bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term Outcomes of Tetralogy of Fallot in the Kingdom of Bahrain
Authors: Agarwal Abhinav , Al Amer Suad R. , Al Tarif Habib , Ismael Aieshah Ahmed , Alshaiji Abdulla Faisal , Arulselvam Vimalarani , Kalis Neale Nicola 
Published: February 2024

Introduction:
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Surgical correction has improved survival but re-intervention is often required.

Objectives:
The objective is to assess outcomes after surgical repair of TOF, long-term follow-up, and factors that influence these results.

Materials and Methods:
This is a retrospective study conducted in a tertiary care center. Records of patients diagnosed with TOF from 1992 to 2019 (37 years) were retrieved from a detailed database. Patients who underwent complete correction were grouped according to diagnosis, the technique utilized in surgical repair, need for staged repair, and syndromic association. Univariate actuarial and event-free survival analysis was performed. The endpoint for an event was death or re-intervention.

Results:
A total of 230 patients were diagnosed with TOF and 174 patients underwent complete surgical repair. At 40 years postoperatively, survival was 96%. Actuarial survival was independent of syndromic associations, anatomical diagnosis, type of surgery, or previous shunt. Event-free survival (EFS) survival was 8.12%. EFS was significantly worse for patients with pulmonary atresia (PA) (Hazard ratio, 4.1125; 95% confidence interval [CI], 1.2654–13.3657; P < 0.0001) and for those that required homograft/conduit. The median duration for EFS was 22.73 years, 19.58 years, and 9.12 years for transannular patch (TAP), pulmonary valve-sparing (PVS), and homograft group, respectively. The survival curve for the PVS group merged with that of TAP 20 years postoperatively. Similarly, it merged at 22 years for staged versus primary repair and at 22.73 years for syndromic versus nonsyndromic patients. A weak correlation was found between age at surgery and event-free duration (cc, 0.309; P < 0.0001). The need for TAP was not influenced by the previous palliation, χ2(1, n = 154) = 3.36, P = 0.0667, or with interval to complete correction after the shunt procedure (P = 0.9672).

Conclusions:
Total correction of TOF has low perioperative mortality and good long-term survival, but the need for re-interventions is high. This study demonstrated that patients requiring homograft/conduit and those with a diagnosis of PA had worse outcomes. Comparison between different surgical groups showed merging of survival curves in follow-up that signifies gradual loss of survival advantage over time.
Meta-analysis Comparing Long-Term Clinical Outcomes of Percutaneous Coronary Intervention versus no Intervention in Patients with Chronic Total Occlusion
Authors: Ibrahem Abdalazeem , Farag Mohamed , Gue Ying X. , Spinthakis Nikolaos , Al-Atta Ayman , Egred Mohaned 
Published: February 2024

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has substantially improved due to increasing operator experience and advancements in equipment, techniques, and management algorithms. However, the overall benefit of CTO PCI remains controversial, particularly since only a few randomized trials have been reported to date.

Methods:
We performed a meta-analysis to evaluate the efficacy of CTO PCI. The study outcomes were the occurrence of all-cause mortality, myocardial infarction, repeat revascularization, stroke, or freedom from angina at the longest documented follow-up period.

Results:
In five trials including 1790 patients, the mean age was 63 ± 10 years, 17% were female, with a median follow-up of 2.9 years. The procedural success rate ranged from 73% to 97% and the right coronary artery was the most involved artery (52%). There was no significant difference between CTO PCI and no intervention regarding all-cause mortality (odds ratio [OR]: 1.10, 95% confidence interval [CI]: 0.49–2.47, P = 0.82), myocardial infarction (OR: 1.20, 95% CI: 0.81–1.77, P = 0.36), repeat revascularization (OR: 0.67, 95% CI: 0.40–1.14, P = 0.14), or stroke (OR: 0.60, 95% CI: 0.26–1.36, P = 0.22). In two trials including 686 patients, significantly more patients were free of angina at 1 year, defined as the Canadian Cardiovascular Society grading of angina pectoris Grade 0, in the CTO PCI group compared to the no intervention group (OR: 0.52, 95% CI: 0.35–0.76, P < 0.001). Meta-regression analyses based on various trial-level covariates (gender, diabetes, previous myocardial infarction, PCI or coronary artery bypass graft, SYNTAX or J-CTO scores, and CTO-related artery percentages) did not suggest any statistically significant relationships.

