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Angiotensin II (AT) is a potent vasoconstrictor and hypertensive drug that is registered for the treatment of severe hypotension in vasoplegic shock. Growing experience with the use of AT in cardiac surgery allows the first therapeutic algorithms to be created. This paper is a proposal for the use of AT in distributive shock after extracorporeal circulation. [ABSTRACT FROM AUTHOR]

Abstract This study is an analysis of the 100 most cited articles in mitral valve surgery. A bibliometric analysis is a tool to evaluate research performance in a given field. It uses the number of times a publication is cited by others as a proxy marker of its impact. The most cited paper Carpentier et al. discusses mitral valve repair in terms of restoring the geometry of the entire valve rather than simply narrowing the annulus (Carpentier, J Thorac Cardiovasc Surg 86:23–37, 1983). The first successful mitral valve repair was performed by Elliot Cutler at Brigham and Women’s Hospital in 1923 (Cohn et al., Ann Cardiothorac Surg 4:315, 2015). More recently percutaneous and minimally invasive techniques that were originally designed as an option for high risk patients are being trialled in other patient groups (Hajar, Heart Views 19:160–3, 2018). Comparison of percutaneous method with open repair represents an expanding area of research (Hajar, Heart Views 19:160–3, 2018). This study will analyse the top 100 cited papers relevant to mitral valve surgery, identifying the most influential papers that guide current management, the institutions that produce them and the authors involved.

Abstract Background The Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW) is a prevalent face-to-face interview method for measuring quality of life by integrating respondent-generated dimensions. To apply this method in clinical trials, a paper-administered alternative would be of interest. Therefore, our study aimed to analyze the agreement between the SEIQoL-DW and a paper questionnaire version (SEIQoL-PF/G). Methods In a crossover design, both measures were completed in a random sequence. 104 patients at a heart surgery hospital in Germany were randomly assigned to receive either the SEIQoL-DW or the SEIQoL-PF/G as the first measurement in the sequence. Patients were approached on their earliest stable day after surgery. The average time between both measurements was 1 day (mean 1.3; SD 0.8). Agreement regarding the indices, ratings, and weightings of nominated life areas (cues) was explored using Bland-Altman plots with 95% limits of agreement (LoA). Agreement of the SEIQoL indices was defined as acceptable if the LoA did not exceed a threshold of 10 scale points. Data from n = 99 patients were included in the agreement analysis. Results Both measures led to similarly nominated cues. The most frequently nominated cues were “physical health” and “family”. In the Bland-Altman plot, the indices showed a mean of differences of 2 points (95% CI, − 1 to 6). The upper LoA showed a difference of 36 points (95% CI, 30 to 42), and the lower LoA showed a difference of − 31 points (95% CI, − 37 to − 26). Thus, the LoAs and confidence intervals exceeded the predefined threshold. The Bland-Altman plots for the cue levels and cue weights showed similar results. The SEIQoL-PF/G version showed a tendency for equal weighting of cues, while the weighting procedure of the SEIQoL-DW led to greater variability. Conclusions For cardiac surgery patients, use of the current version of the SEIQoL-PF/G as a substitute for the SEIQoL-DW is not recommended. The current questionnaire weighting method seems to be unable to distinguish weighting for different cues. Therefore, the further design of a weighting method without interviewer support as a paper-administered measure of individual quality of life is desirable.

The landmark 2016 Minimal Invasive Extracorporeal Technologies International Society (MiECTiS) position paper promoted the creation of a common language between cardiac surgeons, anesthesiologists and perfusionists which led to the development of a stable framework that paved the way for the advancement of minimal invasive perfusion and related technologies. The current expert consensus document offers an update in areas for which new evidence has emerged. In the light of published literature, modular minimal invasive extracorporeal circulation (MiECC) has been established as a safe and effective perfusion technique that increases biocompatibility and ultimately ensures perfusion safety in all adult cardiac surgical procedures, including re-operations, aortic arch and emergency surgery. Moreover, it was recognized that incorporation of MiECC strategies advances minimal invasive cardiac surgery (MICS) by combining reduced surgical trauma with minimal physiologic derangements. Minimal Invasive Extracorporeal Technologies International Society considers MiECC as a physiologically-based multidisciplinary strategy for performing cardiac surgery that is associated with significant evidence-based clinical benefit that has accrued over the years. Widespread adoption of this technology is thus strongly advocated to obtain additional healthcare benefit while advancing patient care. [ABSTRACT FROM AUTHOR]

