A comparison of neurological event and mortality rates between transcatheter aortic valve implantation and surgical aortic valve replacement.

Introduction: Transcatheter aortic valve implantation (TAVI) is the treatment of choice for patients with symptomatic severe aortic stenosis. Aim: To evaluate the neurological event and mortality rates of TAVI in comparison with those of surgical aortic valve replacement (SAVR). Material and methods: A systematic literature search identified pertinent full-text journal articles published from 2000 to 2022 that were taken as the study materials. Results: Patients were at the age of 79.3 ±2.8 years and 79.9 ±2.9 years at the time of intervention/open surgery in the TAVI and SAVR groups, respectively. Patients' age and preoperative comorbidity rates were similar in both groups. A self-expanding valve prosthesis and a percutaneous transfemoral route were the most commonly used in patients receiving TAVI. The duration of the procedure and the hospital stay were much shorter, and the number of transfused blood units was much lower in the TAVI group than in the SAVR group. No significant intergroup difference was found in the prevalence of postoperative stroke, 1-month all-cause mortality, and 1-month and 1-year cardiovascular mortality rates. However, 1-year all-cause mortality was much lower in the TAVI than the SAVR group. The subgroups of risk stratification showed better outcomes for non-high-risk patients compared with high-risk patients. Conclusions: Irrespective of other postoperative complications of TAVI, this study emphasizes the postoperative major neurological events and mortality. TAVI appears to be superior to SAVR with regard to 1-year all-cause mortality. TAVI is thus recommended for elderly patients with symptomatic severe aortic stenosis at very high surgical risk contraindicated for SAVR.

Tracheal Bronchus in Children.

Tracheal bronchus is an uncommon congenital anomaly. It is often of important significance during endotracheal intubation. In paediatrics with tracheal bronchus, stenosis of trachea and (or) bronchus and the management strategies remain to be further clarified. A comprehensive retrieval of literature since 2000 revealed 43 articles with 334 paediatric patients with tracheal bronchus. The delayed diagnosis rate is 4.1%. Paediatric patients with tracheal bronchus most often present with recurrent pneumonia and atelectasis. In less than one-third of the patients, there was an intrinsic or extrinsic stenosis of the trachea, which warrant a conservative or a surgical treatment. A surgical treatment was performed in 15.3% of the patients, in most of which the operations were for relieving the tracheal stenosis. The surgical outcomes were satisfactory. Paediatric patients with tracheal bronchus with tracheal stenosis and recurrent pneumonia and persistent atelectasis warrant active treatments, and surgical treatments are preferred. No treatment is needed in those with no tracheal stenosis or those with no or mild symptoms. Key Words: Abnormality, Congenital, Thoracic surgery, Tracheal stenosis.

Right Atrial Tumour Thrombus in Advanced Hepatocellular Carcinoma: Surgical Techniques and Prognosis.

Hepatocellular carcinoma (HCC) with right atrium (RA) tumour thrombus is a rare condition but the treatment always poses challenges. Debates remain with regard to the use of cardiopulmonary bypass (CPB) in the surgical procedures. The aim of the present review was to summarise the surgical procedures of RA tumour thrombus removal and to discuss the pertinent indications. Twenty-three articles involving 35 patients were collected and recruited into this study. Surgical operation for HCC was performed in 29 (82.9%) patients and non-surgical operation in 6 (17.1%) patients. RA tumour thrombus removal was performed with the aid of CPB in 25 (71.4%), venovenous bypass in 3 (8.6%), and without CPB in 7 (20%) patients. After tumour thrombus removal, RA or vessel wall reconstruction with a graft was required in 7 (20%) patients. The overall median survival time of this patient cohort was 30.8 months. The median survival time of patients who received a hepatectomy was 30.5 months, in comparison to 6.0 months for those who did not receive a hepatectomy. Aggressive surgical treatment prolongs survival of selective patients with HCC with RA tumour thrombus. CPB is helpful for complete removal of the tumour thrombus from the RA. In patients with tumour thrombus invading the RA or vessel walls, a graft repair is warranted. Key Words: Hepatocellular carcinoma, Inferior vena cava, Right atrium, Tumour thrombus.

Mycotic subclavian artery aneurysms: a scoping review.

