Baylor Scott & White The Heart Hospital – Plano

Szerlip, M., S. Anwaruddin, H. D. Aronow, M. G. Cohen, M. J. Daniels, P. Dehghani, D. E. Drachman, S. Elmariah, D. N. Feldman, S. Garcia, J. Giri, P. Kaul, N. Kapur, D. J. Kumbhani, P. M. Meraj, B. Morray, K. R. Nayak, S. A. Parikh, R. Sakhuja, J. M. Schussler, A. Seto, B. Shah, R. V. Swaminathan, D. A. Zidar and S. S. Naidu (2020). “Considerations for Cardiac Catheterization Laboratory Procedures During the COVID-19 Pandemic Perspectives from the Society for Cardiovascular Angiography and Interventions Emerging Leader Mentorship (SCAI ELM) Members and Graduates.” Catheter Cardiovasc Interv Mar 25. [Epub ahead of print].

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The COVID-19 pandemic will impact many patients we care for with cardiovascular
disease. The preparedness of healthcare providers is critical in providing the best quality of care with soon to be limited resources, while keeping all personnel as safe as possible. The current key elements include 1) rescheduling of all non-urgent, elective CCL procedures, 2) careful patient selection for urgent and emergent CCL procedures with recognition of potential shifts in risk/benefit ratios in the setting of a highly contagious virus, 3) meticulous donning and doffing of PPE along with cleaning of CCL areas, 4) performance of bedside procedures when possible, and 5) staffing modifications to limit infectivity and preserve staff availability. (Excerpt from text, no abstract available)

Mwipatayi, B. P., T. Anwari, J. Wong, E. Verhoeven, S. Dubenec, J. M. Heyligers, R. Milner, C. Mascoli, M. Gargiulo and W. P. Shutze (2020). “Sex-related outcomes after endovascular aneurysm repair within the Global Registry for Endovascular Aortic Treatment (GREAT).” Ann Vasc Surg Mar 16. pii: S0890-5096(20)30207-7. [Epub ahead of print].

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BACKGROUND: Abdominal aortic aneurysms (AAAs) are more common in men. However, women have been shown to have more short- and long-term adverse outcomes after endovascular aneurysm repair (EVAR). This disparity is thought to be multifactorial, including anatomical differences, hormonal differences, older age of presentation, and a greater degree of preoperative comorbidities. METHODS: A retrospective analysis that included data for 3758 patients from the Global Registry for Endovascular Aortic Treatment (GREAT) was conducted. Patients were recruited into GREAT between August 2010 and October 2016 and received the Gore Excluder stent graft for infrarenal AAAs repair. Cox multivariate regression analyses were performed to analyse any re-intervention and device related intervention rates. RESULTS: Of the 3758 patients, 3220 were male (mean age 73 years) and 538 were female (mean age 75 years). Women had higher prevalence rates of chronic obstructive pulmonary disease (P <0.0001) and renal insufficiency (P = 0.03), whilst men had higher rates of cardiovascular comorbidities. The AAAs in women were smaller in diameter with shorter and more angulated necks. Women did not experience a significantly higher rate of endoleaks, but did exhibit higher re-intervention rates, including re-intervention for device related issues. In terms of mortality, aorta related mortality was most prevalent within the first 30 days post procedure in both sexes. CONCLUSION: Women were treated at an older age and had a more hostile aneurysmal anatomy. Although the mortality rates were lower in women, they had significantly higher rates of re-intervention, and thus higher morbidity rates post EVAR.

Kirkpatrick, J. N., R. Grimm, A. M. Johri, B. J. Kimura, S. Kort, A. J. Labovitz, M. Lanspa, S. Phillip, S. Raza, K. Thorson and J. Turner (2020). “Recommendations for Echocardiography Laboratories Participating in Cardiac Point of Care Cardiac Ultrasound (POCUS) and Critical Care Echocardiography Training: Report from the American Society of Echocardiography.” J Am Soc Echocardiogr 33(4): 409-422.e404.

