Sutureless bioprosthetic valves demonstrate improved hemodynamic performance compared with stented valves in elderly patients with small aortic annulus, providing better regression of left ventricular hypertrophy and decreased rates of patient-prosthesis mismatch. Aortic cross-clamp and cardiopulmonary bypass times are also decreased.

Renal injury severity after nephron sparing surgery could be quantitatively assessed by measuring urinary NGAL and KIM-1.

Combined analysis of uNGAL and uKIM-1 allowed high prediction rate of the histologic subtype of the radiographic-detected masses among cases with kidney cancer. These biomarkers may enable to select the proper therapeutic agents in cases with metastatic disease without the need of pretreatment biopsy.

Routine water-soluble enema for the evaluation of colorectal anastomosis before ileostomy takedown does not provide additional information that changes patient management. The efficacy of this test in patients after neoadjuvant chemoradiotherapy and low anterior resection should be reassessed.

Background: The life expectancy of hemophiliacs is similar to that of the general population. As a result, the prevalence of age-related cardiovascular diseases has increased. We present our experience with hemophilia patients who underwent cardiac surgery in our Medical Center between 2004 and 2019. Methods: All hemophilia patients who underwent cardiac surgery were identified, and their peri-operative data evaluated retrospectively. Results: Ten patients were identified: six with hemophilia-A, one with hemophilia-B, and three with hemophilia-C (factor XI deficiency). Cardiac procedures included ten coronary artery bypass grafts and one aortic valve replacement. Hemophilia-A and B patients were treated with factor substitution, whereas patients with factor XI deficiency were treated with fresh frozen plasma. One patient died, and one patient suffered from non-active gastrointestinal bleeding. Conclusions: While major cardiac surgery can be performed safely on patients with hemophilia, a multidisciplinary team approach and strict postoperative monitoring are essential in order to achieve optimal results.

OBJECTIVES: To investigate short-and long-term outcomes of a conservative decalcification approach in mitral valve replacement (MVR) surgery in the presence of mitral annulus calcification (MAC). METHODS:Of the 1038 patients who underwent MVR, 133 (13%) had significant MAC with at least 30% of the annular circumference heavily calcified. In most patients, the surgical approach to MAC included conservative decalcification, supra-annular prosthesis implantation and insertion of a pericardial patch between the MV annulus and the prosthesis. These patients were matched by a propensity score to a group of patients who underwent MVR without MAC (n = 118 in each group) and served as a control group.RESULTS: There were 6 early deaths in each group with an overall mortality of 5% (P = 0.90). Early complications included one major stroke in the non-MAC group and acute renal failure needing dialysis in 2 and 3 patients in the MAC and non-MAC groups, respectively. Mean follow-up was 55 ± 37 months and 99.1% complete. There were 38 (33%) and 33 (29%) late deaths with an estimated survival of 61% and 69% at 6 years in the MAC and non-MAC groups, respectively (P = 0.55). At follow-up, functional class did not differ between groups (P = 0.096). Mean echo follow-up time was 40 ± 35 months and was 83% complete. Freedom from moderate or severe mitral regurgitation was 95% and 98%, with an estimated freedom of 95% and 96% at 6 years (P = 0.20), and mean gradient was 4.9 ± 2.3 mmHg and 5.2 ± 2.0 mmHg for MAC and non-MAC groups, respectively (P = 0.58). CONCLUSIONS:A conservative approach for dealing with MAC is suitable for the majority of patients. Early and late clinical and echocardiographic outcomes did not differ between the MAC and non-MAC patients, including freedom from early and late occurrence of MV prosthesis paravalvular leak.

Tadalafil exerts nephroprotective effects in AKI following NSS, as was evident by reduced urinary excretion of KIM-1 and attenuation of SCr elevation. Carefully controlled large clinical studies are needed before defining the role of PDE-5 inhibition therapy in these patients.

Purpose: As laparoscopic surgery becomes more widespread, understanding the adverse effects of pneumoperitoneum becomes more important, especially in patients subjected to laparoscopic unilateral nephrectomy. The purpose of the current study was to investigate the effect of pneumoperitoneum on the remnant kidney after laparoscopic nephrectomy compared to open surgery. Methods:The study group included 30 patients. 22 patients underwent laparoscopic nephrectomy whereas 8 patients underwent open nephrectomy. Serum and urine samples were collected before surgery, 8 and 24 hours after surgery. At these time points urine levels of NGAL and KIM-1, two novel biomarkers for Acute Kidney Injury (AKI) were also determined.Results: Following surgery serum creatinine slightly increased in both groups but then decreased in those who had open procedure compared with the laparoscopic cases where it continued to increase. Urinary NGAL, but not urinary KIM-1, increased in both groups after 8 and 24 hours. The pattern of change of both urinary markers (NAGL and kim-1) after surgery, was not affected by the use of pneumoperitoneum compared to the open procedure. More patients in the laparoscopic group developed acute kidney injury (41% vs. 12%).Conclusions: The present study shows a negative effect of pneumoperitoneum on the kidney function in patients undergoing laparoscopic nephrectomy compared to the open procedure. NGAL and KIM-1 urinary levels were not affected by the increased intra-abdominal pressure.