Percutaneous Mechanical Aspiration for Infective Endocarditis: Proceedings From an Inaugural Multidisciplinary Summit and Comprehensive Review.

The clinical presentation and epidemiology of infective endocarditis (IE) have evolved over time. While the cornerstones of IE treatment remain antimicrobial therapy and surgery, percutaneous mechanical aspiration (PMA) has emerged as an option for carefully selected patients as a complementary modality, based on retrospective data, case series, and expert experience. In this comprehensive review, we summarize the proceedings from an inaugural summit dedicated to the discussion of PMA in the global management of IE, consisting of experts across multiple disciplines from diverse geographic regions and care environments.

"A Bridge-over-the Bar": A Novel Strategy to Prevent Paravalvular Regurgitation during Mitral Valve Replacement for Severe Mitral Annular Calcifications.

Mitral annular calcifications have been known to increase complexity during mitral valve replacement (MVR). Standard procedure requires decalcification followed by reconstruction of the mitral annulus prior to placing the prosthesis. While this is the ideal technique, it is not feasible in every patient due to the associated risks.

Anomalous Right Coronary Artery: Culprit or Innocent Bystander?

Anomalous aortic origin of a coronary artery is a rare congenital heart defect. The detection of anomalous coronary arteries is likely to increase with increased availability and application of cardiac computed tomography and magnetic resonance imaging. Once detected, the recommendation for surgical intervention on anomalous coronary arteries depends upon patient symptoms, the presence or absence of inducible ischemia on stress imaging, and high-risk anatomic features.

Asian Pacific Society of Cardiology Position Statement on the Use of Transcatheter Aortic Valve Implantation in the Management of Aortic Stenosis.

Transcatheter aortic valve implantation (TAVI) has been established as an effective treatment modality in patients with severe aortic stenosis (AS) and the uptake of TAVI is rapidly growing in the Asia-Pacific region. However, there exist a heterogeneity in the management of aortic stenosis and the use of TAVI among countries in the region. Reasons for these differences include anatomic variations, disparity in healthcare resources and infrastructure, and the lack of consensus on the optimal management of AS in the Asia-Pacific region.

In-depth Computational Analysis Reveals The Significant Dysregulation of Key Gap Junction Proteins (GJPs) Driving Thoracic Aortic Aneurysm Development.

Objective: Thoracic Aortic Aneurysm (TAA) represents an aortic pathology that is caused by the deranged integrity of the three layers of the aortic wall, and is related to severe morbidity and mortality. Consequently, it is crucial to identify the biomarkers implicated in the pathogenesis and biology of TAA. The aim of the current computational study was to assess the differential gene expression profile of the gap junction proteins (GJPs) in patients with TAA in order to identify novel potential biomarkers for the diagnosis and treatment of this disease.

Interhospital Variability in 180-day Infections Following Cardiac Surgery.

Objective: This study sought to: (1) evaluate hospital-level variation in infections following cardiac surgery and (2) develop and evaluate a 180-day infection quality metric.

Methods: This study evaluated Medicare claims that were merged with institutional Society of Thoracic Surgeons Adult Cardiac Surgery Database files among patients undergoing cardiac surgery across 33 Michigan centers. The primary outcome was an infection within 180 days of surgery.

Asian Thoracic Oncology Research Group expert consensus statement on the peri-operative management of non-small cell lung cancer.

The peri-operative management of non-small cell lung cancer (NSCLC) in earlier stage disease has seen significant advances in recent years with the incorporation of immune checkpoint inhibitors and targeted therapy. However, many unanswered questions and challenges remain, including the application of clinical trial data to routine clinical practice. Recognising the unique demographic profile of Asian patients with NSCLC and heterogeneous healthcare systems, the Asian Thoracic Oncology Research Group (ATORG) convened a consensus meeting in Singapore on 26 April 2024 to discuss relevant issues spanning diagnostic testing to post-neoadjuvant treatment considerations and future directions.

1-year patency of a novel biorestorative polymeric coronary artery bypass conduit.

Coronary artery bypass graft surgery (CABG) remains the gold standard in the treatment of complex coronary artery disease (CAD). Saphenous vein grafts (SVG) are commonly used for the non-left anterior descending artery (LAD). However, SVG failure rates in CABG surgery have been reported to be as high as 30% at 1 year and ∼50% at 10 years.

Fine-tuning blood culture practices: implementing diagnostic stewardship in cardiothoracic surgery patients.

Overusing blood cultures (BCxs) can lead to false positives, unnecessary antibiotics, and increased healthcare costs. Despite studies on inpatient BCx algorithms, none have focused on cardiothoracic surgery (CTS) patients, with complex postoperative care and invasive devices. This study aimed to evaluate the impact of a BCx algorithm on BCx event (BCE) rates in CTS step-down units.

The Society of Thoracic Surgeons (STS) Clinical Practice Guideline on Surgical Management of Oligometastatic Non-small Cell Lung Cancer.