Conclusions:
CTO PCI appears to have a similar efficacy profile compared to no intervention at long-term follow-up, but with a significant improvement of angina favoring PCI-treated patients. Further adequately powered and long-term trials are required to identify the best management strategy for patients with coronary CTO.
Evolution of Surgical Repair of Patent Ductus Arteriosus - A Historical Timeline
Authors: Murshid Mohsin Yahya , Elassal Ahmed Abdelrahman 
Published: February 2024

Congenital cardiac surgery is one of the most challenging and fascinating branches of modern medicine which continues to advance in areas and improving outcomes, post-operative and pre-operative care.
Patent Ductus Arteriosus was the first congenital heart lesion to be successfully corrected surgically. The landmark surgery was performed by Dr. Robert E. Gross in 1938 and opened up the possibility of subsequent surgical correction of various other lesions, which were considered to be untreatable previously. The first successful surgical closure of persistent ductus arteriosus (PDA) was preceded by years of work and contributed by various surgeons, physicians, and anatomists, dating all the way back to the 1st century. They are all worthy of recognition and praise.
This article covers the important events related to PDA lesions including its first identification, followed by its description in various texts and sources over the course of time, failed attempts at surgical correction, and disputes regarding credits. These contributions to the branch cannot be overstated and serves as an inspiration to cardiac surgeons all over the world and to students, interns, and newly graduated doctors as well, who would one day like to be part of this fascinating branch.
Long-term Consequences of Ventricular Septal Defect Closure Using Nit-Occlud Le VSD Coil Device
Authors: Ghaderian Mehdi , Shahsanaei Farzad , Behdad Samin , Mozafari Safura 
Published: February 2024

Background:
The successful management of ventricular septal defect (VSD) has been possible through the development of advanced techniques. In this regard, percutaneous VSD closure by employing different types of occluders as an alternative for surgery can help to achieve the most desirable postprocedural consequences. However, the studies reported contradictory results on the use of different brands of VSD occluders. Herein, we performed a systematic review and meta-analysis of published studies to assess pooled long-term success rate and potential complications of using the Nit-Occlud Lê VSD coil for VSD closure.

Materials and Methods:
Two reviewers began to deeply search the various databases for all eligible studies in accordance with the considered keywords. The inclusion criterion for retrieving the studies was to describe the mid-term or long-term consequences of VSD closing by the Nit-Occlud Lê VSD coil device. In the final, eight articles were eligible for the analysis. The follow-up time of the studies ranged from 6 months to 5 years.

Results:
The success rate of the procedure ranged from 87.0% to 100% considering the weight of each study, the pooled success rate of VSDs closure by Nit-Occlud Lê VSD coil device was 93.1% (95% confidence interval [CI]: 89.9% to 95.5%). The pooled prevalence of postprocedural residual shunt was estimated to be 9.6% (95%CI: 6.8% to 13.4%). The corrected pooled prevalence of trivial mild aortic regurgitation (AR) was 2.9% (95%CI: 1.5% to 5.4%); however, moderate-to-severe AR and complete heart block or right bundle branch block were shown to be rare.

Conclusion:
VSD closure using a Nit-Occlud Lê VSD coil device can lead to a high success rate with low rates of residual shunt, cardiac conductive or vascular disturbances.
Developing incisional hernia after open liver resection and liver transplantation: A single-center risk factor analysis
Authors: Aldarwish Saeed , Guda Paula , Philipp Mark , Schafmayer Clemens , Hinz Sebastian 
Published: February 2024

Abstract

INTRODUCTION:
Open liver surgery is one of the most common abdominal surgeries, which is associated with a higher risk of developing an incisional hernia (IH). This is mainly because of the extent and type of the surgical incisions in this type of surgery. Of course, many other risk factors may interfere with wound healing and can increase the risk of developing IH after this type of surgery. In this study, we analyzed several perioperative risk factors, particularly the type of surgical incision and the technical suture aspects.