Objectives: Junctional ectopic tachycardia (JET), an arrhythmia of substantial clinical relevance, is no less than an eternal nemesis in cardiac critical care. Hence, we hereby present a bibliometric study evaluating the research trends in the subject. Material and Methods: A Scopus search-based bibliometric analysis of the keyword “Junctional Tachycardia” OR “Junctional Ectopic Tachycardia” restricted to original articles and reviews was undertaken after excluding the veterinary-related papers. The metadata thus obtained was analyzed using Scimago Graphica 1.0.42 and VOSviewer version 1.6.20 to generate a graphical representation of the trends and the timelines based on the author keywords. Results: A total of 926 papers of interest were identified and selected for the analysis, which revealed the geographical distribution of productivity being primarily concentrated in the Western developed nations, topic receptiveness largely appreciated in cardiovascular-related journals, and increased yearly output of the JETassociated papers. Further perusal identified 79 most frequently observed author keywords when limited to a minimum of 5 co-occurrences, which were grouped into seven color-coded clusters by VOSviewer, and mapped into keyword as well as author network, overlay, and density projections. Conclusion: Bibliometric analysis of JET papers from 1967 to 2024 shows a growing interest in the topic, awaiting newer insights into the molecular mechanisms and the preventative treatment strategies. [ABSTRACT FROM AUTHOR]

Abstract Aortic stenosis is a frequent disease in the elderly. Its prevalence is 0.4% with a sharp increase after the age of 65, and its outcome is very poor when the patient becomes symptomatic. The interventional procedure known as TAVI (trans-catheter aortic valve implantation), which was developed in France and carried out for the first time in Rouen by Prof. Alain Cribier and his team in 2002, has proven to be a valid alternative to surgical aortic valve replacement. At first, this technique was shown to be efficient in patients with contra-indications to surgical treatment or deemed to be at high surgical risk. Given the very promising outcomes achieved as a result of close heart team collaboration, appropriate patient selection, simplified procedures and reduced complication rates, transfemoral (TF) TAVI is now preferred in symptomatic intermediate risk patients > 75 years old according to the latest ESC guidelines. In 2017, in France, TAVI is currently performed in 50 centers with on-site cardiac surgery. The 2016 TAVI outcomes recorded in the French national TAVI registry (France TAVI) are very encouraging and show that for 7133 patients treated (age 83.4 ± 7 years, logistic Euroscore 14%), 87% of whom via the TF approach, cross-over to surgery was very low (0.5%) with a 3.0% in-hospital mortality rate. The substantial increase in TAVI indications and the improvement of its outcomes may in the near future call for a reconsideration of the number of high volume centers authorized to carry out this technique. [ABSTRACT FROM AUTHOR]

Background and Aim: To evaluate the publication rate of articles related to cardiac surgery in the four main cardiovascular journals over the last 5 years. Methods: A bibliometric review of all full‐length articles published between January 2014 and March 2020 in the top four cardiovascular journals (Circulation, European Heart Journal (EHJ), Journal of the American College of Cardiology (JACC), and JAMA Cardiology) was conducted. For each eligible article in the four journals, the journal of publication, study design, area of interest, country of origin, and type of intervention tested (for cardiac surgery and interventional cardiology studies) were extracted. The affiliations of all editorial board members were identified from journal websites or from online searches and recorded as from cardiac surgery, cardiology, or another discipline. Correlations between variables were evaluated. Results: A total of 4835 articles were reviewed. Cardiac surgery studies amounted to 6.2% (104) of total research publications in JACC, 4.4% (74) in Circulation, 3.6% (13) in JAMA Cardiology, and 2.0% (22) in EHJ (P <.001). The percentage of cardiac surgery publications was significantly less than interventional cardiology publications (P <.001). Conclusions: Cardiac surgery studies represent only a small minority of the articles published in the top cardiovascular journals over the last 5 years, with significant differences between individual journals. Cardiac surgery studies were more often observational and this may constitute one important reason for their under‐representation. [ABSTRACT FROM AUTHOR]