Introduction: Mycotic subclavian artery aneurysms (SAAs) are a very rare disorder. Aim: To provide an overview of current knowledge on clinical features, management strategies and outcome evaluations of mycotic SAAs. Material and methods: The study materials were based on comprehensive literature retrieval of publications of mycotic SAAs published between 2000 and 2023. Results: Contaminated mechanical injuries and abscess erosions of the arterial walls are mechanisms of mycotic SAAs. The diagnosis relies on detection of pathogenic microorganisms by cultures or microbiological investigations of blood, other fluids and infected tissues as well as medical imaging visualization. The indications for an interventional therapy were poor general condition, high surgical risk, and rescue exclusion for a ruptured pseudoaneurysm. Three (9.1%) pre-treatment deaths were a result of sudden rupture of the mycotic SAAs and thus they lost the opportunity of treatment. All post-treatment deaths occurred in the interventional patient group, whereas the causes of death seemed to be unrelated to mycotic SAAs per se or to treatments of choice. Patient outcome evaluations revealed no significant difference between different treatments of choice. No significant predictive risk factors were responsible for patient outcomes. Conclusions: Once a diagnosis of mycotic SAA is made, sensitive antibacterial drugs are applied immediately to control the infection and control aneurysmal progression. Early treatment is conducted as soon as possible to avoid aneurysmal rupture. A decision on treatment of choice is made based on the patient's specific condition. Antibacterial drug use is continued for about 6 weeks after surgical or interventional therapy.

Sternal Fractures due to Blunt Chest Trauma.

The present article aimed to give an overview of sternal fractures and discuss their management and prognoses. The retrieved pertinent publications of 2011-2021 constituted the materials of the present study. The misdiagnosis rate of X-ray was 5.5% and that of sonography was 6.3% for diagnosing the sternal fractures. There were more patients with complicated than with isolated sternal fractures (98.8% vs. 1.2%, p<0.001). Sternal fractures were treated surgically in 59.5%, conservatively in 39.7%, and staged conservatively and surgically in 0.8% of patients. Extremity fractures, brain injury, lung contusion, and intraabdominal/intraperitoneal injuries were the most common associated injuries to sternal fractures. A small number of patients with sternal fractures have fracture-related delayed complications, most of which require surgical treatments with good outcomes. For solitary sternal fractures, short-term pain relief is sufficient. Most complicated sternal fractures require surgical treatment by sternal fixation. Intrathoracic injuries, especially life-threatening cardiopulmonary injuries that are complicated to sternal fractures warrant resuscitation and corresponding active treatment. The causes of patients' death with sternal fractures were usually not related to the sternum fracture itself, but mostly to the associated injuries. Key Words: Fracture, Sternum, Trauma.

Percutaneous closure of left ventricular pseudoaneurysm.

The aim of the present study is to describe the indications, treatment effects, and patient outcomes of percutaneous management of left ventricular pseudoaneurysm (LVPA). The study materials were based on comprehensive literature retrieval since 2004. The mechanisms of LVPA formation can be divided into surgical, percutaneous, and medial disease related. Of the surgical mechanisms, coronary artery bypass grafting prevailed. The formation time was the longest in medical disease-related LVPAs up to 44.4 months. The percutaneous procedures succeeded on the first try in 79 (84.9%) patients, whereas failures were encountered during the percutaneous manoeuvres in 14 (15.1%) patients. Percutaneous closure of LVPA was especially indicated for patients carrying a high surgical risk. The iatrogenic traumas, such as left ventricular venting, should be avoided to prevent this complication. The preliminary cut-off valves of oversize 3.3 mm and oversize ratio 1.6 should be followed for reference for device choice.

Pulmonary artery pathologies in Alagille syndrome: a meta-analysis.

