Custodiol versus Cold Blood Cardioloplegia in Minimally Invasive Aortic Valve Surgery: A Comparative Study

Background: Myocardial protection is a critical concern during aortic valve replacement. Custodiol cardioplegia and cold blood cardioplegia represent two primary strategies for myocardial preservation. This study sought to compare Custodiol and blood cardioplegia results for myocardial protection in aortic valve replacement. Methods: This prospective study included 200 patients who were evenly divided into two groups based on the cardioplegia solution used: the Custodiol group (Group A) and the cold blood cardioplegia group (Group B). The study evaluated postoperative mechanical ventilation duration, ICU and overall hospital stay lengths, and echocardiographic findings at three and six months postoperatively. Results: Compared with Group B, Group A had significantly shorter ventilation times (min-max: 6-9 vs. 9-15 hours), ICU stays (3-3 vs. 4-5 days), and hospital stays (7-9 vs. 10-20 days) (p<0.001 for all). Group A exhibited shorter cardiopulmonary bypass times (179 ± 9 minutes vs. 216 ± 14 minutes, p<0.001) and cross-clamp times (137 ± 8 minutes vs. 176 ± 18 minutes, p<0.001). Postoperative atrial fibrillation was more common in Group A (66% vs. 20%, p<0.001), while ventricular tachycardia and nodal rhythm post-defibrillation were greater in Group B. Mortality was lower in Group A (2% vs. 9%, p=0.03). However, at three and six months postoperatively, echocardiographic findings were significantly different in terms of left atrial diameter and left ventricular end-systolic diameter between Group A and Group B (p<0.001). Conclusion: Custodiol cardioplegia could be associated with superior postoperative outcomes, including shorter ventilation times, ICU and hospital stays, and lower mortality rates, compared to cold blood cardioplegia in minimally invasive aortic valve replacement surgery

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population