Mitral valve replacement in young patients: review and current challenges.

Mitral valve repair is the ideal intervention for mitral valve disease with excellent long-term survival comparable to the age-matched general population. When the mitral valve is not repairable, mechanical prostheses may be associated with improved survival as compared with biological prostheses. Newer mechanical and biological valve prostheses have the potential to improve outcomes following mitral valve replacement in young patients. Patients presenting for mitral valve surgery after failed transcatheter mitral valve-in-valve have high rates of postoperative mortality and morbidity, exceeding those seen with reoperative mitral valve surgery, which poses issues in young patients who have a higher cumulative incidence of reintervention.

Patients presenting with mitral valve disease, the most common type of heart valve disease, have a survival advantage when they undergo mitral valve repair as opposed to replacement, and this is particularly true for young patients. When the mitral valve is not repairable, mechanical prostheses (prosthetic implants) may be associated with improved survival as compared with biological prostheses, and this difference is mostly observed until the age of 70 years. Newer techniques of treating mitral valve disease without requiring open heart surgery have not yet been shown to be superior or even equivalent to traditional open heart surgery in the general population. Patients presenting for mitral valve surgery after failure of these newer techniques have high rates of death, exceeding those seen with mitral valve reoperation, which has important implications for young patients with mitral valve disease.

Aortic Pseudoaneurysm After Type A Aortic Dissection: Results of Conservative Management.

Aortic pseudoaneurysms after acute Type A aortic dissection (ATAAD) repair have been reported as high as 10-24% and surgical treatment is usually recommended. The objective of this article is to examine the safety and efficacy of a conservative approach to aortic pseudoaneurysm and to compare this approach to standard surgical treatment. We retrospectively examined 39 patients who had an aortic pseudoaneurysm after ATAAD surgery in order to examine outcomes (baseline characteristics, presentation and freedom from aortic events and mortality). We initially identified 31 patients treated conservatively (CT). After close follow up, 5 of them were operated so 13 patients were treated surgically (ST) and analyzed at a long-term follow-up while 26 were in the conservative group. Mean follow- - up of the whole cohort was 7.9 ± 5.9 years. The freedom from aortic-related mortality at 1, 5, and 10 years was 100%, 83.3% and 72.9% for the ST group and 95.8%, 77.3%, and 77.3% for the CT group (P = 0.35). A conservative approach to aortic pseudoaneurysms could be justified in asymptomatic patients. A close follow-up by a dedicated aortic clinic is mandatory so that patients are referred for surgery when necessary.

Should Bilateral Internal Thoracic Arteries be Used in Patients with Chronic Kidney Disease?

Preoperative renal dysfunction is a major determinant of operative and long-term mortality following cardiac surgery. The objective of this study was to assess early and long-term results of CABG in patients with preoperative chronic kidney disease (CKD) using a bilateral internal thoracic artery (BITA) strategy, compared to those without CKD. We retrospectively analyzed data for 2,111 consecutive patients who underwent CABG with BITA between 2000 and 2019. One-to-many propensity score matching was performed to produce a cohort of 132 patients with CKD (defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2), matched to 358 patients with normal renal function (non-CKD). The primary end-point of interest was late freedom from all-cause mortality. Late hospital readmissions were also assessed. Mean eGFR and serum creatinine were: 49.8 versus 84.3 mL/min/m2 and 146.1 versus 83.6 µmol/L (CKD vs non-CKD, P< 0.001). In-hospital outcomes were similar among matched patients, including mortality (CKD 0.8% vs non-CKD 0%, P= 0.31). At a median follow-up of 6.9 years, there was no significant difference in survival between both groups (hazard ratio (HR) 1.37, 95% confidence interval (CI) 0.87-2.16, P= 0.17). Hospital readmission for cardiovascular causes (including repeat coronary revascularization) was comparable between the 2 groups. However, the risk of hospital readmission for renal causes was higher in patients with CKD (6.7%) compared to non-CKD (1.2%). In a propensity score-matched cohort of patients undergoing BITA-CABG, CKD was not associated with increased early or late mortality, nor was there a greater risk of hospital readmission for cardiovascular events.

Off-Pump Coronary Revascularization Using Bilateral Internal Thoracic Arteries in A Patient with Paroxysmal Nocturnal Hemoglobinuria: A Case Report.

