Isolated and concomitant minimally invasive minithoracotomy aortic valve surgery.

OBJECTIVE: To evaluate whether the outcomes of minimally invasive aortic valve surgery were similar in younger versus older patient groups, as well as whether concomitant minimally invasive aortic valve replacement (AVR) surgeries added significant risks in these populations. METHODS: We performed a single-institution retrospective analysis of 1018 patients undergoing isolated AVR and 378 patients undergoing concomitant AVR procedures over a 6-year period. All surgeries were via a right minithoracotomy approach, and patients who underwent reoperation were excluded. RESULTS: Mortality was 1.3% in the isolated AVR group and 3.2% in the concomitant AVR group. The incidence of permanent stroke was low in both the isolated and concomitant AVR groups (0.8% and 1.1%, respectively). In both groups, femoral cannulation was associated with equally low stroke rates (0.8% and 0.6%, respectively). When analyzing operative outcomes by age, mortality was similar for the isolated AVR group (age <80 vs ≥80 years, 0.9% vs 2.2%; P = .07) and the concomitant AVR group (<80 vs ≥80 years, 3.2% vs 3.2%; P = .99), whereas transfusion requirements, intensive care unit and hospital lengths of stay, and atrial fibrillation rates were greater in the older subsets of both AVR groups. CONCLUSIONS: Minimally invasive right thoracotomy AVR surgery was associated with low stroke and mortality rates in all age groups within 30 days of surgery. Similarly, minithoracotomy concomitant AVR surgery demonstrated excellent results and is deemed feasible in patients with multiple pathologies.

Minimally invasive aortic valve replacement in octogenarians performed via a right anterior thoracotomy approach.

BACKGROUND AND AIM OF THE STUDY: A significant number of patients aged > or =80 years are denied aortic valve surgery due to the assumption of poor outcomes with surgery. The study aim was to evaluate the outcomes of minimally invasive aortic valve replacement (AVR), performed via a right anterior thoracotomy approach, in octogenarians. METHODS: A retrospective review was conducted of all minimally invasive isolated AVRs in patients aged > or =80 years performed at the authors' institution between February 2009 and April 2014. The operative times, postoperative complications, hospital length of stay and mortality were analyzed. RESULTS: A total of 255 consecutive patients (133 males, 122 females; mean age 83.5 +/- 3 years) was identified. The mean left ventricular ejection fraction was 57 +/- 10%, and 31 patients (12.2%) had prior cardiac surgery. The median predicted Society of Thoracic Surgeons mortality score was 3.2% (IQR 2.4-4.4%). Postoperatively, four patients (1.6%) had cerebrovascular accidents, 38 (14.9%) had prolonged ventilation, four (1.6%) required reoperation for bleeding, and eight (3.1%) had acute kidney injury. The median intensive care unit length of stay was 48.5 h (IQR 27-92 h) and the postoperative length of stay was 7 days (IQR 5-9 days). The 30-day mortality was 3.1% (n=8), and the combined end point of morbidity and mortality was 19.2% (n=49). The all-cause mortality at one and three years was 6.7%, and 10.2%, respectively. CONCLUSION: Minimally invasive AVR in octogenarians, performed via a right anterior thoracotomy approach, is associated with a low morbidity and mortality. This applies to both primary or reoperative surgery.

Nativity Status and Depressive Symptoms among Hispanic Young Adults: The Role of Stress Exposure.

OBJECTIVE: This article documents nativity differentials in depressive symptoms among Hispanics during their initial years of adulthood and explores how ethnicity, socio-demographic characteristics, and exposure to stressful life events and changes in social roles help to explain those differentials. METHODS: Data is drawn from a large-scale two-wave community study of stress, psychiatric well-being, and substance use disorders among young adults. Our analytic sample includes 553 Hispanic respondents and we employ multivariate regression techniques. RESULTS: Regardless of age at immigration, foreign-born women experience greater declines in depressive symptoms than native-born women during early adulthood. This advantage is explained by differences in perceptions of discrimination, family-based stress, and social role changes. The association between nativity and depressive symptoms is not conditioned by ethnicity, but ethnicity does condition the association between stressful events and depressive symptoms. CONCLUSIONS: The findings suggest that mental health treatment and prevention efforts should focus more heavily on stress exposure.

Risky sexual behaviors among Hispanic young adults in South Florida: nativity, age at immigration and gender differences.

CONTEXT: U.S. Hispanics are disadvantaged compared with whites in regard to sexual health, particularly early sexual initiation and contraceptive use. It is unclear whether differences in nativity and immigration are associated with risky sexual behaviors. METHODS: Data collected between 1998 and 2000 from a community sample in South Florida were analyzed to examine sexual behaviors among 709 Hispanic individuals aged 18-23. Associations between nativity and age at immigration and sexual behaviors were assessed separately by gender using chi-square tests and analyses of covariance. RESULTS: Smaller proportions of sexually experienced women who had immigrated to the United States before age six than of similar U.S.-born women reported having had vaginal sex (83% vs. 91%) and oral sex (71% vs. 86%) in the past year. Compared with U.S.-born women, those who had immigrated at age six or older reported lower levels of oral sex (66% vs. 86% of those with sexual experience) and drug use in conjunction with sex in the past year (mean score, 1.2 vs. 1.6 on a scale of 1-5), and a lower average lifetime number of sexual partners (2.0 vs. 3.7 in the sample overall). Immigrant men were no less likely than U.S.-born men to engage in risky sexual behavior. CONCLUSIONS: Given the diversity of nativity and immigration histories among Hispanics in the United States, it is important that research examine both factors. An understanding of their joint association with sexual activity, plus the conditioning effects of gender, could help professionals to develop effective education and prevention programs for young people who are at risk for engaging in potentially dangerous sexual behavior.