(1) Background: we compare a new SBAR based electronic handover tool versus a paper-based checklist for handover in a pediatric intensive care unit (PICU). (2) Methods: this is a randomized, observational study of 40 electronic vs. 40 paper checklist handovers after pediatric cardiac surgery, with a 48 items checklist for comparison of reporting frequencies and notification of disturbances and noise. PICU staff satisfaction was evaluated by a 12-item questionnaire. (3) Results: in 14 out of 40 cases, there were problems with data processing (incomplete or no data processing). Some item groups (e.g., hemodynamics) were consistently reported at higher frequencies than other groups. Items not specifically asked for did not get reported. Some items, automatically processed in the SBAR handover page, did not get reported. Many handovers suffered a noisy and distracting atmosphere. There was no difference in staff satisfaction between the two handover approaches. Nurses were highly unsatisfied with the general approach by which the handover was performed. (4) Conclusions: human error appears to be a main factor for unreliable data processing. Software is still too complicated, and multitasking is a stressful and error prone event. Handover is a complex task with many factors required for a successful completion. [ABSTRACT FROM AUTHOR]

Pediatric cardiac anesthesia has developed over the past eight decades into a specialty delivering complex clinical care and contributing remarkable scientific progress. The history of this development can be traced through journal articles that mark the strides of the specialty. This article discusses journal articles, chosen by the author, that he considers had a significant impact on the practice of pediatric cardiac anesthesia or are of historical interest. [ABSTRACT FROM AUTHOR]

Aim: (1) To systematically review the literature on developmental outcomes from infancy to adolescence of children with complex congenital heart disease (CHD) who underwent early surgery; (2) to run a meta-regression analysis on the Bayley Scales of Infant Development, Second Edition Mental Developmental Index and Psychomotor Developmental Index (PDI) of infants up to 24 months and IQs of preschool-aged children to adolescents; (3) to assess associations between perioperative risk factors and outcomes.Method: We searched pertinent literature (January 1990 to January 2019) in PubMed, Embase, CINAHL, and PsycINFO. Selection criteria included infants with complex CHD who had primary surgery within the first 9 weeks of life. Methodological quality, including risk of bias and internal validity, were assessed.Results: In total, 185 papers met the inclusion criteria; the 100 with high to moderate methodological quality were analysed in detail. Substantial heterogeneity in the group with CHD and in methodology existed. The outcome of infants with single-ventricle CHD was inferior to those with two-ventricle CHD (respectively: average scores for PDI 77 and 88; intelligence scores 92 and 98). Perioperative risk factors were inconsistently associated with developmental outcomes.Interpretation: The literature on children undergoing surgery in early infancy suggests that infants with a single ventricle are at highest risk of adverse developmental outcomes. [ABSTRACT FROM AUTHOR]

BioGlue is one of the best-known substances used as a tissue adhesive during surgical procedures, especially in cardiac surgery. Inappropriate use of BioGlue can result in inflammation in both the heart and adjacent tissues after its intraoperative application. Inflammation caused by BioGlue in cardiac surgery is a topic that has been discussed by numerous authors in scientific studies, meta-analyses and evaluations of this tissue adhesive. However, there is a lack of collected knowledge on this subject in a single concise article. The purpose of this paper is to review the current medical knowledge on the use of BioGlue in cardiac surgery versus the induction of an inflammatory response. Our paper discusses the details of this problem according to the most recent scientific reports. [ABSTRACT FROM AUTHOR]

