Literature-based considerations regarding organizing and performing cardiac surgery against the backdrop of the coronavirus pandemic.

BACKGROUND: The ongoing coronavirus disease 2019 (Covid-19) pandemic presents challenges for surgeons of all disciplines, including cardiologists. The volume of cardiac surgery cases has to comply with the mandatory constraints of healthcare capacities. The treatment of Covid-19-positive patients must also be considered. Unfortunately, no scientific evidence is available on this issue. Therefore, this study aimed to offer some consensus-based considerations, derived from available scientific papers, regarding the organization and performance of cardiac surgery against the backdrop of the Covid-19 pandemic. METHODS: Key recommendations were extracted from recent literature concerning cardiac surgery. RESULTSː Reducing elective cardiac procedures should be based on frequent clinical assessment of patients on the waiting list (every one or two weeks) and the current local status of the Covid-19 pandemic. Screening tests at admission for every patient are broadly recommended. Where appropriate, alternative treatment methods can be considered, including percutaneous techniques and minimally invasive surgery, if performed by experienced cardiac surgery teams. CONCLUSIONS: There is little evidence on the strategies to organize cardiac surgery in the Covid-19 pandemic. Most authors agree on reducing elective operations based on patients' clinical condition and the status of the Covid-19 pandemic. Admission screenings and the use of percutaneous or minimally invasive approaches should be preferred to reduce in-hospital stays.

Quantitative estimation of aortic valve calcification in multislice computed tomography in predicting the development of paravalvular leaks following transcatheter aortic valve replacement.

INTRODUCTION: Transcatheter aortic valve implantation (TAVI) improves prognosis in patients disqualified from surgical valve replacement. Calcifications of the aortic complex can lead to deformation of the prosthesis, resulting in paravalvular leaks (PVL). AIM: To evaluate the predictive value of quantitative estimation of volume/weight and geometric distribution of calcifications in multislice computed tomography, for the development of PVL. MATERIAL AND METHODS: This was a retrospective, case-control study on patients with a CoreValve aortic prosthesis. The study group consisted of 20 patients with confirmed significant PVL after TAVI. The control group consisted of 20 patients without significant PVL, matched according to valve type and clinical characteristics. The size spatial distribution and shape of calcifications were measured. RESULTS: The average age of patients was 79.9 years (60% women). Cases and controls did not differ in their clinical characteristics. The size of the aortic annulus was significantly larger in cases vs. controls (23.4 ±1.6 vs. 22 ±1.4 mm, p = 0.01). Volume, area and curvature of calcifications were greater in cases vs controls (1.09 ±0.56 vs. 0.59 ±0.41 cm3, p = 0.011; 15.26 ±5.46 vs. 9.50 ±5.29 cm2, p = 0.008; 1.76 ±0.07 vs. 1.68 ±0.13 cm3, p = 0.037). In multivariate analysis, adjusted for aortic annulus size, the area of aortic valve calcifications independently predicted paravalvular regurgitation (OR = 1.41, 95% CI: 0.09-1.92, p < 0.009). CONCLUSIONS: Morphometric analysis of aortic valve calcifications predicted the risk of paravalvular leak following TAVI irrespectively of patients' clinical characteristics.