Structure of multidisciplinary heart teams, a survey based heart team study.

OBJECTIVES Multidisciplinary approach is well established in various disciplines, with evidence highlighting improved patient outcomes. The objective of this survey was to determine the real world practice of heart teams across Europe. METHODS The survey was drafted after a consensus opinion from the authors. The survey was sent to cardiac surgeons and cardiologist identified through electronic search. The survey link and the information sheet were sent through email followed by survey completion reminders. The survey responses were cumulated and analysed. RESULTS Among 2188 invited clinicians, 220 clinicians from 26 countries took part in the survey (response rate 10%). The completion rate for the survey questions was 85%. 140 (64%) were cardiac surgeons and 80 (36%) were cardiologists. The heart team meeting frequency was weekly according to 104 (55%) respondents. This was conducted face to face according to 139 (73%) of the responses. Eighty seven (56%) of the respondents reported 10% - 20% of patients undergoing percutaneous coronary intervention (PCI) were discussed at the heart team meeting. Seventy nine (47%) respondents had ad hoc PCI institutional guidelines. Fifty four (32%) respondents reported an audit process for the heart team decisions. CONCLUSIONS This survey suggests that there is marked variability in the infra-structure and execution of heart teams in different institutions. The results of the survey suggest a need to formulate guidelines on composition and execution of heart teams which may result in an increase in transparency of decision-making within different institutions in reporting and comparing outcomes

The Surgical Treatment of Infective Endocarditis: A Comprehensive Review

Infective endocarditis (IE) is a severe cardiac complication with high mortality rates, especially when surgical intervention is delayed or absent. This review addresses the expanding role of surgery in managing IE, focusing on the variation in surgical treatment rates, the impact of patient demographics, and the effectiveness of different surgical approaches. Despite varying global data, a notable increase in surgical interventions for IE is evident, with over 50% of patients undergoing surgery in tertiary centres. This review synthesizes information from focused literature searches up to July 2023, covering preoperative to postoperative considerations and surgical strategies for IE. Key preoperative concerns include accurate diagnosis, appropriate antimicrobial treatment, and the timing of surgery, which is particularly crucial for patients with heart failure or at risk of embolism. Surgical approaches vary based on valve involvement, with mitral valve repair showing promising outcomes compared to replacement. Aortic valve surgery, traditionally favouring replacement, now includes repair as a viable option. Emerging techniques such as sutureless valves and aortic homografts are explored, highlighting their potential advantages in specific IE cases. The review also delves into high-risk groups like intravenous drug users and the elderly, emphasizing the need for tailored surgical strategies. With an increasing number of patients presenting with prosthetic valve endocarditis and device-related IE, the review underscores the importance of comprehensive management strategies encompassing surgical and medical interventions. Overall, this review provides a comprehensive overview of current evidence in the surgical management of IE, highlighting the necessity of a multidisciplinary approach and ongoing research to optimize patient outcomes

Extracorporeal life support in mitral papillary muscle rupture: Outcome of multicenter study

Background: Post-acute myocardial infarction papillary muscle rupture (post-AMI PMR) may present variable clinical scenarios and degree of emergency due to result of cardiogenic shock. Veno-arterial extracorporeal life support (V-A ECLS) has been proposed to improve extremely poor pre- or postoperative conditions. Information in this respect is scarce.Methods: From the CAUTION (meChanical complicAtion of acUte myocardial infarcTion: an InternatiOnal multiceNter cohort study) database (16 different Centers, data from 2001 to 2018), we extracted adult patients who were surgically treated for post-AMI PMR and underwent pre- or/and postoperative V-A ECLS support. The end-points of this study were in-hospital survival and ECLS complications.Results: From a total of 214 post-AMI PMR patients submitted to surgery, V-A ECLS was instituted in 23 (11%) patients. The median age was 61.7 years (range 46-81 years). Preoperatively, ECLS was commenced in 10 patients (43.5%), whereas intra/postoperative in the remaining 13. The most common V-A ECLS indication was post-cardiotomy shock, followed by preoperative cardiogenic shock and cardiac arrest. The median duration of V-A ECLS was 4 days. V-A ECLS complications occurred in more than half of the patients. Overall, in-hospital mortality was 39.2% (9/23), compared to 22% (42/219) for the non-ECLS group.Conclusions: In post-AMI PMR patients, V-A ECLS was used in almost 10% of the patients either to promote bridge to surgery or as postoperative support. Further investigations are required to better evaluate a potential for increased use and its effects of V-A ECLS in such a context based on the still high perioperative mortality

Bridging Technology and Education: The Development of a Telesimulator and Curriculum in Endoscopic Mitral Valve Surgery

