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| The Monthly Pulse |
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| Identifying Frailty as a Factor Associated With Adverse Outcomes in Cardiovascular Surgery—An Imperfect but Promising Science
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| The Story |
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| Although frailty could be associated with adverse surgical outcomes, it’s not included in most surgical risk calculations. In a recent JAMA commentary, doctors are calling for a reliable and valid risk predictor that accounts for frailty. Specifically, the authors note that there’s a strong case for incorporating frailty into preoperative risk stratification for cardiovascular surgery to potentially help inform medical decisions. |
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| What You Should Know |
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| Most clinicians struggle to define frailty in objective terms, but assert that they know it when they see it. Surgical risk calculations are widely used in cardiac surgery to assist patients and clinicians in making informed decisions. The ability to incorporate frailty as a data point to develop a more accurate risk score could help both surgeons and their patients when considering treatment options.
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| Distal aortic replacement followed by endovascular repair for the management of severe intra-pleural adhesions accidentally detected during open surgery for chronic type B aortic dissection: a report of two cases |
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| The Story |
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| Open repair is the go-to method treatment for patients with chronic type B aortic dissection, but following accidental detection of intra-pleural adhesions during this procedure, complete replacement of diseased aorta cannot be accomplished. In two cases in which open repair was attempted, surgeons switched the procedure to create a distal landing zone for future endovascular repair by replacing the aorta with a vascular graft. The endovascular repair was performed thereafter with good outcomes.
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| What You Should Know |
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| While the data comes from just two instances of this procedure, it suggests a promising option to manage severe adhesions accidentally detected during open repair for chronic type B aortic dissection. Though limited, these findings suggest that the replacement of the distal aorta with a vascular graft could be a suitable landing zone for future endovascular repair.
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| Analysis of changes in “mitral valve reserve” after coronary artery bypass grafts in patients with functional mitral regurgitation |
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| The Story |
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| A recently published study looked to investigate changes in mitral valve reserve in patients with moderate functionalmitral regurgitation (FMR) undergoing isolated coronary artery bypass grafting (CABG). It assessed 104 patients who were followed for one year. Findings indicate mitral valve reserve (MVR) was significantly reduced at six- and 12-month follow-ups. |
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| What You Should Know |
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| Treatment of FMR during CABG is debated, so this study sought to assess improvement in MVR after CABG alone to demonstrate left ventricular recovery. The results show an improvement of MVR that explains the significant reduction of mitral valve regurgitation. The study therefore suggests that patients with moderate FMR who benefit from isolated CABG only have moderately increased left ventricular end-systolic volume indexes (LVESVi). The authors note that further studies are needed to identify an ideal LVESVi cut-off.
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| Leadership Reflections |
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Expertise
While working on some vendor contract renewals, I’ve been reflecting on the importance of expertise. Working with business partners can be seen as a necessary evil but when the partner has expertise, the value and benefits can be deeply felt by your entire team.
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- Experts ask the right questions - Good questions cut through the noise and provide focus on important factors for decision making, resulting in accelerated timelines and overall cost savings.
- Experts provide unique perspectives - They have a wealth of experience, can anticipate industry trends, and offer out-of-the-box solutions to challenging problems.
- Experts have deep industry knowledge - Specific knowledge = significant value for you and your team.
- Experts can stabilize your team - When utilizing an expert’s experience and wisdom, you can address issues quickly and make order out of chaos.
- Experts will make more people want to work for you - Working with experts boosts your brand and builds trust with your current team and prospective providers.
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| Cardiothoracic and vascular surgery are highly specialized and we take our role as experts in this space seriously. The CT Assist ownership and administrative team includes two cardiac surgery PAs, a perfusionist, and a CVICU nurse. We provide a consultative approach to our interactions with providers and clients and love sharing our experience and wisdom. We welcome your outreach if you’re considering how you can better serve your team. |
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| AATS Clinical Trials Methods Course |
| Thurs., Nov. 17, to Sat., Nov. 19 |
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| Surgical Treatment for Arrhythmias and Rhythm Disorders |
| Fri., Dec. 9 to Sat., Dec. 10 |
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| STS 59th Annual Meeting |
| Sat. Jan. 21 to Mon., Jan. 23 |
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| 7th Annual Advances in Congenital Heart Disease Summit: Transposition of the Great Arteries |
| Thurs., Feb. 16 to Sat., Feb. 18 |
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| The Houston Aortic Symposium: Frontiers in Cardiovascular Diseases, the Fifteenth in the Series |
| Thurs., Mar. 16 to Sat., Mar. 18 |
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