OBJECTIVES:This study evaluated routine chest X-ray necessity following ultrasound-guided totally implantable venous access port (TIVAP) placement via internal jugular vein. MATERIALS AND METHODS:We retrospectively analysed 97 adults who underwent ultrasound-guided TIVAP placement at a tertiary cardiovascular surgery clinic in Eastern Turkey (December 2023-December 2024). Intraoperative port functionality (blood aspiration/fluid infusion) and postprocedural chest X-ray findings were assessed. Catheter positions were categorised as optimal, suboptimal, or malpositioned. RESULTS:Among 97 patients (56.7% male; mean age 57.4 ± 15.0 years), pneumothorax occurred in one patient (1.0%), requiring intervention. Nineteen patients (19.6%) had suboptimal/malpositioned catheter tips but required no corrective action as port functionality remained intact. Radiographic findings prompted intervention in only one patient (1.0%). CONCLUSIONS:Routine post-procedural chest X-ray identified catheter tip malpositioning in a subset of patients; however, these findings did not alter clinical management in the absence of port dysfunction. Selective imaging in patients with failed port functionality may safely reduce unnecessary radiation exposure and healthcare costs without compromising outcomes.
OBJECTIVE:Coronary artery disease (CAD) is prevalent in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). Computed tomography-derived fractional flow reserve (CT-FFR) may provide non-invasive functional assessment using existing TAVI planning imaging to evaluate CT-FFR diagnostic performance compared with invasive coronary angiography (ICA) for identifying functionally significant CAD in TAVI candidates. METHODS:This single-centre retrospective study included 37 patients with severe AS undergoing TAVI (June 2016-June 2023). All underwent pre-procedural coronary CT angiography and ICA. CT-FFR was retrospectively analysed using deep learning-based software (threshold < 0.81 for significant stenosis). Diagnostic performance was assessed per-vessel (52 coronary arteries) using ICA as reference standard. RESULTS:Mean age was 79.2 ± 8.4 years; 56.7% were male. ICA identified significant CAD in 14 patients (37.8%), involving 21 lesions. CT-FFR successfully analysed all 52 vessels in the final cohort (mean value 0.86 ± 0.11) identifying 20 lesions (38.4%) as functionally significant; however, 8 of 62 initially screened patients (12.9%) were excluded due to insufficient CT image quality, reflecting a relevant limitation of clinical feasibility. CT-FFR demonstrated sensitivity 80.9% (95% CI: 58.1%-94.6%), specificity 93.5% (95% CI: 78.6%-99.2%), positive predictive value 85.0%, negative predictive value 90.6%, and diagnostic accuracy 88.5%. No significant difference existed between CT-FFR and ICA classifications (p > 0.05). At 30 days, no deaths, myocardial infarctions, or strokes occurred. CONCLUSION:CT-FFR provides good diagnostic performance for detecting haemodynamically significant CAD in TAVI candidates. Integration into routine workflows may reduce purely diagnostic invasive procedures while maintaining accuracy. Larger prospective studies are needed to validate these findings.
BACKGROUND:The prevalence of intracranial aneurysms (IAs) in individuals with autosomal dominant polycystic kidney disease (ADPKD) is about 6%-25%. This rate is higher than that of the general population and is associated with increased morbidity and mortality. Studies in Africa are sparse. Therefore, we aimed to describe the clinical manifestations, imaging features, and long-term prognoses of patients with cerebrovascular complications to inform screening and improve patients' awareness. METHODS:We reviewed the records of patients with ADPKD admitted to Inkosi Albert Luthuli Central Hospital from January 2006 to June 2024. We reviewed 298 records to identify 14 patients who presented with cerebrovascular complications, including intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH), unruptured intracranial aneurysms (UIAs), and spontaneous subdural haematoma (sSDH). We analysed their clinical manifestations, imaging characteristics, and outcomes. RESULTS:The prevalence of cerebrovascular complications was 4.7%. Patients were predominantly men, and the median age at the time of the study was 45 years (range, 31-72). Black Africans and Indians/Asians were the most represented. Ten participants presented with IAs, a prevalence of 3%, of which 5 were ruptured. These presented as ICH in 2 patients, SAH in 2 patients, and concurrent ICH and SAH in 1 patient. The remaining 5 cases were unruptured. Caucasians and Indians were more likely to present with IAs and have a family history of ADPKD. Black Africans predominantly presented with sSDH (3 out of 4) of unknown aetiology. Black Africans had a reduced risk of IA. Intracranial bleeding was significantly associated with higher systolic blood pressure. CONCLUSION:IAs and intracranial bleeds are the most common cerebrovascular events in ADPKD patients. Black Africans were less likely to present with IAs. Good blood pressure control may reduce the risk of intracranial bleeding.
