The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2022
Meta AnalysisMachine learning improves mortality risk prediction after cardiac surgery: Systematic review and meta-analysis.
Interest in the usefulness of machine learning (ML) methods for outcomes prediction has continued to increase in recent years. However, the advantage of advanced ML model over traditional logistic regression (LR) remains controversial. We performed a systematic review and meta-analysis of studies comparing the discrimination accuracy between ML models versus LR in predicting operative mortality following cardiac surgery. ⋯ The present findings suggest that when compared with LR, ML models provide better discrimination in mortality prediction after cardiac surgery. However, the magnitude and clinical influence of such an improvement remains uncertain.
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J. Thorac. Cardiovasc. Surg. · Jun 2022
Pulmonary vein stenosis: Anatomic considerations, surgical management, and outcomes.
The study objective was to evaluate outcomes of pulmonary vein stenosis repair in a large single-center cohort. ⋯ This large single-center surgical pulmonary vein stenosis experience demonstrates encouraging midterm results. A new anatomically focused repair strategy aims to alleviate pulmonary vein angulation to minimize turbulence and shows promising early outcomes. Continued follow-up is required to understand longer-term outcomes for this surgical approach.
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J. Thorac. Cardiovasc. Surg. · Jun 2022
Meta AnalysisMechanical or biological heart valve for dialysis-dependent patients? A meta-analysis.
The optimal selection of prosthetic heart valve for dialysis-dependent patients remains controversial. We investigated the comparative effectiveness and safety of mechanical prosthesis (MP) and bioprosthesis (BP) for these patients. ⋯ MP is a reasonable choice for dialysis-dependent patients without additional thromboembolic risk requiring aortic valve replacement, for its better long-term survival, durability, and noninferior bleeding risk compared with BP. Conversely, BP might be an appropriate selection for patients with MVR, given its similar survival rate and lower bleeding risk. Although our meta-regression demonstrates little influence of age on long-term survival difference between MP and BP, further studies stratifying patients based on age cut-off are mandatory.
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J. Thorac. Cardiovasc. Surg. · Jun 2022
Editorial ReviewHVAD to HeartMate 3 left ventricular assist device exchange: Best practices recommendations.
The HeartWare HVAD System (Medtronic) is a durable implantable left ventricular assist device that has been implanted in approximately 20,000 patients worldwide for bridge to transplant and destination therapy indications. In December 2020, Medtronic issued an Urgent Medical Device Communication informing clinicians of a critical device malfunction in which the HVAD may experience a delay or failure to restart after elective or accidental discontinuation of pump operation. Moreover, evolving retrospective comparative effectiveness studies of patients supported with the HVAD demonstrated a significantly higher risk of stroke and all-cause mortality when compared with a newer generation of a commercially available durable left ventricular assist device. ⋯ The decision to remove the HVAD from commercial distribution now requires the use of the HeartMate 3 left ventricular assist system (Abbott, Inc) if a patient previously implanted with an HVAD requires a pump exchange. The goal of this document is to review important differences in the design of the HVAD and HeartMate 3 that are relevant to the medical management of patients supported with these devices, and to assess the technical aspects of an HVAD-to-HeartMate 3 exchange. This document provides the best available evidence that supports best practices.