Data on outcome for robotic coronary artery bypass grafting (CABG) is sparse. The aim of this study was to compare clinical outcomes between conventional and robotic-assisted CABG. This was a single-center retrospective study comparing conventional and robotic-assisted CABG between January 2024 and October 2024. Baseline patient characteristics, intra-operative details, and post-op outcomes were compared between 2488 conventional and 136 robotic procedures. Propensity matching was done for age, gender, comorbid illness, and operative characteristics. Learning curve was analyzed using a cumulative sum (CUSUM) chart. One hundred and thirty-two propensity-matched pairs were compared. Before matching, the conventional CABG group had a higher frequency of females and diabetes mellitus, and a slightly higher European System for Cardiac Operative Risk Evaluation (EuroSCORE) 2 risk score, while ejection fraction was marginally higher in the robotic surgery group. After matching, the groups were comparable in terms of demographic details, clinical presentation, comorbid illness, and laboratory parameters. The duration of surgery, ventilation duration, and the number of distal anastomoses were higher in the conventional group before matching. After matching, the difference persisted for ventilation duration alone. Patients in the robotic-assisted CABG group had a lower incidence of arrhythmia (5.3

Background: The prevalence of thrombophilia in patients with unprovoked thrombotic events varies across populations, justifying the need for region-specific data to guide appropriate testing strategies. Methods: This study included patients aged 18-50 years presenting with unprovoked venous thrombosis (VT), arterial thrombosis (AT), or combined thrombotic events at an Indian tertiary care center between January 2018 and January 2022. Clinical characteristics and results of the thrombophilia evaluation were analyzed. Results: A total of 226 patients were analyzed, of whom 160 (70.7%) had VT, 53 (23.4%) had AT, and 13 (5.7%) experienced combined thrombotic events. A positive thrombophilia work-up was observed in 33.2% of VT cases and 20.1% of AT cases. Antiphospholipid antibody syndrome (APS) was the most frequent abnormality detected, whereas inherited thrombophilia was less common. In VT patients, pulmonary involvement was significantly associated with positive thrombophilia results (p=0.04). Conclusions: These findings support a selective approach to thrombophilia testing in patients with unprovoked VT, in line with current guideline recommendations, and highlight APS as the predominant thrombophilic abnormality in this population.

To evaluate immediate and long-term outcomes of valve-sparing root replacement (VSRR) for patients with dilated aortic roots. This observational study included all patients undergoing VSRR between June 2009 to October 2024, systematically documenting patient demographics, pre-operative characteristics, surgical details, and valve morphology. The primary outcome was all-cause mortality, with secondary endpoints including valve-related complications and reintervention rates. The cohort consisted of 91 patients, predominantly males (81.3

INTRODUCTION:The capability to accurately predict the ejection fraction (EF) from an electrocardiogram (ECG) holds significant and valuable clinical implications. Various algorithms based on ECG images are currently being evaluated, with most methods requiring raw signal data from ECG devices. In this study, our objective was to train and validate a neural network on a readily available ECG trace image graph to determine the presence or absence of left ventricular dysfunction (LVD). METHODS:12-lead ECG trace images paired with their echocardiogram reports performed on the same day were selected. A DenseNet121 model, using ECG images as input, was trained to identify EF <50 %. and then externally validated. RESULTS:1,19,281 ECG-echocardiogram pairs were used for model development. The model demonstrated comparable performance in both the internal test data and external validation data. The area under receiver operating characteristic and precision-recall curves were 0.92 and 0.78, respectively, for the internal test data and 0.88 and 0.74, respectively, for the external validation data. The model accurately identified more than 85 % of cases with EF <50 % in both datasets. CONCLUSIONS:Actual images of ECGs with simple pre-processing and model architecture can be used as a reliable tool to screen for LVD. The use of images expands the reach of these algorithms to geographies with resource and technological limitations.

