Adoption of Technology by Healthcare Personnel: An Institutional Survey.

BACKGROUND: In the current era, technology has a significant influence on healthcare outcomes. Despite that, there are significant barriers and concerns toward the adoption of digital laboratory reporting systems among healthcare professionals in India. The aim of the study was to understand the overall attitude, barriers, and motivators toward the adoption of technology by healthcare personnel. METHODS: The study was conducted through a single-center and prospective questionnaire survey among physicians and surgeons of various specialities, with 107 participants. The electronic laboratory system at the institution, called "AADI," could be accessed across any computer terminal and through a web-based application that could be downloaded on any mobile device. RESULTS: The results of the study revealed that 98 out of 107 (91.59%) healthcare professionals used the digital platform regularly to access laboratory results, while only 9 (8.4%) did not use it. The mean satisfaction score of the users was 4.62 ± 0.51. The study showed that most users found the digital system to be more secure and reliable, which led to significant time savings compared to the paper-based system. The study also found that age was a determinant of usage, with younger healthcare professionals using the application more frequently. CONCLUSION: Overall, the study suggests that digital laboratory reporting systems have significant benefits, and further efforts are needed to increase adoption in healthcare establishments in India.

Total aortic arch replacement in acute type A aortic dissection - a single institutional experience.

Aim: Total arch replacement in the presence of acute aortic dissections is one of the most challenging areas of aortic surgery. Data on outcome in the Indian scenario is sparse. The aim of this study was to assess the outcome of arch replacements in a single tertiary care center. Material and methods: In this single-center experience, 20 patients underwent total arch replacement between 2012 and 2022. Demographic, intraoperative, and postoperative data were abstracted from hospital records. Only patients with acute type A aortic dissection needing an arch repair were included. Patients with hemi-arch repairs, hybrid repairs, and those operated upon due to aneurysmal disease were excluded from the study. Comparison was made between survivors and non-survivors. Temporal trends for the procedure were assessed. Results: The study included 20 patients who underwent total aortic arch replacement (TAR) during the study period (2012-2022). The mean age was 49.3 ± 12.5 years, and 15 (75%) of the patients were males. Seven (35%) patients were operated within 24 h of symptom onset. Permanent stroke was seen in 1 (5%) patient and temporary neurological dysfunction was observed in 1 (5%) patient. The re-exploration rate was 6 (30%) in the entire cohort and in-hospital mortality was 4 (20%). Follow-up was complete in 18 (90%) of the study population and 14 (87.5%) among survivors. There was one late death in our study which occurred after 46 months of the index operation. The overall mean survival was 76.1 months (95% CI: 49.86-102.43). Conclusion: TAR can be performed both with acceptable mortality and morbidity in the presence of acute aortic dissections.

Transcatheter para mitral annular ring leak device closure - A case report.

Para mitral annular ring leakage can occur following ring dehiscence after mitral annuloplasty. Percutaneous device closure of para-annular ring leakage can be performed successfully to treat such regurgitations with good transesophageal echocardiography guidance and patient selection. While para valvular device closure has been described in the medical literature, there have been few anecdotal reports published on para ring leak device closures. In this case, we highlight our experience from the successful closure of a para mitral annular ring closure with an AVP III device. The patient had a para annular ring regurgitation post coronary artery bypass grafting with mitral ring annuloplasty presenting with hemolytic anemia and acute renal failure, successfully treated by percutaneous device closure. Learning objective: This report describes the safety and effectiveness of a transcatheter para ring leak closure with an AVP III device. We applied the principles of device closure of paravalvular leak from our experience and related data from literature for this case and describe various hardware and techniques used for a successful closure of a para mitral ring leak.

Determinant of outcome in late presenting type A aortic dissection.

