الأبحاث والمنشورات

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.