BACKGROUND:The Ross procedure is a valuable option for aortic valve replacement in young patients, but concerns about autograft durability and limited homograft availability, especially in resource-limited settings, have limited its use. This study evaluated long-term outcomes of the Ross procedure, with a focus on the effectiveness of handmade Dacron (polyethylene terephthalate, Getinge/Maquet) valved conduits as an alternative to homografts. METHODS:The study retrospectively reviewed 252 patients (mean age, 19.6 [SD12.5] years) who underwent the Ross procedure between 2001 and 2023 at a single center (Narayana Health, Bengaluru, India). Pulmonary artery reconstruction was performed using pulmonary homografts (n = 176) or handmade Dacron valve conduits (n = 75). Long-term outcomes, including mortality, reintervention, and valve function, were analyzed using Kaplan-Meier estimates and multivariate regression models. RESULTS:Early mortality was 1.6%. Median follow-up was 6.4 years (interquartile range, 0.8-15 years). At 10 years, freedom from all-cause mortality was 94.3% (95% CI, 91.0-97.7), and freedom from Ross-related reintervention was 89% (95% CI, 84-94). Ross-related reinterventions were performed in 16 (6%) cases, 13 surgical (8 autograft, 5 pulmonary conduit) and 3 balloon valvuloplasties for conduit stenosis. Dacron valved conduits had similar mean right ventricular outflow tract gradients (17.5 [ 9.9] mm Hg vs 16.5 [12.7] mm Hg; P = .75) and comparable overall reintervention rates (2.6% vs 3.4%; P = .93). Younger age was the only independent predictor of late aortic regurgitation (adjusted odds ratio, 0.90; 95% CI, 0.82--0.98; P = .01). CONCLUSIONS:The Ross procedure demonstrates excellent long-term survival and valve durability in young patients. Dacron valve conduits offer a safe and effective alternative to homografts for pulmonary valve replacement.

Introduction Intravenous leiomyomatosis (IVL) is an extremely rare neoplasm characterized by intravascular proliferation of a histologically benign-looking smooth muscle cell tumour mass but not invading the tissue. The unique characteristic of IVL is that it can grow within the uterine and pelvic extrauterine venous system and may extend to the inferior vena cava, right heart, and pulmonary arteries. It can be associated with cardiac symptoms and cardiac murmur, and even in some cases, sudden death. Because of rarity, the diagnosis of IVL is delayed, and the treatment is inadequate. The preoperative diagnosis of IVL depends on good clinical acumen and a huge index of doubt. Case Report A 45-year-old woman presented with progressive breathlessness. Radiologic findings were suggestive of broad ligament leiomyosarcoma with hypervascular tumour thrombus extending into IVC and cardiac chambers. It was decided to offer surgical treatment in multidisciplinary team discussion. After preoperative evaluation, she underwent a one-stage combined multidisciplinary thoraco-abdominal surgery under general anaesthetic. The team comprised of cardio-thoracic, liver transplant, and gynae-oncology surgeons. She underwent exploratory laparotomy with total abdominal hysterectomy, bilateral salpingo-oophorectomy, excision of the right adnexal mass, liver mobilization, IVC thrombectomy, and upward dislodgment of the intracardiac and intravascular tumour by opening the right atrium. Post-operative period was uneventful. Subsequently, the pathologic report confirmed IVL, benign leiomyoma (16 cm) in the right adnexa, and intravenous leiomyomatosis in inferior vena cava, extending into right atrium. She is on regular follow-up. Conclusion Intravenous leiomyomatosis is a rare condition with unique imaging pattern. The diagnosis of IVL remains a challenge. The imaging will be suggestive of pelvic lesion with free filling defect in the blood vessels and heart. The recommended treatment for IVL is complete resection of the distant lesion in addition to total hysterectomy and salpingo-oophorectomy.