BACKGROUND:Off-pump coronary artery bypass grafting (OPCABG) is favoured to reduce surgical trauma during myocardial revascularisation. Severe chronic respiratory conditions, such as interstitial lung disease, are known to significantly complicate perioperative management and long-term survival. For patients with a history of serious cerebral infarction or advanced respiratory disease, awake OPCABG under high thoracic epidural anaesthesia (TEA) provides a highly beneficial alternative to conventional general anaesthesia. CASE PRESENTATION:A 71-year-old male with a 10-year history of chronic interstitial pulmonary fibrosis presented with exertional dyspnoea. Coronary angiography and transthoracic echocardiography revealed two-vessel disease. Based on preoperative pulmonary function tests and the high risk of prolonged endotracheal intubation, the patient was deemed a high-risk candidate for general anaesthesia. In July 2020, during the COVID-19 pandemic, he underwent awake off-pump no-touch aorta double coronary artery bypass grafting using arterial revascularisation under TEA. The patient's recovery was uneventful, and he was discharged on the fifth postoperative day. CONCLUSION:Awake OPCABG under TEA is a viable strategy for elderly patients with severe interstitial lung disease who face substantial risks from general anaesthesia and cardiopulmonary bypass. This complex approach should be restricted to referral centres with extensive experience in advanced off-pump surgery and thoracic epidural anaesthesia techniques.
AIM:Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) induces a systemic inflammatory response, often leading to delayed recovery. This study investigated the predictive value of preoperative inflammatory markers (neutrophil-to-lymphocyte ratio [NLR], systemic immune-inflammation index [SII]) and serum creatinine on the length of hospital stay (LOS) following isolated CABG. METHODS:A single-centre, retrospective cohort study was conducted on 120 patients undergoing elective isolated CABG between January 2023 and December 2025. Patients were categorised by LOS: Group 1 (≤ 7 days, n = 88) and Group 2 (> 7 days, n = 32). Preoperative demographic, intraoperative, and laboratory data were compared. Receiver operating characteristic (ROC) and multivariate logistic regression analyses - adjusted for clinical confounders including CPB time, cross-clamp time, diabetes mellitus (DM), hypertension (HT), and number of grafts - were performed to identify predictors of prolonged stay. RESULTS:Group 2 patients were significantly older and had higher rates of male sex, DM, and HT. Operative times were also significantly longer in Group 2. Preoperative serum creatinine (1.28 ± 0.26 vs. 0.98 ± 0.19 mg/dL), NLR (3.77 ± 1.39 vs. 2.92 ± 0.96), and SII (911 ± 410 vs. 738 ± 306) were significantly elevated in the prolonged stay group (all p < 0.05). ROC analysis revealed creatinine as the strongest predictor (AUC: 0.826, cut-off > 1.1 mg/dL), followed by NLR (AUC: 0.749). In the expanded multivariate analysis adjusting for operative and clinical variables, advanced age (p < 0.001) and elevated creatinine levels (p = 0.042) remained strong independent risk factors for prolonged LOS, whereas NLR and SII did not retain independent statistical significance. CONCLUSIONS:Preoperative serum creatinine and advanced age are strong, independent predictors of prolonged hospital stay after isolated CABG. While NLR and SII are associated with longer stays, they serve better as supportive prognostic indicators in routine preoperative risk stratification.
