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This randomized controlled trial was aimed to compare 1-year morphologic changes of the no-touch saphenous vein graft as Y-composite (Composite group) versus aortocoronary (Aorta group) configurations in coronary artery bypass grafting. The primary endpoint was intima-media thickness of the saphenous vein graft as measured by intravascular ultrasound (IVUS) at the 1-year angiographic evaluation. Recruitment of 25 patients in each group was necessary based on a superiority design. Among the 50 patients, IVUS data were obtained in 22 and 24 patients from the Composite and Aorta groups, respectively. Mean age was 64.8 ± 9.2 years, and the proportion of females was 20.0%. The numbers of distal anastomoses per saphenous vein graft were 2.7 ± 1.1 and 2.6 ± 0.8 in the Composite and Aorta groups, respectively. The intima-media thickness of the saphenous vein graft 1 year after surgery were 0.25 ± 0.04 mm and 0.24 ± 0.06 mm in the Composite and Aorta groups, respectively (P for superiority = .99). Other IVUS parameters of saphenous vein grafts, including vessel diameter, luminal diameter, and the ratio of intima-media thickness to vessel diameter, also demonstrated no differences between the groups. No neointimal hyperplasia or plaque formation was detected using IVUS. All study patients underwent 1-year angiographic evaluation, and the patency rates were 94.7%(89 out of 94 anastomoses) and 100.0%(90 out of 90 anastomoses) in the Composite and Aorta groups, respectively. The intima-media thickness of the saphenous vein graft 1 year after surgery demonstrated no significant difference between the Y-composite and aortocoronary configurations (NCT04782492). Trial Registration: ClinicalTrials.gov NCT04782492.

OBJECTIVES This retrospective study was conducted to evaluate the impact of saphenous vein (SV) harvesting with versus without perivascular tissue on the 5-year angiographic patency in coronary artery bypass grafting. METHODS Among the 944 patients who received coronary artery bypass grafting between 2010 and 2015, 579 patients who received off-pump coronary artery bypass grafting using 1 SV as a Y-composite graft based on the in situ left internal thoracic artery were enrolled. SV harvesting was performed using no-touch technique without perivascular tissue (the NoPVT group) in 342 patients and with perivascular tissue (the PVT group) in 237 patients. Follow-up duration was 84.0 months (interquartile range 66.5–105.4). Propensity score matching was performed, and long-term clinical outcomes and angiographic patency were compared. RESULTS The average number of distal anastomoses per patient was comparable between the groups, although more SV grafts were anastomosed to left anterior descending territory in the PVT group than in the NoPVT group. Overall survival and cumulative incidence of cardiac death were comparable between the groups, whereas cumulative incidence of target vessel revascularization (1.3% vs 4.3% at 5 year, P = 0.009) and that of major adverse cardiac events (7.3% vs 9.9% at 5 year, P = 0.035) were lower in the PVT group than in the NoPVT group. One-year and 5-year angiographic patency rates of the SV grafts were higher in the PVT group than in the NoPVT group [97.0% vs 91.7% (P = 0.004) and 96.3% vs 89.9% (P = 0.007), respectively]. CONCLUSIONS SV grafts harvested using no-touch technique with perivascular tissue further improved the 5-year patency of SV composite grafts compared with those without perivascular tissue. The internal thoracic artery is considered the 1st graft of choice for coronary artery bypass grafting (CABG) because of its excellent long-term patency and survival benefit [1, 2]. Graphical Abstract

