Investigation of raphe function in the bicuspid aortic valve and its influence on clinical criteria-A patient-specific finite element study.

The aortic valve is normally composed of 3 cusps. In one common lesion, 2 cusps are fused together. The conjoined area of the fused cusps is termed raphe.

Healthcare providers' perceptions of a situational awareness display for emergency department resuscitation: a simulation qualitative study.

Importance: Emergency resuscitation of critically ill patients can challenge team communication and situational awareness. Tools facilitating team performance may enhance patient safety.

Objectives: To determine resuscitation team members' perceptions of the Situational Awareness Display's utility.

Aortic Valve Cusp Coaptation Surface Area Using 3-Dimensional Transesophageal Echocardiography Correlates with Severity of Aortic Valve Insufficiency.

Objective: The aim of this study was to test both in humans and using finite element (FE) aortic valve (AV) models whether the coaptation surface area (CoapSA) correlates with aortic insufficiency (AI) severity due to dilated aortic roots to determine the validity and utility of 3-dimensional transesophageal echocardiographic-measured CoapSA.

Design: Two-pronged, clinical and computational approach.

Setting: Single university hospital.

Team communication patterns in emergency resuscitation: a mixed methods qualitative analysis.

Background: In order to enhance patient safety during resuscitation of critically ill patients, we need to optimize team communication and enhance team situational awareness but little is known about resuscitation team communication patterns. The objective of this study is to understand how teams communicate during resuscitation; specifically to assess for a shared mental model (organized understanding of a team's relationships) and information needs.

Methods: We triangulated 3 methods to evaluate resuscitation team communication at a tertiary care academic trauma center: (1) interviews; (2) simulated resuscitation observations; (3) live resuscitation observations.

Repeat Revascularization After Minimally Invasive Coronary Artery Bypass Grafting: Is It a Problem?

Objective: Minimally invasive coronary artery bypass grafting (MICS CABG) via a small left thoracotomy is a novel technique for coronary revascularization that is increasingly used around the world. However, multivessel MICS CABG is difficult, and concerns about repeat revascularization (RR) have been raised. This longitudinal study describes the rates of RR among patients who have undergone MICS CABG and identifies targets for improvement.

Mid-Term Follow-up of Minimally Invasive Multivessel Coronary Artery Bypass Grafting: Is the Early Learning Phase Detrimental?

Objective: Minimally invasive coronary artery bypass grafting (MICS CABG) through a small left thoracotomy is a novel technique for surgical coronary revascularization, which is increasingly being adopted around the world. This study aimed to describe the characteristics and mid-term outcomes of a series of MICS CABG to identify areas for improvement.

Methods: A prospective longitudinal study was performed on the 306 MICS CABG patients operated on by a single surgeon from 2005 to 2015.

Predictors and Outcomes of Sternotomy Conversion and Cardiopulmonary Bypass Assistance in Minimally Invasive Coronary Artery Bypass Grafting.

Objective: This work's objective was to identify the determinants of conversion of minimally invasive coronary artery bypass grafting to sternotomy, with and without cardiopulmonary bypass assistance, and to compare clinical outcomes in patients who needed conversion.

Methods: This is a prospectively collected data on patients who underwent minimally invasive coronary bypass done by a single surgeon from February 2005 to September 2014. Statistical analyses were expressed as mean values ± standard deviation or proportions.

When Should the Mitral Valve Be Repaired or Replaced in Patients With Ischemic Mitral Regurgitation?

Background: Data comparing outcomes after repair versus replacement of chronic ischemic mitral regurgitation (MR) is evolving. Recent data suggest that repair is associated with recurrent MR, but not survival, when compared with replacement. However, it remains unclear when either surgical strategy should be applied based on preoperative mitral valve anatomy.

Operative mortality with coronary artery bypass graft: where do we stand in 2015?

Purpose Of Review: Coronary artery bypass graft (CABG) surgery has evolved and become much safer since its inception. This article outlines recent strategies in optimizing CABG mortality.

Recent Findings: Improving operative mortality around CABG relates to five components.

Is Aortic Valve Repair Reproducible? Analysis of the Learning Curve for Aortic Valve Repair.

Background: Aortic valve (AV) preservation and repair, although effective, is performed in a limited number of centres. Lack of wider application might be due to challenges in dissemination of tacit surgical knowledge. We examined the learning curve in 2 centres that initiated dedicated programs in AV repair.

Impact of aortic annular geometry on aortic valve insufficiency: Insights from a preclinical, ex vivo, porcine model.

Objectives: We sought to create a model of aortic insufficiency in a left heart simulator combined with 3-dimensional echocardiography and finite element modeling of the aortic valve. We examined the effects of aortic root geometry alteration on aortic insufficiency.

Methods: Porcine aortic roots were analyzed on a left heart simulator before (control, n = 8) and after intervention (n = 8).

Aortic root geometry in bicuspid aortic insufficiency versus stenosis: implications for valve repair.

