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Objective: Coronary artery bypass grafting is one of the most commonly performed surgical procedures in cardiovascular surgery with a steadily evolving minimally invasive approach. Methods: Conventional coronary artery bypass grafting (CABG) is performed traditionally via midline sternotomy. Exciting advancements in technology and engineering over the last two decades have resulted in the transition from conventional to minimally invasive CABG including robotically assisted surgery. Results: The minimally invasive techniques are continuously striving to promote coronary revascularization into the arena of minimally invasive surgery. Examination of 10 previously completed studies with relevant follow-up periods enables an insightful vision into the outcomes and pitfalls surrounding robot-assisted CABG (RACAB) as explored in this review. Studies indicate that RACAB is associated with decreased postoperative complications such as major adverse cardiac or cerebrovascular events without compromise in survival rates. Despite this, certain drawbacks such as incurring costs and technical complexity of the procedure cannot be dismissed. Conclusion: There exist patient-related benefits from minimally invasive techniques such as decreased certain postoperative complications. Furthermore, with experience and a specialized stepwise program, it is possible to perform the entire procedure from the console. However, certain pitfalls involving increased expenses, steep learning curve and the lack of proper haptic feedback currently withhold the worldwide expansion of RACAB and limit it to specialized institutions only.

Deficiency of glucose-6-phosphate dehydrogenase enzyme is a common X-linked disorder that affects humans globally. It was first identified in the 1950s as a disorder that primarily affects the red blood cells causing a myriad of symptoms including acute haemolytic anaemia, neonatal jaundice and chronic nonspherocytic haemolytic anaemia. The deficiency has been extensively studied and especially in the last 5 years there have been improvements in the diagnosis and management. Various methods of diagnosis exist, however recent research focusses on the use of biosensors for more accurate and less time-consuming diagnosis. Guidelines suggest on controlling symptomology as there exists no specific treatment. Neonatal jaundice is a common complication of the disease and research on phototherapy has proved to show some effect in managing this condition. In the last year, protein-protein interactions have been studied and are used as a target to enhance enzyme stability and activity. AG1 is a small molecule activator that has demonstrated effectiveness in treating G6PD deficiency in models. The purpose of this review is to summarize existing literature and potential areas of research on glucose-6-phosphate dehydrogenase deficiency including clinical characteristics, diagnosis and management.

Peripheral artery disease is a prevalent illness affecting more than 200 million people worldwide. A commonly used technique to manage the condition has been open endarterectomy. However, in recent times, a shift towards minimally invasive techniques has resulted in endovascular intervention as a popular alternative. This review aims to assess the safety and efficacy of endovascular intervention when compared with endarterectomy. A systematic review of the articles published in PubMed, Ovid, Embase, and Scopus within the last 10 years was conducted. The PRISMA guidelines were adhered to, and the Newcastle-Ottawa and NICE quality assessment scales were used. A meta-analysis of proportions was performed using the RStudio software (RStudio Team (2021). RStudio: Integrated Development Environment for R, PBC, Boston, MA, USA). Twenty-six studies were included, with a total of 7126 patients (endovascular, 2496; endarterectomy, 4630). Technical success was greater for endarterectomy than endovascular intervention with an odds ratio of 0.38; 95% CI [0.27–0.54]. In terms of safety as well endovascular intervention was better than endarterectomy with an odds ratio of 0.22; 95% CI [0.15 to 0.31] for wound infection. Endovascular intervention is a safe and effective procedure; however, it cannot be considered superior to endarterectomy.

Aim: Cardiac implantable electronic device infective endocarditis is a serious infection with poor prognosis. Materials & methods: The systematic review of the literature was conducted using searches from the various databases. We included studies published between January 2010 and June 2021. Results: A total of 35 articles met the inclusion criteria. Patients were approximately 70 years old and an average of 71.2% of patients were male. The most common presenting feature was a fever. The modified Duke criteria was used to aid diagnosis. Management entailed extraction of the cardiac implantable electronic device in 80.5% of the studies. The overall mortality rates ranged from 4 to 36%. The most frequently isolated organism was Staphylococcus aureus. Conclusion: Cardiac implantable electronic device infective endocarditis needs timely diagnosis and effective management for promising outcomes.