Introduction and aim. Left atrial appendage closure (LAAC) is an alternative treatment method to reduce the risk of thromboembolism. Epicardial closure can be performed with LARIAT devices or with AtriClip devices. Manufacturer and User Facility Device Experience (MAUDE) database contains device reports submitted to the U.S. Food and Drug Administration (FDA) by mandatory reporters. The aim of this study was to evaluate and compare the adverse effects of epicardial LAAC between LARIAT and AtriClip device based on MAUDE. Material and methods. Two independent researchers queried the MAUDE to obtain LARIAT and AtriClip device reports from July 2012 to July 2022. Records were included according to study protocol. Results. 460 reports were obtained from the MAUDE database. 287 studies were included. Problem with device occurred in 46.8% of reports for LARIAT (29/62) vs. 67.1% for AtriClip (151/225) (p<0.001). It coexisted with patient complications in 100.0% of cases with device problem in LARIAT (29/29) vs. 14.6% in AtriClip (22/151) (p<0.001). Pericardial effusion and hemorrhage appeared more often in LARIAT group (43.5% vs. 2.2%, p<0.001, 45.2% vs. 14.4%, p<0.001, respectively). Stroke occurred in AtriClip group more often (0.0% vs. 7.8%, p=0.042). Left atrial appendage (LAA) and right ventricle (RV) were perforated more often during LARIAT procedure (80.0% vs. 31.6%, p<0.001, 16.0% vs. 0.0%, p=0.021). Conclusion. Adverse effects of the procedure with the usage of two different devices differ significantly. Patients who undergo LARIAT procedure are more prone to pericardial effusion and hemorrhage, as well as LAA and RV perforation. [ABSTRACT FROM AUTHOR]

The population of patients with congenital heart disease (CHD) is continuously increasing with more and more patients reaching adulthood. A significant portion of these young adults will suffer from arrhythmias due to the underlying congenital heart defect itself or as a sequela of interventional or surgical treatment. The medical community will encounter an increasing challenge as even most of the individuals with complex congenital heart defects nowadays become young adults. Within the past 20 years, management of patients with arrhythmias has gained remarkable progress including pharmacological treatment, catheter ablation, and device therapy. Catheter ablation in patients with CHD has paralleled the advances of this technology in pediatric and adult patients with structurally normal hearts. Growing experience and introduction of new techniques like the 3D mapping systems into clinical practice have been particularly beneficial for this growing population of patients with abnormal cardiac anatomy and physiology. Finally, device therapies allowing maintanence of chronotropic competence and AV conduction, improving haemodynamics by cardiac resynchronization, and preventing sudden death are increasingly used. For pharmacological therapy, ablation procedures, and device therapy decision making requires a deep understanding of the individual pathological anatomy and physiology as well as detailed knowledge on natural history and long-term prognosis of our patients. Composing expert opinions from cardiology and paediatric cardiology as well as from non-invasive and invasive electrophysiology this position paper was designed to state the art in management of young individuals with congenital heart defects and arrhythmias. [ABSTRACT FROM AUTHOR]

Background: Globally, the utilisation of minimally invasive techniques has become increasingly prevalent. While traditional open-heart procedures still dominate the landscape, a significant portion of cardiac surgeries are now performed minimally invasively. The aim of this study is to provide an insightful overview of the current state of minimally invasive cardiac surgery in Africa. Main body: A comprehensive database search was performed on PubMed, African Journal Online, Google Scholar, and Scopus to identify published data reporting on outcomes of minimally invasive cardiac surgery in Africa, from inception till June 2024. We used the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines to undergo this study. The primary outcomes of interest were in-hospital mortality and overall mortality. Data were pooled together and analysed using a random effect model for meta-analysis with R software. Out of a total of 2309 articles identified, only fourteen papers met our inclusion criteria following deduplication and screening. The four countries with published research include Egypt, South Africa, Tanzania, and Morocco, with a total sample size of 1357 patients. The meta-analysis of the reported outcomes produced a pooled in-hospital mortality prevalence of 1.18%, while the pooled overall mortality prevalence was 2.23%. There was no statistically significant difference in outcomes between the mini sternotomy and the full sternotomy group. Conclusion: The pooled outcomes of minimally invasive cardiac surgery in Africa are comparable to those in other regions. However, there are several socio-economic factors limiting its widespread practice in Africa. [ABSTRACT FROM AUTHOR]