BACKGROUND:Pulmonary hypertension (PH) secondary to congenital left-to-right shunts leads to serious consequences in sub-Saharan Africa. This study used various imaging modalities to assess right and left heart dimensions and functions in patients with secondary PH. METHODS:Patients with a mean pulmonary artery pressure ≥ 25 mmHg during right heart catheterisation underwent transthoracic echocardiography, cardiac magnetic resonance imaging (CMRI), and nuclear ventriculography. RESULTS:Seventy-five patients (median age 9.98: 6.01-40.9 years) were included. Right-heart dilation was observed in all, with increased tricuspid valve annular diameter (median z-score 2.44) on echocardiography. Similarly, right ventricular (RV) end-diastolic indexed volumes were at least double the normal reference ranges in most patients (median 240: 165-268 mL/m2) on CMRI. The median normal RV systolic function was 49% for males (IQ1-IQ3, 48.0-50.0%) and 49% for females (IQ1-IQ3, 47.3-49.8%). CMRI showed that 70% of males had a normal RV systolic function compared to only 45% of females (p < 0.05). Echocardiographic markers of RV function correlated poorly with CMRI RV ejection fraction, with correlation coefficients of r = -0.28, r = -0.10, and r = -0.04. Notably, 80% of our patients demonstrated left heart dilation, and 35% had impaired left ventricular (LV) ejection fraction on echocardiography, radionuclide ventriculography, and CMRI. CONCLUSION:Echocardiography and CMRI consistently revealed right heart dilation but correlated poorly for right heart function. The evaluation of LV function should not be neglected, as some patients exhibited decreased LV ejection fraction. A holistic approach incorporating multiple modalities and clinical assessment is recommended, as the pathophysiology of PH may differ in patients with left-to-right shunts.
AIM:In patients with diffuse coronary artery disease (CAD), the absence of a suitable distal target vessel for standard coronary artery bypass grafting (CABG) is the main factor limiting the success of surgical revascularisation. The aim of this study was to evaluate the surgical outcomes, complication profile, and functional recovery of a high-risk patient cohort who underwent single or multiple coronary endarterectomy (CE) concomitantly with CABG in our clinic, in light of the current literature. MATERIALS AND METHODS:This retrospective single-centre study included 24 patients who underwent isolated CABG combined with single or multiple CE for diffuse CAD between January 2022 and December 2025. Clinical data were collected from hospital records. Patients were evaluated in terms of demographic characteristics, operative variables, blood product usage, postoperative complications, and functional outcomes. Left ventricular ejection fraction (EF) before surgery and at six-month follow-up were compared. RESULT:The mean age of the patients was 61 ± 10 years, and 41.7% (n = 10) underwent emergency surgery. A total of 34 coronary artery lesions were treated with endarterectomy in 24 patients (mean 1.41 vessels per patient). Multiple-vessel (two or three vessels) endarterectomy was performed in 33.3% of patients (n = 8). Endarterectomy was most frequently performed in the left anterior descending (LAD) artery (n = 16) and the right coronary artery (RCA) (n = 11). The 30-day mortality rate was 8.3%, and the one-year cumulative survival rate was 91.7%. At postoperative six months, a significant 12% increase in mean EF compared to preoperative values was observed (p < 0.05). However, parallel to procedural complexity, blood product usage was high (mean 4.3 units PRBC, 5.0 units FFP). CONCLUSION:In patients undergoing multiple endarterectomies due to diffuse CAD, acceptable mortality rates and significant improvement in left ventricular function can be achieved despite an increased risk of postoperative bleeding. Aggressive revascularisation using the closed technique represents a safe treatment option - even when applied to multiple coronary arteries - provided appropriate patient selection is ensured.
Cardiac amyloidosis is one of the aetiologies of treatable heart failure. Cardiac amyloidosis is rare in young patients, but it can present atypically, leading to diagnostic delays. In this case, a 33-year-old female patient presenting with dyspnoea underwent echocardiography and cardiac magnetic resonance imaging, which showed left ventricular hypertrophy and raised suspicion for amyloidosis; however, no uptake was observed on technetium-99m pyrophosphate (99mTc-PYP) bone scintigraphy. Fourteen months later, the patient presented with decompensated heart failure and was diagnosed with cardiac amyloidosis based on Grade 2 uptake on repeat 99mTc-PYP bone scintigraphy, with an ejection fraction of 25%. As illustrated in this case, negative imaging findings in the early stages do not rule out a diagnosis of cardiac amyloidosis.
