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JTCVS Techniques ; 2022.
Article in English | ScienceDirect | ID: covidwho-1882629


Objectives Geometric ring annuloplasty has shown promise during bicuspid aortic valve (BAV) repair for aortic insufficiency (AI). This study examined early outcomes of BAV repair associated with proximal aortic aneurysm replacement. Methods From September 2017 to November, 2021, 127 patients underwent BAV repair with concomitant proximal aneurysm reconstruction. Patient age was 50.6±12.7 years (mean±SD), male gender was 83%, NYHA Class was 2 (1,2) (median[IQR]), and preoperative AI grade was 3(2,4). Ascending aortic diameter was 50(46,54) mm, and all patients had ascending aortic replacement. Forty had sinus diameters >45 mm prompting remodeling root procedures. One Hundred-five had Sievers Type 1 valves, 3 had Type 0, and 7 Type 2. One Hundred-eighteen had primarily right/left fusion, 8 had right/non fusion, and 1 left/non fusion. Leaflet reconstruction utilized central leaflet plication and cleft closure, with limited ultrasonic decalcification in 31. Results Ring size was 23(21,23) mm, and 26 of 40 root procedures were selective non-fused sinus replacements. Aortic clamp time was 139(112,170) minutes, and bypass time 178(138.217) minutes. Post-repair AI grade was 0(0,0) (p<0.0001), and mean valve gradient was 10(7,14) mmHg. No early, and one late mortality occurred. Four patients required reoperation for bleeding, and 4 needed pacemakers. At a mean follow-up of 20 months (maximal 93), there were no valve-related complications, 5 late repair failures prompting valve replacement, and 1 death from Covid. Conclusions Geometric ring annuloplasty for BAV repair with proximal aortic aneurysm reconstruction is safe and associated with good early outcomes. Further experience and followup will help inform long-term durability.

J Thorac Cardiovasc Surg ; 161(3): 753-755, 2021 03.
Article in English | MEDLINE | ID: covidwho-1382606
J Card Surg ; 36(9): 3040-3051, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1266339


BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact on health care and cardiac surgery. We report cardiac surgeons' concerns, perceptions, and responses during the COVID-19 pandemic. METHODS: A detailed survey was sent to recruit participating adult cardiac surgery centers in North America. Data regarding cardiac surgeons' perceptions and changes in practice were analyzed. RESULTS: Our study comprises 67 institutions with diverse geographic distribution across North America. Nurses were most likely to be redeployed (88%), followed by advanced care practitioners (69%), trainees (28%), and surgeons (25%). Examining surgeon concerns in regard to COVID-19, they were most worried with exposing their family to COVID-19 (81%), followed by contracting COVID-19 (68%), running out of personal protective equipment (PPE) (28%), and hospital resources (28%). In terms of PPE conservation strategies among users of N95 respirators, nearly half were recycling via decontamination with ultraviolet light (49%), followed by sterilization with heat (13%) and at home or with other modalities (13%). Reuse of N95 respirators for 1 day (22%), 1 week (21%) or 1 month (6%) was reported. There were differences in adoption of methods to conserve N95 respirators based on institutional pandemic phase and COVID-19 burden, with higher COVID-19 burden institutions more likely to resort to PPE conservation strategies. CONCLUSIONS: The present study demonstrates the impact of COVID-19 on North American cardiac surgeons. Our study should stimulate further discussions to identify optimal solutions to improve workforce preparedness for subsequent surges, as well as facilitate the navigation of future healthcare crises.

COVID-19 , Surgeons , Adult , Decontamination , Humans , Pandemics , Perception , SARS-CoV-2
J. Card. Surg. ; 2020.
Article in English | WHO COVID, ELSEVIER | ID: covidwho-644751


The COVID-19 pandemic has transformed cardiac surgical practices. Limitations in intensive care resources and personal protective equipment have required many practices throughout the globe to pause elective operations and now slowly resume operations. However, much of cardiac surgery is not elective and patients continue to require surgery on an urgent or emergent basis during the pandemic. This continued need for providing surgical services has introduced several unique considerations ranging from how to prioritize surgery, how to ensure safety for cardiac surgical teams, and how best to resume elective operations to ensure the safety of patients. Additionally, the COVID-19 pandemic has required a careful analysis of how best to carry out heart transplantation, extra-corporeal membrane oxygenation, and congenital heart surgery. In this review, we present the many areas of multidisciplinary consideration, and the lessons learned that have allowed us to carry out cardiac surgery with excellence during the COVID-19 pandemic. As various states experience plateaus, declines, and rises in COVID-19 cases, these considerations are particularly important for cardiac surgical programs throughout the globe.