Early predictors of intensive care unit admission among COVID-19 patients in Qatar

Background

COVID-19 is associated with significant morbidity and mortality. This study aimed to explore the early predictors of intensive care unit (ICU) admission among patients with COVID-19.

Methods

This was a case-control study of adult patients with confirmed COVID-19. Cases were defined as patients admitted to ICU during the period February 29-May 29, 2020. For each case enrolled, one control was matched by age and gender.

Results

A total of 1,560 patients with confirmed COVID-19 were included. Each group included 780 patients with a predominant male gender (89.7%) and a median age of 49 years (interquartile range = 18). Predictors independently associated with ICU admission were cardiovascular disease (adjusted odds ratio (aOR) = 1.64, 95% confidence interval (CI): 1.16-2.32, p = 0.005), diabetes (aOR = 1.52, 95% CI: 1.08-2.13, p = 0.016), obesity (aOR = 1.46, 95% CI: 1.03-2.08, p = 0.034), lymphopenia (aOR = 2.69, 95% CI: 1.80-4.02, p < 0.001), high AST (aOR = 2.59, 95% CI: 1.53-4.36, p < 0.001), high ferritin (aOR = 1.96, 95% CI: 1.40-2.74, p < 0.001), high CRP (aOR = 4.09, 95% CI: 2.81-5.96, p < 0.001), and dyspnea (aOR = 2.50, 95% CI: 1.77-3.54, p < 0.001).

Conclusion

Having cardiovascular disease, diabetes, obesity, lymphopenia, dyspnea, and increased AST, ferritin, and CRP were independent predictors for ICU admission in patients with COVID-19.

COVID-19-associated hypertriglyceridemia and impact of treatment

Background

Coronavirus disease 2019 (COVID-19) associated hypertriglyceridemia was observed among patients admitted to intensive care units (ICU) in Qatar. This study aimed to describe COVID-19-associated-hypertriglyceridemia in ICU patients and the impact of treating hypertriglyceridemia on clinical outcomes.

Methods

A retrospective observational cohort study of adult patients who were admitted to the ICU with a confirmed diagnosis of COVID-19 pneumonia according to the World Health Organization criteria. Hypertriglyceridemia was defined as triglyceride level of 1.7 mmol/L (≥150 mg/dL) and severe hypertriglyceridemia as fasting TG of ≥5.6 mmol/L (≥500 mg/dL).

Results

Of 1,234 enrolled patients, 1,016 (82.3%) had hypertriglyceridemia. Median age was 50 years and 87.9% were males. Patients with hypertriglyceridemia showed significantly longer time to COVID-19 recovery, ICU and hospital stay, and time to death (29.3 vs. 16.9 days) without a difference in mortality between groups. Of patients with hypertriglyceridemia, 343 (33.8%) received treatment (i.e., fibrate and/or omega-3). Patients in treatment group showed longer time to COVID-19 recovery and hospital stay with no difference in death rates in comparison with those in no-treatment group. Relatively older patients were less likely to experience hypertriglyceridemia (odd ratio (OR) 0.976; 95% CI: 0.956, 0.995) or to receive treatment (OR 0.977; 95% CI: 0.960, 0.994). Whereas patients who received tocilizumab were more likely to experience high TG level (OR 3.508; 95% CI: 2.046, 6.015) and to receive treatment for it (OR 2.528; 95% CI: 1.628, 3.926).

Conclusion

Hypertriglyceridemia associated with COVID-19 did not increase death rate, but prolonged time to death and length of stay. Treating hypertriglyceridemia did not translate into improvement in clinical outcomes including mortality.

Wireless pressure insoles for measuring ground reaction forces and trajectories of the centre of pressure during functional activities

Wireless pressure insoles may enable the assessment of movement biomechanics in a real-world setting, and thus play an important role in the recommendation of clinical management, but they are not yet a gold standard due to the unknown accuracy and reliability with respect to different functional activities. Here, we compare novel wireless pressure insoles with force plates and examine the test-retest reliability of the insoles for measuring vertical ground reaction forces (vGRFs) and trajectories of the center of pressure (COP). In this observational study, healthy adults underwent two data collection sessions during one day. The Bland-Altman analysis was used to compare the outcomes measured with the two instruments during squats, jumps, and the sit-to-stand test. Test-retest reliability was assessed by the interclass correlation coefficient and the standard error of measurement for the outcomes during squats, jumps, walking, and stair ambulation. Trajectories of the COP in the anterior-posterior direction were comparable between the two systems during all activities. The insoles consistently measured shorter trajectories of the COP in the medial-lateral direction (except jumps) and lower vGRFs than the force plates. Test-retest reliability of the insoles was fair to high or excellent for all outcomes during all activities. In conclusion, the insoles provide reliable measures of vGRFs and trajectories of the COP during multiple functional activities in healthy adults. Although the insoles do not produce identical results to the force plate, the qualitative similarity and consistency between the two systems confirm the insoles can be used to measure these outcomes, based on the purpose and accuracy required.

