ABSTRACT Introduction: There is no consensus on the impact of coronary artery disease in patients undergoing transcatheter aortic valve implantation. Therefore, the objective of this study was, in a single-center setting, to evaluate the five-year outcome of transcatheter aortic valve implantation patients with or without coronary artery disease. Methods: All transcatheter aortic valve implantation patients between 2009 and 2019 were included and grouped according to the presence or absence of coronary artery disease. The primary endpoint, five-year all-cause mortality, was evaluated using Cox regression adjusted for age, sex, procedure years, and comorbidities. Comorbidities interacting with coronary artery disease were evaluated with interaction tests. In-hospital complications was the secondary endpoint. Results: In total, 176 patients had aortic stenosis and concomitant coronary artery disease, while 170 patients had aortic stenosis only. Mean follow-up was 2.2±1.6 years. There was no difference in the adjusted five-year all-cause mortality between transcatheter aortic valve implantation patients with and without coronary artery disease (hazard ratio 1.00, 95% confidence interval 0.59-1.70, P=0.99). In coronary artery disease patients, impaired renal function, peripheral arterial disease, or ejection fraction < 50% showed a significant interaction effect with higher five-year all-cause mortality. No significant differences in complications between the groups were found. Conclusion: Five-year mortality did not differ between transcatheter aortic valve implantation patients with or without coronary artery disease. However, in patients with coronary artery disease and impaired renal function, peripheral arterial disease, or ejection fraction < 50%, we found significantly higher five-year all-cause mortality.

ABSTRACT Objective: To compare health-related quality of life (HRQoL) of patients primarily treated with a no-touch saphenous vein graft with that of patients who received a conventional graft. Methods: The study included all individuals treated with a percutaneous coronary intervention (PCI) on a saphenous vein graft (SVG) between January 2006 and June 2020. The RAND-36 health survey was used to assess HRQoL. The Mann-Whitney U test was used to test differences in HRQoL between the two groups. Effect size was estimated via Cohen’s d. The average treatment effect between the groups was tested by propensity score matching (PSM). Results: Of the 346 patients treated with a PCI in a stenosed or occluded SVG, 165 responded to RAND-36 (no-touch: n=48; conventional: n=117). Patients with a no-touch graft reported better mean values on seven of the eight health survey domains. Statistically significant differences were observed for four of the domains, all in favour of the no-touch group. The effect size estimates indicated a small difference for five domains, with the highest values (>0.40) seen for the general health and energy/fatigue domains. PSM confirmed a statistically significant difference for the physical functioning and general health domains. Conclusion: At a mean follow-up of 5.4 years, patients who received a PCI in no-touch vein grafts showed significantly better HRQoL than those who received a PCI in conventional vein grafts.

Abstract The saphenous vein is the most common conduit used in coronary artery bypass grafting (CABG) yet its failure rate is higher compared to arterial grafts. An improvement in saphenous vein graft performance is therefore a major priority in CABG. No-touch harvesting of the saphenous vein is one of the few interventions that has shown improved patency rates, comparable to that of the left internal thoracic artery. After more than two decades of no-touch research, this technique is now recognized as a Class IIa recommendation in the 2018 European Society of Cardiology and the European Association for Cardio-Thoracic Surgery guidelines on myocardial revascularization. In this review, we describe the structural alterations that occur in conventional versus no-touch saphenous vein grafts and how these changes affect graft patency. In addition, we discuss various strategies aimed at repairing saphenous vein grafts prepared at conventional CABG.

Abstract With more than 800,000 coronary artery bypass grafting (CABG) operations annually worldwide and the saphenous vein being the most common conduit used, there is no question that improving saphenous vein graft patency is one of the most important tasks in CABG. This video describes the no-touch harvesting procedure of the saphenous vein on an 80-year old man with hypertension, hyperlipidemia and a previous myocardial infarction with percutaneous coronary intervention to the right coronary artery. He was complaining of exertional chest pain and was diagnosed with stable angina pectoris. The coronary angiography showed advanced three vessel disease with significant stenoses in the left anterior descending (LAD) artery, two marginal arteries (MAs) and the posterior descending artery (PDA), in addition to an occluded diagonal artery (DA). The patient received a triple sequential no-touch vein graft to the PDA and two MAs together with a double sequential no-touch vein graft to the DA and LAD. A vein graft was used to bypass the LAD due to the age of the patient and the low degree of stenosis in the LAD. The no-touch harvesting technique is described in detail in the film with complete narration. A follow-up of this patient was performed at three months both clinically and with a computed tomography angiography (CTA). No angina pectoris symptoms were reported by the patient and the wounds in the chest and lower limb were completely healed. The CTA showed patent no-touch saphenous vein grafts to all the distal anastomoses.

Abstract: Introduction: The “Pediatric Appendicitis Score”, is a tool for the evaluation of abdominal pain in children and defines the probability of appendicitis, using an objective scale that assesses the presence of 8 signs and symptoms. Aim: To demonstrate the usefulness of Pediatric Appendicitis Score for abdominal pain applied in an emergency. Material and methods: An observational, prospective and longitudinal study in the Pediatric Appendicitis Score was adopted as a quick tool for the diagnosis of appendicitis was performed acute, was determined to employ a population of 250 patients by convenience. Male and female patients with acute abdominal pain were included, between six months and 17 years old. Those patients whose relatives refused participation in the study were excluded. They were eliminated subjects prior to admission medication, deficiencies in filling the instrument, who requested voluntary discharge without having completed the study protocol, and those who did not attend the reassessment to 48 hours. Results: The total sample (n = 232), of which 31% (n = 72) had appendicitis; 77% (n = 55) were men, 23% (n = 17) women. The grade obtained in the score, average was 7.59 ± 2.052, with an average of 9.02 ± 5.32 hours of evolution.

Resumen: Introducción: La Escala Pediátrica para Apendicitis es una herramienta para la valoración del dolor abdominal en niños y define la probabilidad de apendicitis, mediante una escala objetiva que valora la presencia de ocho signos y síntomas. Objetivo: Demostrar la utilidad de la Escala Pediátrica para Apendicitis para el dolor abdominal aplicado en un Servicio de Urgencias en una población mexicana. Material y métodos: Se realizó un estudio observacional, prospectivo y longitudinal en el que se adoptó la Escala Pediátrica para Apendicitis como herramienta rápida para el diagnóstico de apendicitis aguda. Se determinó emplear una población a conveniencia de 250 pacientes. Se incluyeron pacientes de uno u otro sexo con dolor abdominal agudo, entre los seis meses y 17 años de edad. Se excluyeron aquellos casos con medicación previa a su ingreso, deficiencias en el llenado del instrumento, alta voluntaria sin haber terminado el protocolo de estudio y quienes no acudieron a la revaloración a las 48 horas. Resultados: Del total de la muestra (n = 232), el 31% (n = 72) tuvo apendicitis; el 77% (n = 55) fueron hombres, 23% (n = 17) mujeres. La calificación que obtuvieron en la escala fue de 7.59 ± 2.052, con un promedio de 9.02 ± 5.32 horas de evolución.