Alagille syndrome, caused by mutations in the gene encoding Jagged1 (JAG1), a ligand in the Notch signaling pathway, is an autosomal dominant disorder with developmental abnormalities affecting the liver, heart, eyes, face and skeleton. The aim of the present study is try to disclose the clinical features, management and outcomes of pulmonary artery stenosis associated with Alagille syndrome. By comprehensive literature retrieval, 38 articles involving 401 patients were recruited for this study. The pertinent variables closely related to pulmonary artery stenosis in patients with Alagille syndrome were comprehensively analyzed by following the PRISMA guidelines. The management of pulmonary artery pathologies, especially a severe type of pulmonary artery stenosis in Alagille syndrome, is a concerned matter. Publications of literature retrieval of recent 3 decades were the study material of this article. The pulmonary artery pathologies, especially the severe type of pulmonary artery stenosis in Alagille syndrome, warrant surgical or interventional treatments. After the procedures, the right ventricular to left ventricular pressure ratio was reduced by 25%. There were no intergroup differences in terms of recovery, reintervention and mortality rates between interventionally and surgically treated patients. Transcatheter treatment is preferable due to less trauma. Surgical treatment of pulmonary artery stenosis can be performed currently with intracardiac defect repair.

Surgical treatment of renal cell carcinoma with inferior vena cava tumor thrombus.

PURPOSE: The present report discusses the indications of cardiopulmonary bypass (CPB) in open nephrectomy and surgical outcomes of conventional and minimally invasive surgical techniques for treating advanced renal cell carcinoma with inferior vena cava tumor thrombus. METHODS: The present study involved a comprehensive retrieval of pertinent literature from the most recent two decades. RESULTS: Comparisons between radical nephrectomy procedures in terms of open, laparoscopic and robotic-assisted surgeries revealed that open surgery had more blood loss, a longer operation time and higher mortality rates than laparoscopic and robotic-assisted surgeries. Furthermore, surgery with CPB was associated with more blood loss than non-CPB surgery. Rates of early and late deaths were much higher in patients with CPB than in those without CPB. CONCLUSIONS: Different surgical techniques had different indications in terms of levels of inferior vena cava tumor thrombus. The laparoscopic, robotic-assisted, open surgical techniques and CPB with deep hypothermic circulatory arrest were indicated for Levels I, II, III and III-IV inferior vena cava tumor thrombus, respectively. Laparoscopic and robotic-assisted surgeries cause less trauma than open surgery but require more complicated equipments to support the procedure. CPB should be avoided in radical nephrectomy whenever possible. The increased application of laparoscopic and robotic techniques in the future is anticipated.

Catheter ablation for tachyarrhythmias during pregnancy.

Introduction: Refractory arrhythmias during pregnancy pose challenges to physicians. Aim: To give an overview of catheter ablation for tachyarrhythmias during pregnancy, and to discuss the indications of the procedure and the outcomes of both mother and fetus. Material and methods: The study materials were based on comprehensive literature retrieval of the pertinent articles published since 2000. Results: The indications for catheter ablation were refractory arrhythmias unresponsive to drug therapy in most of the cases followed by requirement of cardioversion. Atrioventricular nodal reentrant tachycardia was the most common arrhythmia developed during pregnancy. Pregnancy complications were present in 2.4% of the cases. There was no mortality among the pregnant patients. Fetal adverse events occurred in 3.1% of the cases, more in the fluoroscopy than in the zero-fluoroscopy group. The patient cohort with a radiation dose of > 50 mGy in one-third of the cases had a 14.3% fetal adverse event rate. Fetal adverse events occurred only in the second trimester, not in the other two trimesters. Conclusions: Drug-refractory and poorly tolerated tachycardias in pregnant patients warrant catheter ablation. Zero-fluoroscopy technique under guidance with three-dimensional mapping systems is preferred and strict minimal fluoroscopy is only used in extreme necessity. As ablation in the second trimester was associated with a probable higher fetal adverse event rate, it is suggested that ablation is preferably performed in the third trimester.

Next-generation sequence-based preimplantation genetic testing for monogenic disease resulting from maternal mosaicism.

BACKGROUND: Mosaicism poses challenges for genetic counseling and preimplantation genetic testing for monogenic disorders (PGT-M). NGS-based PGT-M has been extensively used to prevent the transmission of monogenic defects, but it has not been evaluated in the application of PGT-M resulting from mosaicism. METHODS: Four women suspected of mosaicism were confirmed by ultra-deep sequencing. Blastocyst trophectoderm cells and polar bodies were collected for whole genome amplification, followed by pathogenic variants detection and haplotype analysis based on NGS. The embryos free of the monogenic disorders were transplantable. RESULTS: Ultra-deep sequencing confirmed that the four women harbored somatic mosaic variants, with the proportion of variant cells at 1.12%, 9.0%, 27.60%, and 91.03%, respectively. A total of 25 blastocysts were biopsied and detected during four PGT cycles and 5 polar bodies were involved in one cycle additionally. For each couple, a wild-type embryo was successfully transplanted and confirmed by prenatal diagnosis, resulting in the birth of four healthy infants. CONCLUSIONS: Mosaic variants could be effectively evaluated via ultra-deep sequencing, and could be prevented the transmission by PGT. Our work suggested that an NGS-based PGT approach, involving pathogenic variants detection combined with haplotype analysis, is crucial for accurate PGT-M with mosaicism.

