Aims Long-term risk stratification and surgical timing remain suboptimal in concomitant aortic and mitral (double) valve surgery. This study sought to examine the predictors, changes, and prognostic implications of right ventricular (RV) remodelling in patients undergoing double-valve surgery. Methods and results In 152 patients undergoing double-valve surgery, four RV remodelling patterns were characterized using transthoracic echocardiography: normal RV size and systolic function (Pattern 1); dilated RV (tricuspid annulus diameter >35 mm) with normal systolic function (Pattern 2); normal RV size with systolic dysfunction (percentage RV fractional area change <35%; Pattern 3); and dilated RV with systolic dysfunction (Pattern 4). The primary endpoint was the composite of heart failure hospitalization and all-cause mortality. Patterns 1, 2, 3, and 4 RV remodelling were present in 41, 20, 23, and 16% of patients, respectively. Patients with Stage 4 RV remodelling had worse renal function, higher EuroSCORE II, and impaired left ventricular ejection fraction. During a 3.7-year median follow up, 45 adverse events occurred. Patterns 3 and 4 RV remodelling were associated with significantly higher adverse event rates compared with Pattern 1 (37 and 75% vs. 11%, P < 0.01) and had incremental prognostic value when added to clinical parameters and EuroSCORE II (χ2 increased from 30 to 66, P < 0.01). At 1 year after surgery (n = 100), Patterns 3 and 4 RV remodelling had a higher risk of adverse events compared with Pattern 1. Conclusion Right ventricular remodelling was strongly related to adverse outcomes and deserves consideration as part of the risk and decision-making algorithms in double-valve surgery.

Background To investigate the safety, feasibility, and oncological outcomes of total laparoscopic right hemicolectomy with transvaginal specimen extraction in the treatment of right-sided colon cancer. Methods We retrospectively reviewed patients with right-sided colon cancer who received total laparoscopic right hemicolectomy in our hospital between January 2017 and January 2020. The patients who underwent abdominal incision were included in the control group and the patients who underwent vaginal incision group were included in the study group. The perioperative characteristics and outcomes were compared between these two groups. Results 25 patients were included in the study group and 55 patients were included in the control group. In terms of baseline data, including age, preoperative body mass index, American Society of Anesthesiologists classification, tumor transverse diameter, tumor location, pathologic differentiation, preoperative clinical staging, there were no significant differences between the two groups (P > 0.05). There were no significant differences in terms of operative duration, intraoperative blood loss, length of resected colon, number of detected lymph nodes, postoperative complications, and postoperative pathological stages between the two groups (P > 0.05). There were statistically significant differences in postoperative pain intensity, time to passage of flatus, and length of postoperative hospital stay between the two groups (P < 0.05). The sexual function index survey showed a statistically significant difference at 3 months (P < 0.05), but not 6 months (P > 0.05), after the surgery between the two groups. The one-year tumor-free survival rate was 100% in both groups. Conclusions Total laparoscopic right hemicolectomy with transvaginal specimen extraction is a safe and feasible method, with satisfactory oncological outcomes, to treat patients with right-sided colon cancer.