The implementation of a real time early warning system using machine learning in an Australian hospital to improve patient outcomes.

Background: Early Warning Scores (EWS) monitor inpatient deterioration predominantly using vital signs. We evaluated inpatient outcomes after implementing an Artificial Intelligence (AI) based intervention in our local EWS.

Methods: A prior study calculated a Deterioration Index (DI) with logistic regression utilising demographics, vital signs, and laboratory results at multiple time points to predict any major adverse event (MAE-all cause mortality, ICU admission, or medical emergency team activation).

Perioperative transfusion and long-term mortality after cardiac surgery: a meta-analysis.

Objectives: Cardiac surgical procedures are associated with a high incidence of periprocedural blood loss and blood transfusion. Although both may be associated with a range of postoperative complications there is disagreement on the impact of blood transfusion on long-term mortality. This study aims to provide a comprehensive review of the published outcomes of perioperative blood transfusion, examined as a whole and by index procedure.

LIMA to LAD grafting returns patient survival to age-matched population: 20-year outcomes of MIDCAB surgery.

Objectives: Previous studies have demonstrated the safety and excellent short-term and mid-term survival after minimally invasive direct coronary artery bypass (MIDCAB). We reviewed the long-term outcomes up to 20 years, including overall survival and freedom from reintervention.

Methods: Consecutive patients who underwent MIDCAB between February 1997 and August 2020 were identified.

Paraprotein associated heparin resistance during cardiopulmonary bypass.

Introduction: Heparin resistance during cardiopulmonary bypass poses a significant intraoperative dilemma. Antithrombin deficiency related heparin resistance is well described, but less common causes are still poorly understood and inadequately managed.

Case Report: We present a case of heparin resistance during cardiopulmonary bypass in a gentleman with no previous haematological history or thrombotic risk factors.

In patients with lung cancer is combined endobronchial ultrasound and endoscopic ultrasound superior to conventional mediastinoscopy in staging the mediastinum?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'In patients with lung cancer, is combined endobronchial ultrasound and endoscopic ultrasound (EBUS + EUS) superior to cervical mediastinoscopy (CM) in staging the mediastinum?' Altogether more than 110 papers were found, of which one meta-analysis, two RCTs, and two cohort studies represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated.

A Trend-Based Early Warning Score Can Be Implemented in a Hospital Electronic Medical Record to Effectively Predict Inpatient Deterioration.

Objectives: To determine whether a statistically derived, trend-based, deterioration index is superior to other early warning scores at predicting adverse events and whether it can be integrated into an electronic medical record to enable real-time alerts.

Design: Forty-three variables and their trends from cases and controls were used to develop a logistic model and deterioration index to predict patient deterioration greater than or equal to 1 hour prior to an adverse event.

Setting: Two large Australian teaching hospitals.

Both surgical and percutaneous revascularization improve prognosis in patients with a coronary chronic total occlusion (CTO) irrespective of collateral robustness.

The impact of surgical or percutaneous coronary revascularization on prognosis in patients with a chronic total occlusion (CTO) remains uncertain. Particularly, whether revascularization of those with robust coronary collaterals improves prognosis is unknown. The objective of this study was to determine the predictors and prognostic impact of revascularization of a CTO, and to determine the clinical impact of robust coronary collaterals.

'Is totally endoscopic coronary artery bypass grafting compared with minimally invasive direct coronary artery bypass grafting associated with superior outcomes in patients with isolated left anterior descending disease?'.

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Is totally endoscopic coronary artery bypass grafting compared with minimally invasive direct coronary artery bypass grafting associated with superior outcomes in patients with isolated left anterior descending disease?' Altogether more than 118 papers were found using the reported search, of which 4 represented the best evidence to answer the clinical question, which included 2 prospective cohort studies and 2 retrospective observational studies. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated.

Operative Results of Mitral Valve Repair and Replacement in Chronic Ischaemic Mitral Valve Regurgitation.

Background: Ischaemic mitral regurgitation (IMR) carries significant morbidity and mortality. Surgical management includes coronary artery bypass surgery alone or concomitant with mitral valve repair or replacement. There is ongoing debate regarding the appropriate approach to the mitral valve in relation to long-term outcomes.