BACKGROUND:In the current era, technology has a significant influence on healthcare outcomes. Despite that, there are significant barriers and concerns toward the adoption of digital laboratory reporting systems among healthcare professionals in India. The aim of the study was to understand the overall attitude, barriers, and motivators toward the adoption of technology by healthcare personnel.METHODS:The study was conducted through a single-center and prospective questionnaire survey among physicians and surgeons of various specialities, with 107 participants. The electronic laboratory system at the institution, called "AADI," could be accessed across any computer terminal and through a web-based application that could be downloaded on any mobile device.RESULTS:The results of the study revealed that 98 out of 107 (91.59%) healthcare professionals used the digital platform regularly to access laboratory results, while only 9 (8.4%) did not use it. The mean satisfaction score of the users was 4.62 ± 0.51. The study showed that most users found the digital system to be more secure and reliable, which led to significant time savings compared to the paper-based system. The study also found that age was a determinant of usage, with younger healthcare professionals using the application more frequently.CONCLUSION:Overall, the study suggests that digital laboratory reporting systems have significant benefits, and further efforts are needed to increase adoption in healthcare establishments in India.

Information Extraction (IE) from document images is challenging due to the high variability of layout formats. Deep models such as LayoutLM and BROS have been proposed to address this problem and have shown promising results. However, they still require a large amount of field-level annotations for training these models. Other approaches using rule-based methods have also been proposed based on the understanding of the layout and semantics of a form such as geometric position, or type of the fields, etc. In this work, we propose a novel approach, EIGEN (Expert-Informed Joint Learning aGgrEatioN), which combines rule-based methods with deep learning models using data programming approaches to circumvent the requirement of annotation of large amounts of training data. Specifically, EIGEN consolidates weak labels induced from multiple heuristics through generative models and use them along with a small number of annotated labels to jointly train a deep model. In our framework, we propose the use of labeling functions that include incorporating contextual information thus capturing the visual and language context of a word for accurate categorization. We empirically show that our EIGEN framework can significantly improve the performance of state-of-the-art deep models with the availability of very few labeled data instances. The source code is available at https://github.com/ayushayush591/EIGEN-High-Fidelity-Extraction-Document-Images.

Total arch replacement in the presence of acute aortic dissections is one of the most challenging areas of aortic surgery. Data on outcome in the Indian scenario is sparse. The aim of this study was to assess the outcome of arch replacements in a single tertiary care center. In this single-center experience, 20 patients underwent total arch replacement between 2012 and 2022. Demographic, intraoperative, and postoperative data were abstracted from hospital records. Only patients with acute type A aortic dissection needing an arch repair were included. Patients with hemi-arch repairs, hybrid repairs, and those operated upon due to aneurysmal disease were excluded from the study. Comparison was made between survivors and non-survivors. Temporal trends for the procedure were assessed. The study included 20 patients who underwent total aortic arch replacement (TAR) during the study period (2012–2022). The mean age was 49.3 ± 12.5 years, and 15 (75

Iatrogenic ventricular septal defect is a rare complication in patients undergoing septal myectomy for hypertrophic obstructive cardiomyopathy, and it necessitates closure in the postoperative period. We describe a novel surgical technique for closure of the ventricular septal defect using a biventricular approach with a custom-made polytetrafluoroethylene device. Our method is easily reproducible.

To assess vaccination among healthcare workers, 14837 healthcare workers across 20 different hospitals were prospectively surveyed. The overall uptake of the vaccine was 13335(90%). Infection rate in vaccinated HCW was 710(6.04%) and was significantly lower than unvaccinated HCW 148(9.9%), P <.001. Uptake of vaccination among healthcare workers in our study was high and provided significant protection compared to unimmunized healthcare workers.

Background Pulmonary endarterectomy is potential curative therapy for chronic thromboembolic pulmonary hypertension patients. Here, we present our experience with pulmonary endarterectomy spanning 17 years and detail our management strategy. Methods This is a single-centre retrospective study conducted on chronic thromboembolic pulmonary hypertension patients who underwent pulmonary endarterectomy at our centre across 17 years. Results Between 2004 and 2020, 591 patients underwent pulmonary endarterectomy. Amongst them 429 (72.4%) were males with a male to female ratio of 2.6:1, the median age was 38 (range, 14–73) years. The median length of hospital stay was 11 days (IQR, 8–16). Extra corporeal membranous oxygenation was used in 82 (13.9%) patients during/after surgery, out of whom 28 (34.1%) survived. There were 70 (11.8%) in-hospital deaths. Female gender ( p < 0.01), pulmonary artery systolic pressure >100 mmHg ( p < 0.05) and use of extra corporeal membrane oxygenation ( p < 0.001) were significant risk factors for in-hospital mortality. The mortality in the first period (2004–2012) was 15.7% which reduced to 9.1% in the later period (2013–2020). The reduction in mortality rate was 42% ( p < 0.05). Following pulmonary endarterectomy, there was a significant reduction in pulmonary artery systolic pressure (86.68 ± 24.38 vs. 39.71 ± 13.13 mmHg; p < 0.001) and improvement in median walk distance as measured by 6-min walk test on follow-up (300 vs. 450 meters; p < 0.001). The median duration of follow-up was 8 months (inter-quartile range: 2–24). Conclusions pulmonary endarterectomy has a learning curve, high pulmonary vascular resistance alone is not a contraindication for surgery. Patients following surgery have improved survival and quality of life.