A standardised template for reporting lower limb kinematic waveform movement compensations from a sensor-based portable clinical movement analysis toolkit

•

Standardised terminology for the interpretation of movement analysis waveforms is provided, to describe the amount, nature and timing of a compensation strategy.

•

A stand-alone application have been created for users to generate a movement analysis report for lower limb joint kinematics.

•

A digital, interactive version of the movement analysis report is now being created in the next iteration of the sensor based portable movement analysis toolkit.

Objectives

To develop a standardised template to support physiotherapist reporting of lower limb kinematic waveform data

Design

Within and between user agreement identification of movement compensation strategies.

Setting

University Health Board Physiotherapy Department

Participants

Fourteen individuals with anterior cruciate ligament reconstruction performed overground gait, double-leg squat, and stair ascent wearing body-worn sensors. Six users viewed 252 kinematic waveforms of hip, knee and ankle joint angles in the sagittal and frontal planes.

Main outcome measures

Between and within-user observed agreement and themes from movement analysis reports

Results

Between-user observed agreement for presence of a movement compensation was 0.6–0.9 for the sagittal plane and 0.75–1.0 for the frontal place. Within-user observed agreement was 0.57–1.00 for the sagittal plane and 0.71–1.00 for the frontal plane. Three themes and seven categories were identified from the waveform interpretations: Amount (qualitative and quantitative description), timing (phase, discrete time point, cycle), and nature (peak, range of motion, timing) of the compensation.

Conclusion

There was good agreement between users at identifying the presence of movement compensation from the kinematic waveforms, but there was variation in how movement compensations were described. An interactive report, a standardised template for interpretation of kinematic waveforms, and training to support the clinical application of a movement analysis toolkit are proposed.

Characteristics and Early Predictors of Intensive Care Unit Admission among COVID-19 Patients in Qatar

Purpose

This study aimed to explore the early predictors of intensive care unit (ICU) admission and in-hospital mortality among patients diagnosed with Coronavirus disease (COVID-19).

Methods & Materials

This was a case-control study of adult patients with confirmed COVID-19. Cases were defined as patients admitted to ICU during the period February 29 - May 29, 2020. For each case enrolled, one control was matched by age and gender. Univariate and multivariate logistic regression models were used to identify the predictors for ICU admission and in-hospital mortality among the COVID‐19 patients.

Results

A total of 1560 patients with confirmed COVID-19 were included. Each group included 780 patients with a predominant male gender (89.7%) and a median age of 49 years (interquartile range, IQR=18). Predictors independently associated with ICU admission included having cardiovascular disease (CVD) (adjusted odds ratio (aOR)=1.64, 95% confidence interval (CI): 1.16 - 2.32, p= 0.005), diabetes (aOR=1.52, 95% CI: 1.08 - 2.13, p= 0.016), body mass index ≥30 kg/m2 (aOR=1.46, 95% CI: 1.03-2.08, p= 0.034), lymphocytes ≤0.8 × 103/μL (aOR=2.69, 95% CI: 1.80-4.02, p<0.001), aspartate aminotransferase (AST) >120 U/L (aOR= 2.59, 95% CI: 1.53-4.36, p<0.001), ferritin >600 μg/L (aOR=1.96, 95% CI: 1.40-2.74, p<0.001), C-reactive protein (CRP) >100 mg/L (aOR=4.09, 95% CI: 2.81-5.96, p<0.001), and dyspnea (aOR=2.50, 95% CI: 1.77-3.54, p <0.001). Similarly, significant predictors of mortality included CVD (aOR=2.16, 95% CI: 1.32- 3.53, p=0.002), diabetes (aOR=1.77, 95% CI: 1.07-2.90, p=0.025), cancer (aOR=4.65, 95% CI: 1.50-14.42, p= 0.008), lymphocytes ≤0.8 x,103/μL (aOR=2.34, 95% CI: 1.45-3.78, p= 0.001), and AST >120 U/L (aOR= 1.89, 95% CI: 1.04-3.43, p=0.036).

