Muhammad Hamza Shah1,2, Eleni Flari1,2, Brandon S H Low3, Subham Roy4, Arjun Ahluwalia1, Aditya Gaur5, John Hanna1, Ashna Arif1, Marco David Bokobza De la Rosa6, Amer Harky71 School of Medicine, Dentistry & Biomedical Sciences, Queen’s University Belfast, Belfast, UK2 Centre for Anatomy, Deanery of Biomedical Sciences, University of Edinburgh, Edinburgh, UK3 College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK4 Hull York Medical School, University of York, York, UK5 School of Medicine, University of Central Lancashire, Preston, UK6 School of Medicine, Lancaster University, Lancaster, UK7 Liverpool Heart & Chest Hospital, Liverpool, UKCorresponding Author: Muhammad Hamza Shah, [email protected] of Medicine, Dentistry & Biomedical Sciences, Queen’s University Belfast, 97 Lisburn Rd, Belfast, UK BT9 7BL

The catastrophe of hypoxia in complex aortic surgery

A document by Sara Zaidi. Click on the document to view its contents.

Paravalvular leak (PVL) is uncommon but can lead to severe complications after surgical or transcatheter aortic valve replacement. Clinical complications such as heart failure, haemolysis and infective endocarditis can be catastrophic results if not treated in promptly. It is, therefore, vital that PVLs are diagnosed early using various imaging modalities. Different approaches have been studies in managing PVL’s; of late, there is an increased interest in the use of minimally invasive procedures such as the transcatheter aortic valve closure procedure due to the decreased occurrence of further operations. This review discusses the classification of PVLs, diagnostic approaches and the available management options.

Clinical assessment or scoring model for acute lung injury: a crossing path?

Emergency surgery for Type A Aortic Dissection in Octogenarians – do we still err on the side of caution?

Transcatheter Aortic Valve Implantation (TAVI) has emerged over the last decade and has become a viable treatment option for those with severe symptomatic aortic stenosis (AS). The numbers of TAVI that are being performed in centres across the world is rising rapidly, and revolutionising treatment for AS and steering away from the need for open heart surgery. TAVI has been targeted for those who are deemed high risk to undergo open heart surgery such as the elderly, frail, or those with multiple co-morbidities. General anaesthesia (GA) has been used to facilitate TAVI especially when the procedure was in its infancy. The use of GA comes with its own set of risks such as haemodynamic compromise, risk for aspiration, longer procedure time and post-operative nausea and vomiting. These side effects and or complications may not be tolerated well in those who are elderly or have numerous co-morbidities. This article seeks to understand the outcomes of patients who undergo TAVI with the support of sedation and local anaesthesia (LA) in comparison to those who received GA.

Background: Cardiothoracic (CT) surgery is a dynamic and demanding specialty, which is popular amongst medical students thus, posing as a favourable career choice for many. However, there is a significant proportion of medical students who prefer to choose other specialities instead, for different reasons. Aim of the study: This review aims to identify factors affecting the uptake of cardiothoracic surgery as a career by medical students, junior doctors and trainees globally. Methods: A comprehensive literature review was conducted using PubMed, EMBASE, SCOPUS and CINAHL using specific keywords including “cardiothoracic surgery” AND “medical student” AND “career”. Inclusion and exclusion criteria were also developed to ensure only relevant studies were used for the paper. Information on the perspectives, knowledge, and beliefs on cardiothoracic surgery amongst medical students and trainee doctors worldwide was collected. Results: Most data was sourced from UK and US-based studies with only a minority of literature from other parts of the world. Uptake of cardiothoracic surgery amongst medical students, junior doctors and trainees is generally low, on a global level. Deterring factors identified from this review included work-life balance, professional satisfaction, lifestyle, and family planning, the latter being especially important for female medical students. Conclusion: Although job posts are still being filled, the increasing numbers of medical students losing interest in a career in cardiothoracic surgery needs to be addressed. Areas of future research into this area would be to re-assess medical school curricula and opportunities to engage more in the field whilst at medical school and beyond.

