Left ventricular recovery after total arterial coronary artery bypass grafting versus conventional coronary artery bypass grafting in patients with multivessel coronary artery disease and reduced left ventricular ejection fraction.

BACKGROUND: We compared total arterial revascularization (TAR) versus conventional revascularization (CR) in terms of left ventricular function recovery in patients with multivessel coronary artery disease (CAD) and reduced left ventricular ejection fraction (LVEF). METHODS: We conducted a retrospective cohort study of 162 consecutive patients with multivessel CAD and reduced LVEF who underwent isolated coronary artery bypass grafting at our institution between January 2013 and July 2022. We assessed left ventricular function by transthoracic echocardiography at admission, before discharge, and at follow-up of 3, 6, and 12 months, using LVEF, global longitudinal peak strain, end-diastolic volume index, and end-systolic volume index. We also evaluated mitral valve regurgitation and graft patency rate at 1 year. RESULTS: The TAR group had a significantly higher increase in LVEF and global longitudinal peak strain, and a significantly lower decrease in end-diastolic volume index and end-systolic volume index than the CR group at 6 and 12 months after surgery. The TAR group also had a significantly lower degree of mitral valve regurgitation than the CR group at all-time points within 12 months after surgery. The TAR group had a significantly higher graft patency rate than the CR group at 12 months. There was no significant difference in hospital mortality or repeat revascularization between the groups. CONCLUSIONS: TAR was associated with better recovery of left ventricular function than CR in patients with multivessel CAD and reduced LVEF. Further studies are needed to confirm these findings in this high-risk population.

Comparison of post-operative pain and quality of life between total thoracoscopic surgery and conventional full-sternotomy for aortic valve replacement.

BACKGROUND: To compare the post-operative pain and quality of life of patients who underwent total thoracoscopic surgery (TTS) or conventional full-sternotomy (CFS) for aortic valve replacement (AVR). METHODS: We reviewed the records of 223 consecutive AVR patients with either TTS or CFS from January 2018 to December 2022. We used a visual analogue scale (VAS) and the Short Form-36 Health Survey (SF-36) to measure the post-operative pain and quality of life, respectively. We also compared the operative data and clinical outcomes between the two groups. RESULTS: The TTS group had lower adjusted mean VAS scores than the CFS group at all time points after surgery (at 1 to 3 days and at 3 and 6 months, p < .001 for all comparisons), indicating less pain. The TTS group also had higher mean SF-36 scores than the CFS group up to 6 months after surgery (p < .001 for all comparisons), indicating better quality of life. The operative time was similar between the two groups (p = .224), but the TTS group had longer cardiopulmonary bypass time and aortic cross-clamp time than the CFS group (p < .001). The TTS group had more pulmonary complications than the CFS group (p = .023). However, there were no significant differences in other major complications or mortality between the two groups. CONCLUSIONS: TTS is a safe and effective alternative to CFS for AVR. TTS resulted in less pain and better quality of life, especially in the early recovery period. However, further prospective randomized controlled studies are needed to confirm our findings.

Safety and efficacy of total thoracoscopic surgery for patients with tricuspid regurgitation and reduced right ventricular function after left heart valves replacement: a retrospective comparative study.

BACKGROUND: Tricuspid valve surgery is the standard treatment for tricuspid valve disease refractory to pharmacologic therapy. However, patients with tricuspid regurgitation after previous left heart valves replacement with reduced right ventricular (RV) function are at greater risk of surgery. We compared the clinical outcomes of tricuspid valve replacement in this subgroup of patients through mini-thoracotomy and conventional full-sternotomy approach. METHODS: We identified 44 patients at our institution with tricuspid regurgitation and reduced right ventricular function after left heart valves replacement who underwent either total thoracoscopic tricuspid valve replacement (T-TVR) or conventional tricuspid valve replacement (C-TVR) from December 2014 and May 2021. Patient clinical characteristics, hospital course, and postoperative changes in RV function were retrospectively reviewed and analyzed. RESULTS: Baseline characteristics between T-TVR (n = 25) and C-TVR (n = 19) were comparable including a high incidence of liver dysfunction and renal insufficiency. There were no statistically differences between the two groups in terms of hospital mortality (8.0% vs. 21.1%, P = .211). Patients in the T-TVR group had less total drainage volume (201.60 ± 77.05 ml vs. 614.74 ± 182.31 ml, p < .001), required fewer postoperative blood product transfusions, and had a lower total length of hospital stay (15(15-16) vs. 16(14-17) days, P = .019) compared to the C-TVR group. T-TVR was associated with better and faster recovery of tricuspid annular plane systolic excursion (TAPSE) and right ventricle fractional area change (RVFAC) (adjusted ß = 0.154, 95% CI: 0.037 to 0.271, p = .010 and adjusted ß = 0.003, 95% CI: 0.000 to 0.005, p = .024; respectively) within the first 3 months postoperatively compared with C-TVR. CONCLUSIONS: T-TVR represents a viable alternative to current surgical strategies as a potentially sicker cohort demonstrated similar hospital mortality compared to conventional surgery, with reduced length of hospital stay, fewer blood transfusions, and more favorable in promoting RV functional recovery in the early period. Future prospective, randomized-controlled trials with longer follow-up durations are needed to validate these findings.