BACKGROUND: Early repair is recommended in type A aortic dissection repair, however, this is not often possible. The aim of this study was to assess the time delays, examine the effect of timing and malperfusion on outcomes, and identify other independent risk factors for mortality. METHODS: This was a retrospective study on data collected prospectively. Primary outcome was 30-day mortality. Secondary outcome was adverse postoperative outcomes. All patients who arrived at the hospital with a type A aortic dissection, irrespective of the timing, were included in the study. Univariate as well as multivariate analysis was carried out. RESULTS: A total of 81 patients presented to our institution during the study period. Half the patients got operated within 86 h of symptom onset and 75% were operated within 183 h. With regards to malperfusion, 6 (8.8%) patients had cerebral malperfusion, 10 (14.7%) had features of myocardial ischemia, and 13 (19.1%) had renal malperfusion. One (1.5%) patient had mesenteric ischemia and 9 (13.2%) had limb ischemia. The duration between symptom onset and operative repair was longer in survivors (152 ± 167 vs. 75 ± 102, p = .29). A total of 29 (42.6%) patients presented with features of one or more organ malperfusion and the mortality in these patients was significantly higher at 10 (34.5%) versus 5 (12.5%); p = .04. Multivariable logistic regression identified CPB time as an independent risk factor in our cohort for 30-day mortality (odds ratio: 1.03; 95% confidence interval: 1.007-1.06). CONCLUSION: In cases of predominantly delayed presentation and operative repair, the outcome is significantly influenced by presence of malperfusion. Surgical repair still produces satisfactory outcomes and should be undertaken at the earliest in most cases.

Uptake and impact of vaccination against COVID-19 among healthcare workers-evidence from a multicentre study.

To assess vaccination among healthcare workers, 14837 healthcare workers across 20 different hospitals were prospectively surveyed. The overall uptake of the vaccine was 13335(90%). Infection rate in vaccinated HCW was 710(6.04%) and was significantly lower than unvaccinated HCW 148(9.9%), P <.001. Uptake of vaccination among healthcare workers in our study was high and provided significant protection compared to unimmunized healthcare workers.

A Novel Surgical Technique to Address Post-Septal Myectomy Ventricular Septal Defect.

Iatrogenic ventricular septal defect is a rare complication in patients undergoing septal myectomy for hypertrophic obstructive cardiomyopathy, and it necessitates closure in the postoperative period. We describe a novel surgical technique for closure of the ventricular septal defect using a biventricular approach with a custom-made polytetrafluoroethylene device. Our method is easily reproducible.

Oversized donor heart transplantation-clinical experience with an underestimated problem.

PURPOSE: Heart transplantation is the definitive treatment for end-stage heart failure. With respect to donor-recipient size matching, the problems with undersized heart transplantation have been widely discussed, but there is a paucity of information on oversized transplants due to the presumed advantage of large hearts. We intend to share our center's experience with oversized heart transplantation and its associated problems which would help to expand the knowledge on oversized cardiac allografts. METHODS: Patients who underwent isolated heart transplantation at our hospital between March 1, 2008, and March 1, 2020, were included. For adults, a donor-recipient predicted heart mass percentage difference exceeding 30% and for children, a donor-recipient weight ratio < 0.8 and > 2.0 was considered a mismatch. We collected data from the in-patient medical records and analyzed the in-hospital outcomes and survival post-transplant among various other parameters. RESULTS: Out of the 43 patients included in this study, 32 (74.4%) patients received a matched heart and 11 (25.6%) patients received oversized hearts. None of the patients received an undersized heart. The in-hospital mortality rate of oversized transplants was 18.2% whereas that of matched transplants was 9.4% (p = 0.432). The post-operative characteristics and 1-year survival were comparable between the groups. We encountered problems specific to oversizing in 5 of the 11 patients (45.4%) which are discussed. CONCLUSION: With the liberalization of donor criteria to overcome organ shortage, oversized heart transplantation poses certain unique challenges, which when efficiently managed offers acceptable outcomes.

Methemoglobinemia Unmasked by Use of Sodium Nitroprusside and Hypothermia in a Case of Chronic Thromboembolic Pulmonary Hypertension During Pulmonary Endarterectomy: A Case Report.

In performing pulmonary endarterectomy (PEA) for a patient with chronic thromboembolic pulmonary hypertension (CTEPH), we encountered methemoglobinemia that was unmasked by hypothermia while on cardiopulmonary bypass (CPB). The patient on dapsone therapy for antiphospholipid antibody syndrome had developed acquired methemoglobinemia that went undiagnosed because her cyanosis was believed to be due to CTEPH and the resulting ventilation-perfusion (V/Q) mismatch. Although pharmacological triggers for methemoglobin are well known, causation by hypothermia is not described. Monitoring saturation while on CPB was challenging because of nonpulsatile blood flow but was overcome using cerebral oximetry.

Redo quadruple-valve repair after Ross procedure: a viable option?