Objective: Subclinical leaflet thrombosis (SLT) develops in 15% of patients undergoing trans‐catheter aortic valve replacement (TAVR). TAVR is a procedure in which a faulty aortic valve is replaced with a mechanical one. An aortic valve replacement can be done with open‐heart surgery; this is called surgical aortic valve replacement (SAVR). A significant problem is defining the best course of treatment for asymptomatic individuals with SLT post‐TAVR, including the use of oral anticoagulation (OAC) in it. Study design: Systematic review. Method: The most pertinent published research (original papers and reviews) in the scientific literature were searched for and critically assessed using the online, internationally indexed databases PubMed, Medline, and Cochrane Reviews. Keywords like "Transcatheter valve replacement" and "Subclinical leaflet thrombosis" were used to search the papers. Selected studies were critically assessed for inclusion based on predefined criteria. Results: The review examined the prevalence and characteristics of SLT after TAVR. To note, the incidence of SLT is seen to be higher in TAVR compared SAVR. Dual antiplatelet therapy, which is utilized in antithrombotic regimens post‐TAVR, can possibly hasten SLT progression which could result in the impaired mobility of leaflets and the worsening of pressure gradients. Conclusion: The use of dual antiplatelet drugs in routine antithrombotic therapy tends to accelerate initial subclinical leaflet thrombosis after TAVI, which results in a developing restriction of leaflet mobility and an increase in pressure differences. [ABSTRACT FROM AUTHOR]

Recently, The Egyptian health sector whether it is public or private; utilizes emerging technologies such as data mining, business intelligence, Internet of Things (IoT), among many others to enhance the service and to deal with increasing costs and growing pressures. However, process mining has not yet been used in the Egyptian organizations, whereas the process mining can enable the domain experts in many fields to achieve a realistic view of the problems that are currently happening in the undertaken field, and thus solve it. This paper presents application of the process mining techniques in the healthcare field to obtain meaningful insights about its careflows, e.g., to discover typical paths followed by certain patient groups. Also, to analyze careflows that have a high degree of dynamic and complexity. The proposed methodology starts by the preprocess step on the event logs to eliminate outliers and clean the event log. And then apply a set of the popular discovery miner algorithms to discover the process model. Then careflows processes are analyzed from three main perspectives: the control-flow perspective, the performance perspective and, the organizational perspective. That contributes with many insights for the domain experts to improve the existing careflows. Through evaluating the simplicity metric of extracted models; the paper suggested a method to quantify the simplicity metric. The paper used a dataset from a cardiac surgery unit in an Egyptian hospital. The results of the applied process mining techniques provide the hospital managers a real analysis and insights to make the patient journey easier. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac surgery requiring cardiopulmonary bypass had been unavailable in Northern Nigeria and the federal capital territory of Nigeria regularly. Several attempts in the past at setting up this service in a self-sustaining manner in Northern Nigeria had failed. This paper is a contrasting response to an earlier publication that emphasized the less-than-desirable role played by international cardiac surgery missions in the evolution of a sustainable open-heart surgery program in Nigeria. Methods: The cardiothoracic unit of Federal Medical Centre, Abuja, was established on March 1, 2021, but could not conduct safe open-heart surgery. The model and strategies employed in commencing open-heart surgeries, including the choice of personnel training within the country and focused collaboration with foreign missions, are discussed. We also report the first seven patients to undergo cardiac surgery under cardiopulmonary bypass in our government-run hospital as well as the transition from foreign missions to local team operations. Results: Seven patients were operated on within the first six months of setting up with high levels of skill transfer and local team participation, culminating in one of the operations entirely carried out by the local team of personnel. All outcomes were good at an average of one-year follow-up. Conclusion: In resource-constrained government-run hospitals, a functional, safe cardiac surgery unit can be set up by implementing well-planned strategies to mitigate encountered peculiar challenges. Furthermore, with properly harnessed foreign missions, a prior-trained local team of personnel can achieve independence and become a self-sustaining cardiac surgery unit within the shortest possible time. [ABSTRACT FROM AUTHOR]

