57. Aortic valve replacement with sutureless valve and mitral valve repair in patient with infected aortic homograft

The approach of implanting aortic sutureless valve inside the calcific homograft is suitable in redo surgery especially if associated with mitral valve surgery. Aortic valve replacement in patients who have undergone previous aortic root replacement with an aortic homograft remains a technical challenge because of homograft degeneration and the need for a redo Bentall operation. We report a case of redo aortic valve replacement (valve in valve) with a sutureless valve and mitral valve repair by miniband annuloplasty in a female patient aged 64years old who underwent aortic valve replacement with homograft 14years ago and presented by sever aortic valve regurge and sever mitral valve regurge because of infective endocarditis. This technique allows rapid aortic valve replacement in a heavily calcified aortic root. It also avoids aortic valve size affection after mitral valve repair by ordinary methods especially in patients with small aortic annulus. This technique is particularly suitable in redo procedures for homograft degeneration, it avoids performing a redo Bentall operation with its known problems as well as to avoid patient prosthesis mismatch

2. Minimally invasive mitral valve surgery why do you take the risks?

During recent years, minimally invasive mitral valve surgery (MIMVS) become the preferred method of mitral valve repair and replacement in many institutions worldwide with excellent results, in spite of there is no clear difinition of minimally invasive surgery and we do not have efficient studies about the risks of MIMVS comparing to conventional mitral valve surgery. Many studies are needed to clarify the need for either conventional or minimally invasive mitral valve surgery instead of personal preference. The patient’s demographic profile, intraoperative data and postoperative outcomes of patients undergoing minimally invasive mitral valve surgery were retrospectively collected from our database from May 2011 to April 2014. We will present early and mid-term outcomes of patients undergoing minimally invasive mitral valve surgery in our institution. Seventy consecutive patients (45 male and 25 female), age 35±12 years, underwent MIMVS surgery. Mean preoperative New York Heart Association function class was 2.6±0.7. Mean ejection fraction was 50±8. Cardiopulmonary bypass was instituted through femoral cannulation (28 of 70, 40%), or direct aortic cannulation (42 of 70, 25%). Aortic cross-clamp used in (66 of 70, 94.2%). Without aortic cross-clamp in (4 of 70, 5.7%), mitral valve repair has been done in (52 of 70, 74.2%), mitral valve replacement (18 of 70, 25.7%). Concomitant procedures included AF ablation (24 of 70, 34.2%), and tricuspid valve repair (33 of 70, 47.1%). No mortality recorded, residual mitral regurge was found in (6 of 70, 8.5%) during 1 year follow up. Cardiopulmonary bypass, and “skin to skin” surgery were 95±35 and 250±74min, respectively. 4 patients (5.7%) underwent reexploration for bleeding and (57 of 70, 81.4%) did not receive any blood transfusions. Six patients (8.5%) sustained face oedema. Mean length of hospital stay was 7±3.8days. 18 patients (25.7%) did not feel any interest regarding cosmotic advantage over conventional surgery. Minimally invasive mitral valve surgery is an excellent alternative to conventional mitral valve surgery in most cases however comparing to conventional mitral surgery it shows long bypass time, long cross clamp time, difficult reexploration for bleeding and multiple body incisions

Letter: The Impact of the Coronavirus (COVID-19) Pandemic on Neurosurgeons Worldwide

This article is made available for unrestricted research re-use and secondary analysis in any form or be any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.The aim of our study was to explore the impact of this pandemic on neurosurgeons with the hope of improving preparedness for future crisis. We created a 20-question survey designed to explore demographics (nation, duration and scope of practice, and case-burden), knowledge (source of information), clinical impact (elective clinic/surgery cancellations), hospital preparedness (availability of personal protective equipment [PPE] and cost of the supplies), and personal factors (financial burden, workload, scientific and research activities). The survey was first piloted with 10 neurosurgeons and then revised. Surveys were distributed electronically in 7 languages (Chinese, English, French, German, Italian, Portuguese, and Spanish) between March 20 and April 3, 2020 using Google Forms, WeChat used to obtain responses, and Excel (Microsoft) and SPSS (IBM) used to analyze results. All responses were cross-verified by 2 members of our team. After obtaining results, we analyzed our data with histograms and standard statistical methods (Chi-square and Fisher's exact tests and logistic regression). Participants were first informed about the objectives of our survey and assured confidentiality after they agreed to participate (Helsinki declaration). We received 187 responses from 308 invitations (60.7%), and 474 additional responses were obtained from social media-based neurosurgery groups (total responses = 661). The respondents were from 96 countries representing 6 continents (Figure ​(Figure11A-​A-11C)