OBJECTIVES This study was conducted to assess long-term clinical outcomes after mitral valve repair using machine-learning techniques. METHODS We retrospectively evaluated 436 consecutive patients (mean age: 54.7 ± 15.4; 235 males) who underwent mitral valve repair between January 2000 and December 2017. Actuarial survival and freedom from significant (≥ moderate) mitral regurgitation (MR) were clinical end points. To evaluate the independent risk factors, random survival forest (RSF), extreme gradient boost (XGBoost), support vector machine, Cox proportional hazards model and general linear models with elastic net regularization were used. Concordance indices (C-indices) of each model were estimated. RESULTS The operative mortality was 0.9% (N = 4). Reoperation was required in 15 patients (3.5%). In terms of C-index, the overall performance of the XGBoost (C-index 0.806) and RSF models (C-index 0.814) was better than that of the Cox model (C-index 0.733) in overall survival. For the recurrent MR, the C-index for XGBoost was 0.718, which was the highest among the 5 models. Compared to the Cox model (C-index 0.545), the C-indices of the XGBoost (C-index 0.718) and RSF models (C-index 0.692) were higher. CONCLUSIONS Machine-learning techniques can be a useful tool for both prediction and interpretation in the survival and recurrent MR. From the machine-learning techniques examined here, the long-term clinical outcomes of mitral valve repair were excellent. The complexity of MV increased the risk of late mitral valve-related reoperation. Mitral valve repair is considered to have better survival and clinical outcomes compared to valve replacement [1–3].

Non-vitamin K direct oral anticoagulant (DOAC) is effective for prevention of embolic events in nonvalvular atrial fibrillation (AF) patients. However, the effectiveness and safety of DOAC in AF patients who have bioprosthetic heart valve (BPHV) is largely unknown. We retrospectively identified patients with AF and BPHV, using the diagnostic code and medical device and surgery information from the Korean National Health Insurance Service database, between 2013 and 2018. A 1:2 propensity score-matched cohort (n = 724 taking warfarin; n = 362 taking DOAC) was constructed and analyzed for the primary clinical outcome, a composite of ischemic stroke and systemic embolism. Important secondary outcomes included major bleeding, all-cause death, and the net clinical outcome, defined as a composite of all embolic events, major bleeding, and death. The mean age was 78.9±6.8 years old, and 45% (n = 489) were male. The mean CHA2DS2-VASc score was 4.7±1.4. DOAC was non-inferior to warfarin for preventing ischemic stroke and systemic embolism (hazard ratio [HR] 1.14, 95% confidence interval [CI] 0.56-2.34), major bleeding (HR 0.80, 95% CI 0.32-2.03) and all-cause death (HR 1.09, 95% CI 0.73-1.63). As for the net clinical outcome, DOAC was also similar to warfarin (HR 1.06, 95% CI 0.76-1.47). These outcomes were not different in various subgroups analyzed. In this nationwide Korean AF population with a BPHV, DOAC was at least as effective and safe as warfarin for the prevention of systemic embolic events. These results suggest that DOAC may be an excellent alternative to warfarin in AF patients with BPHV.

OBJECTIVES This study evaluated suture tie-down forces and cyclic contractile forces (CCFs) after undersized tricuspid annuloplasty using a hybrid band. METHODS Downsized tricuspid annuloplasty was planned in adult male sheep using 8 force transducers attached from the septal to the anterior annular areas of the ring (segments 1 and 2, flexible septal; segments 3 and 4, semi-rigid posterior; segments 5 and 6, semi-rigid anterior; segments 7 and 8, flexible anterior). CCFs were analysed at 3 different levels of peak right ventricular pressure (RVP): 30, 50 and 70 mmHg. RESULTS Eight 5-year-old male Corriedale sheep (average body weight = 66.8 kg) were used. The average suture tie-down force was 4.42 [standard deviation (SD): 2.32] N. When the forces were compared, it was lowest in the flexible anterior area and highest in the flexible septal area (P < 0.001). With the RVP of 30 mmHg, the average CCFs was lowest at segment 3 [0.07 (SD: 0.07) N] and highest at segment 7 [0.15 (SD: 0.08) N]. The CCFs were 0.12 (SD: 0.1) N, 0.09 (SD: 0.12) N, 0.14 (SD: 0.1) N and 0.13 (SD: 0.09) N in the flexible septal, semi-rigid posterior, semi-rigid anterior and flexible anterior parts, respectively (P = 0.208). As the peak RVP increased to 50 and 70 mmHg, the CCFs of each area increased significantly (P < 0.001). Despite this increase, the CCFs remained low (0.1 and 0.3 N), and differences in CCFs between segments and between annular areas showed similar patterns. CONCLUSIONS The flexible end of the hybrid band reduces the CCFs and might prevent annular tears after ring tricuspid annuloplasty, and the risk of tear would be low even in the septal area. Tricuspid valve annuloplasty (TAP) using prosthetic rings has been established as the standard surgical treatment of choice for the correction of tricuspid regurgitation (TR) [1, 2].

