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Introduction: Simulation-based education (SE) in interventional cardiology improves knowledge acquisition and mastery of procedures including the conventional radial access (CRA)., Aim: To evaluate the contribution of SE in CRA compared with theoretical learning alone., Methods: This is a prospective randomized controlled study including cardiology residents and patients with normal radial pulses. Experienced residents as well as patients with contraindications to CRA, requiring urgent intervention, or with hemodynamic instability were not included. Missing the teaching sessions was the exclusion criteria. Residents were randomized into two groups: simulation versus control. They attended a theory lecture explaining CRA and were evaluated Only the simulation group attended an SE session with measurement of heart rate (HR) and stress level. A real application was then performed with measurement of HR and stress level. The primary outcome was success puncture rate., Results: The success of the puncture was similar between the two groups (p=0.651). In the practical application, the stress level was significantly different before the procedure but similar after the end of the procedure. The stress level varied significantly within the same group before and after the procedure The simulation group was significantly less tachycardic both before and during the procedure with a significant difference between the two groups (p <10-3)., Conclusion: This study demonstrated the interest of SE in novice residents for CRA as a complement to theoretical learning upstream of the real-life procedure.

Background: After renal transplant, the haemodialysis (HD) vascular access (VA) is often maintained in the event of graft failure but evidence to recommend the systematic ligation/maintenance are lacking. We investigate the effects of VA preservation/ligation in successfully transplanted patients., Methods: A retrospective analysis of all patients undergoing successful renal transplantation after HD were conducted. Patients with a functioning VA, those undergoing ligation or presenting with post-transplantation spontaneous thrombosis were included. Demographics, comorbidities, reasons for ligation, need for secondary interventions, complications and return in dialysis were assessed., Results: Out of 542 HD patients, 114 (76, 66.7% male, median age 50 years, range 20-70) were included. Eight (7%) accesses thrombosed in a mean of 1.4 days (range 1-3) after transplant; 42 (36.8%) fistulas were ligated and 64 (56.1%) preserved. The reasons for ligation were patient's request (35, 83.3%), steal syndrome (5, 11.9%), heart failure (1, 2.4%) and aneurysmal degeneration (1, 2.4%).During a mean follow-up of 724.9 days (range 80-1082) 25 patients developed complications over the maintained access (40% of stenosis; 32% high flow and 28% thrombosis); 18 (15.8%) needed reoperation; 17 (15%) required further HD. Multivariate analysis showed that coronary artery disease (OR= 12.566 [2.056-76.805], P < 0.06) or age >60 years (OR=0.181 [0.044-0.735], P = 0.017) were risk factor for complications over unused VA., Conclusions: The ligation of a functioning VA after renal transplant should evaluated on an individualized basis. Patients with pre-existing cardiovascular disease or aged >60 years should be monitored closely up as they are at higher risk of complications., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: Studies addressed the influence of pharmaceutical representatives in drug prescribing habits, in terms of quality and quantity., Aim: To describe the representatives' strategies, assess their impact on medical prescribing, and study the various factors influencing doctors' prescribing changes., Methods: We conducted a cross-sectional study including 70 participants. All of them had an anonymous questionnaire to determine their socio-demographic data, the pharmaceutical representative visits details, the influence of gifts on the medical prescription, and the predictive factors of this influence. We also analyzed the solutions to alleviate the conflict of interest., Results: We found that 52.8% of participants thought that gifts were the source of an ethical dilemma and 85.7% of them thought that the priority of the pharmaceutical representative was the promotion of the product rather than the scientific interest. However, 68.5% of them thought that the gifts were useful and therefore we can continue to receive them. Nineteen participants (27.1% of cases) thought that gifts can modify their medical prescription. However, there were significantly more subjects (p=0.049) who thought that other colleagues would be more influenced (72.8%). Factors that favor the prescription changing by gifts, were age (p=0.002, OR=1.2) and the number of visits per month (p=0.015, OR=8.8)., Conclusions: There is a discrepancy between the growing awareness of this ethical issue and the daily practices of physicians who continue to accept gifts. The absence of training in bioethics explains these results.