Early repair is recommended in type A aortic dissection repair, however, this is not often possible. The aim of this study was to assess the time delays, examine the effect of timing and malperfusion on outcomes, and identify other independent risk factors for mortality.

Background The inflammation or degeneration of the heart muscle myocarditis may be fatal. This disease often goes undetected. It may also disguise itself as ischemic valvular or hypertensive heart disease. Here we report eight cases of acute fulminant viral myocarditis suffering from low cardiac output ARDS Acute respiratory distress syndrome formation and successfully treated with ECMO Extra corporeal membrane oxygenation.Methodology All the cases were admitted in the emergency coronary care unit with severe respiratory distress poor hemodynamics and ECHO examination revealed low Left ventricle Ejection Fraction LVEF15-20. Veno - Arterial ECMO was initiated with femoro-femoral cannulation with distal limb perfusion. On ECMO support the hemodynamics were stabilized with no inotropic support. The heart and lungs were given adequate rest time for recovery by maintaining total cardiac output on ECMO. The average ECMO support was 84.2 plusmn 4 hours. Maquet Quadrox PLS Sorin Dideco ECMO oxygenators with rotaflow centrifugal pump were used. Delta pressure pre-pump pressures were continuously monitored.Results Out of the eight cases put on VA ECMO for viral myocarditis seven were successfully weaned off and were discharged success rate of 87.5. Soon after the initiation of ECMO the arterial saturation reached the normal levels. The serum lactate levels which were high gt6 mmolL prior to initiation of ECMO remarkably came down to lt2 mmolL after 24 hours. Seven patients were weaned off and decannulated in the operating room. One patient required LV decompression by Balloon Atrial Septostomy in the Hybrid OR and was successfully weaned off after 48 hours. One patient succumbed due to continuous low cardiac output which was irreversible with full blown septicemia and was not responding to ECMO and medications.Conclusion Peripheral VA-ECMO support is very effective in optimizing myocardial recovery for the treatment of refractory acute fulminant viral myocarditis when maximal conventional supports are ineffective.

In this India story of capacityCapacity development building for cardiac surgeryCardiac Surgery in LMIC in India, the authors present the case of Narayana HealthNarayana Health (NHNH) as a model that has evolved successfully and replicated in the Caribbean region. Leveraging on the volumes, the costs of procedures are reduced. A large population gains access to advanced tertiary care through micro health insurance paying a tiny premium amount. Adoption of technology has helped digitize patient health records and electronic health systems in open APIs for flexible interoperability. SaaS and Cloud have minimized capital investment. Data intelligence and analytics have helped in informed decision-making supplementing clinical observation. Aided by Artificial intelligence and deep learning the costs are closely monitored, detection and interpretation of images, MDR and antibiotics use are also tracked. Communication between the doctors in patient care, online consultations with patients have enhanced the reach and convenience of healthcare delivery. A practical oriented approach to training has produced employable surgical support workforce that is hands-on and productive from day one. The approach has also helped in efficient healthcare delivery and outcomes. With a globally recognized accreditation programs, developing countries can be a major supplier of skilled workforce to the world.

