Effect of Earlier Atrioventricular Valve Intervention on Survival After the Fontan Operation.

Whereas the prevalence and impact of atrioventricular valve (AVV) regurgitation in patients with single ventricle physiology has become increasingly apparent, the optimal timing for valve intervention is unclear. To investigate this, we performed a retrospective review of all 1,167 patients from the Mayo Clinic Fontan database. Thirteen percent (153 patients) had AVV repair or replacement during their staged single ventricle palliation.

Does ablation of atrial fibrillation at the time of septal myectomy improve survival of patients with obstructive hypertrophic cardiomyopathy?

Objective: To evaluate the outcomes after septal myectomy in patients with obstructive hypertrophic cardiomyopathy according to atrial fibrillation and surgical ablation of atrial fibrillation.

Methods: We reviewed patients with obstructive hypertrophic cardiomyopathy who underwent septal myectomy at the Mayo Clinic from 2001 to 2016. History of atrial fibrillation was obtained from patient histories and electrocardiograms.

Outcomes of Tricuspid Valve Operation at the Time of Pericardiectomy for Constrictive Pericarditis.

Background: This study sought to determine the outcome effect of concomitant tricuspid valve operation for regurgitation during pericardiectomy for constrictive pericarditis.

Methods: This cohort study included 310 patients with mild or greater tricuspid valve regurgitation who underwent pericardiectomy for constrictive pericarditis from 2000 to 2016 at the Mayo Clinic in Rochester, Minnesota. Patients were divided into 2 treatment groups: tricuspid valve operation (n = 68) and no tricuspid operation (n = 242).

Comparative Effectiveness of Mechanical Valves and Homografts in Complex Aortic Endocarditis.

Background: The ideal surgical reconstruction of the aortic root in patients with complex endocarditis is controversial. We compared the short- and long-term outcomes between mechanical valves, bioprostheses, and homografts.

Methods: We identified all patients undergoing an operation for active complex aortic endocarditis at our institution between 2003 and 2017.

On Becoming a Master Surgeon: Role Models, Mentorship, Coaching, and Apprenticeship.

Cardiothoracic surgery is a high risk, high reward specialty demanding exceptional performance for desired outcomes. Whereas the demand for technical excellence, critical thinking skills, judgment, and overall experience is clear, the pathway to optimize performance improvement after training is completed is less clear. "Role modeling," "mentorship," "coaching," and "apprenticeship" are all buzz words that have flooded the proverbial air of our specialty in recent years.

Repair of Partial Atrioventricular Septal Defects in Adults: A Single Center Experience.

Limited data are available on long-term outcome after repair of partial atrioventricular septal defects (pAVSD) in adults. We sought to review our experience. Between January 1, 1957 and December 31, 2016, 179 adult patients [median age (IQR) 34 (18, 72) years] underwent primary repair of pAVSD.

The Surgeon's View of the Left Ventricular Outflow Tract in Congenital Heart Surgery.

Left ventricular outflow tract (LVOT) obstruction is a component of many forms of congenital heart disease, including hypertrophic cardiomyopathy, membranous subaortic stenosis, tunnel subaortic stenosis, and outflow tract obstruction related to atrioventricular septal defects. We have gained a particularly extensive experience with the diagnosis and treatment of hypertrophic cardiomyopathy, having performed septal myectomy in over 3,800 patients. In the setting of this review of LVOT obstruction, we use hypertrophic cardiomyopathy as a template by which other pathologies causing LVOT obstruction can be understood.

Early Impact of the COVID-19 Pandemic on Congenital Heart Surgery Programs Across the World: Assessment by a Global Multi-Societal Consortium.

The coronavirus disease 2019 (COVID-19) pandemic currently gripping the globe is impacting the entire health care system with rapidly escalating morbidities and mortality. Although the infectious risk to the pediatric population appears low, the effects on children with congenital heart disease (CHD) remain poorly understood. The closure of congenital heart surgery programs worldwide to address the growing number of infected individuals could have an unintended impact on future health for COVID-19-negative patients with CHD.

Incidence of Ischemic Optic Neuropathy After Cardiopulmonary Bypass: 20-Year Experience.

Objective: This study evaluated the incidence and risk factors for ischemic optic neuropathy (ION) as a complication of cardiac surgery requiring cardiopulmonary bypass (CPB).

Design: Retrospective chart review of prospectively collected data at a tertiary care center.

Setting: Single tertiary academic referral center.

Bidirectional Cavopulmonary Shunt for Right Ventricular Unloading.

