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INTRODUCTION: Avoiding patient-prosthesis mismatch (PPM) in patients with small aortic annulus (SAA) during aortic valve replacement (AVR) is still a challenging surgical problem. Among surgical options available, aortic root enlargement (ARE) and stentless valve implantation (SVI) are the two most commonly used strategies. This systematic review will be conducted searching for superiority evidence based on comparative studies between these two options. METHODS AND ANALYSIS: This systematic review will include all relevant articles published from 1 January 1946 to 31 March 2024, with available full texts from Medline (Ovid), Embase, Cochrane Library and Web of Science databases, without any language restriction. Observational studies and randomised controlled trials comparing surgical results of ARE versus SVI for AVR in patients with small aortic root will be screened. Studies will be classified into three groups: group 1 for studies that reported SVI or other tissue valve outcomes without comparing them with ARE outcomes; group 2 for studies that reported ARE outcomes without comparing them with SVI outcomes; and group 3 for studies that compared ARE outcomes with SVI outcomes. The quality of the evidence of each study will be evaluated according to Oxford Centre for Evidence-Based Medicine criteria. ETHICS AND DISSEMINATION: Ethical approval is not required because no primary data are collected. The findings will be presented at scientific conferences and/or reported in a peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER: PROSPERO, CRD42023383793.

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Background: TeleEKG is gradually being integrated into the care offered to the most isolated Ivorian populations, however, no medico-socio-economic analysis of its impact has yet been conducted. Introduction: The aim of this study was to assess the medico-socio-economic impact of a teleEKG network in the provision of cardiology care in Ivory Coast. Methods: A retrospective study of the data transmitted by the 10 centers involved in the pilot phase of the teleEKG project from January 2015 to December 2017. Results: The average ratio between the cost to the patient of performing an electrocardiogram (EKG) according to the traditional practice and using a teleEKG was 3.8 ± 1.64. The distance avoided by the 6,045 patients was 1,074,090 km (average 177.7 km/patient). The 6,045 teleEKGs carried out over the period of the study produced a total revenue of 36,270,000 XOF (55,290 EUR) or an average revenue per site of 3,627,000 XOF (5,529 EUR). Dyspnea on exertion (22%), and hypertension (21%) were the main indications for performing the EKG, and left ventricular hypertrophy was the most common electrical anomaly detected (19.8%). Acute coronary syndrome with persistent ST segment elevation was diagnosed in 0.7% of cases (40 cases) and atrial fibrillation in 1.12% of cases (68 cases). Discussion: These results confirm the key role telemedicine can play in the treatment of heart conditions in rural populations and the economic sustainability of such telemedicine networks. Conclusions: teleEKG offers economic accessibility to cardiology care for isolated populations in Ivory Coast.

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OBJECTIVES: The study objective was to determine the impact on outcome associated with using the second internal thoracic artery as a free compared with an in situ graft among patients who received the first internal thoracic artery as an in situ internal thoracic artery to the left anterior descending artery. METHODS: Among 2600 patients who underwent bilateral internal thoracic artery with an in situ internal thoracic artery to the left anterior descending artery, the second internal thoracic artery was used as a free graft bilateral internal thoracic artery in 136 patients and as an in situ graft (in situ bilateral internal thoracic artery) in 2464 patients. One-to-many propensity score matching was performed to produce a cohort of 134 patients with a second free graft internal thoracic artery matched to 2359 patients with a second in situ internal thoracic artery. Early and long-term outcomes including survival, hospital readmission, and repeat revascularization up to a maximum of 25.8 years were compared. RESULTS: There were no differences between the 2 matched groups' preoperative baseline characteristics and early adverse events. Long-term survival at 5, 10, and 15 years was significantly higher among patients with an in situ bilateral internal thoracic artery compared with patients with a free graft bilateral internal thoracic artery (hazard ratio free graft bilateral internal thoracic artery vs in situ bilateral internal thoracic artery, 1.53; 95% confidence interval, 1.14-2.10; P = .004). However, the long-term risk of readmission to the hospital for cardiovascular reasons and need for repeat revascularization were not significantly different between the 2 matched groups. CONCLUSIONS: In a small, propensity-matched cohort of patients undergoing coronary artery bypass grafting, the use of a second in situ internal thoracic artery was associated with an increase in late survival compared with the use of a second internal thoracic artery as a free graft. However, the risk of late hospital readmission and the need for repeat revascularization were similar.

