George Tolis
@georgetolisjr
Median sternotomy, pump, Prolene, Steinway. Not certified for Cor-Knot or Atriclip.
Now open access PDF. We need to tighten up our statistical arguments in cardiac surgery if we are to make bold statements about new techniques. Industry sponsored observational studies written by authors with COI and promoted by podium presentations is not good science.
Parish A, Tolis G, Ioannidis JPA. Across 73 meta-analyses mortality improvements are uncommon with newer interventions in adult cardiac surgery. J Clin Epidemiol. 2025 jclinepi.com/article/S0895-…
Mechanical valves are grossly underutilized in the US. There is a solid body of literature slowly emerging to back up this claim.
The great feature of the retro aortic in situ RIMA is that once the heart is dropped to its natural position, the artery becomes more loose. If it reaches the anastomosis, you are safe (unlike the LIMA to LAD which becomes more tense when you drop the heart and inflate the lung).
If I have concerns that in situ RIMA won’t reach the OM, I do in situ RIMA-LAD, in situ LIMA-OM
After an aortic fellowship with the great Dr. Griepp and 23 years in practice, the #1 reason cardiologists reach out is for me to place two in situ IMA grafts on their young , otherwise healthy patients. This is a great revascularization strategy that is still rarely performed.
This is very true. An experienced surgeon who selectively operates on cirrhotic but well compensated patients no matter what their MELD score is will have better outcomes than a surgeon assigned to operate on pre-liver tx patients at a busy tx center who fail cardiac clearance.
The STS risk calculator is broken, by only including patients that got surgery, it has greatly embellish the numbers. All the patients that get turned down (devastating strokes, low baseline functional status, frailty...) never make it to the database.
No immediate solution. But open AVR will become a higher mortality operation, fueling papers about the superiority of TAVI. Just like in CABG in full metal jacket patients. And the STS risk models will lag behind before capturing the true risk, endangering young surgeons’ careers
Saw a case of this last year. Any solutions?
Many redo AVR surgeries in the current era are VIV turndowns for low lying coronary ostia. This has increased the incidence of postop coronary occlusion issues which has not been formally reported in the literature yet. A root enlargement does not mitigate this issue. Caution…
Intra operative TEE and later TTE are notorious for overestimating peak and mean gradients in mechanical aortic prostheses (esp. 19 and 21). A trans-septal puncture gradient prior to sternotomy closure puts this to bed. An echo peak gradient of 80 was only 15 on direct puncture.