MATERIALS AND METHODS:
Retrospectively, we analyzed the development of incisional hernia within the first 36 postoperative months clinically and image-morphologically among 155 patients who had undergone an open liver resection or liver transplantation and met the inclusion criteria between 2015 and 2020 in our institution.

RESULTS:
Most of the incisional hernias occurred during the first 16 postoperative months, with a peak incidence in the eighth postoperative month. The most important preoperative risk factors were the positive past medical history of other hernias (P = 0.05) and overweight/ obesity (P = 0.018). From the operative course, many risk factors were detected, like an intraoperative blood loss of > 1,000 ml (P = 0.043) and an intraoperative blood transfusion of > 10 PRBCs (P = 0.001), a Mercedes-star incision (P = 0.007), the use of Vicryl (polyglactin 910) sutures and interrupted suture techniques for the fascial reconstruction (P = 0.045) and (P = 0.006), and a long operative time of > 240 min (P = 0.033). Postoperative ascites formation as well as the need for revision operation due to a postoperative complication were associated with higher incidence rates of developing IH (P = 0.02) and (P = 0.014).

CONCLUSIONS:
The development of IH cannot be avoided. But the leading risk factors can be modified or optimized. From our experience and according to this analysis, we recommend the careful selection of the surgical approach for each patient and promotion of the use of the minimally invasive approaches, avoiding the angulated incisions as much as possible, applying the running suture technique with (polydioxanone) PDS-loops for the fascial reconstruction, minimizing the intraoperative blood loss and need for blood transfusion, shortening the operative time as much as possible, early detection of postoperative formation of ascites, and managing it properly. In the event of need for a revision operation due to a postoperative complication, a reinforced reconstruction of the fascia can be considered.
Cardiac Involvement in Pediatric Mucopolysaccharidoses Patients and their Genetic Profile: A Retrospective Single-center Study
Authors: Varghese Shruti Irene , Christudoss Joshua Abishek , Aaron Rekha , Danda Sumita , Krupa Jesu 
Published: February 2024

AbstractBackground:Mucopolysaccharidoses (MPS) are rare metabolic disorders of monogenic inheritance, with varying degrees of cardiac involvement due to undegraded glycosaminoglycans getting aggregated in the spongiosa of the cardiac valves, the myocardium, and myointima of the coronary arteries. This study is an effort to understand the cardiac involvement and genetic pattern of pediatric MPS patients at a tertiary care center in South India.Methods:This descriptive study was done by examining records in our hospital database for MPS patients in the age group of 0–15 years, diagnosed between January 2014 and January 2023. Of these patients, 37 patients with echocardiographic loops available in the hospital system were reevaluated by a single pediatric cardiologist to avoid observer bias. The underlying genetic spectrum was also reviewed.Results:The cohort comprised 67.5% of males and a median age of 9.8 years (interquartile range: 6.5–14.9 years) with a distribution of 37.8% MPS I, 32.4% MPS II, 13.5% MPS IV, and 10.8% MPS VI. Early cardiac involvement in the form of valvar thickening, predominantly left sided (mitral [92%] >aortic [38%]), was seen across all MPS subtypes. We also noted an increased involvement of the tricuspid valve (38%) in our cohort. Moderate–severe valvar involvement was seen in 16% of the cohort, mostly MPS I, II, and VI patients, and more in the second half of the age group (>6 years), suggesting an age-associated worsening of cardiac lesions. Genetic analysis done in 68% of the cohort detected 61% of pathogenic variants, with a predominance of missense mutation (43%). However, no genotype–cardiac phenotype correlation could be ascertained.Conclusions:We identified a high proportion of cardiac abnormalities in our pediatric MPS cohort, which ranged from isolated valvar thickening to a more severe clinical picture, including moderate-to-severe valvular insufficiency and/or stenosis and left ventricular hypertrophy. Cardiac pathology is an early manifestation and a known cause of mortality in many MPS subtypes. Echocardiography is a key diagnostic technique for early detection, careful monitoring, and guidance in the initiation of a timely intervention that will help curb its progression. Hence, the need arises to raise awareness among the primary caretakers of this subset of patients on the need for early cardiac evaluation with a detailed echocardiography.
Incidental detection of rare vascular variation during pyeloplasty and its clinical implication – A case report
Authors: Bhirud Deepak Prakash , Tripathi Shashank Shekhar , Aggarwal Amit , Singh Mahendra 
Published: February 2024