In this video, the authors share their latest educational innovations, including the development of a telesimulator and a telesimulation curriculum for endoscopic mitral valve surgery.Mitral valve repair is a highly intricate procedure in cardiac surgery due to the valve's complex structure and the varied pathologies it can present. The challenges are further amplified when the repair is conducted through minimally invasive methods, whether endoscopically, under direct vision, or with robotic assistance.Minimally Invasive Mitral Valve Repair (MIMVR) has proven to be both effective and advantageous for patients. However, its application is largely confined to specialized, high-volume centers and is performed by a limited number of surgeons. The skills acquired in open surgery are not sufficient for initiating a MIMVR program, surgeons must also become proficient in endoscopy and the use of long-shafted instruments. One of the most challenging aspects of endoscopic surgery is the manipulation of these long-shafted instruments, making the learning curve for MIMVR steep and often honed through patient cases.Several years ago, the authors of this video developed a high-fidelity minimally invasive mitral valve simulator. The team has since refined the technology to include 3D printed mitral valves, validated suturing maps, and a specialized curriculum for endoscopic mitral valve surgery. They have offered over 80 courses globally, training more than 1,000 surgeons.To further democratize access to this specialized training, a telesimulation platform was recently launched based on the high-fidelity simulator. This fully 3D printed, transportable platform can be easily assembled and connected to any smart device, offering live connectivity to the training center from anywhere in the world. The simulator features disposable mitral valves and papillary muscles, allowing for training in the repair of various mitral valve pathologies.In addition to the simulator, the team has also developed and tested a telesimulation curriculum aimed at facilitating remote skills training. Reference(s)• Aerts L, Sardari Nia P. Mastering the learning curve of endoscopic mitral valve surgery. Front Cardiovasc Med. 2023 Jun 22;10:1162330. doi: 10.3389/fcvm.2023.1162330. PMID: 37424908; PMCID: PMC10325683.• Arjomandi Rad A, Hajzamani D, Sardari Nia P. Simulation-based training in cardiac surgery: a systematic review. Interdiscip Cardiovasc Thorac Surg. 2023 May 23:ivad079. doi: 10.1093/icvts/ivad079. Epub ahead of print. PMID: 37220905.• Hamid UI, Aksoy R, Sardari Nia P. Suturing Map for tricuspid valve repair. Multimed Man Cardiothorac Surg. August 17, 2022, DOI: 10.1510/mmcts.2022.036• Hamid UI, Sardari Nia P. Suturing map for endoscopic mitral valve replacement. Multimed Man Cardiothorac Surg. August 17, 2022. DOI: 10.1510/mmcts.2022.037 Impact factor:-• Akmaz B, van Kuijk SMJ, Sardari Nia P. Association between individual surgeon volume and outcome in mitral valve surgery: a systematic review. J Thorac Dis. 2021 Jul;13(7):4500-4510.• Sardari Nia P, Heuts S, Daemen JHT, Olsthoorn JR, Chitwood WR, Maessen JG. The EACTS simulation-based training course for endoscopic mitral valve repair: an air-pilot training concept in action. Interact Cardiovasc Thorac Surg. 2020 May 1;30(5):691-698.• Sardari Nia P, Daemen J, Maessen JG. Development of a high-fidelity minimally invasive mitral valve surgery simulator. The Journal of Thoracic and Cardiovascular Surgery 2019 ;157(4):1567-1574.• Sardari Nia P, Olsthoorn J, Heuts S, Maessen J. Suturing map for endoscopic mitral valve repair developed on high-fidelity endoscopic simulator. Multimed Man Cardiothorac Surg. 2018 Jul 26;2018.• Daemen JHT, Heuts S, Olsthoorn JR, Maessen JG, Sardari Nia P. Mitral valve modelling and three-dimensional printing for planning and simulation of mitral valve repair. Eur J Cardiothorac Surg. 2019 ;55(3):543-551.• Sardari Nia P, Heuts S, Daemen JHT, Olsthoorn JR, Chitwood WR, Maessen JG. The EACTS simulation-based training course for endoscopic mitral valve repair: an air-pilot training concept in action. Interact Cardiovasc Thorac Surg. 2020 May 1;30(5):691-698.</p

The Role of Simulators in Safe Adoption of Endoscopic Mitral Valve Surgery

Minimally invasive mitral valve surgery (MIMVS) is one of the most complex and challenging procedures in cardiothoracic surgery. This approach coheres with the continuous trends towards minimally invasive approaches within the surgical field. To this date the learning curve has proven to be challenging. Patient-specific simulation, in combination with mitral valve modelling and three-dimensional printing can help in adaptation of this difficult procedure by enhancing surgical skills and reduce the learning curve. In light of this, we have developed a high-fidelity minimally invasive mitral valve surgery simulator with structural training program for endoscopic mitral valve surgery. In the current chapter we present the promising results of simulation-based training and adaptation of three-dimensional printing for minimally invasive mitral valve surgery

Operative Planning for Safe Endoscopic Mitral Valve Surgery

The increasing interest in minimally invasive approaches has induced fast expansion of minimally invasive mitral valve surgery (MIMVS) over the past two decades. However, MIMVS is not included in the most recent valvular heart disease guidelines due to the lack of convincing data supporting this approach. Due to the different techniques applied by individual surgeons and centers, there has been no scientific nor expertise-based consensus developed regarding standardization in MIMVS and consequently its absolute contraindications. Therefore, a change of mindset is required to shift the focus from the superiority of a procedure toward which particular patients have the greatest benefit from specific surgical approaches. In light of personalized medicine, we have developed a standard procedural planning to ensure a standard approach to patients undergoing MIMVS