Objective: To compare clinical outcomes of reimplantation versus remodeling in patients undergoing valve-sparing aortic root replacement (VSRR) surgery. Method: Electronic database search at PubMed, Scopus, Embase, Ovid, and Google scholar was performed from inception to January 2020. Primary outcomes were aortic valve (AV) reintervention and postoperative grade of aortic insufficiency (AI) while secondary outcomes were 30-day mortality, reoperation for bleeding, and operative times. Results: A total of 21 articles met the inclusion criteria. A total of 1283 patients had reimplantation while 1150 had remodeling. No difference in preoperative demographics was noted except reimplantation patients were younger (48 ± 16 vs. 56 ± 15 years; p < .00001). The cardiopulmonary bypass and aortic cross-clamp times were shorter in the remodeling cohort (168 ± 38 vs. 150 ± 37 min; p = .0001 and 133 ± 31 vs. 112 ± 30 min; p = .0002, respectively). No difference in concomitant total arch surgery (14% in reimplantation vs. 15% in remodeling; p = .53). Postoperatively, there were similar stroke rates (3% in both cohorts; p = .54), rates of reoperation for bleeding (9% in reimplantation vs. 12% in remodeling; p = .88), and 30-day mortality (3% in reimplantation vs. 4% in remodeling; p = .96). No difference in early AV reintervention (1% in reimplantation vs. 2% in remodeling; p = .07), and late AV reintervention (4% in reimplantation vs. 7% in remodeling; p = .07). The AI of +2 grade was significantly lower in the reimplantation cohort (5% vs. 8%; p = .01). Conclusion: Our study shows comparable clinical outcomes between both techniques. The practice of each technique is largely center and surgeon dependent. Larger sample size cohorts with minimal confounding factors are required to confirm the above findings.
Background: Despite being rare, infective endocarditis (IE) is a life‐threatening disease with poor prognosis. New diagnostic and therapeutic strategies are emerging; however, predisposing factors and microbiology of the disease are also changing with time. Because of this, there has been a lack of reduction in the disease's incidence and new challenges for clinicians have arisen such as an increasingly aging population and growing antimicrobial resistance. Aims: In this paper, we aim to provide an overview of the changing trends in IE, current diagnosis, and management strategies, as well as the emerging role of the infective endocarditis teams in the care of patients with this disease. Materials & Methods: A comprehensive electronic search was done utilizing PubMed, Ovid, SCOPUS, Embase and google scholar. The search terms included ‘Endocarditis’, ‘IE’, ‘Infection’, ‘Vegetation’, ‘Duke criteria’, ‘native valve infection’, ‘prosthetic valve’, ‘valve infection’, ‘endocarditis outcome’ and ‘endocarditis bacteriology’. The references of the identified articles were then searched for any potential articles that can be included. The inclusion criteria were any article that discussed the evidence behind incidence and management of IE including the role of endocarditis team. The exclusion criteria were case reports, expert opinion, and editorials. Results: All the relevant findings are summarized in specified tables and within appropriate sections. Discussion: It is vital to determine the current trends in the epidemiology and microbiology of the condition so that the diagnostic threshold can be adapted, to identify new at‐risk groups and achieve an accelerated evaluation strategy that allows for earlier diagnosis and treatment. Conclusion: Management of IE can benefit from the input of different specialties, such as cardiology, cardiothoracic surgery, infectious disease, and microbiology. Therefore, adopting a multidisciplinary approach towards treatment is crucial to reduce morbidity and mortality from preventable complications of this pathology.
INTRODUCTIONGlobally millions of deaths are caused due to sudden cardiac arrest and these are elevated by interplay between substrate and triggering factors, of which hypokalemia in heart cell is the major risk factor.1 Hypokalemia refers to a condition in which concentration of potassium in blood is lower than 3.6 mmol/L.Causes of hypokalemia are: Depletion of potassium due to increased loss of potassium as well as decreased intake of potassium, potassium shift in case of administration of ABSTRACT Background: Potassium is an extremely crucial element in maintaining the normal charge between intracellular and extracellular space. Normal cellular function is maintained through potassium homeostasis. The normal range of plasma potassium is 3.5 to 5.1 mmol/L. The deviation both hypo and hyperkalaemia are associated with cardiovascular diseases especially cardiac arrhythmia. The objective was to study the association of hypokalaemia on cardiovascular diseases. Methods: During this one year of retrospective study socio-demographic profile of the patients were collected from the medical record section of hospital. The participants were grouped into four classes based on the serum potassium levels as, Group A: < 2 mmol/L, group B: 2-2.49 mmol/l, group C: 2.5 -2.9 mmol/L, group D: 3 -3.49 mmol/L and group E (control group) 3.5 to 5.1 mmol/L. The participants were also grouped as those suffering from cardiovascular diseases and those with non-cardiovascular diseases. Results: In our study 4818 records were categorized into 5 groups including control group. Males (61.35%) were slightly more than female (38.65%). The mean age group was 43±4 years. Results revealed that there was positive association between the sexes. Females were more commonly associated as compared to males. Hypokalaemia among cardiovascular diseases was only 22.2% as compared to non-cardiovascular diseases. The mean systolic (142±8) and diastolic Blood pressure (92±2) among cardiovascular diseases was slightly higher as compared with the noncardiovascular diseases. Conclusions: Hypokalaemia is significantly associated with myocardial infarction when compared with other disorders. Hypokalaemia was more commonly associated with cardiovascular diseases as compared with noncardiovascular diseases.
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