Alexander Weymann

Background: Machine learning is a set of models and methods that can automatically detect patterns in vast amounts of data, extract information, and use it to perform decision-making under uncertain conditions. The potential of machine learning is significant, and breast surgeons must strive to be informed with up-to-date knowledge and its applications. Methods: A systematic database search of Embase, MEDLINE, the Cochrane database, and Google Scholar, from inception to December 2021, was conducted of original articles that explored the use of machine learning and/or artificial intelligence in breast surgery in EMBASE, MEDLINE, Cochrane database and Google Scholar. Results: The search yielded 477 articles, of which 14 studies were included in this review, featuring 73 847 patients. Four main areas of machine learning application were identified: predictive modelling of surgical outcomes; breast imaging-based context; screening and triaging of patients with breast cancer; and as network utility for detection. There is evident value of machine learning in preoperative planning and in providing information for surgery both in a cancer and an aesthetic context. Machine learning outperformed traditional statistical modelling in all studies for predicting mortality, morbidity, and quality of life outcomes. Machine learning patterns and associations could support planning, anatomical visualization, and surgical navigation. Conclusion: Machine learning demonstrated promising applications for improving breast surgery outcomes and patient-centred care. Neveretheless, there remain important limitations and ethical concerns relating to implementing artificial intelligence into everyday surgical practices.

Background: Redo mitral valve surgery is a standard of care in patients presenting with degenerated bioprosthetic mitral valve or failed annuloplasty. As surgical redo procedure might be required in up to 35% of patients with a history of MV surgery, we aimed to evaluate our outcomes after transapical transcatheter mitral valve replacement in patients with degenerated mitral bioprostheses or failed mitral ring annuloplasty and high or prohibitive surgical risk for redo mitral valve replacement. Method: We retrospectively analyzed the patients’ data, who between August 2012 and December 2020 underwent transcatheter mitral “valve-in-valve” (n = 25) or “valve-in-ring” (n = 16) implantation at our center. Results: Mean logistic EuroSCORE I was 42.3 ± 20.5%, STS score was 11.9 ± 10.8%, and STS/ACC score was 7.6 ± 4.2%. The procedure was successful in all patients (100%). Early postoperative echocardiographic examinations showed no obstruction of the left ventricular outflow tract and no paravalvular leakage. All patients survived the procedure. We observed a 30-day mortality of 9.8%. Survival was 72% at 1 year and 63% at 3 years. At 2-year follow-up, transvalvular mean pressure gradients were 4.6 ± 1.4 mm Hg. Conclusion: Transapical transcatheter mitral valve-in-valve or valve-in-ring implantation presents a feasible, true minimally invasive alternative to surgical redo procedures, especially in high-risk patients with a history of conventional mitral surgery. Publication Date: 03 February 2022 (online) © 2022. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

: OBJECTIVES: Extended reality (XR), encompassing both virtual reality (VR) and augmented reality, allows the user to interact with a computer-generated environment based on reality. In essence, the immersive nature of VR and augmented reality technology has been warmly welcomed in all aspects of medicine, gradually becoming increasingly feasible to incorporate into everyday practice. In recent years, XR has become increasingly adopted in thoracic surgery, although the extent of its applications is unclear. Here, we aim to review the current applications of XR in thoracic surgery. METHODS: A systematic database search was conducted of original articles that explored the use of VR and/or augmented reality in thoracic surgery in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to December 2020. RESULTS: Our search yielded 1494 citations, of which 21 studies published from 2007 to 2019 were included in this review. Three main areas were identified: (i) the application of XR in thoracic surgery training; (ii) preoperative planning of thoracic procedures; and (iii) intraoperative assistance. Overall, XR could produce progression along the learning curve, enabling trainees to reach acceptable standards before performing in the operating theatre. Preoperatively, through the generation of 3D-renderings of the thoracic cavity and lung anatomy, VR increases procedural accuracy and surgical confidence through familiarization of the patient’s anatomy. XR-assisted surgery may have therapeutic use particularly for complex cases, where conventional methods would yield inadequate outcomes due to inferior accuracy. CONCLUSION: XR represents a salient step towards improving thoracic surgical training, as well as enhancing preoperative planning and intraoperative guidance.

