This study aimed to evaluate the application of synchronized nasal intermittent positive pressure ventilation (SNIPPV) in the respiratory weaning of infants after congenital heart surgery.

We retrospectively analyzed the clinical data of 63 infants who were extubated from mechanical ventilation after congenital heart surgery between January 2020 and September 2020. The data, including demographics, anatomic diagnosis, radiology and laboratory test results, and perioperative variables were recorded.

The extubation failure rate within 48 h after extubation was significantly lower in the SNIPPV group than in the nasal continuous positive airway pressure (NCPAP) group. The PaO2 level and PaO2/FiO2 ratio within 48 h after extubation were higher in the SNIPPV group than in the NCPAP group (P < .05). this website Meanwhile, the PaCO2 level within 48 h was significantly lower in the SNIPPV group (P < .05). Compared with the NCPAP group, the median duration of postoperative noninvasive support and the duration from extubation to hospital discharge were shorter in the SNIPPV group; the total hospital cost was lower in the SNIPPV group. No significant differences were observed between the two groups concerning VAP, pneumothorax, feeding intolerance, sepsis, mortality, and other complications (P > .05).

SNIPPV was shown to be superior to NCPAP in avoiding reintubation after congenital heart surgery in infants and significantly improved oxygenation and reduced PaCO2 retention after extubation. Further studies are needed to confirm the efficacy and safety of SNIPPV as a routine weaning strategy.

SNIPPV was shown to be superior to NCPAP in avoiding reintubation after congenital heart surgery in infants and significantly improved oxygenation and reduced PaCO2 retention after extubation. Further studies are needed to confirm the efficacy and safety of SNIPPV as a routine weaning strategy.Transcatheter aortic valve replacement (TAVR) is regarded as an alternative to balloon aortic valvuloplasty in patients with severe aortic valve stenosis in cardiogenic shock. A low implantation of transcatheter heart valve (THV) can result in “supraskirt” paravalvular aortic regurgitation (PAR) and prosthesis-patient mismatch (P-PM), causing a dilemma in such a setting. A 64-year-old man presented to our emergency department with severe aortic stenosis and acute heart failure causing cardiogenic shock. An urgent transfemoral TAVR was performed under general anesthesia in a hybrid room. Predilatation was performed with a 22-mm compliant balloon, and a 26-mm Venus A-Valve (Venus MedTech, Hangzhou, China) was deployed. After valve implantation, the hemodynamic conditions of the patient rapidly deteriorated; therefore, cardiopulmonary resuscitation and extracorporeal circulation support were initiated. Aortography and transthoracic echocardiography (TEE) illustrated an extremely low implantation of THV, with moderate to severe supraskirt PAR and moderate P-PM. After evaluation of the hemodynamic tolerability of PAR, a median sternotomy was done, and surgery was performed. The patient died due to severe sepsis and hyperkalemia 14 days after the procedure. The management of urgent TAVR in cardiogenic shock should be revised and reexamined. A widespread and practical percutaneous technique to manage implant failure of THV is required to avoid surgical bailout.

Tricuspid valve replacement (TVR) is seldom performed in cardiac valve surgery, and there currently are no clinical guidelines as to which type of prostheses is better in tricuspid valve position. This meta-analysis was performed to compare the results of mechanical and biological prostheses for TVR.

We searched the Pubmed, Cochrane, and Embase clinical trial databases to collect all related studies published from January 1, 2000 to July 31, 2020. A random-effects model was used to evaluate the odds ratios (OR) and its 95% confidence intervals (CI) of time-to-event related effects of the surgical procedures; every study’s quality was evaluated by the Newcastle-Ottawa Scale (NOS).

A total of 13 retrospective studies, including 1453 patients were analyzed. There were no statistically differences between mechanical and biological prostheses with respect to prosthetic valve failure [OR = 0.84, 95% CI(0.54, 1.28), P = .41], bleeding [OR = 0.84, 95% CI(0.54,1.28), P = .41], reoperation [OR = 1.02, 95% CI(0.58gical prostheses with respect to prosthetic valve failure, bleeding, reoperation, early mortality, and long-term survival. The valve disease and patient’s age and risk factors are the most important considerations in the decision-making process. The more specific conclusion needs to be further proved by large-sample, multi-center, randomized, double-blind and control trials.A 57-year-old female with Loeys-Dietz syndrome type 3 and MYH11 gene mutation underwent unexpected intraoperative ascending aortic dissection and subsequent rapid progression of the aortic arch dissecting aneurysm. Intra-surgical contingency plans with regard to aortic dissection and aneurysm should be considered for Loeys-Dietz syndrome, especially with comorbid mutations.

Acute kidney injury (AKI) is a common complication of cardiovascular surgery. The aim of this study was to investigate the correlation between Vasoactive-Inotropic Score (VIS) and postoperative acute kidney injury in adult patients with cardiovascular surgery.

We retrospectively reviewed the data of 1935 adult patients who underwent cardiovascular surgery between September 2017 and May 2019. The data of patients included demographic data, laboratory findings, intraoperative details, and postoperative clinical outcomes. We calculated VIS-max by using the highest doses of vasoactive and inotropic medications during the first 24h after cardiovascular surgery. Logistic regression model was used to evaluate whether the VIS-max was independently associated with postoperative AKI. Additionally, improvements in risk reclassification and discrimination were evaluated by calculating the net reclassification improvement (NRI), C-index and the integrated discrimination improvement (IDI) with the addition of the VIS-max to a baseline model of the Society of Thoracic Surgeons (STS) score for analyzing the association of VIS-max with postoperative AKI.