BACKGROUND:The choice of anaesthetic agent for open-heart surgery (OHS) may influence perioperative physiology and outcomes. This study compared the effects of sevoflurane and propofol on intraoperative parameters and postoperative complications. METHODS:A retrospective analysis was conducted on 202 patients undergoing OHS (propofol: n = 71; sevoflurane: n = 131). Demographic data, intraoperative variables (cardiopulmonary bypass [CPB] duration, aortic cross-clamp time, heparin dose, cardioplegia volume), serial arterial blood gas (ABG) values, and postoperative complications were collected. Statistical analysis included parametric/non-parametric tests and a generalised linear model. RESULTS:Demographic and baseline characteristics were comparable between groups. No significant differences were found in CPB time, cross-clamp time, or heparin dose. Cardioplegia volume differed significantly (p = 0.025). ABG analysis revealed that pH and O2 levels were not significantly influenced by anaesthetic type but were affected by gender and surgical phase. CO2 levels were significantly influenced by anaesthetic type, gender, and time (p < 0.001). Rates of postoperative bleeding/reoperation (propofol: 4.29%; sevoflurane: 4.55%) and other complications showed no significant differences. CONCLUSION:Both sevoflurane and propofol demonstrated comparable safety and efficacy in OHS, with no significant differences in major postoperative complications. However, anaesthetic choice and patient gender significantly influenced intraoperative CO2 dynamics. These findings support the clinical equivalence of both agents while highlighting gender-specific physiological responses that may warrant consideration in perioperative management.
BACKGROUND:Acute decompensated heart failure (ADHF) exhibits a heterogeneous diuretic response. Chloride-bicarbonate imbalances may reduce loop diuretic efficiency. The effect of admission bicarbonate levels on diuretic resistance in unselected ADHF patients remains unclear. We aimed to evaluate whether higher admission bicarbonate identifies patients at risk of early diuretic dose escalation and less effective early decongestion. METHODS:Our study was planned as a retrospective, single-centre, consecutive ADHF cohort. This study included 1000 hospitalised patients with ADHF (mean age 69 years, ± 11.2 years, 42.7% female) who underwent arterial blood sampling and pH ranging from 7.35 to 7.45. Patients were divided into three groups according to their admission bicarbonate value (< 22 mmol/L-group 1, 22-28 mmol/L-group 2, > 28 mmol/L-group 3). The primary endpoint was early diuretic escalation within 48 hours (dose doubling and/or thiazide add-on or infusion switch). Secondary endpoints included diuretic efficiency, 24/48-hour net fluid balance, 48-hour weight change, early spot urine sodium, and safety/utilisation metrics. Multivariable models adjusted for prespecified clinical and laboratory covariates and baseline diuretic regimen. RESULTS:Higher admission bicarbonate (particularly > 28 mmol/L) was independently associated with greater odds of early escalation and with less effective decongestion. Patients with higher bicarbonate demonstrated lower diuretic efficiency, smaller 24-48 hour net fluid losses, attenuated early weight reduction, and lower early urine sodium. Companion markers (lower chloride, higher pH and pCO2) paralleled these findings, consistent with an alkalosis phenotype. CONCLUSION:Admission bicarbonate is a simple, physiologically coherent marker of early decongestion dynamics in ADHF. Embedding this chemistry-based flag within urine-sodium-guided protocols may enable earlier, objective intensification of pharmacologic therapy and more efficient decongestion. Prospective trials should test bicarbonate-informed pathways against usual care on clinical outcomes.
