Randomized study of temporary diaphragm pacing for enhanced recovery after surgery in cardiac surgery patients at risk of prolonged mechanical ventilation.

Objective: Prolonged mechanical ventilation after cardiac surgery significantly increases morbidity and mortality. The aim of this study is to establish the role of diaphragmatic pacing to decrease mechanical ventilation burden in high-risk patients undergoing cardiac surgery.

Methods: This is a prospective, randomized trial of temporary diaphragmatic pacing electrode use in patients undergoing cardiac surgery (NCT04899856).

Elevated myocardial extracellular volume fraction is associated with the development of conduction pathway defects following transcatheter aortic valve replacement.

Background: Transcatheter aortic valve replacement (TAVR) has become an established method of aortic stenosis treatment but suffers from the risk of heart block and pacemaker requirement. Risk stratification for patients who may develop heart block remains imperfect. Simultaneously, myocardial fibrosis as measured by cardiac magnetic resonance imaging (CMR) has been demonstrated as a prognostic indicator of ventricular recovery and mortality following TAVR.

Nonpharmacologic rate control of postoperative atrial fibrillation in the canine sterile pericarditis model.

Introduction: Postoperative atrial fibrillation (POAF) is common following open heart surgery, and is associated with significant morbidity. Medications used for ventricular rate control of POAF may not be effective in controlling rapid ventricular rates during the postoperative period because of increased sympathetic tone. The purpose of this study was to develop nonpharmacologic rate control of POAF by atrioventricular node (AVN) fat pad stimulation using clinically available temporary pacing wires in the canine sterile pericarditis model.

Permanent Pacemaker Insertion Reduction and Optimized Temporary Pacemaker Management After Contemporary Transcatheter Aortic Valve Implantation With Self-Expanding Valves (from the Pristine TAVI Study).

Permanent pacemaker implantation (PPMI) reduction and optimal management of newly acquired conduction disturbances after transcatheter aortic valve implantation (TAVI) are crucial. We sought to evaluate the relation between transcatheter heart valve (THV) implantation depth and baseline and newly acquired conduction disturbances on PPMI after TAVI. This study included 1,026 consecutive patients with severe symptomatic aortic stenosis (mean age 79.

The Evolving Burden of Drug Use Associated Infective Endocarditis in the United States.

Background: The rise in the number of valve operations performed for infective endocarditis (IE) due to drug use is an important manifestation of the opioid epidemic. This study characterized national trends and outcomes of valve surgery for drug use-associated IE (DU-IE).

Methods: Adults undergoing valve surgery for active IE in The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database between July 2011 and June 2018 were stratified as DU-IE and non-DU-IE.

Faculty Development: Using Education for Career Advancement.

Faculty development is important at any level of academic rank but is especially important in early stages. The clinical educator is a rewarding pathway that is emerging as a special track for promotion and advancement. Success is achievable through development of skills, measurement of progress, obtaining funding, and completion of projects through publication.

Surgical Mapping and Ablation in the Left Ventricular Summit Guided by Presurgery Pericardial Mapping.

Successful catheter ablation of ventricular arrhythmias arising from the left ventricular (LV) summit is challenging. The use of a catheter-based epicardial approach may be limited due to the proximity of the major coronary arteries and the presence of epicardial fat. Surgical cryoablation in the LV summit is a viable option for drug-refractory ventricular arrhythmias.

Aortic Dysfunction in Mitral Regurgitation Due to Floppy Mitral Valve/Mitral Valve Prolapse.

Background:  Floppy mitral valve/mitral valve prolapse (FMV/MVP), a heritable disorder of connective tissue, often leads to mitral regurgitation (MR) and is the most common cause for mitral valve surgery in developed countries. Connective tissue disorders may affect aortic function, and a stiff aorta may increase the severity of MR. Aortic function, however, has not been studied in FMV/MVP with MR.

Vascular Assessment for Transcatheter Aortic Valve Replacement: Intravascular Ultrasound Compared With Computed Tomography.

Background: Assessment of the femoral and iliac arteries is essential prior to transcatheter aortic valve replacement (TAVR). It is critical for establishing candidacy for a femoral approach, and can help predict vascular complications. Although computed tomography angiography (CTA) is the standard imaging modality, it has limitations.

Modifications, classification, and outcomes of elephant-trunk procedures.

Background: There are a variety of modified elephant-trunk methods, including use of endovascular stents. Our objectives were to classify these modifications, compare outcomes between the classic anastomotic site and these alternatives, and investigate time to second-stage elephant-trunk completion.

Methods: From May 1992 to January 2011, 526 patients underwent a first-stage elephant-trunk procedure and were the subject of analysis.

Thoracic outlet syndrome caused by fibrous dysplasia of the first rib.

Fibrous dysplasia causing thoracic outlet syndrome is rare. A 41-year-old woman presented with neurogenic thoracic outlet syndrome with imaging that demonstrated a large tumor of her proximal left first rib. Transaxillary excision was unsuccessful due to involvement of the subclavian vasculature and brachial plexus.

Minimally invasive repair of pectus excavatum in patients with Marfan syndrome and marfanoid features.

Purpose: The presence of a pectus excavatum (PE) requiring surgical repair is a major skeletal feature of Marfan syndrome. Marfanoid patients have phenotypic findings but do not meet all diagnostic criteria. We sought to examine the clinical and management differences between Marfan syndrome patients and those who are marfanoid compared with all other patients undergoing minimally invasive PE repair.

Insulin requirements in the intensive care unit in response to infection.

Infectious complications in the intensive care unit (ICU) are classically identified when an elevated temperature triggers obtaining cultures. Elevated temperature, however, is a nonspecific marker of infection and may occur well into the course of the infection. The goal of this study was to evaluate whether escalating insulin demands may serve as an earlier marker for infection.

Inhibition of NF-KB does not induce c-Jun N-terminal kinase-mediated apoptosis in reperfusion injury.

Background: The role of C-Jun N-terminal Kinase (c-Jun Kinase) in apoptosis is unclear. It is likely that c-Jun Kinase activation is cell type and stimulus dependent. c-Jun Kinase promotes tumor necrosis factor (TNF)-alpha mediated apoptosis in nuclear factor (NF)-KB deficient cells.

When it is not an infection: metal allergy after the Nuss procedure for repair of pectus excavatum.

Purpose: Increasing use of implantable bars for minimally invasive pectus excavatum repair has introduced metal allergy (nickel and chromium) to pediatric surgeons. Metal allergy is a well-recognized entity in neurologic, orthopedic, and craniofacial surgery. This study was performed to evaluate metal allergy and its effects on treatment with the Nuss procedure in 862 patients.