Novel homozygous truncating variants in ZMYND15 causing severe oligozoospermia and their implications for male infertility.

Sequence variants of ZMYND15 cause azoospermia in humans, but they have not yet been reported in infertile men with severe oligozoospermia (SO). We performed whole-exome and Sanger sequencing to identify suspected causative variants in 414 idiopathic participating infertile men with SO or azoospermia. Three novel homozygous truncating variants in ZMYND15 were identified in three of the 219 (1.37%) unrelated patients with SO, including c.1209T>A(p.Tyr403*), c.1650delC (p.Glu551Lysfs*75), and c.1622_1636delinsCCAC (p.Leu541Profs*39). In silico bioinformatic analyses as well as in vivo and in vitro experiments showed that the ZMYND15 variants carried by the affected subjects might be the underlying cause for their infertility. One patient accepted intracytoplasmic sperm injection therapy, using his ejaculated sperm, and his wife successfully became pregnant. Our findings expand the disease phenotype spectrum by indicating that ZMYND15 variants cause SO and male infertility and suggest a possible correlation between the severity of male infertility caused by ZMYND15 variants and male age.

Hoarseness Due to Aortic Arch Aneurysms.

OBJECTIVE: To give an overview of the Ortner's syndrome caused by an aortic arch aneurysm. METHODS: By comprehensive retrieval of the pertinent literature published in the past two decades, 75 reports including 86 patients were collected and recruited into this study along with a recent case of our own. RESULTS: The aortic arch aneurysms causing hoarseness were most commonly mycotic aneurysms. In this patient setting, in addition to the left recurrent laryngeal nerve, trachea was the most commonly affected structure by the aortic arch aneurysm. Surgical/interventional/hybrid treatments led to a hoarseness-relieving rate of 64.3%, much higher than that of patients receiving conservative treatment. However, hoarseness recovery took longer time in the surgically treated patients than in the interventionally treated patients. CONCLUSION: The surgical and interventional treatments offered similar hoarseness-relieving effects. Surgical or interventional treatment is warranted in such patients for both treatment of arch aneurysms and relief of hoarseness.

Hoarseness due to aortic arch aneurysms

Abstract Objective: To give an overview of the Ortner's syndrome caused by an aortic arch aneurysm. Methods: By comprehensive retrieval of the pertinent literature published in the past two decades, 75 reports including 86 patients were collected and recruited into this study along with a recent case of our own. Results: The aortic arch aneurysms causing hoarseness were most commonly mycotic aneurysms. In this patient setting, in addition to the left recurrent laryngeal nerve, trachea was the most commonly affected structure by the aortic arch aneurysm. Surgical/interventional/hybrid treatments led to a hoarseness-relieving rate of 64.3%, much higher than that of patients receiving conservative treatment. However, hoarseness recovery took longer time in the surgically treated patients than in the interventionally treated patients. Conclusion: The surgical and interventional treatments offered similar hoarseness-relieving effects. Surgical or interventional treatment is warranted in such patients for both treatment of arch aneurysms and relief of hoarseness.

Parachute Mitral Valve: Anatomy and Operation.

Parachute mitral valve is a rare congenital heart defect characterised by a distorted mitral geometry with a single papillary muscle for all mitral chords to attach. It may develop in isolation or as a constillation of Shone syndrome. By comprehensive retrieval of the pertinent articles published since 2000, 22 articles with 149 cases of parachute mitral valve were recruited into this study. The present article revealed that most patients with a parachute mitral valve had a stenotic or regurgitant mitral valve, which is often associated with left heart obstructions, thereby leading to haemodynamic compromise. Therefore, multiple surgical maneuvers are warranted for such patients. Mitral valve repair is preferred over mitral valve replacement for the mitral valve abnormalities so as to avoid the associated complications of valve replacement procedure. The patients' outcomes are satisfactory with a total event-free survival of surgical patients of 84.8%. Key Words: Cardiac surgical procedures, Congenital heart defects, Mitral valve.

