Artificial Intelligence, Computational Simulations, and Extended Reality in Cardiovascular Interventions

Artificial intelligence, computational simulations, and extended reality, among other 21st century computational technologies, are changing the health care system. To collectively highlight the most recent advances and benefits of artificial intelligence, computational simulations, and extended reality in cardiovascular therapies, we coined the abbreviation AISER. The review particularly focuses on the following applications of AISER: 1) preprocedural planning and clinical decision making; 2) virtual clinical trials, and cardiovascular device research, development, and regulatory approval; and 3) education and training of interventional health care professionals and medical technology innovators. We also discuss the obstacles and constraints associated with the application of AISER technologies, as well as the proposed solutions. Interventional health care professionals, computer scientists, biomedical engineers, experts in bioinformatics and visualization, the device industry, ethics committees, and regulatory agencies are expected to streamline the use of AISER technologies in cardiovascular interventions and medicine in general.

Increasing Surgeon Experience and Cumulative Institutional Experience Drive Decreasing Hospital Mortality after Reoperative Cardiac Surgery

OBJECTIVE

To identify effects of surgeon experience and age, in the context of cumulative institutional experience, on risk-adjusted hospital mortality after cardiac reoperations.

METHODS

From 1951-2020, 36 surgeons performed 160,338 cardiac operations, including 32,871 reoperations. Hospital death was modeled using a novel tree-bagged, generalized varying-coefficient method with 6 variables reflecting cumulative surgeon and institutional experience up to each cardiac operation: 1) number of total and 2) reoperative cardiac operations performed by a surgeon, 3) cumulative institutional number of total and 4) reoperative cardiac operations, 5) year of surgery, and 6) surgeon age at each operation. These were adjusted for 46 patient characteristics and surgical components.

RESULTS

1,470 hospital deaths occurred after cardiac reoperations (4.5%). At the institutional level, hospital death fell exponentially and became less variable, leveling at 1.2% after approximately 14,000 cardiac reoperations. For all surgeons as a group, hospital death decreased rapidly over the first 750 reoperations, then gradually decreased with increasing experience to below 1% after about 4,000 reoperations. Surgeon age up to 75 was associated with ever-decreasing hospital death.

CONCLUSIONS

Surgeon age and experience have been implicated in adverse surgical outcomes, particularly after complex cardiac operations, with young surgeons being novices and older surgeons having declining ability. However, at Cleveland Clinic, outcome of cardiac reoperations improved with increasing primary surgeon experience, without any suggestion to mid-70s of an age cut-off. Patients were protected by the cumulative background of institutional experience that created a culture of safety and teamwork that mitigated adverse events after cardiac surgery.