Peri-operative RBC transfusion after CABG is associated with an increased risk of mortality during a 1-year follow-up period, with a large proportion of deaths occurring within 30-days.

Obese patients are not associated with an increased risk of in-hospital mortality following coronary artery bypass surgery. In contrast, there is a significant increased risk of morbidities and post-operative length of stay in obese patients compared to non-obese patients.

Background: Despite recent advances in aortic surgery, acute type A aortic dissection remains a surgical emergency associated with high mortality and morbidity. Appropriate management is crucial to achieve satisfactory outcomes but the optimal surgical approach is controversial. The present systematic review and meta-analysis sought to access cumulative data from comparative studies between hemiarch and total aortic arch replacement in patients with acute type A aortic dissection.Methods: A systematic review of the literature using six databases. Eligible studies include comparative studies on hemiarch versus total arch replacement reporting short, medium and long term outcomes. A meta-analysis was performed on eligible studies reporting outcome of interest to quantify the effects of hemiarch replacement on mortality and morbidity risk compared to total arch replacement. There was no significant difference in terms of in-hospital mortality between the two groups (RR =0.84; 95% CI: 0.65-1.09; P=0.20; I 2 =0%). Cardiopulmonary bypass, aortic cross clamp and circulatory arrest times were significantly longer in total arch replacement. During follow up, no significant difference was reported from current studies between the two operative approaches in terms of aortic re-intervention and freedom from aortic reoperation.Conclusions: Within the context of publication bias by high volume aortic centres and non-randomized data sets, there was no difference in mortality outcomes between the two groups. This analysis serves to demonstrate that for those centers doing sufficient total aortic arch activity to allow for publication, excellent and equivalent outcomes are achievable. Conclusions on differences in longer term outcome data are required. We do not, however, advocate total arch as a primary approach by all centers and surgeons irrespective of patient characteristics, but rather, a tailored approach based on surgeon and center experience and patient presentation.

The emergence of severe acute respiratory syndrome coronavirus 2 in December 2019, presumed from the city of Wuhan, Hubei province in China, and the subsequent declaration of the disease as a pandemic by the World Health Organization as coronavirus disease 2019 (COVID‐19) in March 2020, had a significant impact on health care systems globally. Each country responded to this disease in different ways, however this was done broadly by fortifying and prioritizing health care provision as well as introducing social lockdown aiming to contain the infection and minimizing the risk of transmission. In the United Kingdom, a lockdown was introduced by the government on March 23, 2020 and all health care services were focussed to challenge the impact of COVID‐19. To do so, the United Kingdom National Health Service had to undergo widespread service reconfigurations and the so‐called “Nightingale Hospitals” were created de novo to bolster bed provision, and industries were asked to direct efforts to the production of ventilators. A government‐led public health campaign was publicized under the slogan of: “Stay home, Protect the NHS (National Health Service), Save lives.” The approach had a significant impact on the delivery of all surgical services but particularly cardiac surgery with its inherent critical care bed capacity. This paper describes the impact on provision for elective and emergency cardiac surgery in the United Kingdom, with a focus on aortovascular disease. We describe our aortovascular activity and outcomes during the period of UK lockdown and present a patient survey of attitudes to aortic surgery during COVID‐19 pandemic.

Although in-hospital mortality after CABG does not seem to be adversely affected by obesity there appears to be a significant increase in mortality in obese patients during a 4-year follow-up period.

Introduction: Dialysis catheter-related infection is a major cause of morbidity and mortality in patients on dialysis. In recent years, there have been reported cases of infections with opportunistic environmental organism, Achromobacter xylosoxidans (AX) causing bacteremia in patients on dialysis. However, no previous such reports on prosthetic valve endocarditis in a dialysis patient with Achromobacter xylosoxidans were found after a Medline search. We report such a case and review the literature. Case: A 69-year-old diabetic man with bioprosthetic aortic valve replacement developed end-stage renal disease following infective endocarditis with Staphylococcus epidermidis. Even though he was treated successfully for his endocarditis, he developed further bacteremia with AX from his peripherally inserted central catheter (PICC) and the line was removed. He had further episodes of bacteremia with AX while having dialysis with tunneled line and the line was also removed. He was re-admitted with pyrexia and vegetations both in mitral and prosthetic aortic valve confirmed with transesophageal echo. His antimicrobial therapy with etrapenum, tigecycline and cotrimoxazole failed. He had both mitral and prosthetic aortic valve replacements but postoperatively developed multiorgan failure and died despite the intensive support. Discussion: Achromobacter xylosoxidans is an aerobic, Gram-negative bacillus and considered to be an opportunistic pathogen with low virulence. Infective endocarditis is a potentially lethal complication of bacteremia. The choice of appropriate antibiotic is crucial in these cases. AX strains are highly resistant to antibiotics. The organism is usually susceptible to antipseudomonal penicillins, carbapenems and trimethoprim-sulfamethoxazole. Conclusion: AX is an emerging pathogen in catheter-related infection in the dialysis population and, therefore, needs vigilance and prompt treatment. Antimicrobial treatment should include susceptibility and synergy testing. Removal of central intravenous catheter should also be considered at the time of early presentation in patients at high risks of developing infective endocarditis.

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Key PointsQuestionIs transcatheter aortic valve implantation (TAVI) noninferior to surgical aortic valve replacement (surgery) in patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk?FindingsIn this randomized clinical trial that included 913 patients at moderately increased operative risk due to age or comorbidity, all-cause mortality at 1 year was 4.6% with TAVI vs 6.6% with surgery, a difference that met the prespecified noninferiority margin of 5%.MeaningAmong patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk, treatment with TAVI was noninferior to surgery with respect to all-cause mortality at 1 year.