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Cardiac point of care ultrasound provides rapid bedside diagnosis of important cardiovascular pathology and is performed by a growing number of users in a variety of clinical settings. Echocardiographers and sonographers may be asked to play a role in training practitioners in cardiac ultrasound who come from disciplines outside of the cardiovascular field. These trainees’ backgrounds, needs, objectives, and available time can create challenges and opportunities for echocardiography laboratories. Furthermore, the presence of additional learners in the echocardiography laboratory will require additional resources. This document is the product of an American Society of Echocardiography writing group composed of representatives from cardiology, critical care medicine, emergency medicine, and cardiac anesthesiology and others, assembled to provide expert guidance. The following recommendations are intended as practical resource to assist echocardiography laboratories to train partners in the provision of high quality cardiac ultrasound: 1: Identify Trainee Needs; 2: Employ Educational Resources; 3: In General, Avoid Certifying Global Competency; 4: Count the Cost in Echocardiography Laboratory Resources; 5. Advocate for Resources to Meet Extra Needs.(Excerpt from text, p. 409; no abstract available.)

Baxter, R. D., J. I. Fann, J. M. DiMaio and K. Lobdell (2020). “Digital Health Primer for Cardiothoracic Surgeons.” Ann Thorac Surg pii: S0003-4975(20)30504-X. [Epub ahead of print].

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The burgeoning demands for quality, safety, and value in cardiothoracic surgery, in combination with the advancement and acceleration of digital health solutions and information technology, provide a unique opportunity to simultaneously improve efficiency and effectiveness in cardiothoracic surgery. This primer on digital health will explore and review data integration, data processing, complex modeling, telehealth with remote monitoring, and cybersecurity as they shape the future of cardiothoracic surgery.

Tarakji, K. G., S. Mittal, C. Kennergren, R. Corey, J. E. Poole, E. Schloss, J. Gallastegui, R. A. Pickett, R. Evonich, F. Philippon, J. M. McComb, S. F. Roark, D. Sorrentino, D. Sholevar, E. Cronin, B. Berman, D. Riggio, M. Biffi, H. Khan, M. T. Silver, J. Collier, Z. Eldadah, D. J. Wright, J. D. Lande, D. R. Lexcen, A. Cheng and B. L. Wilkoff (2019). “Antibacterial Envelope to Prevent Cardiac Implantable Device Infection.” N Engl J Med 380(20): 1895-1905.

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BACKGROUND: Infections after placement of cardiac implantable electronic devices (CIEDs) are associated with substantial morbidity and mortality. There is limited evidence on prophylactic strategies, other than the use of preoperative antibiotics, to prevent such infections. METHODS: We conducted a randomized, controlled clinical trial to assess the safety and efficacy of an absorbable, antibiotic-eluting envelope in reducing the incidence of infection associated with CIED implantations. Patients who were undergoing a CIED pocket revision, generator replacement, or system upgrade or an initial implantation of a cardiac resynchronization therapy defibrillator were randomly assigned, in a 1:1 ratio, to receive the envelope or not. Standard-of-care strategies to prevent infection were used in all patients. The primary end point was infection resulting in system extraction or revision, long-term antibiotic therapy with infection recurrence, or death, within 12 months after the CIED implantation procedure. The secondary end point for safety was procedure-related or system-related complications within 12 months. RESULTS: A total of 6983 patients underwent randomization: 3495 to the envelope group and 3488 to the control group. The primary end point occurred in 25 patients in the envelope group and 42 patients in the control group (12-month Kaplan-Meier estimated event rate, 0.7% and 1.2%, respectively; hazard ratio, 0.60; 95% confidence interval [CI], 0.36 to 0.98; P = 0.04). The safety end point occurred in 201 patients in the envelope group and 236 patients in the control group (12-month Kaplan-Meier estimated event rate, 6.0% and 6.9%, respectively; hazard ratio, 0.87; 95% CI, 0.72 to 1.06; P<0.001 for noninferiority). The mean (+/-SD) duration of follow-up was 20.7+/-8.5 months. Major CIED-related infections through the entire follow-up period occurred in 32 patients in the envelope group and 51 patients in the control group (hazard ratio, 0.63; 95% CI, 0.40 to 0.98). CONCLUSIONS: Adjunctive use of an antibacterial envelope resulted in a significantly lower incidence of major CIED infections than standard-of-care infection-prevention strategies alone, without a higher incidence of complications. (Funded by Medtronic; WRAP-IT ClinicalTrials.gov number, NCT02277990.).