BACKGROUND:Hypertension is a major global health issue, and elevated triglyceride levels may be an independent risk factor. However, existing studies are limited, and the association remains unclear across diverse populations. This study uses the National Health and Nutrition Examination Survey (NHANES) data to investigate this association, supporting hypertension prevention and management strategies. METHODS:Data from NHANES (2007-2018) for adults aged 20 and older were analysed using a weighted multivariable logistic regression to assess the association between triglyceride levels and prevalence of hypertension. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Restricted cubic splines (RCS) explored the nonlinear associations, and subgroup analyses assessed variable impacts on this association. A two-sample Mendelian randomisation (TSMR) analysis based on genome-wide association study (GWAS) summary data was also conducted to investigate the potential causal relationship between triglyceride levels and hypertension. RESULTS:A total of 14,567 participants were included in this study, among whom 6,428 were diagnosed with hypertension. After full adjustment for all covariates, a significant positive association was observed between triglyceride levels and the prevalence of hypertension (OR: 1.002, 95% CI: 1.001-1.003; P < 0.001). RCS regression analysis further demonstrated a significant nonlinear positive association between triglyceride levels and the prevalence of hypertension (P for non-linearity < 0.001; P for overall < 0.001). Subgroup analysis indicated a significant interaction effect by race (P for interaction < 0.001). Mendelian randomisation (MR) analysis also supported a causal effect of elevated triglyceride levels on increased hypertension risk, with no significant pleiotropy or heterogeneity observed. CONCLUSION:The findings of this study suggest that elevated triglyceride levels are significantly associated with increased prevalence of hypertension, highlighting the potential importance of lipid management in hypertension prevention.
BACKGROUND:Childhood obesity is associated with cardiac electrical remodelling, yet the relationship between body mass index (BMI) and ventricular repolarisation (VR) heterogeneity remains incompletely characterised in paediatric obesity. METHODS:This prospective observational comparative study enrolled 184 children (112 obese, 72 normal-weight; age 8-17 years). Electrocardiographic analysis included traditional (QT, QTc, JT) and novel VR parameters (Tp-e interval, Tp-e/QT, Tp-e/QTc ratios). Multiple linear regression and receiver operating characteristic (ROC) analyses identified independent predictors and clinically applicable thresholds. RESULTS:Obese children demonstrated significantly prolonged Tp-e intervals (87.83 ± 12.35 vs. 80.10 ± 16.80 ms, p = 0.002) and elevated Tp-e/QTcB ratios (0.211 ± 0.028 vs. 0.192 ± 0.034, p < 0.001). BMI emerged as the independent predictor of VR heterogeneity (β = 0.308, p < 0.001), after adjustment for insulin resistance, metabolic parameters, and echocardiographic findings. Regression analyses revealed differences in the BMI-repolarisation relationship: strong associations in normal-weight children (β = 0.353, p = 0.003), disappearing in established obesity (β = -0.041, p = 0.699), and a significant BMI × group interaction was observed (β = -2.079, p = 0.001). ROC analysis identified BMI ≥ 23.1 kg/m2 as the optimal threshold for abnormal repolarisation (AUC = 0.682, sensitivity 76.1%, specificity 50.0%, p < 0.001). CONCLUSION:Childhood obesity is associated with VR abnormalities independently of metabolic dysfunction and structural cardiac changes. This study suggests that repolarisation abnormalities occur in the early stages of obesity and through different pathophysiological mechanisms. The defined BMI threshold provides a clinically applicable tool for early risk stratification, highlighting the critical importance of intervention before obesity becomes established.
OBJECTIVES:Pain that develops after cardiac surgery can negatively affect early recovery. In this study, we aimed to investigate the effect of sternal retractor opening on post-sternotomy pain in cardiac surgeries performed with median sternotomy. METHODS:Patients who underwent open cardiac surgery with median sternotomy in our clinic between September 2023 and March 2025 were included in this retrospective study. Postoperative pain assessments were performed using the Visual Analogue Scale (VAS) at the 2nd hour (VAS0), 6th hour (VAS1), first day (postoperative 24th hour) (VAS2), and second day (postoperative 48th hour) (VAS3) after extubation. Patients were divided into two groups: those with sternum retractor opening less than 9 cm (Group 1) and those with 9 cm or more (Group 2). RESULTS:A total of 124 patients were included in the study. The mean age of the patients was 59.8 ± 14.2 (Range: 19-81), and 67 (54%) patients were female. As a result of the analysis, a statistically significant difference was found between the groups only in VAS0 values. While the median VAS0 value was four (range: 0-10) in Group 1, it was found to be six (range: 0-10) in Group 2 (P = 0.033). Although VAS1, VAS2, and VAS3 values were higher in Group 2, there was no statistically significant difference (P values: P = 0.132, P = 0.421, P = 0.267, respectively). CONCLUSIONS:Although there was no statistically significant difference in the pain evaluations at the sixth postoperative hour, on the first day, and on the second day, we found that patients with smaller retractor openings had lower pain scores.