Conclusion

Having CVD, diabetes, lymphopenia, and increased AST were independent predictors for both ICU admission and in-hospital mortality in patients with COVID-19. In addition, obesity, high ferritin, and CRP levels were also associated with increased risk of ICU admission, while cancer was strongly associated with in-hospital mortality. Early identification and monitoring of patients at risk is essential in planning the level of care needed to prevent delay in medical intervention.

Medications adherence post-primary percutaneous coronary intervention in acute myocardial infarction: A population-based cohort study

WHAT IS KNOWN AND OBJECTIVE

The use of medications for secondary prevention is the cornerstone in the treatment of coronary artery disease (CAD). However, adherence to these medications is still suboptimal worldwide. This retrospective observational study aimed to assess the adherence to post-percutaneous coronary intervention (PCI) medications, along with predictors of non-adherence.

METHODS

We conducted a retrospective observational cohort study to assess the adherence to post-PCI medications by determining the rate of prescription refills for 12 months after discharge among STEMI patients, as well as predictors of non-adherence. Adherence was assessed by medication availability 80% of the time monitored by the prescription refills rate for 1 year post-discharge.

RESULTS AND DISCUSSION

A total of 1334 patients who presented with STEMI and underwent primary PCI were included in our retrospective analysis. The majority of patients included were male (96%) with a mean age of 51 ± 10.2 years. The overall adherence rate for all medications was only 28.4%, with an individual adherence rate of 50.5% for aspirin, 49.9% for P₂ Y₁₂ inhibitors, 48.1% for statins, 39.6% for beta-blockers and 42.9% for angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB). Factors that increased the likelihood of non-adherence were prolonged hospital length of stay and getting the medications with charge (aOR = 1.94, 95% CI 1.1-3.3; p-value = 0.017, aOR = 1.87, 95% CI 1.1-3.3; p-value = 0.029, respectively), while having a regular follow-up after discharge and attending the first clinic appointment were significantly associated with decreased likelihood of non-adherence (aOR = 0.01, 95% CI 0.004-0.04; p-value < 0.001, aOR = 0.06, 95% CI 0.03-0.1; p-value < 0.001, respectively).

WHAT IS NEW AND CONCLUSION

The adherence rate to post-PCI medications among patients with STEMI was relatively low; however, attending the first outpatient clinic appointment and having a regular follow-up reduced the likelihood of non-adherence.

Exchange unknown quantum states with almost invisible photons

We propose a quasi-counterfactual quantum swap gate for exchanging Alice's unknown photon state and Bob's unknown atomic state under the condition that only Alice's photon may appear in the transmission channel between Alice and Bob, while the probability of the existence of photon in the transmission channel is controllable and can tend to zero. Unlike standard counterfactual quantum communication protocols, quantum states exchange in present scenario is achieved by multiple phase operations, rather than multiple measurements. The total effect of those operations can be considered as a unitary time evolution operator. Therefore, the communication fidelity and efficiency of our protocol are always one if system imperfection and channel noise are not considered. Compared to standard counterfactual communication protocols, our protocol is easy to implement. We also show that it can be easily converted to a standard counterfactual one.

Repulsive Casimir force between hyperbolic metamaterials

The Casimir force between electric and magnetic hyperbolic metamaterial slabs is investigated. Due to hyperbolic dispersion, the electromagnetic features of these metamaterials along the optical axis are different from those perpendicular to the optical axis; consequently, these features contribute differently to the Casimir effect. The repulsive Casimir force is formed between electric and magnetic hyperbolic metamaterial slabs; moreover, hyperbolic dispersion can enhance the repulsive effect. However, by utilizing the extremely anisotropic behavior of hyperbolic metamaterials and changing the separation distance between the two slabs, the restoring Casimir force emerges. Additionally, by considering the dispersion of both the permittivity and the permeability of hyperbolic metamaterials, the Casimir force reaches several equilibrium points at different separation distances. Furthermore, the Casimir force at room temperature is discussed. Although the temperature can weaken the effect of the restoring Casimir force, stable equilibria may remain upon choosing suitable filling factors. This work shows that hyperbolic metamaterials have potential applications in micro- and nanoelectromechanical systems, especially for maintaining stability and overcoming adhesion problems.