Coronavirus disease 2019 (COVID-19) shows rapid spread around the world. Its classic presentation is a respiratory illness. However, cutaneous manifestations have rarely been described as the first clinical manifestation in patients with this infection. The aim of this article is to describe cutaneous manifestations in patients with COVID-19 through three case reports., (© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The objective of the study was to investigate which kind of native arterious-venous fistula guaranteed the best results in diabetic patients., Methods: A retrospective case-control study with prospective follow-up was conducted on all consecutive patients undergoing creation of the first native vascular access (VA) at our Institution between January 2011 and December 2016. Patients were divided into 2 groups: diabetics (group A) and nondiabetics (group B), and results were evaluated in accordance with site chosen for VA creation. Primary outcomes were maturation and primary patency rate. Secondary outcomes were complications, rate of functional fistulas, and mortality., Results: A total of 410 patients (n 155, 37.8% female; n 255, 62.2% male; mean age 64.21 ± 14.85 years, range 58-78) were divided into 2 nonstatistically different groups (group A: n 170, 41.5% and group B: n 240, 58.5%). Maturation and primary patency were statistically different for antebrachial (P = 0,038 and P = 0.044, respectively), but not for brachial access (P = 1 and P = 0.080, respectively) at 3 years. Hyperflow and steal syndrome rate did not differ between the 2 sites and groups. At a mean follow-up of 42.86 months (range 1-72), 5 patients died. Diabetics demonstrated the higher rate of overall complications at the long-term follow-up., Conclusions: Diabetes mellitus plays a detrimental role in maturation and primary patency of antebrachial fistula; however, brachial fistula results do not differ between diabetic and nondiabetic patients. More robust data and longer-term results from randomized studies are needed to affirm brachial fistula as preferential access in diabetic patients., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives: Our goal was to assess the safety, outcomes and complication rate of axillary artery cannulation for venoarterial extracorporeal membrane oxygenation (VA-ECMO)., Methods: A retrospective analysis was conducted on data obtained from the review of medical charts of all consecutive patients undergoing VA-ECMO implantation between January 2013 and December 2017 at a teaching hospital. Only patients with right axillary VA-ECMO implantation in a non-emergency setting were included. Post-procedural outcomes and local and systemic complications were analysed., Results: One hundred and seventy-four [131 male (75.3%), 43 female (24.7%); mean age 56.8 ± 15.1 years] patients underwent femoral-axillary VA-ECMO. Indications were cardiogenic shock from any cause (n = 78, 44.8%) or post-cardiotomy syndrome (n = 96, 55.2%). Fifty-three (30.5%) patients died while on VA-ECMO support. At the time of VA-ECMO ablation, 89 (51.1%) patients had recovered; 13 (7.5%) patients were bridged to a long-term mechanical support device and 19 (10.9%) patients underwent heart transplants. Thirty-day and 1-year mortality was 36.2% (n = 63) and 49.4% (n = 86), respectively. The 1-year survival rate of patients who were weaned from VA-ECMO support was 72.7% (n = 88). The complications of axillary cannulation were bleeding (n = 7, 4%), local infection (n = 3, 1.7%), upper limb ischaemia (n = 2, 1.1%) and brachial plexus injury (n = 1, 0.6%). Left ventricle unloading was required for 9 (5.2%) patients. The median duration of VA-ECMO support was 7 (range 1-26) days., Conclusions: Right axillary artery cannulation is a safe and reliable method for VA-ECMO support with a low rate of local complications. In the absence of a control group with femoro-femoral cannulation, no definitive conclusion about the superiority of axillary over femoral cannulation can be drawn., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Hydatid disease is one of the most widespread and endemic infections causing a substantial health and economic burden. The liver and lungs remain the most affected viscera. We report the case of a 41-year-old man with an atypical presentation: a hydatid cyst of the liver with a massive extension to the mediastinum through the esophagus hiatus. This patient underwent a single-stage surgical session to treat the mediastinal and abdominal parts of the cyst through a unique thoracic route., (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Constrictive pericarditis is relatively uncommon. Constrictive phenomenon involves in the majority of cases the two layers of the pericardium namely the parietal pericardium and the visceral one. Chronic epicarditis is a distinct and very scarce form where only the visceral pericardium is interested by the pathologic process. We present herein the case of a 25 years old patient admitted in our department for surgical treatment of a chronic visceral pericarditis. We discuss along some important clinical and therapeutic points related to this specific presentation with a special interest to the right ventricular dysfunction after pericardiectomy.

Bone marrow aspiration and trephine biopsy are considered safe procedures. Some serious but rare adverse events directly attributable to these procedures have been related in a few reports in the literature. We report a rare case of ascending aortic injury following a sternal trephine biopsy.

Introduction: Cardiovascular disease is the most common cause of death in chronic hemodialysis patients(1). Cardiac surgery in hemodialysis patients exposes to higher risks inherent in the particular status of these patients. The aim of our study is to report the perioperative particularities of hemodialysis patients undergoing cardiac surgery, and to determine the impact of preoperative clinical status on hospital and late morbidity and mortality., Methods: Between January 1998 and December 2012, 48 patients in chronic hemodialysis (HD) and candidates for cardiac surgery on cardiopulmonary bypass were retrospectively included., Results:   The mean age was 56 years. Causes of renal insufficiency were dominated by diabetes (n = 20; 42%) and nephroangiosclerosis (n= 9, 18.8%). The duration of HD was 48.22 ± 44.5 months (1 month -11 years). Surgical procedures included coronary artery bypass grafting CABG (n = 33, 68.75%), Valvular replacement (n = 13, 27%) and combined surgery (n = 2, 4.25%). Nine patients (18.8%) underwent emergency surgery. The mean Euroscore I was 8.82 ± 7.76. Hospital mortality was 20.8%. Postoperative complications were observed in 87.5%patients. Age, diabetic nephropathy, Duration of hemodialysis greater than 54 months, preoperative hemoglobin <9 g / dl, combined surgery and emergency surgery were independent predictors of hospital mortality with odds ratio respectively 1.21; 2.7; 2.54; 1.83; 2.54 and 2.85. The survival rates at 1, 4 and 7 years were respectively 75, 65 and 50%., Conclusion:   Age, diabetic nephropathy, Duration of hemodialysis greater than 54 months, preoperative hemoglobin <9 g / dl, combined surgery and emergency surgery are predictive factors for hospital mortality. Early diagnosis of coronary and valvular damage and preoperative preparation considering these factors could improve the prognosis.