55. Coronary artery bypass graft for cardiogenic shock post STEMI patients

Cardiogenic shock (CS) complicating AMI continues to have a high mortality of 60–80% despite early revascularization and adjunctive therapies. AMI-CS complicates 5–7% of cases of STEMI and is a leading cause of hospital death AMI. We studied the outcome of CABG for AMI-CS patients. From 10-2013 to 9-2015, 24 patients with post STEMI cardiogenic shock were admitted and underwent emergency CABG. Mean pre-operative ejection fraction (EF) was 29.7 ± 8.4%. 8 patients were on IABP pre-operatively. Operative mortality rate was 21%. Survival rate was 79% and mean follow-up of 10.21 ± 4.8 months. CABG should be considered for patients with AMI complicated by cardiogenic shock when PCI can not be done

52. Early revascularization on veno-arterial ECMO for patients with cardiogenic shock post stemi

Refractory Cardiogenic shock (CS) complicates 5–7% of cases of ST-elevation myocardial infarction (STEMI), and is a leading cause of hospital death after myocardial infarction. CS complicating acute myocardial infarction continues to have a high mortality of 60–80% despite early revascularization and adjunctive therapies. We studied the effectiveness of veno-arterial (VA) – Extracorporeal Membrane Oxygenator (ECMO) for the patients with CS post STEMI during coronary angiography at our institute. Between January 2014 to April 2015, 8 male patients who suffered from progressive severe refractory CS post STEMI underwent emergent peripheral VA-ECMO implantation while performing cardiopulmonary resuscitation during coronary angiography. 7 patients of underwent PCI, while 1 patient was not amenable to PCI or CABG. The mean duration of support was 8.5 ± 5.8 days. 6 patients were successfully weaned from ECMO. While on ECMO support, 2 patients died. Mean EF after ECMO explantation was 32.5% ± 10.5%. The 30-day survival was 50%. Early revascularization on ECMO allows supporting hemodynamic efficiently in cardiogenic shock patients

A test-teach-test approach to support first year undergraduate pharmacy students with pharmaceutical calculations.

Mastering pharmaceutical calculations is an essential skill for healthcare professionals, particularly given the potential harm to patients if performed incorrectly.(Ancker and Kaufman 2007; Taylor and Byrne-Davis 2016). To determine if a test-teach-test approach to teaching pharmaceutical calculations increases the knowledge and confidence of first year undergraduate pharmacy students (PS). The study population was all first year PS (N=140) at one UK university. The study was in three phases. Phase one - a survey. PS listed calculation topics they struggled with. They also indicated their preferred learning methods. Phase two was a teaching session, using phase one data. Participants sat a 10-question calculation test (T1) for 25 minutes. They then had a one-hour teaching session that incorporated their preferred learning methods. After this, they sat another 10-question calculation test (T2), covering the same topics, again over 25 minutes, to determine if scores improved. Following phase two, phase three was an evaluation survey to determine if student confidence had improved. Ethical approval was obtained. Data were analysed in Excel and SPSS. Paired t-test was used to compare mean test scores (p<0.05). Response rate: 62.1% (N=87/140). Topics struggled with included displacement volume, infusion rate, equivalent doses. Preferred learning methods included use of videos and drawings. Paired sample t-test indicated a significant improvement in student knowledge (t1 mean=3.7/10, t2 mean=6.8/10; t(86)=-12.05 (p<0.01)). Almost all (98.9%, N=86/87), stated that their confidence in calculations had improved following the session, with 38.0% (N=33/87) noting a significant improvement. Furthermore, there was an uplift in the proportion of students who stated that they felt they had a high level of understanding of the taught topics. A test-teach-test approach for teaching pharmaceutical calculations not only increases PS knowledge but also their confidence. Taking students’ preferred learning methods into account may also increase engagement and understanding

Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation

Background: The outcome after weaning from postcardiotomy venoarterial extracorporeal membrane oxygenation (VA-ECMO) is poor. In this study, we investigated the prognostic impact of arterial lactate levels at the time of weaning from postcardiotomy VA. Methods: This analysis included 338 patients from the multicenter PC-ECMO registry with available data on arterial lactate levels at weaning from VA-ECMO. Results: Arterial lactate levels at weaning from VA-ECMO (adjusted OR 1.426, 95%CI 1.157–1.758) was an independent predictor of hospital mortality, and its best cutoff values was 1.6 mmol/L (&lt;1.6 mmol/L, 26.2% vs. ≥ 1.6 mmol/L, 45.0%; adjusted OR 2.489, 95%CI 1.374–4.505). When 261 patients with arterial lactate at VA-ECMO weaning ≤2.0 mmol/L were analyzed, a cutoff of arterial lactate of 1.4 mmol/L for prediction of hospital mortality was identified (&lt;1.4 mmol/L, 24.2% vs. ≥1.4 mmol/L, 38.5%, p = 0.014). Among 87 propensity score-matched pairs, hospital mortality was significantly higher in patients with arterial lactate ≥1.4 mmol/L (39.1% vs. 23.0%, p = 0.029) compared to those with lower arterial lactate. Conclusions: Increased arterial lactate levels at the time of weaning from postcardiotomy VA-ECMO increases significantly the risk of hospital mortality. Arterial lactate may be useful in guiding optimal timing of VA-ECMO weaning