Early myocardial changes in patients undergoing rheumatic mitral valve repair versus replacement.

BACKGROUND: Rheumatic mitral valve repair and replacement techniques are frequently used with excellent outcomes in experienced centers. This study aims to evaluate the impact of procedural types on left ventricular function in quinquagenarians. METHODS: Between January 2018 and September 2019, patients with severe rheumatic mitral stenosis were prospectively recruited. Propensity score matching was performed to reduce the selection bias. We compared the strain, twist and synchrony parameters of left ventricle in 70 quinquagenarian patients who underwent rheumatic mitral valve repair and replacement 12 hours before surgery, at 7 days and 6 months postoperatively. RESULTS: The overall group displayed significant improvement of left ventricular deformation after rheumatic mitral valve surgery. Compared with patients undergoing posterior chordal-sparing mitral valve replacement, patients undergoing rheumatic mitral valve repair showed more significant amelioration in global longitudinal strain (-18.6% versus -16.2%, P<0.001), twist (18.2° versus 15.9°, P<0.001), torsion (1.8°/cm versus 1.3°/cm, P<0.001), apical rotation (10.5° versus 8.8°, P<0.001), basal rotation (-7.7° versus -7.1°, P=0.049), systolic dyssynchrony index (4.7% versus 5.1%, P=0.021), standard deviation of time to peak longitudinal (46.9 ms versus 49.3 ms, P=0.024) and radial strain (15.8 ms versus 17.1 ms, P=0.037) at 6-month follow-up. CONCLUSIONS: Rheumatic mitral valve repair might provide patients with better postoperative left ventricular performance than posterior chordal-sparing mitral valve replacement. Longer follow-up is required to compare long-term outcomes.

Outcomes of Coronary Artery Bypass and Stents for Unprotected Left Main Coronary Stenosis.

BACKGROUND: This study assessed the short-, medium-, and long-term outcomes of coronary artery bypass grafting vs stenting for patients with unprotected left main coronary artery disease through a meta-analysis of randomized controlled trials. METHODS: PubMed, Embase, Scopus, Web of Science, Cochrane Library, and major conference proceedings databases were systematically searched for randomized controlled trials of coronary artery bypass grafting compared with stents in unprotected left main coronary artery disease. End points assessed were all-cause death, myocardial infarction, major adverse cardiac and cerebrovascular events, target vessel revascularization, and cerebral stroke. A meta-analysis was conducted according to predefined clinical end points. RESULTS: All-cause death and stroke were similar between stenting and coronary artery bypass grafting at 1 year and at follow-up beyond 1 year. The incidence of myocardial infarction was similar between stenting and coronary artery bypass grafting at each separate time point. The incidence of repeat revascularization was similar between the two groups at 30 days but was higher for stenting at 1 year and beyond. There was a trend toward fewer major adverse cardiac and cerebrovascular events after stenting compared with coronary artery bypass grafting at 30 days, but this difference was no longer significant at 1 year and reversed at follow-up beyond 1 year. CONCLUSIONS: The early advantages of stenting over coronary artery bypass grafting have been shown to progressively shift to coronary artery bypass grafting over time. Further larger sample randomized controlled trials are warranted to confirm the results.

A meta-analysis of robotic versus laparoscopic colectomy.

BACKGROUND: Robotics, as an innovation of minimally invasive surgical methods, is developing rapidly for colectomy. But there is still no consensus on its comparative merit compared with laparoscopic resections. We conducted this meta-analysis that included randomized controlled trials and nonrandomized controlled trials of robotic colectomy (RC) versus laparoscopic colectomy (LC) to evaluate whether the safety and efficacy of RC are equivalent to those of LC. METHODS: A search of five databases (PubMed, Embase, Cochrane Library, Ovid, and Web of Science), gray literature, hand searches, reference, and forward citation were performed for studies that compared clinical or oncologic outcomes of LC with RC. Clinical outcomes evaluated were conversion rates, operation times, estimated blood loss, length of hospital stay, and complications. Oncologic outcome evaluated was the number of lymph nodes collected. RESULTS: A total of 14 studies were identified that included 125,989 patients in total, 4934 in the robotic cohort and 121,055 in the laparoscopic cohort. Meta-analysis suggested that there was a significantly longer hospital stay in the laparoscopic group (mean difference [MD] -0.65; 95% confidence interval [CI] -1.02 to -0.27; P = 0.0008). Robotic surgery was associated with a significantly lower complication rate (odds ratio 0.78; 95% CI 0.72-0.85; P ＜ 0.00001) and a significantly shorter time to recovery of bowel function (MD -0.58; 95% CI -0.96 to -0.20; P = 0.003). There were statistically significant differences in estimated blood loss (MD -19.24; 95% CI -29.38 to -9.09; P = 0.0002) and intraoperative conversion to open (odds ratio 0.56; 95% CI 0.44-0.72; P < 0.00001), but not clinical relevant. There were no significant differences in the number of lymph nodes extracted between the two groups. However, operating time (MD 49.25; 95% CI 36.78-61.72; P < 0.00001) was longer for RC than for LC. CONCLUSIONS: RC can be performed safely and effectively with the number of lymph nodes extracted similar to LC. In addition, it can provide potential advantages of a shorter hospital stay, a shorter time to recovery of bowel function, and lower occurrence of postoperative complications. These findings seem to support the use of robotics for the minimally invasive surgical management of colectomy. However, RC had longer operating time. Future studies involving RC should focus on minimizing duration of operation.

Sex-dependent association of phosphodiesterase 4D gene polymorphisms with ischemic stroke in Henan Han population.

BACKGROUND: Recent evidence has implicated the gene for phosphodiesterase 4D (PDE4D) as susceptibility gene for ischemic stroke (IS) in Icelandic population. However, there are few reports on the associations between PDE4D gene polymorphisms and IS in Chinese individuals. The present study aimed to investigate the possible association of genetic polymorphisms in PDE4D gene with IS in Henan Han population. METHODS: A total of 400 patients with IS and 400 matched controls were examined using a case-control design. Two single nucleotide polymorphism (SNPs) (rs918592 and rs2910829) in PDE4D gene were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated to test the association between the genetic factors and IS. Genetic parameter and association studies were carried out with SPSS 16.0. RESULTS: Among the two SNPs tested, the rs918592 was significantly associated with IS (OR: 1.351, 95%CI: 1.110 - 1.645), especially in male patients (OR: 1.427, 95%CI: 1.105 - 1.844). Haplotype analysis showed that A-T was associated with an increased risk of the IS (OR: 2.114, 95%CI: 2.005 - 2.230) while G-T was associated with decreased risk of IS (OR: 0.419, 95%CI: 0.302 - 0.583). Protecting effect of haplotype G-T was also significant in males (OR: 0.264, 95%CI: 0.162 - 0.431). CONCLUSIONS: The present study demonstrated a strong association of rs918592 with IS. Haplotype A-T increased the risk of IS while haplotype G-T had a protective effect in Henan Han population. The association was sex-dependent with male patients showing stronger effect.