OBJECTIVES Minimally invasive access has become the preferred choice in mitral and/or tricuspid valve surgery (MVR±TVR). Reported outcomes are at least similar to classic sternotomy although aortic cross-clamp times are usually longer. METHODS We analyzed the largest registry of MVR±TVR patients (MMIR) for the relationship between aortic cross-clamp times, mortality and other outcomes. From 2015–2021, 7,513 consecutive patients underwent mini-MVR±TVR in 17 international Heart-Valve-Centres. Data were collected according to MVARC definitions and 6878 patients with one cross-clamp period were analysed. Uni- and multivariable regression analyses were used to assess outcomes in relation to aortic cross-clamp times. RESULTS Median age was 65 years (57% male). Median EuroSCORE II was 1.3% (IQR: 0.80–2.63). Minimally invasive access was either by direct vision (28%), video-assisted (41%) or totally endoscopic/robotic (31%). Femoral cannulation was used in 93%. Three quarters were repairs with 17% additional TVR and 19% AF-ablation. Cardiopulmonary bypass and cross-clamp times were 135 min (IQR : 107–173) and 85 min (IQR : 64–111), respectively. Postoperative events were death (1.6%), stroke (1.2%), bleeding requiring revision (6%), low cardiac output syndrome (3.5%) and acute kidney injury (6.2%, mainly stage I). Statistical analyses identified significant associations between cross-clamp time and mortality, low cardiac output syndrome and acute kidney injury (all p < 0.001). Age, low ejection fraction and emergent surgery were risk factors, but variables of “increased complexity” (redo, endocarditis, concomitant procedures) were not. CONCLUSIONS Aortic cross-clamp time is associated with mortality as well as postoperatively impaired cardiac and renal function. Thus, implementing measures to reduce cross-clamp time may improve outcomes.

Objective With the popularization of catheter-based mitral valve procedures, evaluating risk-specific differentiated clinical outcomes after contemporary mitral valve surgery is crucial. In this study, we assessed the operative results of minimally invasive mitral valve operations across different patient risk profiles and evaluated the value of EuroSCORE II predicted risk of mortality model for risk prediction, in the large cohort of Mini-Mitral International Registry (MMIR). Methods The MMIR database was used to analyze mini-mitral operations between 2015 and 2021. Patients were categorized as low- (<4%), intermediate- (4% to < 8%), high- (8% to < 12%) and extreme risk (≥12%) according to EuroSCORE II. The observed to expected (O: E) mortality ratio was calculated for each risk group. Results A total of 6541 patients were included in the analysis. Of those, 5546 (84.8%) were classified as low risk, 615 (9.4%) as intermediate risk, 191 (2.9%) as high risk and 189 (2.9%) as extreme risk. Overall operative mortality and stroke rates were 1.7% and 1.4%, respectively, and were significantly associated with patient’s risk. The observed mortality was significantly lower than expected -according to the EuroSCORE II- in all risk categories (O: E ratio < 1). Conclusions The present study provides an international contemporary benchmark for operative outcomes after minimally invasive mitral surgery. Operative results were excellent in low-, intermediate- and high risk patients, but were less satisfactory in extreme risk. The EuroSCORE II model overestimated the in-hospital mortality. We believe findings from the MMIR may assist surgeons and cardiologists in clinical decision-making and treatment allocation for patients with mitral valve disease.

Context: Psoriasis, a chronic inflammatory skin disease, may negatively affect sexual function; however, data on the sexual health of female patients with psoriasis in Vietnam are lacking. Aims: To assess the risk of sexual dysfunction (SD) and its associated factors in female patients with psoriasis who visited the Ho Chi Minh City Hospital of Dermato-Venereology from April 2020 to October 2020. Settings and Design: Cross-sectional study. Methods and Material: A total of 302 female patients with psoriasis aged 18 to 49 years were recruited. The Female Sexual Function Index (FSFI) was used to assess the risk of SD (cut-off value at 26). Results: The risk of SD accounted for 79.1% of the study population and was not associated with age, comorbidities, weight, or trigger factors. Urban dwellers had greater odds of SD risk than non-urban dwellers (OR = 2.63). Similar trends were observed in terms of higher education than grade 12, less than once a week of physical activities, and psychological stress as a trigger factor (OR = 1.89, 2.65, and 3.41, respectively). Female psoriasis patients with SD risk had a lower age of onset and higher weight, BMI, waist circumference, and PASI than patients who did not (P < 0.05). Psychological stress and high PASI were independent risk factors of SD risk in female patients with psoriasis (P < 0.05). Conclusions: Factors with negative impacts on psoriasis may also increase the risk of SD in female patients; among these factors, psychological stress and high PASI were the strongest predictors of SD in female patients with psoriasis.

Introduction: The iron deficiency anemia (IDA) is the most common micronutrient malnutrition in the world. This condition has been shown to increase morbidity in adults and to exert negative impact on the psycho-motor development in children. The IDA in children with congenital heart disease (CHD) with its negative consequence has been recognized for a long time but in clinical practice the issue does not gain sufficient attention in developing countries.Objectives: We conducted this study to investigate the prevalence of IDA in children with CHD and to assess the diagnostic values of hemogram, especially the erythrocyte indexes as a simple tool for early recognition of IDA. Materials and methods: Children under 15 years old with confirmed CHD admitted to were recr uited. The total blood cell count, serum iron, ferritin and transferrin were measured preoperatively.Results: There were 69 pediatric patients were recruited in which 36 children with cyanotic CHD and 33 children with acyanotic CHD. There were 11.1% of children with cyanotic CHD and 3% of children with acyanotic CHD who showed true IDA. The prevalence of depletion or reduction of body iron store was very high. Up to 77.8% of children with cyanotic CHD and 87.2% children with acyanotic CHD were at risk of iron deficiency. The erythrocyte indexes proved to be useful as simple tool for detecting IDA in children with cyanotic CHD.Conclusion: IN the present investigation, the prevalence of IDA was found high in the children with CHD. The total blood cell count and erythrocyte indexes were of suggestive value for diagnosis of IDA. Iron supplement treatment should be recommended in this group of patients. AbstractIron deficiency anemia in children with congenital heart disease and the usefulness of erythrocyte indexes as a screening tool.

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