients undergoing cardiovascular surgery. DESIGN: A single center retrospective cohort study. SETTING: A single cardiovascular center. PARTICIPANTS: Patients undergoing cardiovascular surgery between January 2008 and July 2015 (n = 3,535). INTERVENTIONS: Patients' outcomes before and after the policy change were compared to evaluate the effects of the change. MEASUREMENTS AND MAIN RESULTS: The seizure rate decreased significantly after the policy change (6.9% v 2.7%, p < 0.001). However, transfusion volumes and blood loss volumes increased significantly after the policy change (1,840 mL v 2,030 mL, p = 0.001; 1,250 mL v 1,372 mL, p < 0.001, respectively). Thirty-day mortality was not statistically different (1.6% v 1.4%, p = 0.82), nor were any of the other outcomes. Propensity-matched analysis and segmented regression analysis showed similar results. CONCLUSIONS: The mortality rate remained the same even though the seizure rate decreased after the policy change. Blood loss volume and transfusion volume both increased after the policy change. TXA use provides an advantageous benefit by reducing the need for blood transfusion.

Current status of cardiovascular surgery in Japan, 2013 and 2014: A report based on the Japan Cardiovascular Surgery Database (JCVSD). 1: Mission and history of JCVSD.

The Japan Cardiovascular Surgery Database (JCVSD) was created in 2000 with the support of the Society of Thoracic Surgeons (STS). The STS database content was translated to Japanese using the same disease criteria and in 2001, data entry for adult cardiac surgeries was initiated online using the University Hospital Medical Information Network (UMIN). In 2008, data entry for congenital heart surgeries was initiated in the congenital section of JCVSD and preoperative expected mortality (JapanSCORE) in adult cardiovascular surgeries was first calculated using the risk model of JCVSD. The Japan Surgical Board system merged with JCVSD in 2011, and all cardiovascular surgical data were registered in the JCVSD from 2012 onward. The reports resulting from the data analyses of the JCVSD will encourage further improvements in the quality of cardiovascular surgeries, patient safety, and medical care in Japan.