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Sazzad F, Tan YK, Chan LXB, Moideen ISBM, Gohary AE, Stevens JC, Ramanathan KR, Kofidis T. Systematic review of first-in-human and early phase clinical trials for surgically implantable biological mitral valve substitutes. J Cardiothorac Surg 2023; 18:348. [PMID: 38037117 PMCID: PMC10688009 DOI: 10.1186/s13019-023-02464-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND The aim of this review was the creation of uniform protocols to carry out and disclose First-In-Human and preliminary clinical trials of biological mitral valve replacement. The need for consistent methodology in these early trials was highlighted by the observation of significant variability in the methods and protocols used across different research. METHODS An extensive search through six major databases was carried out to retrieve First-In-Human (FIH) clinical studies evaluating surgically implanted bio-prostheses in the mitral position. RESULTS Following the PRISMA guideline, a systematic search identified 2082 published articles until March 2023. After removing duplicates (189), 1862 citations were screened, resulting in 22 eligible studies with 3332 patients for analysis. The mitral valve prostheses in these studies ranged from 21 to 37 mm, with the 29 mm size being most prevalent. Patient numbers varied, with the FIH subgroup including 31 patients and the older subgroup including 163 patients. Average study durations differed: the older subgroup lasted 4.57 years, the FIH subgroup 2.85 years, and the early phase studies spanned 8.05 years on average. CONCLUSION FIH clinical report is essential to assess the significance of clinical data required for a "de novo" surgical implant. In addition, understanding the performance of the device, and recognizing the difficulties associated with the innovation constitute important lessons. These insights could be beneficial for the development of bioprosthetic heart valves and formulating a protocol for an FIH clinical trial.
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Affiliation(s)
- Faizus Sazzad
- Department of Surgery, Yong Loo Lin School of Medicine, Centre for Translational Medicine, National University of Singapore, MD6, 14 Medical Drive, Level-8 (South), Singapore, 117599, Singapore.
| | - Ying Kiat Tan
- Department of Surgery, Yong Loo Lin School of Medicine, Centre for Translational Medicine, National University of Singapore, MD6, 14 Medical Drive, Level-8 (South), Singapore, 117599, Singapore
| | - Li Xuan Beverly Chan
- Department of Surgery, Yong Loo Lin School of Medicine, Centre for Translational Medicine, National University of Singapore, MD6, 14 Medical Drive, Level-8 (South), Singapore, 117599, Singapore
| | - Irwan Shah Bin Mohd Moideen
- Department of Surgery, Yong Loo Lin School of Medicine, Centre for Translational Medicine, National University of Singapore, MD6, 14 Medical Drive, Level-8 (South), Singapore, 117599, Singapore
| | - Abdulrahman El Gohary
- Department of Surgery, Yong Loo Lin School of Medicine, Centre for Translational Medicine, National University of Singapore, MD6, 14 Medical Drive, Level-8 (South), Singapore, 117599, Singapore
| | - John C Stevens
- Department of Surgery, Yong Loo Lin School of Medicine, Centre for Translational Medicine, National University of Singapore, MD6, 14 Medical Drive, Level-8 (South), Singapore, 117599, Singapore
| | - K R Ramanathan
- Department of Surgery, Yong Loo Lin School of Medicine, Centre for Translational Medicine, National University of Singapore, MD6, 14 Medical Drive, Level-8 (South), Singapore, 117599, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Theo Kofidis
- Department of Surgery, Yong Loo Lin School of Medicine, Centre for Translational Medicine, National University of Singapore, MD6, 14 Medical Drive, Level-8 (South), Singapore, 117599, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Hospital, Singapore, Singapore
