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Objectives: Patient-prosthesis mismatch (PPM) may impair functional capacity and survival after aortic valve replacement (AVR). A mechanical prosthesis tends to have less PPM than a biological prosthesis, but these differences in clinical outcomes remain unclear. This study aimed to investigate the impact of PPM on long-term survival and quality of life (QoL) after mechanical and biological AVRs. Methods: The presence of PPM was defined in 595 consecutive patients who had undergone isolated AVR. Patients were divided into two groups according to whether they had received a biological or mechanical prosthesis. The groups with and without PPM present were compared with regard to baseline characteristics, operative characteristics, survival, severe complications, freedom from angina and QoL up to 6 years of follow-up. PPM calculation was performed using the EOA value provided by the manufacturer for every prosthesis divided by the patient’s body surface area. Results: The moderate-to-severe PPM rates were 69.8% and 3.7% after biological and mechanical prostheses implantation, respectively. Patients with a biological prosthesis implanted had mean survival significantly shorter in the PPM group (50.2 months, 95% confidence interval [CI] 45.2-55.3) when compared to the no-PPM group (60.1 months, 95% CI 55.7-64.4) (p = 0.035). In the mechanical prosthesis group, there was no difference in mean survival between the PPM group (66.6 months, 95% CI 58.3-74.9) when compared to the no-PPM group (64.9 months, 95% CI 62.6-67.2) (p = 0.50). The physical score of the QoL questionnaire was significantly lower in the PPM group when compared to the no-PPM group with a biological prosthesis (39.4 ± 8.4 vs. 45.7 ± 10.1, p < 0.001) compared to patients with a mechanical prosthesis (43.9 ± 9.4 vs. 46.9 ± 8.3, p = 0.18). Conclusions: PPM is common after biological valve implantation and significantly impacts long-term survival and QoL. If the risk of PPM after implantation of a biological prosthesis is suspected, prospective strategies to avoid PPM at the time of operation are warranted.

BACKGROUND Preoperative use of platelet function tests contributes to the decrease of re-intervention rate due to bleeding and the necessity of transfusion in coronary artery bypass grafting (CABG) patients. The aim was to investigate the predictive value and to justify routine preoperative use of multiple electrode aggregometry in these patients. METHODS A prospective observational trial which included 416 consecutive patients subjected to elective isolated CABG was conducted. The Multiplate® test was used to assess platelet function. Platelet function test results, postoperative blood loss, and transfusion requirements were compared between high and low bleeding risk patients. Receiver operating characteristic analysis was performed to assess the sensitivity and specificity of the arachidonic acid (ASPI) and adenosine di-phosphate high sensitive (ADPHS) tests. RESULTS ADPHS and ASPI test results significantly predicted total bleeding > 1000 ml (AUC, 0.685, p

This article reviews the context and evidence of recent myocardial revascularization trials on PCI versus CABG with particular emphasis on patient selection and treatment of surgical patients. Moreover, one of our intended purposes is to identify the values underpinning the integrated care model, which incorporates decision to proceed with surgical myocardial revascularization in conjunction with established pillars of the use of optimal surgical techniques, and aggressive risk-factor modification through guideline-directed pharmacological therapies and lifestyle modifications.

Annual age grouping of children according to their birth year is a common practice of the educational systems of many countries. This variation in birth dates among children grouped in the same generation is known as relative age and its implications on different developmental outcomes are referred to as relative age effects (RAEs). The previous body of research of RAEs in youth populations has focused on sporting samples; however, studies examining RAEs in physical education are scarce. The current study investigates the influence of the RAEs on motor abilities in a sample of adolescent pupils. The results indicate significant differences in motor abilities between relatively older and relatively younger participants of both sexes. Since RAE is an under-researched area in physical education, the results may have substantial implications for PE assessment given the fact that many PE teachers still carry out typical norm-referenced assessments. Possible recommendations for future research are discussed.