Background: The number of citations an article receives is a marker of its scientific influence within a particular specialty. This bibliometric analysis intended to recognise the top 100 cited articles in minimally-invasive cardiac surgery, to determine the fundamental subject areas that have borne considerable influence upon clinical practice and academic knowledge whilst also considering bibliometric scope. This is increasingly relevant in a continually advancing specialty and one where minimally-invasive cardiac procedures have the potential for huge benefits to patient outcomes.Methods: The Web of Science (Clarivate Analytics) data citation index database was searched with the following terms: [Minimal* AND Invasive* AND Card* AND Surg*]. Results were limited to full text English language manuscripts and ranked by citation number. Further analysis of the top 100 cited articles was carried out according to subject, author, publication year, journal, institution and country of origin.Results: A total of 4716 eligible manuscripts were retrieved. Of the top 100 papers, the median (range) citation number was 101 (51-414). The most cited paper by Lichtenstein et al. (Circulation 114(6):591-596, 2006) published in Circulation with 414 citations focused on transapical transcatheter aortic valve implantation as a viable alternative to aortic valve replacement with cardiopulmonary bypass in selected patients with aortic stenosis. The Annals of Thoracic Surgery published the most papers and received the most citations (n = 35; 3036 citations). The United States of America had the most publications and citations (n = 52; 5303 citations), followed by Germany (n = 27; 2598 citations). Harvard Medical School, Boston, Massachusetts, published the most papers of all institutions. Minimally-invasive cardiac surgery pertaining to valve surgery (n = 42) and coronary artery bypass surgery (n = 30) were the two most frequent topics by a large margin.Conclusions: This work establishes a comprehensive and informative analysis of the most influential publications in minimally-invasive cardiac surgery and outlines what constitutes a citable article. Undertaking a quantitative evaluation of the top 100 papers aids in recognising the contributions of key authors and institutions as well as guiding future efforts in this field to continually improve the quality of care offered to complex cardiac patients. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to develop a model to help parents cope with decisional conflict. Background: Parents of children with congenital heart defect experience decisional conflict when they are uncertain about treatment decisions for their child, which may lead to delay in seeking care or distress over the decision made. Design: Correlational design with model building and data triangulation was used. Methods: Data were collected through surveys and interviews with a consecutive sample of 221 parent respondents from June to December 2018. Structural equation modelling and qualitative data analysis were used. Results: Lower decisional conflict was seen in parents with higher income, more nurse support and physician risk communication. Time delay for surgery was correlated with the child's age, social service coverage, and social support. Decisional conflict mediated the influence of income, nurse support and physician risk communication on satisfaction with decision. Based on model fit parameters, the emerging model is a good and parsimonious model of decisional conflict. The overall theme, 'Deciding for Surgery: What Matters Most', described the processes parents went through in making treatment decisions. Conclusion: Nurses may help parents feel more certain, less conflicted, and more satisfied with their decision by addressing factors including knowledge gaps, personal values, available support, and resource access. Summary statement: What is already known about this topic? Decisional conflict occurs when parents are uncertain of the best action for their child because treatment options entail risks for undesirable outcomes, value compromise, unclear prognosis, or anticipated regret over the decision.Professional support, information, and communication are vital to parents' decision‐making process.Child, parent, and support factors may influence parent treatment decisions in varied paediatric conditions. What this paper adds? Child's age at the time of decision‐making had an effect on the delay in surgery. However, assisting parents to weigh their options and focus on personal values allowed them to make their treatment decision.Low income, costly health services, and bureaucratic processes impeded the timely availment of surgery. Healthcare reforms that provide a system of government funding, streamlined health structure, and social insurance may be looked into.Family support weighed in on the parents' decision to delay surgery for fear of blame or guilt. Providing relevant information enabled parents to make a choice and stand by their decision regardless of the outcome. The implications of this paper: Modelling provides a framework to identify which factors are more important and how they interact to affect decision‐making. It may be used as an approach to find solutions to clinical problems for groups with different diagnoses.Though nursing support, information, and communication are essential, a more holistic family nursing care approach may be considered to assist parents to make appropriate treatment decisions for their child.Familiarity with the healthcare system may equip nurses to aid parents in processing available healthcare funding and dealing with financial uncertainty affecting decisions for their child's treatment. [ABSTRACT FROM AUTHOR]

The authors present the case of a patient with tetralogy of Fallot. The patient underwent surgery to correct the defect 30 years ago. Our patient remains in good condition, currently reporting only poorer exercise tolerance. The authors attempted to analyse the development of treatment methods for tetralogy of Fallot based on world literature with reference to the case described in this paper. This paper presents the history and advances that have been made in the treatment of Fallot syndrome. Numerous details and dates are cited regarding the history of the treatment of the defect. Due to the vastness of the subject of tetralogy of Fallot, the article does not discuss contemporary treatments for the defect. [ABSTRACT FROM AUTHOR]