Minerva cardioangiologica最新文献

This article reviews the context and evidence of recent myocardial revascularization trials on PCI versus CABG with particular emphasis on patient selection and treatment of surgical patients. Moreover, one of our intended purposes is to identify the values underpinning the integrated care model, which incorporates decision to proceed with surgical myocardial revascularization in conjunction with established pillars of the use of optimal surgical techniques, and aggressive risk-factor modification through guideline-directed pharmacological therapies and lifestyle modifications.

Coronary artery disease (CAD) is the leading cause of death worldwide and improving the prognosis and survival of patients with ischemic heart disease remains a priority of cardiovascular specialists. This article will review the principles of myocardial viability, present the noninvasive imaging tests available to clinicians, as well as critically appraise the latest literature on myocardial viability, coronary revascularization and outcome with a final outlook at studies in the pipelines and future evidence in myocardial viability that will be soon available.

The tremendous and rapid technological advances that humans have achieved in the last decade have definitely impacted how surgical tasks are performed in the operating room (OR). As a high-tech work environment, the contemporary OR has incorporated novel computational systems into the clinical workflow, aiming to optimize processes and support the surgical team. Artificial intelligence (AI) is increasingly important for surgical decision making to help address diverse sources of information, such as patient risk factors, anatomy, disease natural history, patient values and cost, and assist surgeons and patients to make better predictions regarding the consequences of surgical decisions. In this review, we discuss the current initiatives that are using AI in cardiothoracic surgery and surgical care in general. We also address the future of AI and how high-tech ORs will leverage human-machine teaming to optimize performance and enhance patient safety.

Several novel technological developments and surgical approaches have characterized the field of aortic surgery in the recent decade. The progressive introduction of endovascular procedures, minimally invasive surgical techniques and hybrid approaches have changed the practice in aortic surgery and generated new trends and questions. Also, the advancements in the manufacturing of tissue engineered vascular grafts as substitutes for aortic replacements are enlightening new avenues in the treatment of aortic disease. This review will provide an overview of the current novel perspectives, debates and trends in major thoracic aortic surgery.

The saphenous vein graft (SVG) remains the most commonly used conduit in coronary artery bypass grafting (CABG). In light of this further research must be aimed at the development of strategies to optimize SVG patency and thereby improve both short- and long-term outcomes of CABG surgery. SVG patency in large part depends on the protection of the structural and functional integrity of the vascular endothelium at the time of conduit harvesting, including optimal storage conditions to prevent endothelial damage. This review provides an overview of currently available storage and preservation solutions, including novel endothelial damage inhibitors, and their role in mitigating endothelial damage and vein graft failure.

Global longitudinal strain (GLS) has emerged as a valuable diagnostic and prognostic tool for evaluating left ventricular (LV) function. GLS has been shown to be a more sensitive marker of LV dysfunction than LV ejection fraction alone and have prognostic impact in non-surgical cardiac populations. GLS, is validated, reproducible, and easily obtained from 2-dimensional speckle-tracking echocardiography. While there is strong evidence for using GLS in clinical decision-making in non-surgical populations, there is less summarized evidence on using GLS in the cardiac surgical population. This review combines the evidence on the implications of using baseline transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) GLS in cardiac surgical populations including ischemic and structural heart disease to determine surgical outcomes. We found that results seem promising on the prognostic utility of LV strain in cardiac surgical populations. However due to the variability of study populations and outcomes, and modalities (TTE versus TEE), further research on normal versus abnormal values for different surgical populations, as well potential treatment options that may modify and potentially decrease surgical risk for those with abnormal GLS are needed.