Transcatheter Aortic Valve Implantation in Bicuspid Aortic Valve with Aortic Stenosis: a Meta-Analysis and Trial Sequential Analysis

Abstract Objectives: Bicuspid aortic valve (BAV) is an important aetiology of aortic stenosis and the use of transcatheter aortic valve implantation (TAVI) has not been fully explored in this cohort. This systematic review and meta-analysis compared the outcomes of TAVI in stenotic BAV against tricuspid aortic valve (TAV). Methods: An electronic literature search was performed in PubMed, MEDLINE, EMBASE, and Scopus to identify all studies comparing TAVI in stenotic BAV versus TAV. Only studies comparing TAVI in BAV versus TAV were included, without any limit on the study date. Primary endpoints were 30-day and 1-year mortality, while secondary endpoints were postoperative rates of stroke, acute kidney injury (AKI), and permanent pacemaker (PPM) requirement. A trial sequential analysis (TSA) was performed for all endpoints to understand their significance. Results: Thirteen studies met the inclusion criteria (917 BAV and 3079 TAV patients). The BAV cohort was younger (76.8±7.43 years vs. 78.5±7.12 years, P=0.02), had a higher trans-aortic valve gradient (P=0.02), and larger ascending aortic diameters (P<0.0001). No significant difference was shown for primary (30-day mortality [P=0.45] and 1-year mortality [P=0.41]) and secondary endpoints (postoperative stroke [P=0.49], AKI [P=0.14], and PPM requirement [P=0.86]). The BAV group had a higher rate of significant postoperative aortic regurgitation (P=0.002). TSA showed that there was sufficient evidence to conclude the lack of difference in PPM requirements, and 30-day and 1-year mortality between the two cohorts. Conclusion: TAVI gives satisfactory outcomes for treating stenotic BAV and should be considered clinically.

Clinical and laboratory risk indicator for necrotizing fasciitis score in predicting the outcomes in necrotizing soft tissue infection patients

Background: Necrotizing soft tissue infection (NSTI) is a serious condition that can be diagnosed on a high index of suspicion and require urgent surgical treatment. NSTI involved epidermis and dermis but more frequently it affects the deeper layer of adipose tissue, fascia, and muscle. NSTI diagnosis and its treatment include emergent surgical intervention and the use of appropriate antibiotics. In this study, we have been evaluated the laboratory risk indicator for necrotizing fasciitis (LRINEC) score in predicting the outcomes in patients of NSTI.Methods: We have conducted a prospective study of 36 patients with NSTI. The LRINEC score, predisposing factors, etiology, risk factors, causative microbiological organisms have been studied.Results: LRINEC score >8 is associated with NSTI in all cases. The mortality and morbidity, length of stay including ICU stay increases with an increase in LRINEC score. The most common microorganism was found to be E. coli followed by Klebsiella.Conclusions: Although, we used the emergent and liberal debridement and appropriate antibiotic and resuscitation. In this study, morbidity, mortality, and length of hospital stay all are increased with respect to the increase in LRINEC score.

Fiber dissection of the visual pathways: Analysis of the relationship of optic radiations to lateral ventricle: A cadaveric study.

Objective: Using a fiber-dissection technique, our aim is to study the fiber bundles of the optic radiation. We focused on the course, the length, anatomical relations with lateral ventricle and the relevance of these finding during surgery in the region. Materials and Methods: Five previously frozen and formalin-fixed cadaveric human brains were used. The dissection was done using the operating microscope. Fiber dissection techniques described by Klingler were adopted. The primary dissection tools were handmade, thin, and wooden and curved metallic spatulas with tips of various sizes. Lateral and inferior temporal approaches were made and the optic fiber tracts were dissected. Results: Resections that extend through the roof of the temporal horn more than 30 mm behind the temporal pole cross the Meyer's loop. In the middle temporal gyrus approach, resection that is taken through the lateral wall of the temporal horn more than 55-60 mm behind the temporal pole may cross the optic radiation during their course here on the lateral wall. Conclusion: The presented fiber dissection study clarifies the relationship of optic radiation. Such fiber dissection studies are only few in the literature.