Deep Parasternal Intercostal Plane Blocks and Their Role in a Cardiac Fast-Track Program.

Objectives: To determine if deep parasternal intercostal plane (DPIP) blocks are associated with reduced opioid consumption and a subsequent reduction in postoperative delirium after cardiac surgery.

Design: A retrospective observational study.

Setting: A single-center tertiary care hospital.

Trans-atrial Inflow Cannula Configuration for Durable HeartWare Left Ventricular Assist Device in Hypertrophic Cardiomyopathy: A Case Series and a Word of Caution.

Background/objectives: Implantation of a durable left ventricular assist device (LVAD) in patients with hypertrophic cardiomyopathy (HCM) is technically challenging. We describe our experience using a trans-atrial inflow cannulation and a left atrial-to-aorta (LA-Ao) LVAD configuration. Pump hemodynamics, selection criteria, technical considerations, and postoperative management reflections are discussed.

Tet1 safeguards lineage allocation in intestinal stem cells.

Intestinal stem cells (ISCs) balance self-renewal and differentiation to maintain the intestinal epithelial barrier, which is replaced weekly throughout adult life. Genetic control of ISC differentiation is well-defined relative to transcription factor (TF) activity, but less is known regarding the role of chromatin regulation in ISC biology. Prior work from our lab and others has shown that , a chromatin modifying enzyme involved in DNA demethylation, is specifically enriched in ISCs and early secretory progenitors.

Moving Beyond the Perfect Donor: An Interdisciplinary Approach to Optimizing Donor Utilization.

Background: Despite a growing demand for donor hearts, more than two-thirds of viable hearts are discarded in North America. Our initiative sought to improve donor heart utilization by reviewing institutional donor acceptance practices and implementing targeted interventions.

Objectives: Our aim was to increase donor heart utilization rate to 20% and reduce the rate of missed viable opportunities to ≤10% within a 12-month period, and assess the incidence of primary graft dysfunction preintervention and postintervention.

sensitizes the intestinal epithelium to doxorubicin-induced apoptosis.

Doxorubicin (DXR) is a widely used chemotherapy drug that can induce severe intestinal mucositis. Although the influence of gut bacteria on DXR-induced damage has been documented, the role of eukaryotic commensals remains unexplored. We discovered () in one of our mouse colonies exhibiting abnormal tuft cell hyperplasia, prompting an investigation into its impact on DXR-induced intestinal injury.

A two-centre study investigating the association between brain natriuretic peptides & outcomes in continuous flow left ventricular assist device recipients.

Background: Natriuretic peptides are useful prognostic markers in patients with heart failure and this study aims to evaluate the association between N-terminal pro-brain natriuretic peptide and outcomes in patients with a continuous-flow left ventricular assist device.

Methods: Adult patients with a continuous-flow left ventricular assist device as bridge to transplant or destination therapy and discharged from hospital were included in the study. Multi-variable Cox regression models with natriuretic peptide as a time-dependent covariate modelling multiple measures per patient, and cubic spline analysis were used to evaluate the association between natriuretic peptides and patient outcomes, taking median N-terminal pro-brain natriuretic peptide of 244 pmol/L as the reference value.

Prothrombin Complex Concentrate vs Frozen Plasma for Coagulopathic Bleeding in Cardiac Surgery: The FARES-II Multicenter Randomized Clinical Trial.

Importance: Excessive bleeding is a common and prognostically important complication of cardiac surgery. For bleeding related to coagulation factor deficiency, frozen plasma is the most used therapy. Preliminary trials indicate that 4-factor prothrombin complex concentrate (PCC) may be a suitable alternative.

Peripheral versus central cannulation of VA-ECMO for primary graft dysfunction after heart transplantation: A systematic review and meta-analysis.

Background: Severe primary graft dysfunction (PGD) after heart transplantation (HT) is a major cause of death and requires veno-arterial extracorporeal membrane oxygenation (VA-ECMO).

Methods: We conducted a systematic review and meta-analysis including studies of adult HT recipients who required VA-ECMO for PGD to determine whether a peripheral or central configuration was associated with higher mortality. The primary endpoints were short-term and one-year mortality.

Relationship between Systolic Ejection Time and Inflammation in End-Stage Heart Failure.

Objectives: Systolic ejection time (SET) and systemic inflammation are two essential indicators of heart failure (HF) progression. We aimed to evaluate the associations between SET and inflammatory mediators in end-stage HF.

Methods: Participants included 16 patients with end-stage HF recruited from the Heart Failure Clinic at Toronto General Hospital and 16 healthy individuals free of any known cardiovascular disease.

Seven-year outcomes after surgical aortic valve replacement with a stented bovine pericardial bioprosthesis in over 1100 patients: a prospective multicentre analysis.