Parachute tricuspid valve: a systematic review.

BACKGROUND: A parachute tricuspid valve is a very rare congenital cardiac anomaly. Its morphological features and clinical implications have not been sufficiently described so far. The purpose of the present systematic review is to disclose the morphological and clinical characteristics of parachute tricuspid valve, and to discuss its diagnostic methods, treatments and patients' outcomes. MAIN BODY: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines were followed in this systematic review. Publications were systematically searched in the PubMed, Highwire Press, and the Cochrane Library databases. By comprehensive retrieval of the pertinent literature published between 1979 and 2019, 13 reports were collected with 14 patients recruited into this study. Their ages ranged from neonate to 52 years old with a median age of 23 years. Tricuspid valve regurgitation of a less-than-severe degree was seen in 6 (60%) patients, tricuspid valve stenosis was present in 3 (30%) patients and normally functioning tricuspid valve was noted in 1 (10%) patient. All patients had a single papillary muscle in the right ventricle. The chordae tendineae could be normal in length and thickness, or elongated, or shortened and thickened. Forty percent of the patients were asymptomatic or with only mild symptoms and did not need a surgical or interventional therapy, and 6 (60%) patients were indicated for a surgical/interventional treatment due to their severe presenting symptoms, associated congenital heart defects, and the resultant severe right ventricular inflow obstruction and (or) tricuspid stenosis. Patients' outcomes varied depending on the substantial status of the patients with a survival rate of 70% and mortality rate of 30%. CONCLUSION: A few patients with a parachute tricuspid valve are asymptomatic or only with mild symptoms and a surgical or interventional treatment is not required. The surgical/interventional indications for parachute tricuspid valve patients are their severe presenting symptoms, associated congenital heart defects, and the resultant severe right ventricular inflow obstruction and (or) tricuspid stenosis. The survival rate of this patient setting is satisfactory.

Coronary Artery Bypass Grafting in Patients with Systemic Lupus Erythematosus.

Surgical treatment of coronary artery disease in the systemic lupus erythematosus (SLE) patients has not been comprehensively addressed. The present review aimed to give an overview of coronary artery disease in the SLE patients receiving coronary artery bypass grafting (CABG). The study materials were based on comprehensive literature retrieval, which recruited 17 pertinent articles with 30 patients. No differences were found in the graft patencies between the arterial and venous grafts; and between the early and late patency rates. Pathological inspections revealed that all graft vessels were normal with no signs of SLE-related atherosclerosis or vasculitis, one coronary artery was pathologically normal, and another coronary artery showed vasculitis. The coexisting disorders, including diabetes mellitus, hyperlipidemia, and nephropathy in the SLE patients cause early deterioration of the saphenous vein grafts. Early occlusion of the saphenous vein grafts was also observed in SLE patients. The left anterior descending coronary artery was most commonly affected by SLE and was the most common coronary artery requiring a CABG procedure. The graft vessels, both arterial and venous, rarely degenerated; whereas, early and late graft failure was usually caused by technical failures. The lack of vasculitis and atherosclerosis in the arterial grafts encourage surgeons to prefer to use the arterial grafts in SLE patients. Less invasive surgical technique would favour the patients in terms of long-term outcomes. Key Words: Coronary artery bypass grafting, Graft occlusion, Vascular, Systemic lupus erythematosus.

Interleukin-6 in Patients with Cardiac Myxoma.

The relationships between interleukin (IL)-6 and cardiac myxoma remain to be clarified. This article systematically reviewed the IL-6 properties in cardiac myxoma patients based on retrieval of pertinent literature published between 1998 and 2018. Significant differences were found in circulating IL-6 values between preoperation and 1 and 6 months after operation. Preoperative circulating IL-6 correlated significantly with tumour volume (r=0.8552, p=0.003), while there were no significant correlations with maximal tumour dimension (r=0.2443, p=0.190). No correlation was found between circulating IL-6 at 1 and 6 months after tumour resection with either tumour volume or with maximal tumour dimension. The positive rate of immunostaining of IL-6 in cardiac myxoma tissues was 93.3%. Overproduction of IL-6 is responsible for the inflammatory presentations, constitutional symptoms, and recurrence and distal embolisation of cardiac myxoma. Cardiac myxoma could be a cellular source of IL-6 release. Cardiac myxoma resection is an absolute choice of eliminating IL-6 production in these patients. Key Words: Cardiac surgical procedures, Cytokines; Inflammation, Interleukin-6, Neoplasms.

