consensus expert
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2022 ◽  
Vol 25 (1) ◽  
pp. E008-E019
Author(s):  
Alfredo Rego ◽  
W. Douglas Boyd ◽  
Enrique Gongora ◽  
William E. Johnson, III ◽  
Nabil A. Munfakh ◽  
...  

Background: As of 2019, pericardial closure was performed in only a small portion of the over 320,000 cardiac surgeries performed annually. However, evidence regarding the benefits of pericardial closure or reconstruction has been accruing, particularly with the publication of the RECON study in 2019.  Methods: This group of authors convened to try to arrive at consensus expert opinion regarding pericardial reconstruction. Structured topic questions initially were used to stimulate discussion. Subsequently, a survey of proposed expert opinion statements was conducted among the authors. Based on that survey, consensus expert opinion statements and recommendations were compiled. Results: The expert opinions encompass various topics relating to pericardial reconstruction, including definitions, benefits/risks, and technique. Observed benefits include reductions in: (1) adhesions; (2) postoperative pericardial effusion, atrial fibrillation, and bleeding; and (3) readmissions and length of hospital stay. Expert opinion recommendations regarding surgical technique are compiled into a single chart. Complete pericardial reconstruction should be performed, using native pericardial tissue if available and viable; if not feasible, a patch may be used. Patches that stimulate the formation of site-specific tissue in situ (such as natural extracellular matrix) may have additional benefits (including bioregenerative properties and lack of inflammatory response). Closure should be taut, but tension-free. Adequate drainage of the closed pericardium must be ensured. Conclusions: Based on available data and collective surgical experience, we endorse pericardial reconstruction as standard approach in appropriately selected patients. We also endorse adoption of standardized pericardial reconstruction techniques to optimize patient outcomes and improve evidence quality in future studies.


2021 ◽  
Vol 73 (5) ◽  
Author(s):  
Costantino DI CARLO ◽  
Massimo ABBONDANZA ◽  
Antonella AGNELLO ◽  
Giovanni CAVALLI ◽  
Lorenza DRIUL ◽  
...  

2020 ◽  
Vol 9 (12) ◽  
pp. 3810
Author(s):  
Johannes Kersten ◽  
Tobias Heck ◽  
Laura Tuchek ◽  
Wolfgang Rottbauer ◽  
Dominik Buckert

Background: This prospective single-center study sought to investigate the impact of cardiovascular magnetic resonance (CMR) on the diagnosis of myocarditis, with special attention given to absolute T1 values and defined cutoff values. Methods: All patients referred to our center with the suspicion of an inflammatory myocardial disease were diagnosed by a consensus expert consortium blinded to CMR findings. Classical Lake Louise criteria were then used to confirm or change the diagnosis. Results: Of a total of 149 patients, 15 were diagnosed with acute myocarditis without taking CMR findings into account. Acute myocarditis was excluded in 91 patients, whereas 42 cases were unclear. Using classical Lake Louise criteria, an additional 35 clear diagnoses were made, either confirming or excluding myocarditis. In the remaining patients, there was no further increase in definitive diagnoses using T1 measurements. The diagnostic performance of T1 mapping in distinguishing acute myocarditis patients from healthy controls was good (area under the curve (AUC) 0.835, cutoff value 1019 ms, sensitivity 73.7%, specificity 72.4%). In the group of patients with suspected and then excluded myocarditis, the cutoff value had a false-positive rate of 56.6%. Conclusions: Acute myocarditis should be diagnosed on the basis of clinical and imaging factors, whereas T1 mapping could be helpful, especially for excluding acute myocarditis.


Author(s):  
David P. Al‐Adra ◽  
Laura Hammel ◽  
John Roberts ◽  
E. Steve Woodle ◽  
Deborah Levine ◽  
...  

2020 ◽  
Vol 41 (10) ◽  
pp. 1292-1295
Author(s):  
Scott J. Ellis ◽  
Jeffrey E. Johnson ◽  
Jonathan Day ◽  
Cesar de Cesar Netto ◽  
Jonathan T. Deland ◽  
...  

Recommendation: There is evidence indicating that the amount of bony correction performed in the setting of progressive collapsing foot deformity reconstructive surgery can be titrated within a recommended range for a variety of procedures. The typical range when performing a medial displacement calcaneal osteotomy should be 7 to 15 mm of medialization of the tuberosity. The typical range when performing an Evans lateral column lengthening should be 5 to 10 mm of a laterally based wedge in the anterior calcaneus. The typical range when performing a plantarflexion opening wedge osteotomy of the medial cuneiform (Cotton) osteotomy should be 5 to 10 mm of a dorsal wedge. Level of Evidence: Level V, consensus, expert opinion.


2020 ◽  
Vol 41 (10) ◽  
pp. 1289-1291
Author(s):  
Jeffrey E. Johnson ◽  
Bruce J. Sangeorzan ◽  
Cesar de Cesar Netto ◽  
Jonathan T. Deland ◽  
Scott J. Ellis ◽  
...  

Recommendation: Forefoot varus is a physical and radiographic examination finding associated with the Progressive Collapsing Foot Deformity (PCFD). Varus position of the forefoot relative to the hindfoot is caused by medial midfoot collapse with apex plantar angulation of the medial column. Some surgeons use the term forefoot supination to describe this same deformity (see Introduction section with nomenclature). Correction of this deformity is important to restore the weightbearing tripod of the foot and help resist a recurrence of foot collapse. When the forefoot varus deformity is isolated to the medial metatarsal and medial cuneiform, correction is indicated with an opening wedge medial cuneiform (Cotton) osteotomy, typically with interposition of an allograft bone wedge from 5 to 11 mm in width at the base. When the forefoot varus is global, involving varus angulation of the entire forefoot and midfoot relative to the hindfoot, other procedures are needed to adequately correct the deformity. Level of Evidence: Level V, consensus, expert opinion.


2020 ◽  
Vol 41 (10) ◽  
pp. 1277-1282
Author(s):  
Cesar de Cesar Netto ◽  
Mark S. Myerson ◽  
Jonathan Day ◽  
Scott J. Ellis ◽  
Beat Hintermann ◽  
...  

Recommendation: There is evidence that the use of WEIGHTBEARING imaging aids in the assessment of progressive collapsing foot deformity (PCFD). The following WEIGHTBEARING conventional radiographs (CRs) are necessary in the assessment of PCFD patients: anteroposterior (AP) foot, AP or mortise ankle, and lateral foot. If available, a hindfoot alignment view is strongly recommended. If available, WEIGHTBEARING computed tomography (CT) is strongly recommended for surgical planning. When WEIGHTBEARING CT is obtained, important findings to be assessed are sinus tarsi impingement, subfibular impingement, increased valgus inclination of the posterior facet of the subtalar joint, and subluxation of the subtalar joint at the posterior and/or middle facet. Level of Evidence: Level V, consensus, expert opinion.


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