Background Redo mitral valve surgeries have high mortality and morbidity and can be physically demanding for patients. Median sternotomy remains the gold standard for most cardiac surgeries. To tackle certain risks with a re‐sternotomy, alternative procedures such as the right anterolateral minithoracotomy have been explored. This review aims to compare the clinical outcomes of re‐sternotomy (MS) versus right mini thoracotomy (MT) in mitral valve surgery. Methods A systematic, electronic search was performed according to Preferred Reporting items for Systematic Reviews and Meta‐analysis guidelines to identify relevant articles that compared outcomes of the MS versus MT procedures in patients who have had cardiac surgery via a MS approach. Results Twelve studies were identified, enrolling 4514 patients. Length of hospital stay(MD = −3.71, 95% confidence interval [CI] [−4.92, −2.49]), 30‐day mortality(odds ratio [OR] = 0.59, 95% CI [0.39, 0.90]), and new‐onset renal failure(OR = 0.38, 95% CI [0.22, 0.65]) were statistically significant in favor of the MT approach. Infection rates(OR = 0.56, 95% CI[0.25, 1.21]) and length of intensive care unit (ICU) stay (MD = −0.55, 95% CI[−1.16, 0.06]) was lower in the MT group; however, the difference was not significant. No significant differences were observed in the CPB time(MD = −2.33, 95% CI [−8.15, 3.50]), aortic cross‐clamp time MD = −1.67, 95% CI[−17.07, 13.76]), and rates of stroke(OR = 1.03, 95% CI[0.55, 1.92]). Conclusion Right MT is a safe alternative to the traditional re‐sternotomy for patients who have had previous cardiac surgery. The approach offers a reduced length of hospital stay, ICU stay, and a lower risk of new‐onset renal failure requiring dialysis. This review calls for robust trials in the field to further strengthen the evidence.

Aim To compare the safety and efficacy of endovascular stenting to endarterectomy in treating femoral artery disease. Method We searched databases such as PubMed, Ovid, Embase and Scopus for studies done on endovascular and endarterectomy treatments in the last decade. The inclusion criteria comprised of latest studies within the last 10 years, human studies and restricting to only femoral artery disease. Relevancy of the articles were assessed using PRISMA and the Newcastle-Ottawa quality assessment scale. Thereafter, the data were extracted, and the statistical variables were calculated using MedCalc software. The PRISMA checklist was used to assess risk of bias. Results Total of twenty-six retrospective, prospective and sub-analysis studies met the inclusion criteria with a total of 7126 patients (endovascular, 2496; endarterectomy, 4630). A division of the outcomes into primary and secondary were assessed based on direct correlation to the parameters evaluated. Our review demonstrated a higher value of technical success for endovascular intervention than endarterectomy with an odds ratio of 4.27 and statistically significant at 95% CI (2.87–6.38). In terms of safety, wound complications, and mortality (short and long-term) were evaluated. For wound infection, endovascular had better odds ratio of 0.65; 95% CI [0.51 to 0.81] and thus preferrable. Delayed wound healing and dehiscence occurred only in 0.15% of endovascular procedures in contrast to 0.99% in endarterectomy. There was no significant difference in both the mortality rates in the two groups appraised. Conclusions Endovascular treatment of femoral artery disease is a safe and effective alternative to endarterectomy. It has a lower incidence of wound related and other perioperative complications.

Aim Redo mitral valve surgery is a high-risk cardiac procedure. Median re-sternotomy (MS) remains a common approach in many centres. However, there is a significant risk of morbidity and mortality associated with this approach. Alternative procedures such as the right anterolateral minithoracotomy (MT) have been explored. This review compares the clinical outcomes of re-sternotomy versus right mini thoracotomy in mitral valve surgery. Method A systematic, electronic search was performed according to PRISMA guidelines to identify relevant articles that compared outcomes of the MS versus MT procedures in redo mitral valve surgery. Data regarding mortality, length of hospital stay, stroke, infection were extracted and analysed Results Thirteen studies were identified, enrolling 4,549 patients. Length of hospital stay (MD= -3.70, 95% CI[-4.89, -2.51]), 30-day mortality (OR=0.58, 95% CI[0.39, 0.87]), new-onset renal failure (OR=0.38, 95% CI [0.22, 0.65], and length of ICU stay (MD=-0.62, 95% CI[-1.21, 0.02]) were statistically significant in favour of the MT approach. Infection rates (OR=0.52, 95% CI[0.24, 1.12]) were lower in the MT group; however, the difference was not significant. No significant differences were observed in the CPB time (MD=-2.68, 95% CI[-8.53, 3.17]), aortic cross-clamp time (MD=-2.40, 95% CI[-17.07, 12.27]), and rates of stroke (OR=1.03, 95% CI[0.55, 1.92]). Conclusions Right mini thoracotomy is a safe alternative to the traditional re-sternotomy for patients who have had previous cardiac surgery. The approach offers a reduced length of hospital stay, ICU stay, and a lower risk of new onset renal failure requiring dialysis. This review calls for robust trials in the field to further strengthen the evidence.