Post-cardiac Surgery Chylopericardium.

Post-cardiac surgery chylopericardium is a rare complication. This systematic review included 87 articles with 119 patients of post-cardiac surgery chylopericardium. Chylopericardium developed after operations for congenital heart defect more than those for acquired heart disease, and more patients in whom post-cardiac surgery chylopericardium developed were with complex than with simple congenital heart defects. Cardiac tamponade occurred in 35 (29.4%) patients. The onset time of chylopericardium was 18.2 days earlier in patients operated for acquired than in those for congenital heart defects. Post-cardiac surgery chylopericardium were curable to conservative treatment in most patients. The recurrence of post-cardiac surgery chylopericardium was on day 13.2 ±18.2 after the initial treatment. The overall early and late mortality rates were 1.7% (2/119) and 1.7% (2/117), respectively. Most patients with post-cardiac surgery chylopericardium were diagnosed by laboratory analysis of chylous fluid. Patients with mild chylopericardium usually show good response to conservative treatment. Whereas, patients with massive chylopericardium and rapid accumulation, incurable to conservative treatment and recurrent to either conservative or surgical treatment, warrant further surgical treatment. Key Words: Cardiac surgical procedures, Pericardial effusion, Postoperative complications.

Fetal Intrapericardial Teratomas: An Update.

Fetal intrapericardial teratomas are rare and benign cardiac tumors. By comprehensive literature retrieval of the pertinent articles published since 2000, 49 articles with 61 cases of intrapericadial teratomas were recruited into this study. The intrapericardial teratomas were found during pregnancy in 55 cases (fetal group), while the tumors were detected until neonatal period in 6 cases (neonatal group). In the fetal group, 15 cases were critical with fetal/neonatal respiratory distress or cardiac tamponade. Antenatal treatments including centesis, shunt placement, open fetal surgery and the ex utero intrapartum treatment were required in 24 (43.6%) fetal cases. Postnatal intubation was required in 19 cases with 18 of them having immediate intubation after birth. Postnatal tumor resection was performed in 41 (95.3%) cases. In neonatal group, 4 neonates had respiratory distress and/or cardiac tamponade. Neonatal intubation was required in 1 (16.7%) patient. Surgical tumor resection was performed in all 6 patients. A comparison between the fetal and neonatal groups revealed that the fetal group was associated with higher refractory effusions while the neonatal group had a higher incidence of respiratory distress. Although the all cause death rate was higher in the fetal group than in the neonatal (25.5 vs. 0%), but lack of a statistical significance. Antenatal treatments for fetal intrapericardial teratomas are feasible but carry higher risks in comparison to neonatal cases.

Harmonic Scalpel for Internal Mammary Artery Harvest.

Internal mammary artery (IMA) harvest by using a harmonic scalpel for coronary artery bypass grafting (CABG) have not been sufficiently evaluated. This review aimed to assess the outcomes of IMA harvest by a harmonic scalpel and to compare by conventional electrocautery. The study materials were based on literature retrieval. In total Eight articles describing IMA harvest by a harmonic scalpel for 1,893 patients, and pateints with IMA harvest by electrocautery were taken as controls. IMA harvest by a harmonic scalpel was associated with less thermal injury with potentially better preservation of the endothelial cells, satisfactory intraoperative IMA flow, and promising postoperative IMA patency. Apart from the harvesting merits, the harmonic scalpel had many other advantages in terms of clinical outcomes, such as decreased postoperative mortality and morbidity rates. Nevertheless, IMA harvesting by using a harmonic scalpel is associated with longer harvest time, prolonged operative time, and increased hospitalisation expenses. Therefore, they could be used in selected and non-emergent patients for CABG. Key Words: Coronary artery bypass grafting, Internal mammary artery, Surgical instruments.