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BACKGROUND: Surgical skills acquisition in cardiac surgery requires consistent and hard practice. Furthermore, training using cadaver is advocated as a means of transferring learned skills to the operating room and recreate surgical situations for trainees to practice and hone their skills. We expose our experience in training for cardiac surgical procedures using human cadavers. METHODS: From June 2013 to November 2016, we performed 302 cardiac surgical procedures on 50 human cadavers obtained according to the Ivorian laws in force. Cadavers were preserved in 10% formaldehyde and by cryopreservation. RESULTS: In open heart, cardiac surgical techniques were achieved via sternotomy (n = 24) or via "lid-anterolateral thoracotomy" (n = 2). Pericardotomy (n = 26) and/or pericardiectomy (n = 26) were systematic. Aortic and caval canulations and pulmonary artery control (n = 30) were performed. After cardiotomy and arterial incisions (n = 34), 18 atrial and ventricular septal defects repair, 1 Fontan operation, 1 arterial switch, 11 enlargement procedures of the whole right ventricular outlet and 15 acquired valve heart diseases corrections were performed. In closed-heart surgery, procedures were achieved via sternotomy (n = 7), posterolateral thoracotomy (n = 12), or Marfan retroxiphoid approach (n = 3). Pericardotomy (n = 7) or pericardiectomy (n = 7) were performed. Great vessels dissections and expositions (n = 21) were achieved to perform 4 pulmonary artery bandings, 12 patent ductus arteriosus closures, 3 Waldhausen procedures, 7 Brock Operations, and 2 Blalock-Taussig shunts. In both situations, 29 direct pulmonary arterial, auricular, and ventricular sutures were achieved. CONCLUSION: Surgical simulation in cadaver models offer an opportunity for trainees to practice their surgical skills before entering operating room.

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BACKGROUND: Surgical experience with chronic constrictive pericarditis (CCP) is rarely documented in Africa; the aim of this study is therefore to review our African experience with CCP from 1977 to 2012 in terms of clinical and surgical outcomes and risk factors of early death after pericardiectomy. METHODS: This retrospective study is related to 120 patients with CCP; there were 72 men and 48 women with an average age at 28.8±10.4 years standard deviation (SD) (8-51 years). The main etiology was tuberculosis (99%). Symptoms secondary to systemic venous congestion were always present: patient were functionally classified according New York Heart Association (NYHA) functional classification: 63 patients presented in class II NYHA and 57 in class III or IV NYHA. The diagnosis confirmed by surgical report was: sub-acute CCP (n=12; 10%), fibrous CCP (n=36; 30%), calcified CCP (n=72; 60%). A pericardiectomy including an epicardiectomy with a systematic release of the ventricles was carried out in every case. Median sternotomy was frequently performed (n=117; 97.5%). RESULTS: Fifteen early deaths (12.5%) were observed, the cause of hospital deaths was due to a low cardiac output (n=12) and to a hepatic failure (n=3). Class III or IV (NYHA) (P=0.01), mitral regurgitation (P<0.05), persistent a diastolic syndrome after surgery (P<0.05) and low cardiac index (CI) (P<0.02) were the important risk factors. Age, size of cardiac X-ray silhouette, right and left ventricular diastolic pressures, ejection fraction (EF), atrial fibrillation and pericardial calcifications had no impact on early survival. The average follow up was 4 years (1-10 years); we lost 22 patients during follow-up. Among survivors, there was no late death; the patients were in class I or II NYHA. Post-operative catheterization evaluation (n=30) shown a significant decrease of the right and left ventricular end-diastolic pressures (P<0.05), of the pulmonary capillary wedge pressure (PCWP) (P<0.05) and of the right atrial pressure (RAP) (P<0.05) and a disappearance of the lack of ventricular diastolic distensibility. CONCLUSIONS: Based on our experience, CCP surgery can be performed safely with an acceptable hospital mortality and a significant improvement of patients' functional status at long term after surgery.

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BACKGROUND: Few centers for open heart surgery (OHS) are in Sub-Saharan Africa. Lack of OHS results is also noted. By reporting our African experience on OHS, the aim of this study was to fill the gap. METHODS: It is a retrospective study on 2,612 patients who were subject to an OHS between 1978 and 2013. Data were collected from demographical, clinical, investigative studies, surgical and outcomes parameters. RESULTS: There were 1,475 cases of rheumatic heart diseases (RHD), 126 endomyocardial fibrosis (EMF), 741 congenital heart diseases (CHDs) and 270 various affections. Related to rheumatic valvular surgery we enumerated 1,175 monovalvular (mitral n=778, aortic n=336, tricuspid n=61); 280 bivalvular (mitral + aortic n=150, mitral + tricuspid n=130) and 20 trivalvular. For RHD, average age was 26±10.1 years (4-69 years) and 60% of our patients presented a functional class III or IV according to New York Heart Association (NYHA) classification. A total of 1,481 valvular replacements (bioprostheses n=489, mechanical prostheses n=992) and 445 valvular repair were carried out with a global and late mortality surgery respectively at 7% and 8%. One hundred and twenty-six [126] cases of EMF with right sided form 39, left sided form 40, and bilateral form 47 were colligated. Average age was 12±0.6 years (2-15 years). All patients with EMF underwent surgery; an endocardectomy in all patients combined with valvular reconstruction (n=36) or valvular replacement (n=90) was carried out with a hospital mortality at 16% (n=20). Concerning CHD, the most frequent were ventricular septal defect (VSD) (n=240), atrial septal defect (ASD) (n=200), partial atrio-ventricular sepal defect (n=30) and tetralogy of Fallot (T4F) (n=220), a total correction was performed for those CHD with an early mortality at 6.4% (n=44). CONCLUSIONS: OHS in Cote d'Ivoire was successfully performed in most of our patients, the spectrum of acquired valvular heart diseases and CHDs in our country is similar to others in Sub-Saharan Africa.

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