Paroxysmal nocturnal hemoglobinuria (PNH) is an ultra-orphan disease. We report the first case in the literature of Off-Pump Coronary Revascularization Using Bilateral Internal Thoracic Arteries in a patient with paroxysmal nocturnal hemoglobinuria. A 36-year-old man came to the emergency department with acute non-ST elevation myocardial infarction (NSTEMI). He presented paroxysmal nocturnal hemoglobinuria diagnosed in 2016. Coronary angiography revealed tripple vessel disease. The conduits used for coronary revascularization were both internal thoracic arteries (left ITA-right ITA [LITA-RITA]). We consider that off-pump coronary artery bypass grafting (OPCABG) using Bilateral Internal Thoracic Arteries (BITA) can be safely performed with low in-hospital mortality and complications rates, even in patient with PNH.

Off-Pump coronary revascularization using bilateral internal thoracic arteries in a patient with paroxysmal nocturnal hemoglobinuria: a case report

Abstract Paroxysmal nocturnal hemoglobinuria (PNH) is an ultra-orphan disease. We report the first case in the literature of Off-Pump Coronary Revascularization Using Bilateral Internal Thoracic Arteries in a patient with paroxysmal nocturnal hemoglobinuria. A 36-year-old man came to the emergency department with acute non-ST elevation myocardial infarction (NSTEMI). He presented paroxysmal nocturnal hemoglobinuria diagnosed in 2016. Coronary angiography revealed tripple vessel disease. The conduits used for coronary revascularization were both internal thoracic arteries (left ITA-right ITA [LITA-RITA]). We consider that off-pump coronary artery bypass grafting (OPCABG) using Bilateral Internal Thoracic Arteries (BITA) can be safely performed with low in-hospital mortality and complications rates, even in patient with PNH.

Acute penetrating atherosclerotic ulcer of the ascending aorta.

A 67-year-old man presented with chest pain. Clinical examination revealed hypertension (160/90 mm Hg). Electrocardiogram indicated no acute coronary syndrome and cardiac enzymes were normal. Catheterization was performed owing to the patient's continuing chest pain and ascending aortogram revealed irregular aortic wall. A computed tomography image showed the shape of penetrating ulcer. The patient was taken to the operating room and intraoperative examination confirmed the diagnosis of penetrating atherosclerotic ulcer (PAU). Coronary artery bypass graft and bovine pericardial patch repair of PAU was performed. A bovine pericardial patch was done as aortic root was heavily calcified and was easy to handle and more hemostatic.

Factores predictivos de colecistitis aguda gangrenosa / Predictive factors of acute gangrenous cholecystitis

Introducción: La colecistitis aguda gangrenosa (CAG) es una complicación severa de la colecistitis aguda, afectando entre el 2 y 20% de las mismas. En la actualidad no hay disponibles guías definidas para detectar estos casos y definir su conducta quirúrgica con rapidez. El objetivo de este trabajo es contribuir al estudio de los factores predictivos de la CAG para identificar los pacientes que requieren cirugía de urgencia. Material y métodos: Se realizó una búsqueda retrospectiva de pacientes que fueron sometidos a colecistectomía con diagnóstico preoperatorio de colecistitis aguda en el Nuevo Hospital San Roque, entre enero de 2011 y diciembre de 2012. El Nuevo Hospital San Roque es un centro público de atención de tercer nivel al que acceden de forma gratuita los habitantes de la Ciudad de Córdoba (Argentina) y alrededores que no cuentan con cobertura de salud privada. Los factores de riesgo preoperatorios evaluados incluyeron sexo, edad, diabetes, obesidad, vómitos, fiebre, recuento de glóbulos blancos, eritrosedimentación, enzimas hepáticas, amilasa y hallazgos ecográficos como diámetro de la pared vesicular y líquido perivesicular. Los pacientes fueron divididos en 2 grupos de acuerdo con el diagnóstico anatomopatológico: el grupo 1 incluyó pacientes con CAG y el grupo 2, pacientes con colecistitis aguda no gangrenosa. Resultados: De un total de 183 pacientes sometidos a colecistectomía, 101 (55,1%) presentaron CAG. El análisis multivariado determinó que en nuestro grupo de estudio la razón de probabilidades de CAG asociadas a las variables fiebre, diabetes, y sexo masculino son mayores de 2 y estadísticamente significativas. Asimismo, la razón de probabilidades de CAG aumenta con el nivel de glóbulos blancos y eritrosedimentación. Conclusión: Las variables fiebre, diabetes, sexo masculino, glóbulos blancos, y eritrosedimentación pueden ser consideradas factores predictivos independientes en nuestro caso de estudio.