Objectives: The contribution of aortic annular and root disease in bicuspid aortic valve (BAV) insufficiency remains unclear. We compared aortic root geometry between BAV stenosis and aortic insufficiency (AI), before and after repair.

Methods: Patients presenting for surgery for BAV insufficiency (n = 58) were compared with patients with BAV stenosis (n = 58).

Unusual cause of an ejection murmur: myxoma in the left ventricular outflow tract.

We present the case of a healthy, asymptomatic 50-year-old woman with a systolic ejection murmur who was found to have an obstructive left ventricular outflow tract mass. Transthoracic echocardiography revealed a large mobile mass attached to the basal anterior septum of the left ventricle. Surgical resection was performed and a benign left ventricular outflow tract myxoma was diagnosed.

Can minimally invasive coronary artery bypass grafting be initiated and practiced safely?: a learning curve analysis.

Objective: We examined the effects of learning curve on clinical outcomes and operative time in minimally invasive coronary artery bypass grafting (MICS CABG).

Methods: We studied 210 consecutive MICS CABG cases performed by the same surgeon, composed of 3 cardiopulmonary bypass (CPB)-assisted single-vessel small thoracotomy (SVST), 87 off-pump SVST, 51 CPB-assisted multivessel small thoracotomy (MVST), and 69 off-pump MVST. For each MICS CABG technique, the frequency of early clinical events (mortality, reopening, stroke, myocardial infarction, and revascularization) was compared between the first 25 cases and the remainder.

Transesophageal echocardiography simulation is an effective tool in teaching psychomotor skills to novice echocardiographers.

Background: Performance of transesophageal echocardiography (TEE) requires the psychomotor ability to obtain interpretable echocardiographic images. The purpose of this study was to determine the effectiveness of a simulation-based curriculum in which a TEE simulator is used to teach the psychomotor skills to novice echocardiographers and to compare instructor-guided with self-directed online delivery of the curriculum.

Methods: After institutional review board approval, subjects inexperienced in TEE completed an online review of TEE material prior to a baseline pre-test of TEE psychomotor skills using the simulator.

Results of the Minimally Invasive Coronary Artery Bypass Grafting Angiographic Patency Study.

Objective: Minimally invasive coronary artery bypass grafting is safe and widely applicable, and may be associated with fewer transfusions and infections, and better recovery than standard coronary artery bypass grafting. However, graft patency rates remain unknown. The Minimally Invasive Coronary Artery Bypass Grafting Patency Study prospectively evaluated angiographic graft patency 6 months after minimally invasive coronary artery bypass grafting.

Measuring aortic valve coaptation surface area using three-dimensional transesophageal echocardiography.

Background: As aortic valve (AV) repairs become more sophisticated, surgeons need increasingly detailed information about the structure and function of this valve. Unlike two-dimensional transesophageal echocardiography (2D-TEE), using three-dimensional (3D)-TEE makes it possible to image the entire AV. We hypothesized that measuring coaptation surface area (CoapSA) would be feasible and reproducible, and CoapSA would decrease in patients with aortic insufficiency.

Handsewn proximal anastomoses onto the ascending aorta through a small left thoracotomy during minimally invasive multivessel coronary artery bypass grafting: a stepwise approach to safety and reproducibility.

Minimally invasive coronary artery bypass grafting (MICS CABG) is a nonrobotic, nonthoracoscopic operation that achieves complete anatomical graft similarity with conventional CABG, while avoiding sternotomy and cardiac anoxia. We describe the stepwise approach to perform proximal anastomoses directly off the ascending aorta and also early results of this operation. All myocardial territories are accessed via a 4- to 6-cm left fifth intercostal thoracotomy.

Assessing residents' disclosure of adverse events: traditional objective structured clinical examinations versus mixed reality.

Objective: The skill of disclosing adverse events is difficult to assess. Assessment of this competency in medical trainees is commonly achieved via the objective structured clinical examination (OSCE) using a standardized patient (SP). We hypothesized that the addition of a simulated clinical adverse event prior to the SP encounter could increase trainees' engagement and empathy, thereby improving performance.

Modeling leaflet correction techniques in aortic valve repair: A finite element study.

In aortic valve sparing surgery, cusp prolapse is a common cause of residual aortic insufficiency. To correct cusp pathology, native leaflets of the valve frequently require adjustment which can be performed using a variety of described correction techniques, such as central or commissural plication, or resuspension of the leaflet free margin. The practical question then arises of determining which surgical technique provides the best valve performance with the most physiologic coaptation.

Minimally invasive coronary artery bypass grafting via a small thoracotomy versus off-pump: a case-matched study.

Objective: The minimally invasive coronary artery bypass grafting (MICS CABG) operation performed via a small thoracotomy has not previously been examined in a direct comparison to sternotomy off-pump coronary artery bypass grafting (OPCAB).

Methods: We matched, according to age, gender, left ventricular function, and median number of distal anastomoses, 150 patients who underwent MICS CABG via small left thoracotomy, and 150 patients who received sternotomy OPCAB. All operations were performed by the same surgeon.