Massive pulmonary hemorrhage during pulmonary thromboendarterectomy (PTE) can be managed by a conservative approach with mechanical ventilatory support, positive end-expiratory pressure, lung isolation, reversal of heparin, and correct of coagulopathy. We present three challenging cases that developed intrapulmonary hemorrhage during/after PTE and managed successfully. The first patient had bleeding from the bronchial artery and right internal mammary collaterals, which was managed by coil-embolization. The second patient had a breach in the blood airway barrier in the right upper lobar segment of the lung, and the repair was done using a surgical absorbable hemostat. The third patient developed reperfusion injury, he was instituted on veno-venous extracorporeal membranous oxygenation, a week later, the patient recovered completely. An algorithm was adopted and modified to our requirements; all the 3 challenging intrapulmonary hemorrhage cases were successfully managed. This algorithm can be used for satisfactory outcomes in patients who suffer intrapulmonary hemorrhage during PTE.

Abstract Introduction Chronic thromboembolic pulmonary hypertension (CTEPH) is classed as group 4 in the present classification of pulmonary hypertension. The pathophysiology of CTEPH is complex, mainly is a consequence of prior acute pulmonary embolism with failure of thrombi to resolve and the recent recognition of added small vessel changes which impacts long-term outcomes even after surgical management. The role of thrombophilia testing in this condition has been debated. Hence, we here analyzed the utility of thrombophilia testing in CTEPH from a center in a developing country. Methods This is a single institution (Narayana Health City, Bangalore); retrospective study including patients ≥ 18 years of age who underwent thrombophilia workup in a diagnosis of CTEPH from January 2019 till July 2021. Tests done to evaluate thrombophilia included factor V Leiden; prothrombin F20210A mutation; MTHFR gene mutation; Protein C, S, and antithrombin deficiency; lupus anticoagulant, anti-beta2 glycoprotein I (IgM and IgG) and anticardiolipin antibody (IgM and IgG); hyperhomocysteinemia and anti-nuclear antibody testing (ANA-IF). The study was approved by the ethics committee of the institute and was carried out in accordance with the principles of the declaration of Helsinki. Results and discussion The study included 56 patients with a median age of 37 years (range 23-50), and 36 (64%) were males. Patients with recurrent venous thrombosis included 37 (66%), with the majority having thrombosis at 2 sites (53%; 22 patients with associated deep vein thrombosis). A family history of thrombosis was present in 4 patients. The majority of patients received vitamin K antagonists (76%), with the rest receiving direct oral anticoagulants (DOAC). Among the tests sent for acquired thrombophilia, ANA-IF and antiphospholipid antibody (APLA) were most frequently evaluated (94%). ANA-IF and APLA tests were positive in 5.6% and 30.1%, respectively. Among the APLA tests, Anti-beta2 glycoprotein I (IgM or IgG) was the most commonly detected antibody (13/46), followed by anticardiolipin antibody (IgG or IgM) (9/43) and lupus anticoagulant (7/40). Double and triple positive APLA were present in 3 and 4 patients, respectively. Homocysteine levels were high in 93.7% though only 16 patients were tested in this cohort. Among the tests for inherited thrombophilia, genetic tests (factor V Leiden, prothrombin F20210A mutation, and MTHFR gene mutation) were tested in only ~50%. Twenty-three percent were positive for heterozygous MTHFR followed by MTHFR compound heterozygous (10%) and heterozygous factor V Leiden heterozygous (10%). Antithrombin III, protein C, and S were tested in ~30% of patients. Antithrombin III was low in only 1 patient, with protein C and S assays being normal in all the patients. The cost analysis was calculated, showed a median of $364 (₹ 27,055) was spent per person on thrombophilia workup. The median cost incurred per patient for inherited thrombophilia workup was $232 (₹ 17,300) and for acquired thrombophilia was $132 (₹ 9814), respectively. Conclusion This single-institution study on thrombophilia workup in CTEPH patients reveals that APLA was the most commonly performed test with high positivity rates of 30.1%. Among the inherited thrombophilia, the positivity rate of MTHFR mutation was highest (33.3%), with other tests having a low positivity rate (0-10%). Hence, we would recommend APLA testing in all patients with CTEPH considering its high positivity and clinical utility. Testing for other thrombophilias should be pursued judiciously especially in economically restrictive settings. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.