INTRODUCTION:Heart valve disease is a significant cause of morbidity and mortality, and aortic valve replacement (AVR) is a common treatment option. Recently, sutureless biological valves have gained increasing use. This study aimed to evaluate the concordance between preoperative computed tomography-derived annulus measurements and valve sizes implanted during surgery rather than the direct clinical impact of imaging on prosthesis selection. METHODS:A total of 40 patients with aortic valve stenosis who underwent elective open-heart surgery and preoperative multislice computed tomography between February 20 and May 20, 2024, were included and were randomly allocated into two groups: sutureless biological valve (n = 20) and mechanical valve (n = 20). Data were obtained from patient records and the hospital's data system and analysed statistically. RESULTS:A total of 40 patients were included in the study: 20 received sutureless, rapidly implantable biological valves, and 20 underwent mechanical AVR. The mean age of the cohort was 61.5 ± 9.1 years, with 45% females and 55% males. Compared with the sutureless group, the mechanical valve group had significantly longer cross-clamp (73.5 vs. 53.0 minutes, p < 0.001) and cardiopulmonary bypass times (102 vs. 92 minutes, p = 0.011), as well as smaller sinotubular junction diameters (30.2 vs. 32.3 mm, p = 0.025). In contrast, the sutureless group demonstrated a significantly greater optimal effective orifice area index (1.58 vs. 0.77, p < 0.001). CONCLUSION:Preoperative computed tomography is a reliable tool for planning AVR. Sutureless biological valves provide shorter cross-clamp and bypass times and favourable haemodynamic performance, whereas mechanical valves are more often associated with smaller valve sizes and longer procedures. Early postoperative outcomes were comparable between groups.
BACKGROUND:Rheumatic heart disease (RHD) poses a significant global health challenge due to its high rates of premature morbidity, mortality, and disability, particularly in low-income countries. Existing risk scoring systems for valve replacement in cardiac surgery have primarily focused on non-RHD cases, making them less applicable to RHD patients due to the distinct pathology of valvular damage. This study aims to evaluate the Model for End-stage Liver Disease, including sodium (MELD-Na) score, as a predictive tool for pre-operative mortality risk assessment following cardiac surgery in RHD patients. METHODS:This retrospective cohort study was conducted at Tenwek Hospital in Kenya and included 93 patients who underwent open heart valve replacement surgery between March 2022 and March 2023. Patients who underwent mechanical mitral valve replacement (MVR), mechanical aortic valve replacement (AVR), and tricuspid valve repair surgery (TVr) were included. Data were collected from Tenwek Hospital's electronic medical record system, and statistical analysis was performed using IBM SPSS Statistics 27.0, including Chi-square and binary logistic regression. Operative mortality was defined as all deaths occurring during the hospitalisation period of the operation and within 30 days post-discharge, unless unrelated to the procedure. RESULTS:The study included a cohort of 93 patients, comprising 36 (38.7%) males and 57 (61.3%) females, with a median age of 25. The majority of patients presented with mitral valve disease, 63 (67.7%), with varying degrees of mitral regurgitation, 32 (34.4%) and mitral stenosis, 31 (33.3%). Notably, 43 (46.2%) of patients exhibited an elevated MELD-Na score falling within the range of 9-15, while 20 (21.5%) had severely elevated scores exceeding 15. The overall mortality rate was 10 (10.8%), with a majority, six (60%), of deaths occurring in patients with severely elevated MELD-Na scores and the remaining 40% in the moderate category. Logistic regression analysis was employed to compare the predictive value of MELD-Na score with EuroScore II as a baseline indicator. Subsequently, the analysis was repeated, incorporating individual components of the MELD-Na score. The results indicated a significant link between the MELD-Na score and operative mortality (p = 0.003), showing an odds ratio (OR) of 1.17 (95% confidence interval (CI): 1.05-1.30). Additionally, both serum creatinine (p = 0.012, OR: 1.04, 95% CI: 1.02-1.09) and the international normalised ratio (INR) (p = 0.005, OR: 2.8, 95% CI: 1.38-6.0) emerged as notable predictors of operative mortality. CONCLUSION:Elevated MELD-Na scores are associated with an increased risk of operative mortality following RHD valve surgery, suggesting potential utility as a pre-operative risk stratification tool. Our findings underscore the utility of the MELD-Na score, particularly its components serum creatinine and INR, in predicting mortality risk following cardiac surgery in patients with RHD. Further prospective multicentre studies with larger sample sizes and longer durations are warranted to validate these findings.
