Background: Interest on 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.Methods: The present systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement. Discrimination ability was assessed using c-statistic. Pooled c-statistics and its 95% credibility interval for ML models and LR were obtained were obtained using a Bayesian framework. Pooled estimates for ML models and LR were compared to inform on difference between the two approaches. Results:We identified 459 published citations of which 15 studies met inclusion criteria and were used for the quantitative and qualitative analysis. When the best ML model from individual study was used, meta-analytic estimates showed that ML were associated with a significantly higher c-statistic (ML 0.88; 95%CrI 0.83-0.93 vs LR 0.81; 95%CrI 0.77-0.85; P=0.03). When individual ML algorithm were instead selected, we found a non-significant trend toward better prediction with each of ML algorithms. We found no evidence of publication bias (P=0.70). Conclusions:The present findings suggest that when compared to LR, ML models provide better discrimination in mortality prediction after cardiac surgery . However, the magnitude and clinical impact of such an improvement remains uncertain.

Spontaneous distal tube migration is successful in 40% of SAP patients, with higher CT severity index predicting intragastric retention; in such cases EN by NG tubes seems to provide a pragmatic alternative opportunity with similar outcomes.

OBJECTIVES We sought to provide further evidence on the safety and efficacy of aortic valve neocuspidization (AVNeo) using autologous pericardium in adult patients with aortic valve disease by reporting clinical and echocardiographic results from the first UK experience and performing a meta-analytic comparison with other biological valve substitutes. METHODS We reported clinical and echocardiographic outcomes of 55 patients (mean age 58 ± 15 years) undergoing AVNeo with autologous pericardium in 2 UK centres from 2018 to 2020. These results were included in a meta-analytic comparison between series on AVNeo (7 studies, 1205 patients, mean weighted follow-up 3.6 years) versus Trifecta (10 studies, 8705 patients, 3.8 years), Magna Ease (3 studies, 3137 patients, 4.1 years), Freedom Solo (4 studies, 1869 patients, 4.4 years), Freestyle (4 studies, 4307 patients, 7 years), Mitroflow (4 studies, 4760 patients, 4.1 years) and autograft aortic valve (7 papers, 3839 patients, 9.1 years). RESULTS In the present series no patients required intraoperative conversion. After mean follow-up of 12.5 ± 0.9 months, 3 patients presented with endocarditis and 1 required reintervention. The remaining patients had absent or mild aortic valve insufficiency with very low peak and mean transvalvular gradients (16 ± 3.7 and 9 ± 2.2 mmHg, respectively). Meta-analytic estimates showed non-significant difference between AVNeo and all but Magna Ease valves with regards to structural valve degeneration, reintervention and endocarditis. When compared Magna Ease valve, AVNeo and other valve substitutes showed an excess of valve-related events. CONCLUSIONS AVNeo is safe, associated with excellent haemodynamic profile. Its midterm risk of valve-related events is comparable to most biological valve substitutes. Magna Ease is potentially the best biological choice as far as risk of reintervention is concerned.

Background Tetralogy of Fallot repair results in late occurrence of pulmonary regurgitation, which requires pulmonary valve replacement in a large proportion of patients. Both homografts and bioprostheses are used for pulmonary valve replacement as uncertainty remains on which prosthesis should be considered superior. We performed a long‐term imaging and clinical comparison between these 2 strategies. Methods and Results We compared echocardiographic and clinical follow‐up data of 209 patients with previous tetralogy of Fallot repair who underwent pulmonary valve replacement with homograft (n=75) or bioprosthesis (n=134) between 1995 and 2018 at a tertiary hospital. The primary end point was the composite of pulmonary valve replacement reintervention and structural valve deterioration, defined as a transpulmonary pressure decrease ≥50 mm Hg or pulmonary regurgitation degree of ≥2. Mixed linear model and Cox regression model were used for comparisons. Echocardiographic follow‐up duration was longer in the homograft group (8 [interquartile range, 4–12] versus 4 [interquartile range, 3–6] years; P <0.001). At the latest echocardiographic follow‐up, homografts showed a significantly lower transpulmonary systolic pressure decrease (16 [interquartile range, 12–25] mm Hg) when compared with bioprostheses (28 [interquartile range, 18–41] mm Hg; mixed model P <0.001) and a similar degree of pulmonary regurgitation (degree 0‐4) (1 [interquartile range, 0–2] versus 2 [interquartile range, 0–2]; mixed model P =0.19). At 9 years, freedom from structural valve deterioration and reintervention was 81.6% (95% CI , 71.5%–91.6%) versus 43.4% (95% CI , 23.6%–63.2%) in the homograft and bioprosthesis groups, respectively (adjusted hazard ratio, 0.27; 95% CI , 0.13–0.55; P <0.001). Conclusions When compared with bioprostheses, pulmonary homografts were associated lower transvalvular gradient during follow‐up and were associated with a significantly lower risk of reintervention or structural valve degeneration.