Impact of frailty status on clinical and functional outcomes after concomitant valve replacement and bipolar radiofrequency ablation in patients aged 65 years and older.

BACKGROUND: To evaluate the prognostic value of frailty in older recipients of concomitant valve replacement (VR) and bipolar radiofrequency ablation (BRFA), we examined whether clinical and functional outcomes differed between frail and non-frail groups of older patients referred for concomitant VR and BRFA. METHODS: In a single-center retrospective observational cohort study, we compared the clinical and functional outcomes in frail versus non-frail patients. Frailty was assessed using the 5-item Cardiovascular Health Study (CHS) frailty scale. Patients were divided into two groups, frail and non-frail. Functional outcome was assessed using the internationally validated Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) questionnaire. RESULTS: We enrolled 185 patients aged ≥ 65 years who underwent concomitant VR and BRFA. About 36.2% (n = 67) of the patients were included in the frail group and the remaining patients (n = 118) in the non-frail group. Follow-up was complete with a median duration of 58 months (interquartile range 44-76 months). Significant differences were observed between the two groups with respect to postoperative pulmonary complications (frail vs. non-frail patients, 50.74% vs. 22.9%, respectively, P < .001) and hospital mortality (10.45% vs. 1.69%, respectively, P = .021). The frail group had a higher adjusted risk for all-cause mortality (adjusted HR 4.06; 95% CI 1.33 to 12.38; P = .014) and all-cause hospitalization (adjusted HR 2.24; 95% CI 1.12 to 4.50; P = .023). Frailty was associated with lower overall AFEQT scores at baseline (Estimate, - 0.400; 95% CI - 0.532 to - 0.267; P < .001). Compared to the non-frail group, the frail group continued to have lower overall AFEQT scores with no significant improvement in follow-up at 1 year and 2 years after concomitant VR and BRFA. CONCLUSION: Frail patients had lower baseline AFEQT scores and were more likely to have adverse outcomes from postoperative pulmonary complications, and frailty was also an independent risk factor for long-term all-cause mortality and all-cause rehospitalization. Further studies are needed to assess the impact of frailty.

Recognition of Freezing of Gait in Parkinson's Disease Based on Machine Vision.

Background: Freezing of gait (FOG) is a common clinical manifestation of Parkinson's disease (PD), mostly occurring in the intermediate and advanced stages. FOG is likely to cause patients to fall, resulting in fractures, disabilities and even death. Currently, the pathogenesis of FOG is unclear, and FOG detection and screening methods have various defects, including subjectivity, inconvenience, and high cost. Due to limited public healthcare and transportation resources during the COVID-19 pandemic, there are greater inconveniences for PD patients who need diagnosis and treatment. Objective: A method was established to automatically recognize FOG in PD patients through videos taken by mobile phone, which is time-saving, labor-saving, and low-cost for daily use, which may overcome the above defects. In the future, PD patients can undergo FOG assessment at any time in the home rather than in the hospital. Methods: In this study, motion features were extracted from timed up and go (TUG) test and the narrow TUG (Narrow) test videos of 50 FOG-PD subjects through a machine learning method; then a motion recognition model to distinguish between walking and turning stages and a model to recognize FOG in these stages were constructed using the XGBoost algorithm. Finally, we combined these three models to form a multi-stage FOG recognition model. Results: We adopted the leave-one-subject-out (LOSO) method to evaluate model performance, and the multi-stage FOG recognition model achieved a sensitivity of 87.5% sensitivity and a specificity of 79.82%. Conclusion: A method to realize remote PD patient FOG recognition based on mobile phone video is presented in this paper. This method is convenient with high recognition accuracy and can be used to rapidly evaluate FOG in the home environment and remotely manage FOG-PD, or screen patients in large-scale communities.