Quantum Secure Group Communication

We propose a quantum secure group communication protocol for the purpose of sharing the same message among multiple authorized users. Our protocol can remove the need for key management that is needed for the quantum network built on quantum key distribution. Comparing with the secure quantum network based on BB84, we show our protocol is more efficient and securer. Particularly, in the security analysis, we introduce a new way of attack, i.e., the counterfactual quantum attack, which can steal information by “invisible” photons. This invisible photon can reveal a single-photon detector in the photon path without triggering the detector. Moreover, the photon can identify phase operations applied to itself, thereby stealing information. To defeat this counterfactual quantum attack, we propose a quantum multi-user authorization system. It allows us to precisely control the communication time so that the attack can not be completed in time.

Measurement of deep-subwavelength emitter separation in a waveguide-QED system

In the waveguide quantum electrodynamics (QED) system, emitter separation plays an important role for its functionality. Here, we present a method to measure the deep-subwavelength emitter separation in a waveguide-QED system. In this method, we can also determine the number of emitters within one diffraction-limited spot. In addition, we also show that ultrasmall emitter separation change can be detected in this system which may then be used as a waveguide-QED-based sensor to measure tiny local temperature/strain variation.

Tunable Goos-Hänchen shift from graphene ribbon array

The Goos-Hänchen (GH) shift of light beam incident on graphene ribbon array is investigated by Green's function method. Due to the resonance effects of leaky surface plasmons on ribbons, the zeroth-order reflection field shows both giant positive and negative GH shifts. By tuning the graphene Fermi level, we can control the shift conveniently. This effect is important to graphene-based metasurface and electro-optical devices.

Counterintuitive dispersion violating Kramers-Kronig relations in gain slabs

We demonstrate the counterintuitive dispersion effect that the peaks (dips) in the gain spectrum correspond to abnormal (normal) dispersion, contrary to the usual Kramers-Kronig point of view. This effect may also lead to two unique features: a broadband abnormal dispersion region and an observable Hartman effect. These results are explained in terms of interference and boundary effects. Finally, two experiments are proposed for the potential experimental verification.

Protocol for direct counterfactual quantum communication

It has long been assumed in physics that for information to travel between two parties in empty space, "Alice" and "Bob," physical particles have to travel between them. Here, using the "chained" quantum Zeno effect, we show how, in the ideal asymptotic limit, information can be transferred between Alice and Bob without any physical particles traveling between them.

Quantum lithography beyond the diffraction limit via Rabi oscillations

We propose a quantum optical method to do the subwavelength lithography. Our method is similar to the traditional lithography but adding a critical step before dissociating the chemical bound of the photoresist. The subwavelength pattern is achieved by inducing the multi-Rabi oscillation between the two atomic levels. The proposed method does not require multiphoton absorption and the entanglement of photons. It is expected to be realizable using current technology.

Visfatin concentration in Asian Indians is correlated with high density lipoprotein cholesterol and apolipoprotein A1

BACKGROUND

Visfatin is a recently described adipose tissue derived hormone whose role in humans remains largely unknown.

OBJECTIVES

To determine visfatin's relationship to lipoproteins and body composition parameters in Asian Indians and Caucasians.

DESIGN

A cross-sectional study.

PATIENTS

Men and women living in Montreal, Canada between the ages of 20 and 60 years were recruited for participation in this study. Subjects were excluded if they had a history of CVD or were taking lipid lowering medication. Individuals identified themselves as Asian Indian or Caucasian.

MEASUREMENTS

Anthropometric measurements were collected including weight, height, waist circumference, hip circumference and body fat percentage (BF%). Serum samples were analysed for total cholesterol, HDL-C, apoA1, apoB and visfatin.

RESULTS

There was no difference in visfatin levels between Indian and Caucasian men (64.50 +/- 3.98 ng/ml vs 73.01 +/- 6.45 ng/ml, ns, respectively) and Indian and Caucasian women (59.03 +/- 5.71 ng/ml vs 77.70 +/- 7.63 ng/ml, ns, respectively), despite large differences in BF%, apoB and the apoB/apoA1 ratio. Visfatin correlated positively to HDL-C and apoA1 in the Indian men (R = 0.42, P = 0.004 and R = 0.48, P = 0.003) and Indian women (R = 0.46, P = 0.05 and R = 0.59, P = 0.01).