Delayed diagnosis of right-sided valve endocarditis causing recurrent pulmonary abscesses: a case report.

Background: Pulmonary valve infective endocarditis is a rare diagnosis that is usually associated with immunocompromised states or structurally abnormal hearts. It is unusual for it to occur in structurally normal hearts or to cause recurrent symptoms after targeted antibiotics. Although guidelines suggest follow-up with repeat echocardiography and inflammatory marker surveillance, this case demonstrates that these are not always useful investigations, and instead imaging of the chest may be more appropriate.

Temporary extracorporeal bypass modalities during aortic surgery.

The key to aortic surgery is protection of the brain, heart, spinal cord, and viscera. For operations involving the aortic arch, the focus is on cerebral protection, while for pathology involving the descending thoracic aorta, the focus is on spinal protection. Optimal cerebral and spinal protection requires an extensive knowledge of the operative steps and an understanding of the cardiopulmonary bypass modalities that are possible.

An Unusual Case of Cannula Obstruction Resulting from Venous Thromboembolism.

Cerebral strokes of unknown origin frequently present with a patent foramen ovale (PFO), a common atrial septal defect occurring in approximately 25% of the adult population. Deep vein thrombosis (DVT) or pulmonary embolism (PE) in the presence of a PFO can produce paradoxical systemic embolization subsequent to an increase in pulmonary pressure, permitting entry of thrombi into the arterial circulation. Diagnosis of an impending paradoxical embolism (IPDE) involves the detection of DVT or PE in the presence of an abnormal communication between left and right circulations and may include a right-to-left shunt.

A Review of the Endovascular Management of Thoracic Aortic Pathology.

Background: Thoracic endovascular aortic repair (TEVAR) has recently gained popularity, but there is ongoing debate surrounding its safety and efficacy. We present 13 years of TEVAR experience at our institution.

Methods: Data from procedures performed between September 2000 and October 2013 were sourced.

Impending paradoxical embolism: have we lost the clot?

Impending paradoxical embolism is a rare diagnosis that requires urgent treatment. We present a case where surgical thromboembolectomy was undertaken. The thrombus vanished from view on transesophageal ultrasound and was presumed to have undergone embolisation while bypass was established.

Arrhythmogenicity of hypothermia - a large animal model of hypothermia.

Background: Therapeutic hypothermia (TH) is used to mitigate cerebral injury after an out of hospital cardiac arrest. There is a perceived risk of increased arrhythmias with temperatures lower than the current target of 32-34°C for TH. This study sought to develop and investigate the electrophysiological changes in a sheep model of systemic hypothermia regarding the susceptibility to ventricular arrhythmias.

Liberal use of axillary artery cannulation for aortic and complex cardiac surgery.

Objectives: Axillary artery cannulation for cardiopulmonary bypass has been described previously as a safe and reliable technique, with a low risk of atheroemboli, avoidance of malperfusion in aortic dissection and facilitation of selective antegrade cerebral perfusion during hypothermic circulatory arrest. The aim of this study was to document the broad applicability of axillary cannulation and its associated morbidity and identify where it was not possible to use planned axillary cannulation.

Methods: A retrospective review of a single surgeon's 10-year experience of axillary cannulation using the side-graft technique in 184 consecutive patients (age 22-92 years) in aortic and complex cardiac surgery from July 2002 to June 2012.

Axillary artery cannulation for aortic and complex cardiac surgery.

Background: Cannulation of the axillary artery for cardiopulmonary bypass (CPB) avoids manipulation of an atherosclerotic, aneurysmal, or dissected ascending aorta. Advantages include: low risk of atheroemboli, low risk of malperfusion in dissections, and facilitates selective antegrade cerebral perfusion (SACP) during hypothermic circulatory arrest (HCA).

Methods: A single surgeon's seven year experience of axillary cannulation using the side-graft technique in 116 consecutive patients (age 22-87 years) in aortic and cardiac surgery where the ascending aorta was unapproachable.