Temporary Emergency Guidance to STEMI Systems of Care During the COVID-19 Pandemic: AHA's Mission: Lifeline

The American Heart Association (AHA) Get With The Guidelines Coronary Artery Disease Advisory Work Group, and the Acute Care and Interventional Science Subcommittees of the AHA Council on Clinical Cardiology, are responding to the call of concern on ideal ST-segment–elevation myocardial infarction (STEMI) Systems of Care during the coronavirus disease 2019 (COVID-19) pandemic. Emergency interim guidance is being provided, pivoting from the conventional AHA evidence-based meticulous peer review process. This statement addresses STEMI Systems of Care issues throughout the pandemic, to ensure that patients with STEMI continue to receive life-saving treatments while maintaining patient and healthcare worker safety

Minimal access median sternotomy for aortic valve replacement in elderly patients

BACKGROUND: We report our clinical experience with a approach for aortic valve replacement (AVR) via minimal access skin incision and complete median sternotomy. This approach was used in patients with higher age and multiple co-morbidities, facilitating an easy access with short bypass and cross clamp times. It was especially performed in patients asking for an excellent cosmetic result, who did not qualifying for minimally-invasive AVR via partial upper sternotomy. METHODS: AVR via minimal-access median sternotomy, was performed in 58 patients between 01/2009 and 11/2011. Intra- and postoperative data including cross clamp time, cardiopulmonary bypass time, mortality, stroke, pacemaker implantation, re-operation for bleeding, ventilation time, ICU and hospital stay, wound infection, sternal dehiscence or fracture and 30 day mortality were collected. RESULTS: Mean patients age was 76.1 +/−9.4 years, 72% were female. Minimal-access AVR could be performed with a mean length of midline skin incision of 7.8 cm. Aortic cross-clamping time was 54.6 +/−6.3 min, cardiopulmonary bypass time 71.2+/−11.3 min and time of surgery 154.1 +/−26.8 min. Re-operation for bleeding had to be performed in 1 case (1.7%). There were no strokes or pacemaker implantations needed. Mean ventilation time was 4.5 h, ICU stay was 2 days and mean length of hospital stay was 6 days. 6 months follow up showed mortality of 0% and no sternal dehiscence or wound infection was observed. CONCLUSION: Minimal-access AVR via complete median sternotomy can be performed safely,in this elderly patient cohort without adding additional operative risk compared to conventional AVR. By avoidiance of large skin incisions this approach combines excellent cosmetic results with fast surgery time and excellent postoperative recovery

Treatment Times and In-Hospital Mortality Among Patients with ST-Elevation Myocardial Infarction Throughout the Waves of the COVID-19 Pandemic: Lessons Learned

Previous studies about the COVID-19 pandemic on STEMI patient outcomes have conflicting results. It remains unclear if this may be attributed to regional differences and/or differences during COVID-19 wave periods. Using the American Heart Association Get With The Guidelines–Coronary Artery Disease registry data, we evaluated (1) time metrics related to STEMI system goals and (2) regional variation in STEMI incidence and in-hospital mortality during pandemic wave time periods. The study included all patients 18–100 years old admitted with STEMI (n = 72,516) to 1 of 435 American Heart Association Get With The Guidelines–Coronary Artery Disease hospitals (1 October 2019–31 December 2021). Of these, 70.8% were male and 73.0% non-Hispanic White, with a median age of 63 (IQR 18) years. Compared to pre-pandemic time frames, patients with STEMI had a higher risk profile, delayed time to treatment, were treated with fibrinolytic therapy or primary PCI, and were transferred for primary PCI at similar rates, and had higher adjusted in-hospital mortality (during the second wave in the South and Midwest). Preservation of STEMI systems of care resulted in an overall lower in-hospital mortality rate than predicted, although opportunities exist to improve treatment delays. Regional differences in mortality rates require further study

Et 2

Inert weakly coordinating carborane anions, CB(11)H(6)X(6)(-) (X = Cl, Br), allow access to the long sought, highly electrophilic diethylaluminum moiety in Et(2)Al(CB(11)H(6)X(6)). X-ray crystallography reveals ion-like structural features reminiscent of the corresponding trialkylsilylium species. Et(2)Al(CB(11)H(6)X(6)) is a potent catalyst for the electrophilic ethenation of benzene, the polymerization of cyclohexene oxide, and the oligomerization of ethene to a low molecular weight, highly branched product