Abstract
Crossing vessels is one of the important causes of pelviureteric junction obstruction (PUJO). Accessory lower polar vessels are commonly seen with congenital PUJO, but they are not always the cause of obstruction. We incidentally encountered a variation in the lower polar crossing vessel while doing laparoscopic pyeloplasty in a patient with congenital PUJO. We encountered a right accessory lower polar artery and vein along with a right gonadal artery arising from the accessory right renal artery and right gonadal vein draining into the right lower polar crossing accessory renal vein. Knowledge of variations in genitourinary vasculature is important in the current era to prevent inadvertent complications.
Robotic hernia repair with the novel HUGO robot system – An initial experience from a tertiary centre
Authors: Jebakumar S. Gilbert Samuel , Swain Sudeepta Kumar , Munikrishnan Venkatesh , Jayapal Loganathan , Kumar R Santhosh , Baskaran Aravind , Tasgaonkar Siddhesh , Srivatsan Sumanth 
Published: February 2024

Abstract

Background:
Hernia repair using robotic platforms has been on the rise in the last decade. The HUGO robotic-assisted surgery (RAS) system, introduced in 2021, is a new addition to the field. In this study, we share our experience with this innovative system for the management of ventral and groin hernias.

Patients and Methods:
The aim of our study was to evaluate the feasibility and safety of using the HUGO robotic platform for hernia surgeries. We conducted a retrospective analysis of all hernia surgeries performed with the HUGO system over a 1-year study period. The study assessed various aspects, including the technical manoeuvres of the robotic system, duration of surgery, length of hospital stay, post-operative pain levels and 30-day morbidity rates.

Results and Conclusions:
A total of seven hernia surgeries were performed using the HUGO system, including five ventral hernias and two groin hernias. The average duration of surgery was 128 min, with a docking duration of 22.8 min. Notably, there were no intraoperative or post-operative adverse events reported during these procedures. The HUGO system features an open console that provides a panoramic view of the operating room. In addition, the individual arm carts can be easily manoeuvred around the operating table, facilitating improved access to multiple quadrants during surgery. In our case series, Robotic hernia repair using the HUGO system has demonstrated feasibility, with post-operative outcomes comparable to traditional approaches. This innovative system serves as an additional tool in the armamentarium of hernia surgery and shows potential for improving surgical outcomes. However, further investigation through large-scale prospective studies is necessary to comprehensively evaluate its efficacy and benefits.
A comparative study of indocyanine green instillation in inguinal node versus foot web space using da Vinci indocyanine green FireFly™ technology in identifying thoracic duct during robotic-assisted transthoracic oesophagectomy
Authors: Somashekhar S. P. , Saldanha Elroy , Kumar Rohit , Monteiro Ashma , Pillarisetti Sai Ram , Ashwin K. R. 
Published: February 2024

Abstract

Introduction:
Chyle leak is a serious complication following oesophagectomy with incidence varies from 1% to 9%. Near infra-red fluorescence imaging of thoracic duct (TD) can provide real-time dynamic imaging during the surgery. In this study, we intend to compare indocyanine green (ICG) dye instillation through inguinal node with subcutaneous first web space instillation for visualisation of TD during robotic-assisted minimally invasive oesophagectomy (RAMIE) procedure.

Patients and Methods:
A prospective study of 50 patients underwent RAMIE with da Vinci X System. After general anaesthesia, patients were divided into inguinal node and foot first web space ICG instillation group. The former group had 1 ml of ICG dye instilled on bilateral inguinal nodes under ultrasound guidance and while the other group received 1 mL of ICG dye injected at bilateral foot first web space and then underwent surgery. TD was visualised using ICG FireFly™ fluorescence technology, first at the time of docking and subsequently for every 5 min until 60 min of instillation time and analysed.