Abstract OBJECTIVES This study compared the mid-term patency of expanded polytetrafluoroethylene grafts without rings versus that of bovine pericardial conduits used for superior vena cava reconstruction for various thoracic diseases. METHODS Among 80 patients who underwent superior vena cava resection and reconstruction between 2009 and 2023 at our institution, 31 patients who received polytetrafluoroethylene grafts without rings (Polytetrafluoroethylene group) and 28 patients who received bovine pericardial conduits (Bovine group) were enrolled. Median follow-up durations were 19.5 and 64.6 months in the Polytetrafluoroethylene and Bovine groups, respectively. Primary outcome was midterm graft patency rate, and secondary outcomes were early and midterm clinical outcomes, including all-cause mortality and superior vena cava reintervention. RESULTS Operative mortality was 1.7%. Cumulative incidence of all-cause mortality was not significantly different between the groups. Graft occlusion was detected in 22 patients. Cumulative incidence of graft occlusion was 24.2%, 36.4%, 42.4%, 48.5% and 60.6% at 1 month, 3 months, 6 months, 1 year and 2 years, respectively, in the Bovine group, whereas no graft occlusion was observed in the Polytetrafluoroethylene group (P = 0.007). Although the incidence of graft occlusion was higher in the Bovine group, cumulative incidence of reintervention was not significantly different between the groups (0.0% vs 3.0% in Polytetrafluoroethylene vs Bovine groups at 1 year, P = 0.406). Multivariate analysis demonstrated that bovine pericardial conduit (polytetrafluoroethylene graft as reference) and left brachiocephalic vein reconstruction (right brachiocephalic vein reconstruction as reference) were significant risk factors for graft occlusion. CONCLUSIONS In superior vena cava reconstruction, polytetrafluoroethylene grafts without rings were superior to bovine pericardial conduits in terms of midterm graft patency. Advanced thymic epithelial tumours infiltrating the superior vena cava (SVC) can be surgically treated by resection and prosthetic reconstruction of the SVC via a multimodal therapeutic approach if it is radically resectable [1–4]. Graphical abstract

Background Non-vitamin K direct oral anticoagulant (DOAC) is effective for prevention of embolic events in nonvalvular atrial fibrillation (AF) patients. However, the effectiveness and safety of DOAC in AF patients who have bioprosthetic heart valve (BPHV) is largely unknown. Methods We retrospectively identified patients with AF and BPHV, using the diagnostic code and medical device and surgery information from the Korean National Health Insurance Service database, between 2013 and 2018. A 1:2 propensity score-matched cohort (n = 724 taking warfarin; n = 362 taking DOAC) was constructed and analyzed for the primary clinical outcome, a composite of ischemic stroke and systemic embolism. Important secondary outcomes included major bleeding, all-cause death, and the net clinical outcome, defined as a composite of all embolic events, major bleeding, and death. Results The mean age was 78.9±6.8 years old, and 45% (n = 489) were male. The mean CHA2DS2-VASc score was 4.7±1.4. DOAC was non-inferior to warfarin for preventing ischemic stroke and systemic embolism (hazard ratio [HR] 1.14, 95% confidence interval [CI] 0.56–2.34), major bleeding (HR 0.80, 95% CI 0.32–2.03) and all-cause death (HR 1.09, 95% CI 0.73–1.63). As for the net clinical outcome, DOAC was also similar to warfarin (HR 1.06, 95% CI 0.76–1.47). These outcomes were not different in various subgroups analyzed. Conclusion In this nationwide Korean AF population with a BPHV, DOAC was at least as effective and safe as warfarin for the prevention of systemic embolic events. These results suggest that DOAC may be an excellent alternative to warfarin in AF patients with BPHV.

