Objective: The coronavirus disease 2019 (COVID-19) pandemic has resulted in an increase in hospital resource utilization and the need to defer nonurgent cardiac surgery procedures. The present study aims to report the regional variations of North American adult cardiac surgical case volume and case mix through the first wave of the COVID-19 pandemic.Methods: A survey was sent to recruit participating adult cardiac surgery centers in North America. Data in regard to changes in institutional and regional cardiac surgical case volume and mix were analyzed.Results: Our study comprises 67 adult cardiac surgery institutions with diverse geographic distribution across North America, representing annualized case volumes of 60,452 in 2019. Nonurgent surgery was stopped during the month of March 2020 in the majority of centers (96%), resulting in a decline to 45% of baseline with significant regional variation. Hospitals with a high burden of hospitalized patients with COVID-19 demonstrated similar trends of decline in total volume as centers in low burden areas. As a proportion of total surgical volume, there was a relative increase of coronary artery bypass grafting surgery (high þ7.2% vs low þ4.2%, P ¼ .550), extracorporeal membrane oxygenation (high þ2.5% vs low 0.4%, P ¼ .328), and heart transplantation (high þ2.7% vs low 0.4%, P ¼ .090), and decline in valvular cases (high -7.6% vs low -2.6%, P ¼ .195).
Conclusions:The present study demonstrates the impact of COVID-19 on North American cardiac surgery institutions as well as helps associate region and COVID-19 burden with the impact on cardiac surgery volumes and case mix. (J
Background. The Thoracic Surgery Social Media Network (TSSMN) represents a collaborative effort of leading journals in cardiothoracic surgery to highlight publications via social media, specifically Twitter. We conducted a prospective randomized trial to determine the effect of scheduled tweeting on nontraditional bibliometrics of dissemination.Methods. A total of 112 representative original articles (2017-2018) were selected and randomized 1:1 to an intervention group to be tweeted via TSSMN or a control (nontweeted) group. Four articles per day were tweeted by TSSMN delegates for 14 days. Primary endpoints included change in article-level metrics (Altmetric) score pre-tweet and post-tweet compared with the control group. Secondary endpoints included change in Twitter analytics day 1 posttweet and day 7 post-tweet for each article compared with baseline.Results. Tweeting via TSSMN significantly improved article Altmetric scores (pre-tweet 1 vs post-tweet 8; P < .001), Mendeley reads (pre-tweet 1 vs post-tweet 3; P < .001), and Twitter impressions (day 1 post-tweet 1599 vs day 7 post-tweet 2296; P < .001). Subgroup analysis demonstrates that incorporating photos into the tweets trended toward increased link clicks to the full-text article (P ¼ .08) whereas tweeting at 1 pm Eastern Standard Time and 9 pm Eastern Standard Time generated the highest and lowest audience reach (P ¼ .022), respectively. Articles published in adult cardiac surgery achieved the highest change in Altmetric score (P ¼ .028) and Mendeley reads (P ¼ .028), and were more likely to be retweeted (P ¼ .042) than were those published on education, general thoracic surgery, and congenital surgery.Conclusions. Social media highlights of scholarly literature via TSSMN Twitter activity improves article Altmetric scores, Mendeley reads, and Twitter analytics, with dissemination to a greater audience.
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in modern clinical practice, with an estimated prevalence of 1.5-2%. The prevalence of AF is expected to double in the next decades, progressing with age and increasingly becoming a global medical challenge. The first-line treatment for AF is often medical treatment with either rate control or anti-arrhythmic agents for rhythm control, in addition to anti-coagulants such as warfarin for stroke prevention in patient at risk. Catheter ablation has emerged as an alternative for AF treatment, which involves myocardial tissue lesions to disrupt the underlying triggers and substrates for AF. Surgical approaches have also been developed for treatment of AF, particularly for patients requiring concomitant cardiac surgery or those refractory to medical and catheter ablation treatments. Since the introduction of the Cox-Maze III, this procedure has evolved into several modern variations, including the use of alternative energy sources (Cox-Maze IV) such as radiofrequency, cryo-energy and microwave, as well as minimally invasive thoracoscopic epicardial approaches. Another recently introduced technique is the hybrid ablation approach, where in a single setting both epicardial thoracoscopic ablation lesions and endocardial catheter ablation lesions are performed by the cardiothoracic surgeon and cardiologist. There remains controversy surrounding the optimal approach for AF ablation, energy sources, and lesion sets employed. The goal of this article is review the history, classifications, pathophysiology and current treatment options for AF.
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