Predictors of Early Mortality After Aortic Valve Replacement in Middle-Aged Rheumatic Patients

Background: Several risk factors, including emergency surgery, predicted early mortality after aortic valve replacement (AVR).  Euroscore II is used to predict the mortality after cardiac operations. We aimed to review our experience in AVR and determine the early mortality predictors Methods: We collected the data of 200 rheumatic patients who had standard AVR in two centers. Median sternotomy and cardiopulmonary bypass were used in all patients. Transcatheter and minimally invasive aortic valve replacement patients were excluded. We used 15 types of aortic valve prostheses, either mechanical or biological. Follow-up echocardiography was done in the intensive care unit, on discharge, and one month after discharge.     Results: 128 patients (64%) had mechanical AVR, and 130 patients (65%) were males. The mean age was 48.2 ± 19 years, and body mass index was 1.8 ± 0.2 Kg/m2. The mean preoperative ejection fraction was 54 ± 9.4 %, end-diastolic dimension was 5.3 ± 0.8 cm, and end-systolic dimension was 3.5 ± 0.9 cm. Nine patients (4.5%) died in the early postoperative period (6 months). Euroscore II was the only factor significantly associated with early mortality (P value= 0.031).  The mean Euroscore II was 1.3 ± 0.9 and 10.1 ± 10.7 for survivors and non-survivors, respectively.  Conclusion: Euroscore II score was significantly associated with early mortality after aortic valve replacement in rheumatic patients and can be used for risk stratification in those patients

Left Ventricular Rupture Post Mitral Valve Replacement

Prevention is better than cure best applies here. As per many authors, posterior leaflet chordae preservation prevent Left ventricular rupture (LVR) and preserve LV geometry. We are presenting here 5 types of left ventricular rupture (LVR) post Mitral valve replacement (MVR) with different methods to repair with the advantages and disadvantages of each. The mortality rate is still very high despite the advances in cardiac surgery. Many therapeutic approaches have been adopted. Yet, none is ideal

Biopsia liquida nei pazienti con diagnosi di carcinoma del colon retto metastatico pre-trattato RAS e BRAF wt candidati a rechallenge con anti-EGFR: risultati preliminari dello studio PARERE

Il rechallenge con anti-EGFR è una strategia promettente in pazienti con carcinoma del colon retto metastatico pre-trattato RAS e BRAF wt pre-trattato, che abbiano tratto beneficio da questi farmaci in una linea di trattamento precedente. Riproporre un anti-EGFR dopo progressione è tuttavia efficace soltanto in pazienti selezionati da un punto di vista molecolare, ovvero che risultino wt per RAS e BRAF alla biopsia liquida prima del rechallenge, come dimostrato da precedenti trial di fase II. Nella popolazione RAS e BRAF wild-type, e questo è il dato più interessante, più di un quarto dei pazienti reca ancora una potenziale mutazione driver di resistenza, evidenziando l’utilità del pannello NGS nel caratterizzare ulteriormente questa popolazione da un punto di vista molecolare. Questa caratterizzazione molecolare sarà approfondita in questo elaborato, in cui verranno analizzati i risultati preliminari dello studio PARERE, un trial randomizzato di fase II in cui pazienti potenzialmente candidabili al rechallenge vengono sottoposti a screening centralizzato con biopsia liquida per confrontare l’efficacia terapeutica di Panitumumab seguito da Regorafenib rispetto alla sequenza inversa come strategia di trattamento in pazienti chemorefrattari pretrattati con anti-EGFR