Redo mitral valve replacement remains the standard treatment for recurrent mitral valve disease. Most patients referred for a redo surgery in the western world are older and present with multiple comorbidities. With the successful broad implementation of anti-infective treatment, rheumatic mitral valve disease has become highly uncommon. Nonetheless, rheumatic heart disease is still thriving in developing countries causing the most severe mitral valve conditions. The guidelines are there to help us in our decision-making process, but the actual decision has to be made based on each patients' individual criteria.

Aortic valve reconstruction remains the ideal approach to treat aortic valve disease, with an aim to increase durability and prevent anticoagulation. Owing to its availability, handling ease, and low cost, autopericardium has been regularly used since the early days of cardiac surgery. Many of these methods have not been standardized yet and are underutilized. One method with promising long-term results is neocuspidization of the aortic valve, as described by Ozaki using glutaraldehyde-fixed autopericardium. Neocuspidization of the aortic valve includes valve prosthetics with its own pericardium. We performed a literature review on aortic valve neocuspidization. Received 13 October 2020. Revised 6 November 2020. Accepted 11 November 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and study design: B.K. Kadyraliev, V.B. Arutyunyan, I.I. Chernov, A.H. Umarov, K.Yu. Zhigalov, A. Weymann, S.T. EnginoevDrafting the article: B.K. Kadyraliev, V.B. Arutyunyan, S.T. EnginoevCritical revision of the article: V.B. Arutyunyan, A.H. Umarov, S.T. EnginoevFinal approval of the version to be published: B.K. Kadyraliev, V.B. Arutyunyan, I.I. Chernov, A.H. Umarov, K.Yu. Zhigalov, A. Weymann, S.T. Enginoev

Непосредственные результаты операции Ozaki: многоцентровое исследование

Background Bronchial artery aneurysms (BAAs) are a rare vascular entity. They can have various presentations ranging from an incidental finding on radiological examination to life‐threatening hemoptysis. Material and Methods We report the case of a 60‐year‐old woman with three posterior mediastinal BAAs who presented with unilateral periscapular pain, shortness of breath, hoarseness, and dysphagia. The BAAs were removed successfully via thoracotomy, with excellent recovery and relief of the periscapular pain. Discussion and Conclusion We use this case as a platform to discuss the treatment options for BAAs.

To determine the feasibility of aortic valve neocuspidization (AVNeo) with glutaraldehyde-treated autologous pericardium. One hundred and seventy (170) AVNeo (84 males/86 females) were performed from January 2017 through March 2019 in three centers. All the records were prospectively collected and retrospectively reviewed. Most of the patients were older than 60 years and over 95% were operated for aortic stenosis. Preoperatively, pressure gradients were 69.9±21.3 mmHg for patients with aortic stenosis, and the surgical annular diameter was 21.0±2.0 mm for all patients. Effective orifice area (EOA) and indexed EOA (iEOA) averaged 0.7±0.3 cm2 and 0.4±0.2 cm2/m2 for patients with aortic stenosis before surgery, respectively. There was no conversion to prosthetic aortic valve replacement. Eight patients needed reoperation for bleeding, but no patient needed reoperation due to early infective endocarditis. There were five in-hospital deaths due to noncardiac cause. Compared to preoperative echocardiographic measurements, postoperative peak pressure gradient decreased significantly (-58.7±1.7 mmHg; P mild). AVNeo is feasible and reproducible with good clinical results. Hemodynamically, AVNeo produces immediate postoperative low-pressure gradients, large EOA, and minimal regurgitation of the aortic valve. Further studies are necessary to evaluate mid- and long-term evolution.