Quadruple-valve repair or replacement is associated with significant morbidity and mortality because the clinical situation of severe disease of all 4 valves implies incipient myocardial damage. We report a case of redo quadruple-valve repair in a patient with rheumatic heart disease who had undergone the Ross procedure 14 years earlier. He presented with heart failure. Cardiac evaluation revealed severe disease of all 4 valves, necessitating surgery. Because he was in advanced heart failure and all 4 valves were suitable for repair, a quadruple-valve repair was performed.

Surgical repair of tricuspid valve leaflet tear following percutaneous closure of perimembranous ventricular septal defect using Amplatzer duct occluder I: Report of two cases.

Tricuspid valve (TV) injury following transcatheter closure of perimembranous ventricular septal defect (PMVSD) with Amplatzer ductal occluder I (ADO I), requiring surgical repair, is rare. We report two cases of TV tear involving the anterior and septal leaflets following PMVSD closure using ADO I. In both the patients, the subvalvular apparatus remained unaffected. The patients presented with severe tricuspid regurgitation (TR) 6 weeks and 3 months following the device closure. They underwent surgical repair with patch augmentation of the TV leaflets. Postoperatively, both are asymptomatic with a mild residual TR.

A novel treatment for pulmonary hemorrhage during thromboendarterectomy surgery.

Injury to the pulmonary artery during thromboendarterectomy is a rare but potentially fatal complication with no reported surgical techniques to combat it. Treatment is only supportive and morbidity is high. We report the intraoperative diagnosis and surgical management of pulmonary hemorrhage in 3 patients after pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension.

Incidence of chronic thrombo-embolic pulmonary hypertension following acute pulmonary thrombo-embolism: an Indian perspective.

Chronic thrombo-embolic pulmonary hypertension (CTEPH) remains a severe disabling disease causing a significant amount of mortality and morbidity worldwide. The incidence and severity of this condition is quite obscure. The initial inciting event, the reason of progression, the natural history of the disease and the predictors of adverse outcomes are not yet adequately clarified. From the Indian subcontinent, data regarding this disease is limited. But with the advent of the multi-detector computed tomography, the understanding of this disease is gradually improving. As most of the available data suggests, acute pulmonary embolism (PE) as the main initial trigger leading to CTEPH, we prospectively analysed all patients being admitted in our hospital with acute PE and followed them over a period of one-and-a-half years to determine the incidence of CTEPH in this group. This is just an attempt to increase the awareness about the disease pattern and determine the rate of progression, risk factors of poor outcome, so that early detection and prompt treatment can benefit the patient care.

Entrapped central venous catheter after mitral valve replacement and its surgical retrieval.

Central venous pressure monitoring line insertion is routine prior to the conduct of cardiac surgery, and in rare instances, malposition can contribute to operative complications. We describe here how a central venous line lying in the right atrium became caught in a left atrial (LA) closure suture during a mitral valve replacement. The opening of the LA suture line is highly unsafe without cardiopulmonary bypass (CPB) because of the possibility of systemic air embolism, but by employing an ingenious method of suturing over and unravelling the continuous sutures closing the left atrium, it was possible to surgically retrieve it without the use of a CPB.

Mast cell disease: surgical and anesthetic implications.

Mast cell disease (MCD) is a clonal disorder of the mast cell and its precursor cells. Cardiac surgery in MCD is rarely described. We report an unusual case of a 14-year-old girl who was admitted for atrial septal defect closure and incidentally found to have hepatosplenomegaly with lymphadenopathy who underwent a successful open-heart surgery, after a diagnosis of MCD.

Marsupialization of intramyocardial left anterior descending artery: a novel approach for easy access during revascularization.

The left anterior descending (LAD) artery is the most important vessel bypassed during coronary revascularization procedures. This artery usually runs a superficial course, making it easy for localization and grafting. However, many times it takes a course deep in the myocardium or is embedded in thick epicardial fat, which results in technical challenges to the surgeon for localization and grafting. So far, many techniques are described for overcoming these problems, but all require cardiopulmonary bypass (CPB), and in fact, intramyocardial LAD is considered a relative contraindication for off-pump coronary artery bypass grafting (OPCAB). In the present era of enhanced interest in OPCAB, these techniques are not as helpful as they are for conventional CABG with CPB. Here, we describe a novel approach of marsupialization of the LAD for revascularization of intramyocardial LAD that is useful for off-pump as well as conventional revascularization procedures and makes grafting simple and reproducible.