Background: The use of local consolidative therapy (LCT) in patients with oligometastatic non-small cell lung cancer (NSCLC) is rapidly evolving, with a preponderance of data supporting the benefits of such therapeutic approaches incorporating pulmonary resection for appropriately selected candidates. However, practices vary widely institutionally and regionally, and evidence-based guidelines are lacking.

Methods: The Society of Thoracic Surgeons assembled a panel of thoracic surgical oncologists to evaluate and synthesize the available evidence regarding the role of pulmonary resection as LCT.

Contemporary Management of the Aortic Valve-Narrative Review of an Evolving Landscape.

Aortic valve replacement has undergone novel changes in recent decades, providing not only a multitude of procedural options but expanding the treatable patient population. Specifically, a number of minimally invasive and interventional treatment options have allowed for the treatment of high and prohibitive risk surgical patients. Further, technology is allowing for the development of innovative surgical and transcatheter valve models, which will advance the treatment of aortic valve disease in the future.

Glycated Haemoglobin (HbA) in Cardiac Surgery: A Narrative Review.

Perioperative dysglycaemia in cardiac surgery is associated with poor outcomes. Glycaemic variability rather than glucose levels is a predictor of the length of an ICU stay, a rise in creatinine and acute kidney injury after cardiac surgery. Glycated haemoglobin (HbA) values correspond closely to average blood glucose levels and cut-off values can be used to define a diabetic and pre-diabetic status.

Standardization to Characterize the Complexity of Vessel Network Using the Aortic Ring Model.

Regeneration after ischemia requires to be promoted by (re)perfusion of the affected tissue, and, to date, there is no therapy that covers all needs. In treatment with mesenchymal stem cells (MSC), the secretome acts via paracrine mechanisms and has a positive influence on vascular regeneration via proangiogenic factors. A lack of standardization and the high complexity of vascular structures make it difficult to compare angiogenic readouts from different studies.

Automated Detection and Differentiation of Stanford Type A and Type B Aortic Dissections in CTA Scans Using Deep Learning.

Background/objectives: To develop and validate a model system using deep learning algorithms for the automatic detection of type A aortic dissection (AD), and differentiate it from normal and type B AD patients.

Methods: In this retrospective study, a deep learning model is developed, based on aortic computed tomography angiography (CTA) scans of 498 patients using training, validation and test sets of 398, 50 and 50 patients, respectively. An independent test set of 316 patients is used to validate and evaluate its performance.

Autoimmune Encephalitis Induced by SARS-CoV-2 Infection Treated with Thymectomy.

Thymomas have been associated with the generation of paraneoplastic autoantibodies to neurogenic epitopes, collapsin-response-mediator protein-5 receptor (CRMP-5) and alpha-amino-3-hydroxyl-5methyl-4isoxazolepropionic acid receptor (AMPAR), in patients with acute viral infection. We report a patient with thymoma and myasthenia gravis, with SARS-CoV-2 infection, who became comatose secondary to autoimmune encephalitis. Plasmapheresis, high-dose steroids, pyridostigmine, eculizumab, and rituximab did not restore neurologic function.

Primary vs Staged Biventricular Repair for Neonatal IAA with VSD and LVOTO.

Background: This study sought to determine the safety of primary and staged biventricular repair in neonates with interrupted aortic arch (IAA), ventricular septal defect (VSD), and severe left ventricular outflow tract obstruction (LVOTO).

Methods: Patients with a fundamental diagnosis of IAA and VSD between 2015 and 2020 were extracted from The Society of Thoracic Surgeons National Database by using a Participant User File. The objective was to compare outcomes for neonates undergoing primary and staged Yasui and Ross operations.

Facilitating a More Diverse Workforce: The Value of Mentorship in Cardiothoracic Surgery.

Background: Cardiothoracic surgery (CTS) is one of the least diverse surgical specialties in both gender and race. Aside from the inherent benefits of a diverse working environment, mitigating this diversity gap improves patient care. Mentorship is important for creating a diverse, nurturing environment for trainees.

To Cut (Minimally Invasively) Is to Cure: Robotic Lobectomy for Pulmonary Mucormycosis.

Pulmonary mucormycosis is a rapidly progressive and highly morbid disease commonly found in immunosuppressed patients. Rapid diagnosis and treatment are essential, with thoracotomy and video-assisted thoracoscopic surgery techniques previously described for surgical resection of infected lobes. Here we present the case of a patient with acute myeloid leukemia and nonresolving pneumonia treated with robotic left upper lobectomy.

Mortality After Pediatric Cardiac Surgery in Patients From Disadvantaged Neighborhoods.

Background: Disadvantaged socioeconomic status correlates with adverse outcomes for patients with congenital heart disease. We examined individual and neighborhood characteristics associated with adverse short-term surgical outcomes and investigated potential drivers of disparities.

Methods: Single-center retrospective analysis collected clinical and demographic information on cardiovascular surgery patients over a 15-year period (2007-2022) from the District of Columbia metropolitan area.