Journal and News Scan

The authors conducted a retrospective review of two concurrent groups undergoing elective aortic transverse hemiarch reconstruction:  Group DHCA underwent deep hypothermic circulatory arrest with retrograde cerebral perfusion; group MHCA underwent moderate hypothermic (>25 degrees C) circulatory arrest with antegrade cerebral perfusion.  A total of 376 patients were included in their study.  All preoperative demographics were similar, except the MHCA patients were significantly older.  Intraoperative CPB and X-clamp times were significantly shorter for the MHCA group, and postoperative outcomes for both groups were excellent and equivalent.  Hence--at least according to this retrospective single-center study--moderate hypothermia along with antegrade cerebral perfusion may be a viable strategy for patients undergoing elective hemiarch surgery.

This is a follow up study by the investigators on aortic valve opening during continuous flow LVAD support. Their earlier study looked at the rate of aortic insufficiency during CF LVAD support therapy comparing patients who achieved aortic valve opening during rest versus those who did not. This current study examines the compression of patients who achieve aortic valve opening versus those patients who do not achieve this during exercise and the rate of aortic insufficiency development.  Findings included improved exercise tolerance and decreased re-admission rates for those patients who achieved aortic valve opening. The investigators recommend aggressive cardiac rehabilitation programs to decrease AI and improve QOL for patients treated with CF LVAD devices.

In this excellent case report the authors describe the use of ECMO on a 28 year old pregenant female (26 weeks gestation) that developed ARDS requiring ECMO support for survival. The outcome for both mother and child was described as excellent with both being discharged from hospital care.  The article has several important elements regarding ECMO for pulmonary failure and adds to the successful management of these patients with factors including pregnancy and long distance air transport. With recent reports of ECMO use increasing upwards of 400% over the last several years, technological advancements and improved protocols, including earlier intervention, the use of ECMO may increase to a point that manpower considerations may be something that needs to be addressed by the acute care community in advance to avoid an inability to provide an effective therapy for patients with severe pulmonary failure.

In this paper, Nilsson et al present the first international survival prediction model for heart-transplanted patients.  The findings from this study show that a flexible non-linear artificial neural network model can be used to predict both short- and longterm mortality with higher accuracy. Furthermore, the results indicate that a survival prediction based organ sharing system may allocate more organs compared with a criterion-based system.