Introduction: Acute gangrenous cholecystitis (AGC) is a severe complication of acute cholecystitis affecting between 2 and 20% of them. To date, there are no defined guidelines available to triage high-risk surgical patients. Our objective is to contribute to the literature studying predictive factors of AGC aimed at identifying patients who require emergency surgery. Materials and methods: We conducted a retrospective search of patients who underwent cholecystectomies with preoperative diagnosis of acute cholecystitis at Nuevo Hospital San Roque between January 2011 and December 2012. Nuevo Hospital San Roque is a public hospital in Argentina that provides health services to non-privately insured residents of the Cordoba metropolitan area. The resulting sample was used to perform a multivariate analysis encompassing the following preoperative risk factors: gender, age, diabetes, obesity, vomiting, fever, white blood cell count, erythrocyte sedimentation rate, liver enzymes, amylase and sonographic findings like diameter of gallbladder wall and perivesicular liquid. Patients were divided into two groups according to pathological diagnosis: group 1 included patients with acute AGC and group 2 with no gangrenous acute cholecystitis. Results: One hundred and one patients presented AGC out of a total of 183 patients analyzed. Our multivariate analysis determined that the odds ratio of CAG associated with the variables fever, diabetes, and male gender are greater than 2 and statistically significant. Likewise, the odds ratio of CAG is increasing in the level of white blood cells and in the erythrocyte sedimentation rate. Conclusion: We found that fever, diabetes, male gender, white blood cells, and erythrocyte sedimentation rate can be considered independent predictors in our sample.

Correlación de ecografía y anatomía patológica en apendicitis aguda / Correlation of ultrasound and pathological anatomy in acute appendicitis

INTRODUCCIÓN: Se define al término “Abdomen Agudo” como al dolor abdominal de aparición repentina e intensidad severa que requiere una medida terapéutica inmediata. Debe ser considerado una emergencia médica. El cuadro clínico de apendicitis aguda presenta las características antes mencionadas, por lo que el diagnóstico certero y precoz es de importancia relevante. No siempre puede realizarse a un diagnóstico fiable y preciso con la anamnesis, el examen físico y los resultados de laboratorio de análisis, por lo que el diagnóstico imagenológico juega un rol importante para decidir la conducta a seguir. La ecografía es un examen dinámico, en tiempo real, de bajo costo y repetible debido a que no presenta los efectos adversos de la radiación. Diferentes estudios demostraron que la tasa de apendicectomías negativas disminuyó a aproximadamente el 10% con el uso rutinario de la ecografía. OBJETIVO: Correlacionar los resultados ecográficos con el diagnóstico anatomopatológico de pacientes operados con diagnóstico de apendicitis. Determinar si es un método complementario confiable para establecer diagnóstico y determinar conducta. Evaluar la tasa de apendicectomías negativas. MATERIAL Y MÉTODOS: Éste estudio de cohorte retrospectivo relacionó la ecografía y los resultados de anatomía patológica de 219 pacientes con diagnóstico de apendicitis intervenidos quirúrgicamente, entre el 1º de enero y 30 de Junio de 2014. RESULTADOS: Se realizaron ecografía abdominal a la totalidad de los pacientes operados con diagnóstico de apendicitis. De éstas, el 60,3% fueron informadas positivas para dicho diagnóstico. Todos los apéndices resecados fueron enviados a anatomía patológica, confirmándose el diagnóstico de apendicitis en el 87,7% de las piezas. Ciento cincuenta casos fueron positivos en ecografía y anatomía patológica, lo que representa el 68,49%. Once casos fueron negativos en ecografía y anatomía patológica, lo que representa el 5,02%...

INTRODUCTION: It defines the term “acute abdomen” as the sudden onset abdominal pain and severe intensity that requires immediate therapeutic measure. Should be considered medical emergency. The clinical picture of acute appendicitis presents the above characteristics, so the accurate and early diagnosis is of significant importance. You cannot always be a reliable and accurate diagnosis with history, physical examination and laboratory results of analysis, so the diagnostic imaging plays an important role in deciding what action to take. Ultrasound testis a dynamic, real-time, low-cost, repeatable because no adverse effects of radiation. Different studies showed that negative appendectomy rate decreased to approximately 10%with routine use of ultrasound. OBJECTIVE: To correlate the sonosoon graphic findings with pathologic diagnosis of patients operated with a diagnosis of appendicitis. Determine if it is a complementary method to establish reliable diagnosis and determine be havior. Assessing the negative appendectomy rate. METHODS: This retrospective cohort study linked the ultrasound and pathology results of 219 patients diagnosed with appendicitis surgery between January 1 and June 30, 2014. RESULTS: Abdominal ultra sound to all operated patients diagnosed with appendicitis were performed. Of these, 60.3% were reported positive for the diagnosis. All resected appendices were sent to pathology, confirming the diagnosis of appendicitis in 87.7% of the parts. One hundred and fifty cases were positive in ultra sound and pathology, representing 68.49%. Eleven cases were negative on ultra sound and pathology, representing 5.02%...