Thalassaemia is paradoxically associated with a reduced risk of in-hospital complications and mortality in COVID-19: Data from an international registry

Although numerous patient-specific co-factors have been shown to be associated with worse outcomes in COVID-19, the prognostic value of thalassaemic syndromes in COVID-19 patients remains poorly understood. We studied the outcomes of 137 COVID-19 patients with a history of transfusion-dependent thalassaemia (TDT) and transfusion independent thalassaemia (TIT) extracted from a large international cohort and compared them with the outcomes from a matched cohort of COVID-19 patients with no history of thalassaemia. The mean age of thalassaemia patients included in our study was 41 ± 16 years (48.9% male). Almost 81% of these patients suffered from TDT requiring blood transfusions on a regular basis. 38.7% of patients were blood group O. Cardiac iron overload was documented in 6.8% of study patients, whereas liver iron overload was documented in 35% of study patients. 40% of thalassaemia patients had a history of splenectomy. 27.7% of study patients required hospitalization due to COVID-19 infection. Amongst the hospitalized patients, one patient died (0.7%) and one patient required intubation. Continuous positive airway pressure (CPAP) was required in almost 5% of study patients. After adjustment for age-, sex- and other known risk factors (cardiac disease, kidney disease and pulmonary disease), the rate of in-hospital complications (supplemental oxygen use, admission to an intensive care unit for CPAP therapy or intubation) and all-cause mortality was significantly lower in the thalassaemia group compared to the matched cohort with no history of thalassaemia. Amongst thalassaemia patients in general, the TIT group exhibited a higher rate of hospitalization compared to the TDT group (p = 0.001). In addition, the rate of complications such as acute kidney injury and need for supplemental oxygen was significantly higher in the TIT group compared to the TDT group. In the multivariable logistic regression analysis, age and history of heart or kidney disease were all found to be independent risk factors for increased in-hospital, all-cause mortality, whereas the presence of thalassaemia (either TDT or TIT) was found to be independently associated with reduced all-cause mortality. The presence of thalassaemia in COVID-19 patients was independently associated with lower in-hospital, all-cause mortality and few in-hospital complications in our study. The pathophysiology of this is unclear and needs to be studied in vitro and in animal models.

Gender Differences in the Presentation and Outcomes of Hospitalized Patients With COVID-19

Gender-related differences in COVID-19 clinical presentation, disease progression, and mortality have not been adequately explored. We analyzed the clinical profile, presentation, treatments, and outcomes of patients according to gender in the HOPE-COVID-19 International Registry. Among 2,798 enrolled patients, 1,111 were women (39.7%). Male patients had a higher prevalence of cardiovascular risk factors and more comorbidities at baseline. After propensity score matching, 876 men and 876 women were selected. Male patients more often reported fever, whereas female patients more often reported vomiting, diarrhea, and hyposmia/anosmia. Laboratory tests in men presented alterations consistent with a more severe COVID-19 infection (eg, significantly higher C-reactive protein, troponin, transaminases, lymphocytopenia, thrombocytopenia, and ferritin). Systemic inflammatory response syndrome, bilateral pneumonia, respiratory insufficiency, and renal failure were significantly more frequent in men. Men more often required pronation, corticosteroids, and tocilizumab administration. A significantly higher 30-day mortality was observed in men vs women (23.4% vs 19.2%; P = .039). Trial Numbers: NCT04334291/EUPAS34399.

[The National Registry of Cardiac Tumors (the 1996-1997 report)]

We presented the first report of the national database of heart tumors. We described the origin, development and goals reached during the years 1996 and 1997, the way the data was collected and the form used. The cases collected until 31st of December of 1997 include 165 tumors in 155 patients distributed all around the country. Age and gender distribution, way of diagnosis, morphologic classification, treatment and follow-up of this pathology is reported.

Surgical repair of double-outlet right atrium

The case of a patient with abnormal position of the atrial septum resulting in a right atrium with two atrioventricular valves and a disconnected left atrium is presented. The left superior vena cava drained into the left atrium; the right superior vena cava and the coronary sinus were absent. The surgical technique for repair of this anomaly is described. A possible explanation of the embryopathogenesis of double-outlet right atrium is given. To our knowledge, this is the second case of double-outlet right atrium to be reported in the thoracic surgical literature.