Objectives: Safety, efficacy and durability are important considerations when selecting a bioprosthesis for aortic valve replacement (AVR). This study assessed 7-year clinical outcomes and haemodynamic performance of the Avalus bioprosthesis.

Methods: Patients indicated for surgical AVR were enrolled in this prospective, nonrandomized trial, conducted across 39 sites globally.

International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates-2024.

The "International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates-2024" updates and replaces the "Listing Criteria for Heart Transplantation: International Society for Heart and Lung Transplantation Guidelines for the Care of Cardiac Transplant Candidates-2006" and the "2016 International Society for Heart Lung Transplantation Listing Criteria for Heart Transplantation: A 10-year Update." The document aims to provide tools to help integrate the numerous variables involved in evaluating patients for transplantation, emphasizing updating the collaborative treatment while waiting for a transplant. There have been significant practice-changing developments in the care of heart transplant recipients since the publication of the International Society for Heart and Lung Transplantation (ISHLT) guidelines in 2006 and the 10-year update in 2016.

Prevalence and Risk Factors for Chronic Postsurgical Pain After Thoracic Surgery: A Prospective Cohort Study.

Objective: Thoracic surgery is associated with one of the highest rates of chronic postsurgical pain (CPSP) among all surgical subtypes. Chronic postsurgical pain carries significant medical, psychological, and economic consequences, and further interventions are needed to prevent its development. This study aimed to determine the prevalence, characteristics, and risk factors associated with CPSP after thoracic surgery.

Minimally invasive extracorporeal circulation versus conventional cardiopulmonary bypass in patients undergoing cardiac surgery (MiECS): Rationale and design of a multicentre randomised trial.

IntroductionThe ultimate answer to the question whether minimal invasive extracorporeal circulation (MiECC) represents the optimal perfusion technique in contemporary clinical practice remains elusive. The present study is a real-world study that focuses on specific perfusion-related clinical outcomes after cardiac surgery that could potentially be favourably affected by MiECC and thereby influence the future clinical practice.MethodsThe MiECS study is an international, multi-centre, two-arm randomized controlled trial.

Conventional versus minimally invasive extra-corporeal circulation in patients undergoing cardiac surgery: A randomized controlled trial (COMICS).

IntroductionThe trial hypothesized that minimally invasive extra-corporeal circulation (MiECC) reduces the risk of serious adverse events (SAEs) after cardiac surgery operations requiring extra-corporeal circulation without circulatory arrest.MethodsThis is a multicentre, international randomized controlled trial across fourteen cardiac surgery centres including patients aged ≥18 and <85 years undergoing elective or urgent isolated coronary artery bypass grafting (CABG), isolated aortic valve replacement (AVR) surgery, or CABG + AVR surgery. Participants were randomized to MiECC or conventional extra-corporeal circulation (CECC), stratified by centre and operation.

Examining the typical hemodynamic performance of nearly 3000 modern surgical aortic bioprostheses.

Objectives: The objective of this analysis was to assess the normal haemodynamic performance of contemporary surgical aortic valves at 1 year postimplant in patients undergoing surgical aortic valve replacement for significant valvular dysfunction. By pooling data from 4 multicentre studies, this study will contribute to a better understanding of the effectiveness of surgical aortic valve replacement procedures, aiding clinicians and researchers in making informed decisions regarding valve selection and patient management.

Methods: Echocardiograms were assessed by a single core laboratory.

Days alive and out of hospital for adult female and male cardiac surgery patients: a population-based cohort study.

Background: Research shows women experience higher mortality than men after cardiac surgery but information on sex-differences during postoperative recovery is limited. Days alive and out of hospital (DAH) combines death, readmission and length of stay, and may better quantify sex-differences during recovery. This main objective is to evaluate (i) how DAH at 30-days varies between sex and surgical procedure, (ii) DAH responsiveness to patient and surgical complexity, and (iii) longer-term prognostic value of DAH.

Do postoperative hemodynamic parameters add prognostic value for mortality after surgical aortic valve replacement?

Background: Although various hemodynamic parameters to assess prosthetic performance are available, prosthesis-patient mismatch (PPM) is defined exclusively by effective orifice area (EOA) index thresholds. Adjusting for the Society of Thoracic Surgeons predicted risk of mortality (STS PROM), we aimed to explore the added value of postoperative hemodynamic parameters for the prediction of all-cause mortality at 5 years after aortic valve replacement.

Methods: Data were obtained from the Pericardial Surgical Aortic Valve Replacement (PERIGON) Pivotal Trial, a multicenter prospective cohort study examining the performance of the Avalus bioprosthesis.

Dialysis preserves heart function during ex situ heart perfusion.

Background: Ex situ heart perfusion (ESHP) has been used to optimize donor organs before heart transplantation. However, cardiac function often deteriorates with the development of myocardial edema. The use of dialysis during ESHP could assist in cardiac preservation.