CONCLUSION

Visfatin concentrations may be related to HDL metabolism in Asian Indian immigrants.

Body composition and the apoB/apoA-I ratio in migrant Asian Indians and white Caucasians in Canada

Migrant and native South Asians appear to be at increased risk of Type II diabetes mellitus and coronary disease. The aim of the present study was to determine the relationship between the most accurate summary index of the lipoprotein-related risk of vascular disease, the apoB (apolipoprotein B-100)/apoA-I (apolipoprotein A-I) ratio, and body composition in established migrant South Asians and white Caucasians living in Canada. Men and women living in Montreal, Canada between the ages of 20–60 years were recruited for participation in the study. Subjects were excluded if they had a history of cardiovascular disease or were taking lipid-lowering medication. Individuals identified themselves as Asian Indian or Caucasian. Anthropometric measurements were collected, including weight, height, waist circumference, hip circumference and body fat percentage. Plasma samples were analysed for total cholesterol, HDL-C (high-density lipoprotein-cholesterol), apoA-I and apoB. Indian subjects had a substantially higher WHR (waist-to-hip ratio) than Caucasian subjects [men, 0.93±0.01 compared with 0.86±0.01 respectively (P<0.001); women, 0.88±0.01 compared with 0.77±0.01 respectively (P<0.0001)]. WHR correlated strongly with body fat percentage in Caucasians (men, r=0.63, P=0.0002; women, r=0.74, P<0.0001). By contrast, there was no correlation in Indians (men, r=0.22, P value not significant; women, r=0.23, P value not significant). In addition, Indian men and women had a higher apoB/A-I ratio than Caucasians [men, 0.85±0.04 compared with 0.66±0.04 respectively (P=0.001); women, 0.73±0.04 compared with 0.56±0.03 respectively (P=0.0003)]. Of interest, there were also significant correlations between the apoB/apoA-I ratio and WHR in all of the groups, except the Indian women, which were stronger than the correlation of the apoB/apoA-I ratio with BMI. On the other hand, there was no significant relationship between the apoB/apoA-I ratio and the body fat percentage in any of the groups. In conclusion, the present study confirms that, as body fat percentage increases, the distribution of body fat differs between migrant Indians and Caucasians living in Canada. It also relates differences in body fat distribution to differences in the apoB/apoA-I ratio, providing at least part of the answer as to why South Asians may be at increased risk of vascular disease.

Leptin and adiponectin in relation to body fat percentage, waist to hip ratio and the apoB/apoA1 ratio in Asian Indian and Caucasian men and women

Background

Asian Indian immigrants have an increased risk for developing cardiovascular disease (CVD); however, there is very little data examining how the adipokines leptin and adiponectin relate to CVD risk factors such as body fat percentage (BF%), waist to hip ratio (WHR) and the apoB/apoA1 ratio in Asian Indian men and women living in Canada.

Subjects and methods

A cross-sectional study comparing leptin, adiponectin, lipoproteins and anthropometric parameters in Asian Indian men and women to Caucasian men and women (4 groups). Anthropometric data (BMI, BF%, WHR), circulating lipids (apoA1, apoB, total cholesterol, and HDL-cholesterol), leptin and adiponectin were measured.

Results

Asian Indian men and women had higher leptin and lower adiponectin concentrations then Caucasian men and women, respectively. Leptin (positively) and adiponectin (negatively) correlated with anthropometric parameters and lipoproteins in all four groups. Using stepwise forward multiple regression, a model including TC/HDL-C ratio, WHR, BF%, hip circumference and waist circumference predicted 74.2% of leptin concentration in men. In women, apoB, BF%, waist circumference and age predicted 77.5% of leptin concentration. Adiponectin concentrations in men were predicted (30.2%) by HDL-C, total cholesterol, hip circumference and BF% while in women 41.2% of adiponectin concentration was predicted by the apoB/apoA1 ratio, WHR and age.

Conclusion

As is evident from our data, there is a strong relationship between leptin, adiponectin, and abdominal obesity with increased CVD risk, as assessed by the apoB/apoA1 ratio. Dysregulation of these parameters may account for the increased risk of CVD in Asian Indians.