OBJECTIVE:To describe a patient education (PE) pilot project named "theHeart School" at Cheikh Anta Diop University of Dakar. METHODS:This cross-sectional study included all patients referred to a PE program. PE was delivered in weekly one-onone sessions. Progression was assessed through self-evaluation scales with scores ranging from 0 to 10, administered before and after the program. Data analysis was performed with SPSS version 18 with a significance level of p < 0.05. RESULTS:45 patients benefited from this educational program. Coronary artery disease (CAD) was the primary indication in 87% of cases. At the end of the program, there was a significant improvement in knowledge of the disease (4.5 vs. 7.4; p < 0.001) and its treatment (4.7 vs. 6.8; p < 0.001), as well as good practices of physical activity (4.5 vs. 7; p < 0.001), cardioprotective diet (4.2 vs. 7; p < 0.001) and motivation to change lifestyle (5.6 vs. 7.8; p < 0.001). CONCLUSION:Results from this pilot project were promising. However, long-term follow-up is necessary to better assess the sustainability of these results.
BACKGROUND:The advantages of direct oral anticoagulants (apixaban, rivaroxaban, edoxaban, dabigatran) over warfarin and low molecular weight heparin have been demonstrated in many studies in the treatment of patients with acute venous thromboembolism (VTE). However, a single-centre study comparing the effectiveness and safety of oral anticoagulants against each other has not yet been conducted. AIM:The study aimed to compare the results of the efficacy and safety profiles of direct oral anticoagulants (DOACs). The purpose of this study was to compare the effectiveness and safety profiles of DOACs. METHODS:The study included 192 patients diagnosed with VTE in Ankara City Hospital between 2019 and 2022. Patients diagnosed with deep vein thrombosis by venous doppler ultrasonography and those diagnosed with pulmonary embolism by pulmonary computed tomography angiography (CTA) were included in the study. The patients who received regular treatment for six months and came to their controls regularly were analysed. During the six months, control venous doppler ultrasonography or pulmonary CTA was performed in all patients with symptoms or examination findings suspicious of VTE. Relevant blood values of patients with hepatic or renal dysfunction were observed at the beginning of the treatment. The primary endpoints were recurrent VTE, mortality, and major bleeding events. RESULTS:The 192 patients included in the study were divided into four groups, with at least 45 patients in each drug group. There was no significant difference between the groups regarding gender, age, weight, comorbidity, rate of provoked VTE, and kidney and liver function tests. 90.6% of the patients had isolated deep venous thrombosis. There was a provoking reason in 49.5%. Obesity and immobilisation were the most frequent provoking causes. During the six-month treatment period, recurrent VTE was observed in three patients, major bleeding in two patients, and death in four patients. Non-major bleeding was seen in 40 patients. There was no significant difference between the four drug groups regarding efficacy and safety. CONCLUSION:Our study is essential in comparing the efficacy and safety of four direct oral anticoagulant drugs. Our findings supported that dabigatran, apixaban, edoxaban, and rivaroxaban treatments can be used safely and effectively in the treatment of acute VTE. While high efficacy was achieved with all drugs, a low rate of side effects was observed.