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Chen D, Wang W, Wang S, Tan M, Su S, Wu J, Yang J, Li Q, Tang Y, Cao J. Predicting postoperative delirium after hip arthroplasty for elderly patients using machine learning. Aging Clin Exp Res 2023; 35:1241-1251. [PMID: 37052817 DOI: 10.1007/s40520-023-02399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Postoperative delirium (POD) is a common and severe complication in elderly hip-arthroplasty patients. AIM This study aims to develop and validate a machine learning (ML) model that determines essential features related to POD and predicts POD for elderly hip-arthroplasty patients. METHODS The electronic record data of elderly patients who received hip-arthroplasty surgery between January 2017 and April 2021 were enrolled as the dataset. The Confusion Assessment Method (CAM) was administered to the patients during their perioperative period. The feature section method was employed as a filter to determine leading features. The classical machine learning algorithms were trained in cross-validation processing, and the model with the best performance was built in predicting the POD. Metrics of the area under the curve (AUC), accuracy (ACC), sensitivity, specificity, and F1-score were calculated to evaluate the predictive performance. RESULTS 476 Arthroplasty elderly patients with general anesthesia were included in this study, and the final model combined feature selection method mutual information (MI) and linear binary classifier using logistic regression (LR) achieved an encouraging performance (AUC = 0.94, ACC = 0.88, sensitivity = 0.85, specificity = 0.90, F1-score = 0.87) on a balanced test dataset. CONCLUSION The model could predict POD with satisfying accuracy and reveal important features of suffering POD such as age, Cystatin C, GFR, CHE, CRP, LDH, monocyte count, history of mental illness or psychotropic drug use and intraoperative blood loss. Proper preoperative interventions for these factors could reduce the incidence of POD among elderly patients.
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Affiliation(s)
- Daiyu Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weijia Wang
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Siqi Wang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Minghe Tan
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Song Su
- Center for Artificial Intelligence in Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jiali Wu
- Center for Artificial Intelligence in Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jun Yang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingshu Li
- Department of Pathology, School of Basic Medicine, Chongqing Medical University, Chongqing, China
| | - Yong Tang
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China.
| | - Jun Cao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Sonaglioni A, Nicolosi GL, Rigamonti E, Lombardo M. Impact of Chest Wall Conformation on the Outcome of Primary Mitral Regurgitation due to Mitral Valve Prolapse. J Cardiovasc Echogr 2022; 32:29-37. [PMID: 35669134 PMCID: PMC9164916 DOI: 10.4103/jcecho.jcecho_71_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/08/2021] [Accepted: 01/08/2022] [Indexed: 11/20/2022] Open
Abstract
Background The possible influence of chest wall conformation on cardiovascular (CV) outcome of patients with mitral regurgitation (MR) due to mitral valve prolapse (MVP) has never been previously investigated. Methods This retrospective study included all consecutive symptomatic patients with MVP and moderate MR who underwent exercise stress echocardiography at our institution between February 2014 and February 2021. Modified Haller Index (MHI; chest transverse diameter over the distance between sternum and spine) was noninvasively assessed. During the follow-up, we evaluated the occurrence of any of the following: (1) CV hospitalization, (2) mitral valve (MV) surgery, and (3) cardiac death or sudden death. Results Four hundred and twenty-four consecutive patients (66.8 ± 11.5 years, 48.3% men) were retrospectively analyzed. Overall, MVP patients had concave-shaped chest wall (MHI = 2.55 ± 0.34) and were found with small cardiac chamber dimensions. During a mean follow-up time of 3.2 ± 1.7 years, no patients died, 55 patients were hospitalized due to CV events, and 20 patients underwent MV surgery. On multivariate Cox analysis, age (heart rate [HR] 1.05, 95% confidence interval [CI] 1.03-1.06), diabetes mellitus (HR 3.26, 95% CI 2.04-5.20), peak exercise-E/e' ratio (HR 1.07, 95%CI 1.05-1.09), and peak exercise-effective regurgitant orifice area (HR 2.53, 95% CI 1.83-3.51) were directly associated to outcome, whereas MHI (HR 0.15, 95%CI 0.07-0.33) and beta-blocker therapy (HR 0.26, 95% CI 0.19-0.36) showed strong inverse correlation. An MHI ≥2.7 showed 80% sensitivity and 100% specificity for predicting event-free survival (area under the curve = 0.98). Conclusions Symptomatic patients with moderate MR due to MVP and MHI ≥2.7 have an excellent prognosis over a medium-term follow-up. Noninvasive chest wall shape assessment should be encouraged in clinical practice.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, Ospedale San Giuseppe Multi Medica IRCCS, Milan, Italy
