: OBJECTIVES: The Magna Ease aortic valve (Edwards Lifesciences, Irvine, CA) is a third-generation bioprosthetic valve developed as a modification of the well-studied Perimount and Magna valve designs. This study’s objective is to evaluate a large, single-centre experience with Magna Ease aortic valve replacement (AVR) focusing on clinical outcomes and haemodynamic performance. METHODS: All patients undergoing AVR between 8/2010 and 10/2018 at our institution implanted with the Magna Ease valve were included except those undergoing ventricular assist device or congenital aortic surgery. Primary outcomes were overall survival and freedom from reoperation. Mean transprosthetic gradient (mTPG) and structural valve deterioration (SVD) served as secondary outcomes. RESULTS: Totally 1126 consecutive implantations of Magna Ease valves were included. Concomitant procedures were performed in 56.5% (n = 636). No severe patient–prosthesis mismatch (PPM) was present at implantation. Overall survival at 30 days, 1 year, 5 years and 9 years was 97.2%, 95.0%, 86.1% and 78.2%, respectively, with improved survival for isolated AVR. Total of 2.4% (n = 27) of patients required reoperation with 0.3% (n = 4) for SVD. Echocardiographic follow-up data revealed low mTPG throughout the study period. SVD occurred in 28.7% of patients at a mean of 3.9 years post implantation. CONCLUSIONS: Magna Ease AVR maintained low mean transprosthetic gradients throughout mid-term evaluation and was associated with excellent overall survival and freedom from reoperation at nine years post implantation.

Nutrition in pediatric populations who require life-saving extracorporeal membrane oxygenation (ECMO) remains a debate. We sought to identify if nutritional needs were met in a patient cohort. A retrospective chart review of patients (N = 64) requiring ECMO at Helen DeVos Children’s Hospital between 2018 and 2022 was evaluated for demographics, daily nutritional data, laboratory values, ECMO complications, and outcome data, with primary outcome measures of percent protein and percent caloric intake. Secondary outcome measures included the intensive care unit length of stay, time on ECMO, mortality, and day 1 severity of illness scores (Pediatric Logistic Organ Dysfunction). The timeline partially overlapped with the COVID-19 pandemic. Data were collected for 467 ECMO days with a median age of 2.6 months; 57.8% of patients were male and 65.6% were with one pre-existing comorbidity. Venoarterial (VA) ECMO was utilized in 84.4% of patients; the ECMO indication was cardiac in 53.1% of patients. The 28-day mortality was 43.8%. The proportion of days in which the caloric goal was met was 0%; the proportion of days in which protein goals were met was 33.3%. Non-cardiac ECMO patients had a greater number of days where caloric goals were met (p-value = 0.04). Mortality at 28 days was not statistically significant (p-value = 0.28) for calories or protein administered. The patient cohort struggled to meet calorie and protein goals while on ECMO.

Thoits T, et al. J Clin Neurol. 2020 Jul;16(3):433-437. https://doi.org/10.3988/jcn.2020.16.3.433

Background: A multidisciplinary heart team (HT) approach to patients with complex coronary artery disease has a class IB recommendation, yet there are limited data on adherence to HT treatment recommendations and long‐term clinical follow‐up. The objective of this study was to assess adherence rates to HT recommendations and assess long‐term mortality rates among patients with complex CAD. Methods and Results: Six hundred eighty‐four sequential HT cases for complex coronary artery disease from January 2015 to May 2017 were reviewed. After excluding cases with significant comorbid valve disease, baseline characteristics were compared based on HT treatment recommendations: optimal medical therapy, percutaneous coronary intervention, and coronary artery bypass grafting. Adherence rates were manually extracted, and 5‐year mortality rates were obtained from the Michigan Death Registry. Seventy‐two percent of 405 included patients were men (mean age 66±11 years), with high rates of medical comorbidities. Estimated surgical risk scores were lowest in the coronary artery bypass grafting group. Optimal medical therapy was recommended in 138 patients (34%), percutaneous coronary intervention in 95 (23%), and coronary artery bypass grafting in 172 (42%). Adherence to HT recommendations across groups was high (96%) and did not differ between treatment groups. Over 5 years of follow‐up, there were 119 deaths, resulting in a cumulative mortality rate of 29%. Conclusions: In the largest HT cohort in the United States to date, high rates of adherence to HT recommendations were observed among high‐risk patients with coronary artery disease. High rates of adherence to HT recommendations were observed irrespective of treatment group recommendation, suggesting that HT recommendations were individualized and acceptable to both patients and physicians alike.

The contribution of high radiation dose outliers to cumulative occupational radiation dose is understudied. Physician radiation data were collected during consecutive coronary cases, and per case doses were ranked by magnitude. The relationship between the per case rank and relative contribution to cumulative dose was summed for cases ≤50th percentile and for cases >90th percentile. A similar methodology was applied for radiation doses among structural interventionalists, interventional echocardiographers, scrub technologists, and nurse circulators. Multivariable logistic regression was fit to identify independent predictors of physician radiation dose >90th percentile during coronary cases. Across 363 coronary cases, the median physician radiation dose per case was 10.2 (3.2, 35.5) μSv, and the cumulative radiation dose was 13,230 μSv. Coronary cases ≤50th percentile accounted for only 5.0% of the cumulative radiation dose. Cases >90th percentile accounted for 60.3% of the cumulative dose. Cases >90th percentile accounted for 51.3%, 39.9%, 45.8%, and 64.8% of the cumulative dose among structural interventionalists, interventional echocardiographers, scrub technologists, and nurse circulators, respectively. ST-segment elevation myocardial infarction (OR, 6.2; 95% CI, 1.5-26.3; P = .01), percutaneous coronary intervention (OR, 5.6; 95% CI, 2.2-14.2; P < .001), right heart catheterization (OR, 4.4; 95% CI, 1.7-11.7; P = .003), and male sex (OR, 3.2; 95% CI, 1.3-8.0; P = .01) were independently associated with physician radiation dose >90th percentile. Physician radiation dose outliers contribute disproportionately to the cumulative radiation dose, with cases above the 90th percentile accounting for 60% of the cumulative dose. High radiation dose outliers are an important target for future radiation mitigation efforts.