The adipocyte life cycle hypothesis

The adipocyte life cycle hypothesis states that the metabolic properties of an adipocyte vary predictably during its life cycle: that as an adipocyte matures, it accumulates triacylglycerol (triglyceride) and becomes larger; that the rates of triacylglycerol synthesis and lipolysis are matched within adipocytes and that larger adipocytes, in general, have greater rates of triacylglycerol synthesis and, concurrently, greater rates of lipolysis and, therefore, larger adipocytes have greater rates of transmembrane fatty acid flux; and that the secretion of cytokines can also be related to adipocyte size with larger adipocytes having a more unfavourable profile of cytokine secretion than smaller adipocytes. Adipocyte location is an important modifier of this relationship and the favoured sites of adipocyte proliferation are a function of gender and the position within the life cycle of the organism at which proliferation occurs. The adipocyte life cycle hypothesis posits that the metabolic consequences of obesity depend on whether expansion of adipose tissue is achieved primarily by an increase in adipocyte number or adipocyte size. This hypothesis may explain a variety of previously unanswered clinical puzzles such as the vulnerability of many peoples from South East Asia to the adverse metabolic consequences of obesity.

Atopy in Omani patients with asthma

OBJECTIVES

To determine the range of serum IgE in healthy subjects and in asthmatic patients in Oman and to assess the degree of atopy in the asthmatic patients.

METHOD

Serum IgE and in vivo (the skin prick test) and in vitro (the ImmunoCAP test) allergen-specific IgE levels were measured in 44 patients with asthma. Control groups were 19 healthy subjects and 27 asymptomatic allergic subjects.

RESULTS

The normal range for serum IgE in the Omani population was established at ≥ 101 IU/ml. The geometric mean (and 95% confidence interval) for asthmatic patients was 468 IU/ml (323-676). Positive results for allergen-specific IgE, defined as responses to ≥ 1 allergen mix in the ImmunoCAP and to ≥ 3 allergens in the skin prick test, occurred in 26/35 (74%) and in 34/44(77%) asthmatic patients respectively. Six out of 38 patients with serum IgE ≥ 101 IU/ml and 2/6 with levels <101 IU/ml gave negative and positive results respectively in the skin prick test. Overall, the degree of reactivity in the skin prick test correlated with the level of total serum IgE (r= 0.54, p<0.001). A similar correlation could not be established with ImmunoCAP reactivity, but sIgE levels ≥ 101 IU/ml were supported by a high frequency of positive ImmunoCAP responses for the majority of allergen mixes.

CONCLUSIONS

Total serum IgE levels should be routinely monitored in asthmatic subjects as this may give an indication of atopy where skin prick testing is not indicated. Since in a minority of patients serum IgE levels and skin prick results do not predict in the same direction, all laboratory data should be interpreted in context of clinical history.

Results of the Ross operation in rheumatic versus non-rheumatic aortic valve disease

BACKGROUND AND AIM OF THE STUDY

A total of 213 patients underwent the Ross operation at our institution between January 1990 and January 1999. Outcome was assessed in rheumatic (RH) patients and compared with that in patients with other etiology (non-RH).

METHODS

After exclusion of 69 patients with a follow up of <18 months, the study group comprised 144 patients (119 RH, 25 non-RH). Patients were studied clinically and by echo-Doppler cardiography preoperatively, within 2 months and 6-8 months after surgery, and yearly afterwards. Preoperative assessment included age, gender, body surface area (BSA), type of aortic valve lesion and additional valve disease, left and right ventricular outflow tract (LVOT, RVOT) dimensions, and left ventricular (LV) size, function and mass. Postoperatively, patients were studied for presence and severity of autograft regurgitation, mitral regurgitation, LV size, function and mass, and incidence and timing of reoperation.

RESULTS

On average, RH patients were older and had higher BSA, more aortic regurgitation than stenosis, more additional mitral valve disease (mostly regurgitation), larger LV size and poorer LV function. Mitral valve repair was performed in 24% of RH patients versus 0% of non-RH patients. Postoperatively, differences in LV size, function and mass remained present, but diminished during follow up. The autograft reoperation incidence was 22% (26/119) in RH patients versus 8% (2/25) in non-RH patients (p = NS). Preoperative predictors for reoperation in the RH group were severe concomitant mitral regurgitation (MR), followed by male gender and large indexed LVOT (all p<0.001 by discriminant analysis).

CONCLUSION

Marked differences were present in patient characteristics between rheumatic and nonrheumatic patients who underwent the Ross operation. Rheumatic patients had a higher incidence of autograft reoperation. Severe concomitant MR was the most important predictor for reoperation in rheumatic patients.