Results:
Twenty-five patients were enrolled in each group. The mean docking time for thoracic phase was 13.76 ± 3.43 min. TD was visualised in 72% (18/25) of cases of first web space instillation group, whereas 100% in ultrasound guidance inguinal node instillation group. None of the patients had a chyle leak.

Conclusion:
ICG FireFly™ fluorescence technology for the identification of TD during oesophageal mobilisation is safe and effective and provides real-time dynamic visualisation with high accuracy in ultrasound-guided bilateral inguinal node instillation group. It is an effective method for the surgeons planning to negotiate their initial learning curve in RAMIE procedures.
Cholecystectomy clip-induced biliary stone: Case report and literature review
Authors: Tanimu Sabo , Coombs Reilly A. , Tanimu Yusuf , Onitilo Adedayo A. 
Published: February 2024

Abstract
Migration of cholecystectomy surgical clip into the common bile duct with subsequent stone formation is a rare phenomenon, one which may lead to complications including obstruction, pain, nausea, vomiting and fever. The mechanism of migration is largely unknown but may result from a combination of factors including necrosis, intra-abdominal pressure or poor surgical technique with migrated clip serving as a nidus for stone formation. We present a 55-year-old woman with clip-induced stone impacted at the distal common bile duct 12 years post-cholecystectomy and a review of the literature related to cholecystectomy clip stone formation. In addition, we reviewed relevant English language case reports and literature reviews by searching PubMed using search terms ‘stone’, ‘clip’, ‘cholecystectomy’ and ‘biliary’. There was no limit to the date of publication. Our study found 68 unduplicated cases of clip-induced stones which had a wide range of onset and presenting systems. Further research is needed to identify risk factors, methods of prevention and benefits of early detection screening.
Quick Sequential Organ Failure Assessment Score for the Detection of Incipient Sepsis in Diabetic Skin and Soft-tissue Infections
Authors: Sandra A. , Vijayan K. N. 
Published: February 2024

Abstract

Background:
Skin and soft-tissue infections (SSTIs) are the common complications in diabetes, often posing a high risk of progressing to sepsis due to weakened immune defences. Recognising and treating sepsis early is crucial. With recent understanding of sepsis, the sepsis 3 guidelines defines it as life-threatening organ dysfunction due to uncontrolled response to infection with the introduction of the quick sequential organ failure assessment (qSOFA) criteria, a simple tool for identifying adult patients with suspected infections who may have poor outcomes.

Aim:
To analyse the performance of qSOFA and systemic inflammatory response syndrome (SIRS) criteria in detecting incipient sepsis in diabetics with SSTIs at initial presentation.

Materials and Methods:
A prospective, observational study was conducted involving 143 patients with diabetic SSTIs at our tertiary care. Patients underwent a standardised sepsis investigation according to the hospital protocol. Relevant data were collected to establish infection and calculate qSOFA, SOFA and SIRS scores. Patients with a SOFA score of 2 points or higher were classified as having sepsis. The study evaluated the performance of qSOFA and SIRS criteria by comparing the proportion of patients in sepsis who met these criteria.

Results:
qSOFA as a diagnostic or screening tool had a sensitivity of 79.7% and a specificity of 100% with area under the receiver operating characteristic (AUROC) curves 0.899 (95% confidence interval [CI], 0.849–0.949) vs. 100%), making it a fairly good screening method considering its simplicity. It has a 100% positive predictive value (PPV) and an 80% negative predictive value (NPV) with an accuracy of 88.8%. On the contrary, SIRS criteria had a higher sensitivity of 100% but poor specificity of 17.2% with AUROC curves 0.586 (95% CI: 0.536–0.636). It had a 100% NPV with a 59.8% PPV with an accuracy of 62.9%.

Conclusion:
We recommend the use of qSOFA as a quick and simple assessment score and screening criteria for the early detection of incipient sepsis in a population of diabetics with SSTI.