Prognostic effect of symptomatic extracranial lesions on survival of recursive partitioning analysis Class III brain metastatic patients treated with stereotactic radiotherapy.

OBJECTIVE: To explore the outcome and prognostic factors of recursive partitioning analysis (RPA) Class III brain metastatic patients treated with stereotactic radiotherapy (SRT). MATERIALS AND METHODS: Fifty-six consecutive patients with metastatic brain tumors and Karnofsky performance scale (KPS) scores <70 treated with SRT from January 2008 to October 2013 were involved in the analysis. Twenty-five patients (44.6%) were with symptomatic extracranial lesions (SELs), and the other 31 patients (55.4%) were without SELs. The detailed follow-up data of KPS scores were available in 44 patients. The KPS score drop time (KDT) was calculated as the time between SRT and 10 points drop of KPS scores compared to the baseline. Kaplan-Meier and Cox proportional hazards regression analyses were performed for univariate and multivariate analyses. RESULTS: The median overall survival time was 5.0 months (95% confidence interval [CI] 3.42-6.59) for the whole group. In multivariate analysis, the presence of SELs (P = 0.007, relative risk = 4.44, 95% CI 1.036-20.818) was the independent prognosis factor for survival. Median survival time was 3 months for the patients with SELs, 8 months for the patients without SELs. The median KDT of the 44 patients was 3.0 months (95% CI, 1.927-4.073 months). Again only the presence of SELs (P = 0.001, OR = 6.622, 95% CI, 2.108-20.801) was significantly related to KDT in multivariate analysis. The median KDT of the patients with SELs was 1.5 months, which was 5 months for the patients without SELs. CONCLUSION: The presence of SELs was a negative prognosis factor for the survival of RPA Class III brain metastatic patients. If RPA Class III brain metastatic patients were without SELs, SRT may be a reasonable treatment option, but if they had SELs, SRT may not be a reasonable treatment due to the short overall survival time and KDT.

Fractionated stereotactic radiotherapy for small-cell lung cancer patients with brain metastases.

OBJECTIVE: Patients with small-cell lung cancer (SCLC) are at high risk of developing brain metastases (BM). Fractionated stereotactic radiotherapy (FSRT) alone or combined with whole brain radiation therapy can be used to treat intracranial metastases. This study was aimed to explore FSRT for BM from SCLC. MATERIALS AND METHODS: We retrospectively analyzed 45 patients with BM from SCLC treated with fractionated linear accelerator FSRT. Multivariate analysis was used to determine independent risk factors of overall survival (OS). RESULTS: There were 35 patients treated with salvage FSRT and 10 patients treated with primary FSRT. The median OS was 10 months from the beginning of FSRT and 19 months from diagnosis of BM. The median OS of salvage FSRT group and primary FSRT group was 22 and 10 months from the diagnosis of BM, respectively (P = 0.011); 11 and 8 months from FSRT, respectively (P = 0.828). Recursive partitioning analysis class and the stage of the primary tumor were independent predictors of increased OS (relative risk [RR] = 2.634, P = 0.021 and RR = 2.324, P = 0.0210, respectively). CONCLUSIONS: Salvage and primary FSRT were both effective treatment options for BM from SCLC. Salvage and primary FSRT may have different OS from the time of diagnosis of BM.

Fifty percent patients avoid whole brain radiotherapy: stereotactic radiotherapy for multiple brain metastases: a retrospective analysis of a single center.

