Research & Publications

Background
To compare overall and hemocompatibility-related outcomes across third-generation centrifugal-flow HeartMate 3 (HM3) versus second-generation axial-flow HeartMate II (HMII) and centrifugal-flow HeartWare (HVAD) in routine clinical practice.

Methods
We conducted a multicenter observational cohort of adult LVAD recipients (n = 327: HVAD n = 112, HMII n = 142, HM3 n = 73). Baseline characteristics and perioperative variables were recorded. Overall survival was analyzed using Kaplan–Meier and Cox proportional hazards models with HM3 as reference. Hemocompatibility-related adverse events (HRAE; pump thrombosis, ischemic stroke, major bleeding) were assessed with cumulative incidence functions (Aalen–Johansen) and Fine–Gray competing-risk regression with death as a competing event; the hemocompatibility score (HCS) summarized event burden over follow-up.

Results
HM3 demonstrated superior long-term survival compared with both HMII and HVAD in Kaplan–Meier analyses (log-rank p 

(1) Background: Prosthesis–patient mismatch (PPM) after aortic valve replacement (AVR) impairs left ventricular (LV) recovery and is more common in women due to smaller aortic dimensions. Although the Perceval sutureless valve provides larger effective orifice areas, sex-specific PPM outcomes remain unclear. This study evaluated sex-related differences in PPM incidence, severity, and early impact after Perceval AVR. (2) Methods: We retrospectively analyzed 139 patients (68 males, 71 females) who underwent Perceval AVR between 2016 and 2020. PPM was defined per Valve Academic Research Consortium-3 (VARC-3) criteria using indexed effective orifice area (EOAi) and stratified by body-mass-index (BMI) (

Background: The standard approach for mitral valve surgery was a sternotomy, but with the new trends, mitral valve surgery can now be performed with right mini thoracotomy incision. Minimally invasive mitral valve surgery has demonstrated superior cosmetic outcomes, less surgical trauma, shortened intensive care unit and hospital stays, cost effectiveness, and faster recovery, while the efficacy is comparable to conventional sternotomy. Objective: The aim of this research is to investigate the short-term outcomes of thoracoscopic minimally invasive mitral valve replacement in comparison with the conventional technique. Subjects and Methods: This study included 100 patients with isolated mitral valve disease, who were randomly divided into two equal groups. Group A underwent a right anterolateral video-assisted mini-thoracotomy, while Group B was approached via a conventional median sternotomy. Results: The minimally invasive group had significantly longer total operative time (291.3±48.89 min vs. 227.68±49.18 min, p = 0.001). However, Group A demonstrated better post-operative outcomes, including shorter ICU stay (2.1±1.07 vs. 3.82±1.49 days, p = 0.002), shorter extubation time (4.24±1.12 vs. 8.45±4.55 hours, p = 0.0001), reduced post-operative blood loss (271.7±107.09 ml vs. 449.2±230.93 ml, p < 0.0001). Post-operative pain scores were significantly lower in Group A (VAS 3.84±1.53 vs. 7.58±1.62, p < 0.0001), and hospital stay was shorter (7.22±1.37 vs. 11.21±3.53 days, p < 0.0001). Conclusions: Minimally invasive mitral valve surgery can be a safe and effective alternative to traditional MVS in patients with mitral valve disease.

