Totally endoscopic, robotic-assisted tricuspid valve repair and biatrial CryoMAZE.

We describe in detail our technique for totally endoscopic, robotic-assisted tricuspid valve repair for iatrogenic tricuspid regurgitation and biatrial cryoMAZE.

Cardiac Surgeons' Treatment Approaches for Infective Endocarditis Based on Patients' Substance Use History.

U.S. cardiac surgeons encounter complex decision-making when treating patients with injection drug use-associated infective endocarditis (IDU-IE). We evaluated surgeons' treatment approaches for IDU-IE compared to non-IDU-IE. This is an anonymous survey of U.S. cardiac surgeons who answered hypothetical infective endocarditis (IE) clinical scenarios that varied based on patient substance use history, addiction treatment, and history of IE. Treatment approaches were classified as operative vs nonoperative. Responses were descriptively analyzed. The survey response rate was 8.7% (n = 208). Survey respondents were mostly male (85.6%) and non-Hispanic white (67.8%), but were from all regions of the United States. Surgeons reported they would operate at similar proportions for patients with native valve non-IDU-IE (63%) and IDU-IE engaged in methadone treatment (64.5%). Most surgeons reported they would operate on patients with recurrent non-IDU-IE (93.1%) compared to only 26.4% for patients with recurrent IDU-IE (P < 0.001). Most surgeons reported they would place no limits on the number of operations for patients with recurrent non-IDU-IE (73.1%), whereas 83.5% of surgeons would limit the number of surgeries for patients with recurrent IDU-IE (P < 0.001). Most respondents reported having declined to operate on patients with IDU-IE (63.5%). Cardiac surgeons are less likely to report favoring operative management for primary and recurrent infection in patients with IDU-IE, though patient engagement in methadone treatment increased the likelihood of them taking an operative approach. There is opportunity to standardize the care, including addiction treatment, of patients with IDU-IE to optimize positive short and long-term outcomes.

Combined Valve Operations in the Aortic and Mitral Positions With or Without Added Tricuspid Valve Repair.

There is limited clinical evidence on when to address tricuspid regurgitation in patients with aortic and mitral valve disease requiring surgical intervention. In this study, we aimed to investigate the potential added value of performing a tricuspid valve repair concomitantly in patients requiring double valve surgery (DVS) of the aortic and mitral valves. We reviewed 223 cases of multivalve surgery from 2011 to 2016. In this single-institution series, 190 underwent DVS in aortic and mitral positions and 33 had triple valve surgery in aortic, mitral, and tricuspid positions. Preoperative and postoperative echocardiograms were evaluated to determine changes in valve function. A logistic regression model was performed to assess relationship of patient comorbidities and type of valve operations to perioperative adverse events. Mid-term survival was similar between the 2 groups (P = 0.541). Compared to DVS, TVS was not associated with an increased risk of perioperative adverse events, including need for pacemaker or mortality on multivariable analysis. Within the DVS subgroup, 19.8% of patients experienced improvement in tricuspid valve function with decrease in the degree of tricuspid regurgitation within a 6-month postoperative follow-up. Our study indicates that repairing the tricuspid valve while addressing the aortic and mitral valves does not pose significant additional risk. The observed improvement of the degree of tricuspid regurgitation without tricuspid operation suggests the need to further define subpopulations of patients with multivalvular disease.

Infections in patients with multiple myeloma treated with conventional chemotherapy: a single-center, 10-year experience in Pakistan

ABSTRACT Introduction: Multiple myeloma (MM) is a common hematologic malignancy with variable degrees of immunodeficiency. Disease- and treatment-related compromise of the immune system predisposes patients to infections, which are a major cause of morbidity and mortality. Objective: We aimed to establish the incidence and main characteristics of infections in MM patients treated at our center over a 10-year period. Method and results: Of the 412 patients retrospectively analyzed, 154 (37.4%) were documented to have at least one episode of infection and were included in this study. A total of 244 infectious episodes were documented. The most common site of infection was the lung, followed by the genitourinary system. The most common infections were bacterial, followed by viral. Escherichia coli were the most common organism. In 160 (65.5%) episodes, the organism was not isolated. Thalidomide with dexamethasone was the most common treatment regimen, followed by melphalan with dexamethasone. Infection was the main cause of death in 26 (6.3%) out of all 412 patients. Conclusion: Infections are a notable cause of morbidity and mortality in the clinical course of MM patients. By considering patient and disease characteristics, a risk-adapted selection of the MM treatment should be employed, with special attention toward patient age and disease-associated organ dysfunction. Patient education, access to healthcare and physician vigilance are also essential. Vaccination and antimicrobial prophylaxis may be considered prior to or during therapy.