PURPOSE: To summarize the outcomes of stereotactic radiotherapy (SRT), with or without whole-brain radiotherapy (WBRT), in the treatment of multiple brain metastasis and to explore the status of WBRT and SRT in the management of multiple brain metastasis. METHODS: From May 1995 to April 2010, 98 patients with newly diagnosed, multiple brain metastasis were treated in our center. Forty-four patients were treated with SRT alone for the initial treatment, and 54 were treated with SRT + WBRT. Kaplan-Meier and Cox proportional hazards regression analyses were used for the survival analysis. RESULTS: The median survival time (MST) was 13.5 months. No difference was observed in MST between the SRT and the SRT + WBRT groups (p = 0.578). The Karnofsky Performance Score at the time of treatment (p = 0.025), the interval time between diagnosis of primary tumor and brain metastasis (P = 0.012) and the situation of extracranial disease (p = 0.018) were significant predictors of survival. The crude distant intracranial recurrence (DIR) rates were 47.7 % in the SRT group and 24.1 % in the SRT + WBRT group (p = 0.018). In addition, 52.3 % patients in the SRT group were free from DIR and did not require WBRT in their whole lives. CONCLUSIONS: Our data suggest that use of SRT as the initial treatment while reserving WBRT as the salvage therapy in case of distant intracranial recurrence made about 50 % of the patients avoid WBRT throughout the course of their lives and may be another optional treatment modality for multiple brain metastases.

Hypofractionated stereotactic radiotherapy for brain metastases larger than three centimeters.

BACKGROUND: To evaluate the efficacy and outcomes of hypofractionated stereotactic radiotherapy (HSRT) for brain metastases > 3 cm. METHODS: From March 2003 to October 2009, 40 patients with brain metastases larger than 3 cm were treated by HSRT. HSRT was applied in 29 patients for primary treatment and in 11 patients for rescue. Single brain metastasis was detected in 21 patients. Whole brain radiotherapy was incorporated into HSRT in 10 patients for primary treatment. HSRT boosts were applied in 23 patients. The diameters of the brain metastases ranged from 3.1 to 5.5 cm (median, 4.1 cm). The median prescribed dose (not including HSRT boosts) was 40 Gy (range, 20-53 Gy) with a median of 10 fractions (range, 4-15 fractions) to the 90% isodose line. The median dose of the boost was 20 Gy (range, 10-35 Gy) in 4 fractions (range, 2-10 fractions). RESULT: The median overall survival time was 15 months. The overall survival and local control rate at 12 months was 55.3% and 94.2%, respectively. Four patients experienced local progression of large brain metastases. Nine patients died of intracranial disease progression. One patient died of radiation necrosis with brain edema. CONCLUSION: HSRT was a safe and effective treatment for patients with brain metastases ranged from 3.1 to 5.5 cm. Dose escalation of HSRT boost may improve local control with an acceptable toxicity.

Risk factors of distant brain failure for patients with newly diagnosed brain metastases treated with stereotactic radiotherapy alone.

OBJECTIVE: To explore the risk factors of distant brain failure (DBF) for patients with brain metastasis (BM) who were treated with stereotactic radiotherapy alone and to group the patients on the basis of their risk levels. METHODS AND MATERIALS: We retrospectively analyzed 132 newly diagnosed BM patients who were treated with stereotactic radiotherapy alone from May 2000 to April 2010. Kaplan-Meier and Cox proportional hazards regression analyses were performed for univariate and multivariate analyses. RESULTS: The 1-year incidence rate of DBF was 44.7%, and the median DBF time (MDBFT) was 18 months. In multivariate analysis, the risk factors of DBF were the number of BMs greater than 1 (p = 0.041), uncontrolled extracranial disease (p = 0.005), interval time (IT) of less than 60 months between the diagnosis of primary tumor and BM (p = 0.024), and total volume of BM was greater than 6 cc (p = 0.049). Each risk factor was assigned 1 score. The median survival times for the patients with scores of 0-1, 2-3, and 4 were 31, 12, and 10 months, respectively, and the corresponding MDBFTs were not reached, 13, and 3 months, respectively, (p < 0.001). The crude DBF incidence rates in patients with scores of 0-1, 2-3, and 4 were 14.8%, 50.0%, and 76.9%, respectively, (p < 0.001). CONCLUSIONS: The patients with scores of 0-1 had a lower risk of DBF than the patients with higher scores did, and it may be reasonable to treat these patients with SRS alone and resort to whole-brain radiation therapy only for salvage. The patients with a score of 4 had the highest risk of developing DBF after stereotactic radiotherapy alone, these patients may be candidates for initial whole-brain radiation therapy or clinical trials. The patients with a score of 2-3 had a moderate risk of developing DBF, SRT alone combined with close clinical monitoring would be the optimal treatment regimen for such patients, and for those patients with difficulties in receiving close clinical mornitoring, SRT combined with WBRT will be more suitable.