Frozen Elephant Trunk (FET) has revolutionized management of aortic arch and proximal descending aorta pathologies. Despite significant advancement in FET prosthesis design in recent years, adverse outcomes related with neurologic and visceral ischemic events remained unsolved. To address this issue, several publications evaluated protection strategies to reduce body lower ischemic time. In the present commentary we put the technique promoted as “Release and Perfuse Technique” on scale that is for achievement of less lower body circulatory arrest time.
In this article, the author provides synopses of the factors that have finally propelled healthcare education and practice to join, at times reluctantly, the overarching digital transformative process that has been swept other industries over the last few decades. The key contributors and driving forces that have energized the entry of healthcare education and practices are mentioned. The roles of major universities, large technology companies and the expanding roles of Artificial Intelligence and Machine Learning are described. The projected future developments are predicted to continue to be substantial, sweeping and forcing changes that are unprecedented. Thus, academicians and practitioners should be alerted to what the rapidly changing landscape is likely to become and accordingly take steps to manage and preserve their roles or risk be left behind or worse be forced out.
Title Page:Title: Letter to the Editor: Long-term outcomes of elderly patients receiving continuous flow left ventricular supportArticle Type: Letter to the EditorCorrespondence: 1. Saad Ahmed qureshiContact No: +92-3360135206. Email: Saadqureshi1099@gmail.comInstitute: Ziauddin medical college KarachiAddress: NHS phase 4 tower 5b flat 5/7ORCID: 0000-0003-0857-3818Co-Authors: 2. Hamid ullah khanContact No: +92-3040215080. Email: firstname.lastname@example.orgInstitute: Ziauddin University karachiAddress: Plot no AS 04 sector 32-D Nasir colony Korangi no 01ORCID: 0000-0002-0938-6080Co-Authors: 3. Umer sami KhanContact No: +92-304044743. Email: Umersamikhan@gmail.comInstitute: Ziauddin University karachiAddress: B4, Block B, Gulshan-e-jamal, Rashid minhas Road, KarachiORCID: 0000-0003-0849-7915Word Count: 320
This letter is in response to the case report by Kuzmin et al. entitled “Left atrial appendage occlusion device causing coronary obstruction: A word of caution” , published in November 2020 issue of Journal of Cardiac Surgery. The report describes a circumflex lesion occurring following mitral valve (MV) repair, tricuspid valve repair, and left atrial appendage closure (LAAO) using AtriClip device. The authors concluded that LAAO is a safe procedure, but in the setting of a concomitant MV surgery LAAO may be a contributor to the reported event. Circumflex coronary artery occlusion or impingement during MV repair is well described in the literature. On the reported two-dimensional cine, the position of the stenosis is typical of mitral repair induced injury. A ring suture can gather and compress tissue adjacent to the coronary creating stenosis without a discrete ligation. It is also true that vigorous traction on the LAA without due attention to distortion of the adjacent circumflex might be capable of creating compression or accordioning of the vessel. To mitigate this, the clip should be placed at the true base of the appendage. A residual pouch carries as much or more risk as not attempting to close the appendage at all. The authors’ recommendation to place the clip more distally will inevitably lead to incomplete closures. In conclusion, the reported event was more likely due to a mitral stitch, the path of which is not directly visualized after it breaches the endocardium.
TITLE PAGE Title: Letter to the Editor: Minimally invasive aortic valve repair using geometric ring annuloplastyArticle type: Letter to the editorCorrespondence : 1. Bilawal NadeemContact: +92-3137562580 Email: email@example.comInstitute: King Edward Medical University, LahoreAddress: Mianwal Ranjha Dera Allah Wadhaya Tehsil and District Mandi Bahauddin, 50400Words count: 418Conflict of interest: noneDisclosure: noneFunding: none
Background: There is emerging evidence to support pre-emptive thoracic endovascular aortic repair (TEVAR) intervention for uncomplicated type B aortic dissection (unTBAD). Pre-emptive intervention would be particularly beneficial in patients that have a higher baseline risk of progressing to complicated TBAD (coTBAD). There remains debate on the optimal clinical, laboratory, morphological and radiological parameters which would identify the highest-risk patients that would benefit most from pre-emptive TEVAR. Aim: This review summarises evidence on the clinical, laboratory, and morphological parameters that increase the risk profiles of unTBAD patients. Methods: A comprehensive literature search was carried out on multiple electronic databases including PubMed, EMBASE, Ovid and Scopus in order to collate all research evidence on the the clinical, laboratory, and morphological parameters that increase the risk profiles of unTBAD patients Results: At present, there are no clear clinical guidelines using risk-stratification to inform the selection of unTBAD patients for TEVAR. However, there are noticeable literature trends that can assist with the identification of the most at-risk unTBAD patients. Patients are at particular risk when they have refractory pain and/or hypertension, elevated C-reactive protein (CRP), larger aortic diameter and larger entry tears. These risks should be considered alongside factors that increase the procedural risk of TEVAR to create a well-balanced approach. Advances in biomarkers and imaging are likely to identify more pertinent parameters in future to optimise the development of balanced, risk-stratified treatment protocols. Conclusion: There are a variety of risk profiling parameters that can be used to identify the high-risk unTBAD patient, with novel biomarkers and imaging parameter emerging. Longer-term evidence verifying these parameters would be ideal. Further randomized controlled trials and multicentre registry analyses are also warranted to guide risk-stratified selection protocols.
Improvements in medical imaging and a steady increase in computing power are leading to new possibilities in the field of cardiovascular interventions. Interventions can be planned in advance in greater detail, even to the point of simulating procedures. Nevertheless, all techniques are at an early stage of development. It is of utmost importance that tools, especially if they can be used as decision support are intensively validated and their accuracy is demonstrated. In our commentary, we summarize current techniques for guiding improvement planning, but also critically discuss the downsides of these techniques. Following the work of Kenichi and colleagues, we also discuss necessary steps in advancing new tools and techniques, particularly as they are used in routine clinical practice. We also discuss the role of artificial intelligence, which could play a crucial role in this context in the future.
TITLE: Letter to the Editor: The choice of palliative arterial switch operation as an alternative for selected cases in a single center: Experience and midterm resultsARTICLE TYPE: letter to the editorCORRESPONDENCE: 1 . Arun KumarContact: +92 331 3856579 Email: Arunchawla@rocketmail.comInstitute: Ghulam Muhammad Mahar Medical College, SukkurAddress: Flat No 108 Columbus Tower Teen Talwar Karachi
The future of CABG can be bright if cardiac surgeons will change the paradigm followed so far and will return in history, abandoning the current comfortable life and accepting the burden represented by the cost of innovation, which has a path already mapped out but not sufficiently trodden for guilty lack of commitment.