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| The Monthly Pulse |
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| Innominate artery direct cannulation provides brain protection during total arch replacement for acute type A aortic dissection
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| The Story |
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| To prevent nerve injury during aortic arch surgeries, strategies such as systemic hypothermia and maintenance of cerebral blood perfusion are often implemented. In a recent study of 29 patients, researchers sought to assess the safety of direct innominate arterial cannulation using a pediatric arterial cannula to establish selective antegrade cerebral perfusion during total arch replacement for acute Stanford type A aortic dissection. |
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| What You Should Know |
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| Because thoracic surgery has a high rate of neurological complications, brain protective strategies have remained an important area of interest for researchers over the years. While this study was small, consisting of only 29 patients, its results are positive. The approach appears to be safe, simple, and effective, as there were no cases of IA injuries.
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| TAVR for Aortic Regurgitation Off to a Good Start in the Real World |
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| The Story |
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| Early experiences with transcatheter aortic valve replacement (TAVR) using the Jenavalve Trilogy System appear promising, according to surgeons in Germany who have performed the procedure on 45 patients. Procedures saw 100% technical success, none or trace paravalvular regurgitation at discharge in 91% of cases, and no myocardial infarction, cardiothoracic surgery, stroke, or death, thus suggesting the system could be safe and effective.
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| What You Should Know |
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| Despite positive results thus far, there was a 23% rate of new pacemakers after TAVR. According to one of the German doctors, this could be a result of aortic regurgitation patients being more prone to conduction disturbances. Further studies will be needed to confirm the safety and efficacy of the system, which has received FDA approval for a premarket approval trial in the US.
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| Anticoagulation in New Onset Postoperative Atrial Fibrillation: An Analysis from the Society of Thoracic Surgeons Adult Cardiac Surgery Database |
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| The Story |
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| In an analysis from the Society of Thoracic Surgeons Adult Cardiac Surgery database, researchers note that patients discharged on oral anticoagulation experienced a higher mortality rate. This patient population also experienced significantly higher bleeding and no reduction in ischemic stroke. |
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| What You Should Know |
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| While anticoagulation has been posited as a potential therapy to prevent new-onset postoperative atrial fibrillation after cardiac surgery, this research suggests the treatment does not appear to benefit patients. Anticoagulation does appear to reduce myocardial infarction for the first 30 days following discharge, but the effect decreases over time. Researchers note that there is a need for further research to identify the optimal treatment strategies to reduce postoperative atrial fibrillation.
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| Leadership Reflections |
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Wisdom
Most of us have been told that wisdom comes with age and life experience, so waiting for wisdom to develop over time has been seen as a somewhat passive process. In reality, wisdom can be developed and utilized now in our work and personal lives, which is great news!
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The article Why You Need Wisdom and How to Be (More) Wise - According to Science outlines five strategies for developing wisdom:
- Consider others - The wise person thinks about how their actions will affect those around them.
- Manage yourself - As you develop wisdom, actively reflect on your own state of mind, opinions, and attitudes.
- Seek diversity - Wisdom demands ongoing learning, and this can only come from true openness to different points of view and a belief that we don’t already have all the answers.
- Embrace uncertainty - The maturity of wisdom allows us to make judgements, take action, and be constructive, even without much clarity.
- Take a long term view - Wisdom is built through putting aside short-term gain to make decisions that serve longer term goals.
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| Wisdom is associated with decreased loneliness and increased compassion, engagement, happiness, fulfillment, and even a healthy gut microbiome! So let’s stop being passive and get to work on developing wisdom together. |
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| 19th Annual Perioperative and Critical Care Conference |
| Thurs., Sept. 8 - Sat., Sept. 10 |
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| Virginia Perfusion Symposium |
| Sat., Sept 10 - Sun., Sept. 11 |
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| APPex Advanced Practice Provider (APRN & PA) Leadership Summit |
| Fri., Sept. 16 - Sat., Sept. 17 |
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| AAPA Leadership and Advocacy Summit |
| Thurs., Sept 29 to Sat., Oct 1 |
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| Eastern Cardiothoracic Surgical Society 60th Annual Meeting |
| Thurs., Oct. 6 - Sun., Oct. 9 |
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