Safety of internal thoracic artery use in patients with prior mediastinal radiation undergoing coronary artery bypass grafting: a Maryland statewide propensity-matched analysis.

Background: The safety of internal thoracic artery (ITA) grafting in patients undergoing coronary artery bypass grafting (CABG) with prior mediastinal radiation remains controversial due to concerns regarding compromised sternal perfusion and radiation-induced injury. This study evaluated whether prior mediastinal radiation is associated with adverse perioperative outcomes in patients undergoing CABG with ITA grafting.

Methods: We conducted a retrospective cohort study using the Maryland Cardiac Surgery Quality Initiative (MCSQI) database.

Investigating the dynamics of intracranial pressure and cerebral autoregulation during extracorporeal cardiopulmonary resuscitation using a porcine model.

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a promising intervention for refractory cardiac arrest, with potential benefits in survival and neurological outcomes. However, the impact of ECPR's rapid, non-pulsatile restoration of cerebral blood flow on intracranial physiology and autoregulation remains poorly understood.

Methods: Using a porcine model, this study investigated the dynamics of intracranial pressure (ICP), cerebral autoregulation, and pulsatility during key experimental phases: Baseline, Fibrillation, ECMO, and ROSC.

Impact of Obesity on Neurologic Outcomes in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation.

Objective: To investigate the impact of body mass index (BMI) on neurologic outcomes in venoarterial extracorporeal membrane oxygenation (VA-ECMO) DESIGN: Retrospective observational study SETTING: Single center PARTICIPANTS: Adults INTERVENTIONS: VA-ECMO MEASUREMENTS AND MAIN RESULTS: Obese (BMI≥30 kg/m²) and nonobese (BMI<30 kg/m²) patient groups were compared. The primary outcome was neurologic outcomes at discharge, with "good" (modified Rankin Scale [mRS] score 0-3) and "poor" (mRS score 4-6). Secondary outcomes were acute brain injury (ABI) and mortality.

Ultra-Low-Field Portable Brain Magnetic Resonance Imaging in Patients With Cardiac Devices: Current Evidence and Future Directions.

The use of cardiac devices, including mechanical circulatory support (MCS), cardiac implantable electronic devices (CIEDs), and pacing wires, has increased and significantly improved survival in patients with severe cardiac failure. However, these devices are frequently associated with acute brain injuries (ABIs) including ischemic strokes, intracranial hemorrhages, seizures, and hypoxic-ischemic brain injury which contribute substantially to morbidity and mortality. Computed tomography (CT) and magnetic resonance imaging (MRI), the standard imaging modalities for ABI diagnosis, can pose significant challenges in this patient population due to the risks associated with patient transportation and the incompatibility of ferromagnetic components of certain cardiac devices with high magnetic field of the MRI.

Impact of Nighttime Cardiovascular Intensive Care Unit Staffing on Failure to Rescue and Revenue.

Background: Failure to rescue (FTR) is mortality after at least 1 postoperative complication. We investigated the impact of nighttime intensivist staffing and FTR after cardiac surgery.

Methods: We included patients who underwent cardiac surgery to examine FTR, defined as mortality in those who experienced a Society of Thoracic Surgeons-defined major complication.

Clinical Use of Bedside Portable Ultra-Low-Field Brain Magnetic Resonance Imaging in Patients on Extracorporeal Membrane Oxygenation: Results From the Multicenter SAFE MRI ECMO Study.

Background: Early detection of acute brain injury (ABI) at the bedside is critical in improving survival for patients with extracorporeal membrane oxygenation (ECMO) support. We aimed to examine the safety of ultra-low-field (ULF; 0.064-T) portable magnetic resonance imaging (pMRI) in patients undergoing ECMO and to investigate the ABI frequency and types with ULF-pMRI.

Use of veno-venous extracorporeal membrane oxygenation for stabilization prior to redo sternotomy for aortic pseudoaneurysm repair.

Aortic pseudoaneurysms are particularly dangerous because of the risk of rupture and compression of mediastinal structures, including the trachea, and resultant respiratory distress. If respiratory distress progresses to respiratory failure, extracorporeal membrane oxygenation may be used to provide oxygenation prior to or during pseudoaneurysm repair. A 62-year-old male with a history of emergent aortic ascending and arch replacement for Stanford Type A dissection 10 months prior presented to his primary care physician with dyspnea.

Statewide data on surgical ablation for atrial fibrillation: The data provide a path forward.

Objective: Atrial fibrillation (AF), if left untreated, is associated with increased intermediate and long-term morbidity/mortality. Surgical treatment for AF is lacking standardization in patient selection and lesion set, despite clear support from multi-society guidelines. The aim of this study was to analyze a statewide cardiac surgery registry to establish whether or not there is an association between center volume and type of index procedure with performance of surgical ablation (SA) for AF, the lesion set chosen, and ablation technology used.