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BACKGROUND: Perioperative complications of transcatheter aortic valve replacement (TAVR) are decreasing but can be catastrophic when they occur. Systematic reports of the nature of these events are lacking in the contemporary era. Our study aimed to report the incidence, outcomes, and perioperative management of catastrophic cardiac events in patients undergoing TAVR and to propose a working strategy to address these complications. METHODS: This is a retrospective cohort study of patients who developed catastrophic cardiac events during or immediately after TAVR between 2015 and 2019 at a single academic center. RESULTS: Of 2102 patients who underwent TAVR, 51 (2.5%) developed catastrophic cardiac events. The causes included cardiac perforation and tamponade (n=19, 37.3%), acute left ventricular failure (n=10, 19.6%), coronary artery obstruction (n=10, 19.6%), aortic root disruption (7, 13.7%), and device embolization (n=5, 9.8%). Twenty-four patients (47.0%) with catastrophic cardiac events required stabilization by either intra-aortic balloon counter-pulsation or extracorporeal membrane oxygenation. The in-hospital mortality rate increased by 11.7-fold for patients with catastrophic cardiac events compared to those without (25.5% vs 2.0%, p

Guideline directed medical therapy (GDMT) following coronary artery bypass graft (CABG) surgery has been shown to prolong survival and decrease major adverse cardiovascular events (MACE) and the need for repeat revascularization. Unfortunately, compliance with GDMT in CABG patients may be as low as 50%, thus negating the beneficial long-term effects of CABG surgery. This chapter will review those GDMT interventions that have been shown to prolong survival and minimize MACE following CABG. Strategies will be provided by which GDMT can be instituted, and compliance maintained, to achieve the best long-term outcomes in CABG patients.

Sternal wound infections resulting in mediastinitis following coronary artery bypass graft surgery increase morbidity, prolong hospital length of stay, raise hospital costs, and increase both short- and long-term mortality. The increased risk for sternal infections has discouraged the use of bilateral internal thoracic artery grafts, especially in diabetic patients. This chapter reviews the preoperative, intraoperative, and postoperative principles for preventing sternal wound infections and mediastinitis following coronary artery bypass graft surgery.

Despite accumulating evidence from several large nonrandomized risk-adjusted observational studies and metaanalyses supporting the use of bilateral internal mammary artery (BIMA) grafts in coronary artery bypass grafting (CABG) surgery, utilization remains fairly low worldwide as the merits of this technique are still debated. Concerns of increased superficial or deep sternal wound infections (DSWIs) with associated increased morbidity and mortality contribute to surgeons’ reluctance to adopt more BIMA grafting. The occurrence of sternal wound complications is multifactorial and cannot be attributed to a single measure. Strict adherence to the American Association for Thoracic Surgery guidelines for preventing sternal wound infections has reduced the incidence of DSWI. Harvesting the IMAs in a skeletonized fashion can reduce the incidence of sternal wound complications in high-risk patients who profit the most from multiarterial grafting.

OBJECTIVE: National Institutes of Health (NIH) funding is becoming increasingly difficult to obtain. We sought to determine trends in NIH funding for cardiac surgeons hypothesizing they are at a disadvantage in obtaining funding due to intensive clinical demands. METHODS: Cardiac surgeons (adult/congenital) currently at the top 141 NIH-funded institutions were identified using institutional websites. The NIH funding history for each cardiac surgeon was queried using NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER). Total grant funding, publications, and type was collected. Academic rank, secondary degrees, and fellowship information was collected from faculty pages. Grant productivity was calculated using a validated Grant Impact Metric. RESULTS: A total of 818 academic cardiac surgeons were identified, of which 144 surgeons obtained 293 NIH grants totaling $458 million and resulting in 6,694 publications. We identified strong associations between an institution’s overall NIH funding rank and the number of cardiac surgeons, NIH grants to cardiac surgeons, and amount of NIH funding to cardiac surgeons (all p

Sternal wound infections (SWIs), however rare, pose as important predictor of mortality and reduced long-term life expectancy after heart surgery and in particular coronary artery bypass grafting (CABG) ( Figure 1 ) (1).