Background: Right-sided heart failure remains a challenge in the care of congenital heart disease patients, both those with right ventricular dilation and dysfunction and those with right ventricular hypoplasia. Two strategies for treatment are atrial septal fenestration and bidirectional cavopulmonary shunt (BCPS).

Methods: This review details the strategies for right ventricular unloading, with summaries of pertinent data and commentaries on the subject.

Impact of Hematologic Malignancies on Outcome of Cardiac Surgery.

Background: Previous studies suggest that patients with prior or current hematologic malignancy are at increased risk of intraoperative and postoperative complications when undergoing cardiac surgery. The aim of this review was to compare clinical outcomes of patients with a history of hematologic malignancy to those of similar patients with no known blood dyscrasia.

Methods: From January 1993 to June 2017, 37,839 patients underwent elective cardiac surgery at Mayo Clinic.

Transapical Septal Myectomy for Hypertrophic Cardiomyopathy With Midventricular Obstruction.

Background: Midventricular obstruction (MVO) is an uncommon variant of hypertrophic cardiomyopathy (HCM). In patients receiving septal myectomy for HCM, failure to recognize the concurrent MVO in the context of basal septum thickening can lead to inadequate excision and residual gradient. In this report, we detail the operative outcomes of MVO with and without coexistent basal septal hypertrophy.

COVID-19: FAQs-Congenital Heart Surgery Recovery and Defining a "New Normal".

As recovery of congenital heart surgery programs begins during this COVID-19 pandemic, we review key considerations such as screening, protection of patients and health care workers (HCWs), case prioritization, barriers to reactivation, redesign of patient care teams, contribution of telemedicine, modification of trainees' experiences, preparation for potential resurgence, and strategies to maintain HCW wellness. COVID-19 has tested the resolve and grit of our specialty and we have an opportunity to emerge more refined.

Courage, Fortitude, and Effective Leadership of Surgical Teams During COVID-19.

The world as we once knew it has been drastically altered secondary to coronavirus disease 2019 (COVID-19). The impact of these changes, particularly for those practicing in the medical profession, extends beyond the physical to the psychological, emotional, and spiritual. We discuss the factors that contribute to these stresses, way to manage them, and how we as leaders of our teams can inspire resilience and help our colleagues endure these most difficult times.

High-Risk Reoperative Sternotomy-How We Do It, How We Teach It.

With the increasing number of congenital heart disease patients living into adulthood and requiring reoperations, learning a safe and efficient reoperative sternotomy is essential. This article provides insight into the successful reoperative sternotomy, including preoperative evaluation, assessing risk for cardiac injury and preparations to take depending on the level of risk, safeguards taken before and during the sternotomy, and pearls and pitfalls in managing untoward events.

Volume-Outcome Association of Mitral Valve Surgery in the United States.

Importance: Early surgery for severe primary degenerative mitral regurgitation is recommended, provided optimal outcomes are achievable. Contemporary national data defining mitral valve surgery volume and outcomes are lacking.

Objective: To assess national 30-day and 1-year outcomes of mitral valve surgery and define the hospital- and surgeon-level volume-outcome association with mitral valve repair or replacement (MVRR) in patients with primary mitral regurgitation.

Bicuspid Aortic Valve Repair: Causes of Valve Failure and Long-Term Outcomes.

Background: Repair of bicuspid aortic valves (BAVs) for aortic regurgitation (AR) has favorable outcomes, but the impact of natural disease progression on durability of repair is uncertain. We evaluated causes of reoperation and compared outcomes of BAV repair to those of patients undergoing aortic valve replacement (AVR).

Methods: Between January 1993 and December 2016, 113 patients had BAV repair at our institution for significant AR.

Septal Myectomy in patients with previous coronary revascularization - hypertrophic cardiomyopathy masquerading as ischemic heart disease.

Background: Patients with obstructive hypertrophic cardiomyopathy (HCM) may have symptoms mimicking ischemic heart disease, including chest pain and shortness of breath. Some patients undergo coronary revascularization which may not lead to symptomatic improvement. This study assesses clinical presentations and outcomes of patients with previous coronary revascularization undergoing septal myectomy.

The Use of Virtual Reality to Reduce Preoperative Anxiety in First-Time Sternotomy Patients: A Randomized Controlled Pilot Trial.

Objective: To report the first randomized controlled trial to investigate if immersive virtual reality (VR) treatment can reduce patient perceptions of anxiety compared with a tablet-based control treatment in adults undergoing a first-time sternotomy.

Methods: Twenty first-time sternotomy patients were prospectively randomized (blinded to investigator) to a control or VR intervention. The VR intervention was a game module "Bear Blast" (AppliedVR) displayed using a Samsung Gear Oculus VR headset.