Background: Renal complications following cardiac surgery are fairly common and may require renal replacement therapy. Most of such cases recover with either conservative management or temporary, short period requirements for renal replacement therapy. Several studies highlight compelling evidence for such complications to be recognised and managed promptly. Aim: In this review, we aim to address the identified risk factors and pathophysiology of cardiac surgery associated renal injury. Furthermore, data regarding acute kidney injury and the long-term renal complications post-cardiac surgery will also be analysed. Methods: A comprehensive review of literature was conducted using appropriate keywords on search engines of SCOPUS, Wiley, PubMed, and SAGE Journals. Conclusion: Various risk factors during the periods of surgery have been identified to be linked to the occurrence of these adverse outcomes. Many of these factors have been identified through extensive research and are modifiable while several others are still unclear or needs deeper understanding and studies.

Type B Aortic Dissection (TBAD) occurs seldomly in pregnancy, but has disastrous consequences for both mother and fetus. The focus of immediate surgical repair of Type A Aortic Dissection due to higher mortality of patients is less clear in its counterpart, TBAD, in which management is controversial and debated. Risk factors for TBAD include: aortic wall stress due to hypertension, previous cardiac surgery, structural abnormalities (bicuspid aortic valve, aortic coarctation), and connective tissue disorders. In pregnancy, pre-eclampsia is a cause of increased aortic wall stress. Management of this condition is often conservative, but this is dependent on a number of factors, including gestation, cardiovascular stability of the patient, and symptomology. In most cases, a Caesarean section prior to intervention is carried out, unless certain indications are present. Due to a scarce number of cases across decades, it is difficult to determine which management is optimal. This article collates knowledge so far on this rare event during pregnancy.

Background: Acute type A aortic dissection (ATAAD), is a surgical emergency often requiring intervention on the aortic root. There is much controversy regarding root management; aggressively pursuing a root replacement, versus more conservative approaches to preserve native structures. Methods: Electronic database search we performed through PubMed, Embase, SCOPUS, google scholar and Cochrane identifying studies that reported on outcomes of surgical repair of ATAAD through either root preservation or replacement. The identified articles focused on short- and long-term mortalities, and rates of re-operation on the aortic root. Results: There remains controversy on replacing or preserving aortic root in ATAAD. Current evidence supports practice of both trends following an extensive decision-making framework, with conflicting series suggesting favourable results with both procedures as the approach that best defines higher survival rates and lower perioperative complications. Yet, the decision to perform either approach remains surgeon decision and bound to the extent of the dissection and tear entries in strong correlation with status of the aortic valve and involvement of coronaries in the dissection. Conclusions: There exists much controversy regarding fate of the aortic root in ATAAD. There are conflicting studies for impact of root replacement on mortality, whilst some study’s report no significant results at all. There is strong evidence regarding risk of re-operation being greater when root is not replaced. Majority of these studies are limited by the single centred, retrospective nature of these small sample sized cohorts, further hindered by potential of treatment bias.

Objectives: Mitral valve disease is increasingly prevalent. Timely diagnosis and the choice of the right intervention are very important in the early stages, as valvular dysfunction often leads to cardiac failure and even sudden death. The focus of this paper is on the various pathologies of the mitral valve, their etiology, and clinical management. Methods: Mitral regurgitation (MR) can be managed surgically, percutaneously or medically. Treatment methods for primary MR include percutaneous mitral valve (MV) repair, MV replacement, minimally invasive mitral valve surgery (MIMVS), and more recently, robotics. Additionally, conventional sternotomy has been used for both MR and mitral stenosis. Nonetheless, ongoing clinical trials are a clear indicator that the management of valve diseases is continuously evolving. Results: Multiple studies favour MV repair via MIMVS, over conventional sternotomy or percutaneous approach. However, more data is needed to optimize patient selection. Robot assisted repair is a new alternative, but attention should be given to the steep learning curve and medical training of professionals wishing to perform this intervention. Cost effectiveness and possible side effects should be explored by clinical trials as well. While guidelines are fairly straightforward for primary MR, there is insufficient evidence to suggest that surgical treatment is advantageous for secondary MR. Management is usually pharmaceutical and aims to treat symptoms rather than cause. Conclusion: Mitral valve disease remains a medical challenge, but numerous research and clinical trials have been embarked upon to refine old methods and discover new ones to improve treatment success and procedural safety.