| | | | - Elisabetta Rigamonti
- Department of Cardiology, Ospedale San Giuseppe Multi Medica IRCCS, Milan, Italy
| | - Michele Lombardo
- Department of Cardiology, Ospedale San Giuseppe Multi Medica IRCCS, Milan, Italy
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Risk Factors and a Nomogram Model Establishment for Postoperative Delirium in Elderly Patients Undergoing Arthroplasty Surgery: A Single-Center Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6607386. [PMID: 34901277 PMCID: PMC8660191 DOI: 10.1155/2021/6607386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/30/2021] [Accepted: 11/09/2021] [Indexed: 12/11/2022]
Abstract
Objective To explore the related risk factors of postoperative delirium (POD) after hip or knee arthroplasty in elderly orthopedic patients and the predictive value of related risk factors. Material and Methods. In total, 309 patients (≥60 years) who received knee and hip arthroplasty between January 2017 and May 2020 were consecutively selected into the POD and nonpostoperative delirium (NPOD) groups. Group bias was eliminated through propensity score matching. Univariate and multivariable logistic analysis was used to determine the risk factors for POD. The nomogram was made by R. Results 58 patients were included in each group after propensity score matching; multivariable analysis demonstrated that LDH (OR = 4.364, P = 0.017), CHE (OR = 4.640, P = 0.004), Cystatin C (OR = 5.283, P = 0.006), arrhythmia (OR = 5.253, P = 0.002), and operation duration (OR = 1.017, P = 0.050) were independent risk factors of POD. LDH, CHE, Cystatin C, and arrhythmia were used to construct a nomogram to predict the POD. The nomogram was well calibrated and had moderate discriminative ability (AUC = 0.821, 95% CI: 0.760~0.883). Decision curve analysis demonstrated that the nomogram was clinically useful. Conclusions Our study revealed that arrhythmia, operation duration, the increase of lactate dehydrogenase and Cystatin C, and the decrease of cholinesterase were reliable factors for predicting postoperative delirium after elderly hip and knee arthroplasty. Meanwhile, the nomogram we developed can assist the clinician to filtrate potential patients with postoperative delirium.
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Henning RJ. The current diagnosis and treatment of high-risk patients with chronic primary and secondary mitral valve regurgitation. Future Cardiol 2021; 18:67-87. [PMID: 33840221 DOI: 10.2217/fca-2020-0189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Mitral valve regurgitation (MR) is due primarily to either primary degeneration of the mitral valve with Barlow's or fibroelastic disease or is secondary to ischemic or nonischemic cardiomyopathies. Echocardiography is essential to assess MR etiology and severity, the remodeling of cardiac chambers and to characterize longitudinal chamber changes to determine optimal therapies. Surgery is recommended for severe primary MR if persistent symptoms are present or if left ventricle dysfunction is present with an EF <60% or a left ventricle end-systolic diameter ≥40 mm. For secondary MR, therapy of heart failure with vasodilators and diuretics improves forward cardiac output. Coronary artery bypass grafts (CABG) or percutaneous coronary intervention (PCI) should be considered for severe MR due to ischemia. This review summarizes the pathophysiology, the characteristics, the management and the different interventions for high risk patients with chronic primary and secondary MR.
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Affiliation(s)
- Robert J Henning
- University of South Florida, Tampa, FL 33612, USA.,James A Haley Hospital, Tampa, FL 33612, USA
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Antunes MJ. Commentary: Rheumatic mitral valve repair: Where is the real word? J Thorac Cardiovasc Surg 2020; 164:68-69. [PMID: 32891448 DOI: 10.1016/j.jtcvs.2020.07.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Manuel J Antunes
- Faculty of Medicine, Clinic of Cardiothoracic Surgery, University of Coimbra, Coimbra, Portugal.
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