Ariana Axiaq

and 4 more

Background: Cardiothoracic (CT) surgery is a dynamic and demanding specialty, which is popular amongst medical students thus, posing as a favourable career choice for many. However, there is a significant proportion of medical students who prefer to choose other specialities instead, for different reasons. Aim of the study: This review aims to identify factors affecting the uptake of cardiothoracic surgery as a career by medical students, junior doctors and trainees globally. Methods: A comprehensive literature review was conducted using PubMed, EMBASE, SCOPUS and CINAHL using specific keywords including “cardiothoracic surgery” AND “medical student” AND “career”. Inclusion and exclusion criteria were also developed to ensure only relevant studies were used for the paper. Information on the perspectives, knowledge, and beliefs on cardiothoracic surgery amongst medical students and trainee doctors worldwide was collected. Results: Most data was sourced from UK and US-based studies with only a minority of literature from other parts of the world. Uptake of cardiothoracic surgery amongst medical students, junior doctors and trainees is generally low, on a global level. Deterring factors identified from this review included work-life balance, professional satisfaction, lifestyle, and family planning, the latter being especially important for female medical students. Conclusion: Although job posts are still being filled, the increasing numbers of medical students losing interest in a career in cardiothoracic surgery needs to be addressed. Areas of future research into this area would be to re-assess medical school curricula and opportunities to engage more in the field whilst at medical school and beyond.

Wahaj Munir

and 3 more

Background: Acute type A aortic dissection (ATAAD), is a surgical emergency often requiring intervention on the aortic root. There is much controversy regarding root management; aggressively pursuing a root replacement, versus more conservative approaches to preserve native structures. Methods: Electronic database search we performed through PubMed, Embase, SCOPUS, google scholar and Cochrane identifying studies that reported on outcomes of surgical repair of ATAAD through either root preservation or replacement. The identified articles focused on short- and long-term mortalities, and rates of re-operation on the aortic root. Results: There remains controversy on replacing or preserving aortic root in ATAAD. Current evidence supports practice of both trends following an extensive decision-making framework, with conflicting series suggesting favourable results with both procedures as the approach that best defines higher survival rates and lower perioperative complications. Yet, the decision to perform either approach remains surgeon decision and bound to the extent of the dissection and tear entries in strong correlation with status of the aortic valve and involvement of coronaries in the dissection. Conclusions: There exists much controversy regarding fate of the aortic root in ATAAD. There are conflicting studies for impact of root replacement on mortality, whilst some study’s report no significant results at all. There is strong evidence regarding risk of re-operation being greater when root is not replaced. Majority of these studies are limited by the single centred, retrospective nature of these small sample sized cohorts, further hindered by potential of treatment bias.

Bianca Botezatu

and 6 more

Objectives: Mitral valve disease is increasingly prevalent. Timely diagnosis and the choice of the right intervention are very important in the early stages, as valvular dysfunction often leads to cardiac failure and even sudden death. The focus of this paper is on the various pathologies of the mitral valve, their etiology, and clinical management. Methods: Mitral regurgitation (MR) can be managed surgically, percutaneously or medically. Treatment methods for primary MR include percutaneous mitral valve (MV) repair, MV replacement, minimally invasive mitral valve surgery (MIMVS), and more recently, robotics. Additionally, conventional sternotomy has been used for both MR and mitral stenosis. Nonetheless, ongoing clinical trials are a clear indicator that the management of valve diseases is continuously evolving. Results: Multiple studies favour MV repair via MIMVS, over conventional sternotomy or percutaneous approach. However, more data is needed to optimize patient selection. Robot assisted repair is a new alternative, but attention should be given to the steep learning curve and medical training of professionals wishing to perform this intervention. Cost effectiveness and possible side effects should be explored by clinical trials as well. While guidelines are fairly straightforward for primary MR, there is insufficient evidence to suggest that surgical treatment is advantageous for secondary MR. Management is usually pharmaceutical and aims to treat symptoms rather than cause. Conclusion: Mitral valve disease remains a medical challenge, but numerous research and clinical trials have been embarked upon to refine old methods and discover new ones to improve treatment success and procedural safety.