BackgroundProsthesis-patient mismatch (PPM) is linked to a poor prognosis following surgical aortic valve replacement (SAVR). The exploration of sex differences in PPM outcomes is currently limited. This study seeks to assess the sex-specific effects of PPM following SAVR was rapid deployment AV (RDAVR) prosthesis the Edwards Intuity.MethodsFrom 2018 to 2023, a total of 256 patients (60 females and 196 males) who received isolated or combined RDAVR at our institution were included. The definition of PPM was established through the use of the indexed effective orifice area (EOAi) in accordance with the Valve Academic Research Consortium-3 (VARC-3) criteria. A Multivariate logistic regression was performed to identify predictors of any degree PPM.ResultsFemale had higher left ventricular ejection fraction preoperatively (p = 0.018). The incidence of any PPM-degree for patients with BMI <30 kg/cm2 was significantly higher in female than in male [33 (55%) vs. 26(13.3%), p < 0.001]. The same was noted for the incidence of PPM in patients with BMI ≥30 kg/cm2 [7 (11.7%) vs. 4 (2.0%), p = 0.004]. And the incidence of severe PPM (EOAi ≤0.65 cm2/m2) for patients with BMI <30 kg/cm2 was 16.7% in females vs. 0 in males (p < 0.001). The in-hospital mortality did not differ between males and females. In the multivariate logistic regression, we could not identify independent predictors of PPM.ConclusionsIn Patients receiving RDAVR, the incidence of PPM was significantly higher in female than in male. However, we did not find a correlation with early clinical outcomes. The incidence of severe PPM after RDAVR was low in both females and males. Due to differences in geometry and function of the LV in women, further studies are necessary to indicate whether the definition of PPM in men may adhere to elevated EOAi thresholds compared to women.

Background: Perioperative right ventricular (RV) dysfunction is a frequent complication of cardiac surgery linked to poor outcomes and may result from the loss of pericardial support. We investigated whether pericardial closure preserves early postoperative RV function. Methods: We compared patients with pericardial closure versus open pericardium. Co-primary endpoints were early postoperative RV longitudinal function by tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (TASV). Adjusted comparisons used analysis-of-covariance (postoperative value adjusted for baseline) with prespecified covariates (baseline outcome, LV global longitudinal strain, left-ventricular ejection fraction, LVEDVI, sex, procedure; cardiopulmonary bypass and cross-clamp times when available). Holm correction-controlled multiplicity across the co-primary endpoints. Sensitivity linear mixed-effects models (time × group) were performed. Results: Pericardial closure was associated with better early RV longitudinal function after multivariable adjustment. TAPSE: adjusted mean difference (AMD, Closed–Open) 1.531 mm (95% CI 0.130–2.931; p = 0.033). TASV: AMD 1.694 cm/s (95% CI 0.437–2.951; p = 0.009; Holm-adjusted p = 0.018). Sensitivity analyses yielded consistent estimates. Conclusions: Pericardial closure was independently associated with improved early RV longitudinal function. These adjusted findings address baseline LV imbalances and support considering closure to preserve RV performance; confirmation in prospective trials is warranted.

Introduction and importance: Empyema necessitans is a rare and severe complication of pleural effusion characterized by the extension of purulent material from the pleural cavity into the surrounding soft tissues, resulting in the formation of a subcutaneous abscess. Case presentation: A one-year-old boy presented with symptoms that were in line with empyema necessitans, and Escherichia coli was shown to be the causative organism. A successful outcome required early detection, rapid diagnosis, and proper management, which included targeted antibiotic medication and drainage of the pleural collection. When a young patient exhibits a growing chest wall swelling, empyema necessitans should be considered in the differential diagnosis. Clinical discussion: The best care for individuals with empyema necessitans requires a multidisciplinary approach comprising pediatricians, thoracic surgeons, infectious disease experts, and interventional radiologists. Escherichia coli infection requires a comprehensive approach involving antibiotic therapy and surgical intervention if necessary. Conclusion: Empyema necessitans in pediatric patients, caused by Escherichia coli , is an infrequent disease that requires more investigation to enhance our understanding of the associated risk factors, optimal treatment modalities, and potential long-term consequences. Highlights

Background Nodular fasciitis (NF) is a rare non-neoplastic inflammatory tumor and usually presents as a painless, rapidly growing subcutaneous soft tissue mass. The head and neck are relatively common locations for nodular fasciitis, particularly in children. NF in the trachea is rare and may evolve to a fatal condition, especially due to its rapidly growing nature that can cause life-threatening tracheal obstruction. Case presentation We report the case of a 5-year-old child with NF in the trachea and subtotal tracheal obstruction. Bronchoscopy and biopsy proved the diagnosis, and bronchoscopic excision of the tumor was performed. Conclusions NF is a rare airway tumor, occurring mostly in adults, and may presenting with pneumonia-like symptoms. Early detection of the lesion is essential to avoid life-threatening airway obstruction.