There are limited data regarding whether mortality is higher in patients with non cystic fibrosis bronchiectasis (bronchiectasis) than in those without bronchiectasis. Using 2005–2015 data from the Korean National Health Insurance Service, we evaluated hazard ratio (HR) for all-cause mortality in the bronchiectasis cohort relative to the matched cohort. The effect of comorbidities over the study period on the relative mortality was also assessed. All-cause mortality was significantly higher in the bronchiectasis cohort than in the matched cohort (2505/100,000 vs 2142/100,000 person-years, respectively; P  < 0.001). Mortality risk was 1.15-fold greater in the bronchiectasis cohort than in the matched cohort (95% confidence interval [CI] 1.09–1.22); mortality was greatest among elderly patients (HR = 1.17, 95% CI 1.10–1.25) and men (HR = 1.19, 95% CI 1.10–1.29). Comorbidities over the study period significantly increased the risk of death in the bronchiectasis cohort relative to the matched cohort: asthma (adjusted HR = 1.20, 95% CI 1.11–1.30), chronic obstructive pulmonary disease (adjusted HR = 1.24, 95% CI 1.15–1.34), pneumonia (adjusted HR = 1.50, 95% CI 1.39–1.63), lung cancer (adjusted HR = 1.85, 95% CI 1.61–2.12), and cardiovascular disease (adjusted HR = 1.34, 95% CI 1.23–1.45). In contrast, there were no significant differences in the risk of death in patients without bronchiectasis-related comorbidities and the matched cohort, except in the case of non-tuberculous mycobacterial infection. In conclusion, all-cause mortality was higher in patients with bronchiectasis cohort than those without bronchiectasis, especially in elderly patients and men. Comorbidities over the study period played a major role in increasing mortality in patients with bronchiectasis relative to those without bronchiectasis.

Objective To investigate the agreement and reliability of estimating the volumes and normative percentiles (N%) of segmented brain regions among NeuroQuant (NQ), DeepBrain (DB), and FreeSurfer (FS) software programs, focusing on the comparison between NQ and DB. Materials and Methods Three-dimensional T1-weighted images of 145 participants (48 healthy participants, 50 patients with mild cognitive impairment, and 47 patients with Alzheimer’s disease) from a single medical center (SMC) dataset and 130 participants from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) dataset were included in this retrospective study. All images were analyzed with DB, NQ, and FS software to obtain volume estimates and N% of various segmented brain regions. We used Bland–Altman analysis, repeated measures ANOVA, reproducibility coefficient, effect size, and intraclass correlation coefficient (ICC) to evaluate inter-method agreement and reliability. Results Among the three software programs, the Bland–Altman plot showed a substantial bias, the ICC showed a broad range of reliability (0.004–0.97), and repeated-measures ANOVA revealed significant mean volume differences in all brain regions. Similarly, the volume differences of the three software programs had large effect sizes in most regions (0.73–5.51). The effect size was largest in the pallidum in both datasets and smallest in the thalamus and cerebral white matter in the SMC and ADNI datasets, respectively. N% of NQ and DB showed an unacceptably broad Bland–Altman limit of agreement in all brain regions and a very wide range of ICC values (-0.142–0.844) in most brain regions. Conclusion NQ and DB showed significant differences in the measured volume and N%, with limited agreement and reliability for most brain regions. Therefore, users should be aware of the lack of interchangeability between these software programs when they are applied in clinical practice.