BACKGROUND:Sutureless aortic valve replacement (AVR) has been recognised as a potential option in the management of High-risk patients, characterised by reduced procedural times and satisfactory haemodynamic results. However, mid-term results of valve-related outcomes are scarce. This study aimed to investigate clinical, echocardiographic, and valve-related outcomes of high-risk patients undergoing Perceval sutureless AVR. METHODS:The current retrospective, single-centre study included 50 consecutive high-risk patients who had isolated Perceval sutureless AVR. The time period was between January 2023 and December 2024. The primary endpoint was one-year valve-related survival. The secondary endpoints included echocardiographic performance, paravalvular leakage (PVL), patient-prosthesis mismatch (PPM), and the need for pacemaker implantation. Transthoracic echocardiography was performed at discharge and follow-up. RESULTS:Complete echocardiographic follow-up at 12 months was available for 44 patients (88%). The transvalvular gradient significantly decreased from 46.8 ± 11.2 to 12.4 ± 3.6 at discharge and remained stable at 12 months (12.1 ± 3.5; p < 0.001). The indexed effective orifice area increased from 0.58 ± 0.09 to 1.10 ± 0.16 cm2/m2 at 12 months. No case of severe patient-prosthesis mismatch (PPM) was noted, but moderate PPM occurred in 12%. PVL was trivial or mild in all patients. Permanent pacemaker implantation was necessary in 20%, all within the index hospitalisation period, without any recovery of native conduction at follow-up. Valve-related survival at 12 months was 94%, with death from non-valve-related causes. CONCLUSION:Sutureless Perceval aortic valve implantation has been shown to provide excellent clinical and haemodynamic results at midterm follow-up in high-risk patients with low rates of valve-related complications, PVL, and patient prosthesis mismatch.
OBJECTIVE:This study aimed to evaluate whether a PRECISE-DAPT score ≥ 25 identifies a high-risk phenotype associated with adverse ischemic and bleeding outcomes, hospitalisation, and mortality among patients treated with fixed-dose acetylsalicylic acid and clopidogrel. METHODS:We conducted a prespecified subgroup analysis of the DAPT-TR registry, a prospective, multicentre observational cohort including 1,500 patients who were initiated on fixed-dose combination dual antiplatelet therapy (aspirin 75 mg/day plus clopidogrel 75 mg/day) for the treatment of acute and stable coronary artery disease. Patients were stratified according to PRECISE-DAPT score categories (≥ 25 vs < 25). Six-month clinical outcomes, including all-cause and cardiovascular hospitalisation, myocardial infarction, stent thrombosis, BARC type 1 bleeding, all-cause mortality, cardiovascular mortality, and stroke, were compared between groups. Multivariable logistic regression analysis was performed to evaluate independent associations between PRECISE-DAPT score categories and clinical outcomes. RESULTS:Of 1,500 patients, 344 (22.9%) had a PRECISE-DAPT score ≥ 25. Compared with patients with a PRECISE-DAPT score < 25, those with a PRECISE-DAPT score ≥ 25 were older (mean age 71.9 vs. 60.8 years; p < 0.001), more frequently female, and had significantly more comorbidities and reduced LVEF. At 6 months, patients with a PRECISE-DAPT score ≥ 25 experienced higher rates of all-cause hospitalisation (19.5% vs. 10.9%; p < 0.001), cardiovascular hospitalisation (11.6% vs. 6.7%; p = 0.003), stent thrombosis (2.6% vs. 1.0%; p = 0.029), and BARC type 1 bleeding (7.5% vs. 2.2%; p < 0.001). All-cause mortality (1.7% vs. 0.2%; p = 0.003) and cardiovascular mortality (1.2% vs. 0.1%; p = 0.011) were also significantly higher. After adjustment, a PRECISE-DAPT score ≥ 25 remained independently associated with mortality (OR: 3.8; 95% CI: 1.2-12.1) and hospitalisation (OR: 2.1; 95% CI: 1.5-3.1). CONCLUSION:A PRECISE-DAPT score ≥ 25 delineates a clinically vulnerable subgroup with elevated ischemic, haemorrhagic, and mortality risks, even under uniform fixed-dose DAPT. These findings suggest that the PRECISE-DAPT score may serve as a multidimensional prognostic tool beyond bleeding risk stratification.