Background: Minimally invasive mitral valve surgery (MIMVS) is associated with less surgical trauma. However, its advantages over the conventional approach are controversial. This study aims to compare the early postoperative pain, hospital stay, and pulmonary function between minimally invasive and conventional mitral repair. Methods: Fifty patients with non-ischemic mitral valve disease who had mitral valve repair between 2017 and 2019 were included in the study. Patients were randomly divided into two equal groups. Group A (n=25) included patients who had minimally invasive mitral valve repair via anterolateral mini-thoracotomy with video assistance, and Group B (n=25) included patients who had mitral valve repair via median sternotomy. Results: The cross-clamp (99.45±16.01 vs. 87. 5±19.16 min; p= 0.058) and the total bypass times (134.08±27.38 vs. 120.71±22.18 min; p= 0.35) were nonsignificantly longer in Group A. Operative time was significantly longer in Group A (207.08±44.31 vs. 173.54±28.25 min; p= 0.001). The ICU stay in Group (A) was 2.58±1.44 days, and in Group (B), the ICU stay was 3.75±1.77 days (p= 0.001). The hospital stay was 7.87±1.59 days in Group A, and 14.5 ±5.05 days in Group B (P<0.001). Postoperative FEV1 was  2.06±0.63 L in Group A and 1.39±0.43 L in Group B (p= 0.001). There was no difference in postoperative ejection fraction between both groups (p= 0.9). Conclusion: Minimal invasive mitral valve repair could reduce postoperative pain, length of ICU, and hospital stay and improve the postoperative respiratory function when compared to the conventional approach.

Background
Overall, coronary artery bypass graft (CABG) surgery achieves excellent outcomes regarding anginal relief and resumption of normal activities. In general, completeness and stability of revascularization are superior with surgical revascularization versus percutaneous interventions.
This study aimed at assessment of the early postoperative outcome of the first 100 CABG cases grafted in the cardiothoracic surgery department, Qena university hospital, Qena, Egypt.
Results
This study was conducted on 100 patients with coronary artery disease. Only 5 patients had single vessel disease and 95 patients had multi-vessel disease, two or more. No one had left main disease. There was a great prevalence of diabetes mellitus (55%), hypertension (69%), dyslipidaemia (55%) and smoking (58%). Operatively, we used left internal mammary artery to left anterior descending coronary artery anastomosis in the majority of cases. In only two cases, right internal mammary artery was used, and great saphenous vein graft was used in anastomosis of remaining diseased vessels. Most cases underwent elective CABG. An intra-aortic balloon pump was used only in 2% of cases. Septicaemia was a significant complication. After 6 months, 97% of the patients were alive.
Conclusions
Institutional results are essential to enable surgeons and interventionists to decide if international data is keeping with local findings or not. However, the likenesses between international data and our results confer confidence in our findings.

Background
Early diagnosis and management of traumatic diaphragmatic hernia (TDH) can be challenging for the emergency department or the trauma surgeon, as these injuries are often clinically masked by other associated severe injuries.
Methods
We retrospectively reviewed data of 50 patients diagnosed with an acute traumatic hernia from September 2014 to September 2017.
Results
50 patients were included in this study. Blunt trauma was the main cause in 40 patients (80%) patients. TDH occurred more on the left side; in 72% of patients. The diagnosis was preoperative in 20 patients (40%). In our study, 74% of cases were repaired through abdominal approach and 26% patients through thoracic approach. Complications of TDH occurred in 30 patients (60%) and were mainly pneumonia in 16 patients (32%), only 8 patients (16%) died (6 patients of them had delayed referral and 3 patients of them had severe head injury).
Conclusions
TDH may be masked by associated injuries in multiple trauma patients and may lead to life-threatening intestinal and gastric strangulation. So, early diagnosis and treatment of TDH are important. Emergency physicians and trauma surgeon should maintain a high index of suspicion of TDH while dealing with patients assessed for abdominal or respiratory symptoms regardless the history of trauma was recent or delayed.