Enlargement of the aortic annulus by resecting the commissure between the left and noncoronary cusps

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Closure of the right atrioventricular valve in the modified Fontan operation for univentricular heart

Surgical palliation of univentricular hearts by a modified Fontan operation has become a useful procedure for these complicated cases. Closure of the right atrioventricular valve is an important part of the operation. Patch closure has been the technique used by most surgeons. Heart block and dehiscence of the patch have been two common complications of this technique; both involve severe hemodynamic upset and often death to the patients in the early postoperative period. We closed the right atrioventricular valve by approximating the leaflets using pledgeted mattress sutures in two patients. Advantages of this type of closure are avoidance of the conduction system and secure closure of the valve.

Aspirin or Coumadin as the drug of choice for valve replacement with porcine bioprosthesis

Eight hundred twenty-four patients who had cardiac valve replacement with a porcine bioprosthesis were given either Coumadin (sodium warfarin) or aspirin. No patient in sinus rhythm no matter what valve or valves were replaced had thromboembolism whether treated with Coumadin (124 patients) or aspirin (260 patients). One hundred fifty-one patients who had mitral valve replacement, were in atrial fibrillation, and were treated with Coumadin had seven embolic events (4.6%), while 135 similar patients treated with aspirin had five embolic events (3.7%). Fifty-one patients who had double-valve replacement, were in atrial fibrillation, and were treated with coumadin had three embolic episodes (5.9%), while 86 similar patients treated with aspirin had three embolic events (3.5%). No statistical difference was found in the incidence of thromboembolism between similar groups of patients whether treated with Coumadin or aspirin (p greater than 0.05). Hemorrhagic complications were higher and reached statistical significance (p less than 0.001) for the group treated with Coumadin. This study shows that aspirin prevents thromboembolic complications as well as Coumadin in patients having cardiac valve replacement with a bioprosthesis, and results in a lower rate of complications.

Early leaflet perforation as a cause of bioprosthetic dysfunction

Of 699 patients with 900 bioprostheses, who lived longer than six months, three cases of early perforation of bioprosthetic leaflets are reported. In two cases the cut ends of the suture used for valve insertion had perforated the bioprosthetic cusps from repeated trauma. Insertion of the sutures in the periphery of the sewing ring and cutting the sutures flush with the knots should avoid this complication. The third case showed massive collagen breakdown with destruction of most of the cusp tissue. A possible explanation for such a massive early tissue breakdown could be an inadequate collagen fixation by glutaraldehyde.

Rupture of the tricuspid valve associated with disruption of De Vega's annuloplasty

A case of sudden ruptured chordae tendineae of the tricuspid valve associated with failure of De Vega's tricuspid annuloplasty, 27 months after surgery, is reported. This is the first case to our knowledge of spontaneous ruptured chordae tendineae of the tricuspid valve reported in the literature.

Surgical treatment of annulo aortic ectasia. Experience in eight consecutive patients

Eight patients with ectasia of the aortic annulus due to cystic degeneration of the media are presented. All patients were operated with a technique similar to the one described by Bentall and De Bono. Six patients had the aortic valve replaced by a bioprosthesis and two patients with a St. Jude Medical Valve Prosthesis. Manoeuvers to avoid anastomotic tension, adequate myocardial protection, and a careful control of postbypass blood pressure are described. There was no early or late mortality. Patients have been followed for a mean period of twelve months. Seven patients are in grade I of the N.Y.H.A., and one in grade II. Five patients studied postoperatively with cardiac catheterization and angiography showed normal ventricular function, normal prosthetic function and no aneurysm or pseudoaneurysm in any of the suture lines and with a good coronary anatomy.

Transaortic cannulation for balloon pumping in a "crowded aorta"

A technique for cannulating the ascending aorta or aortic arch to introduce a balloon catheter for intraortic balloon pumping is described. It is performed without the use of a partial occlusion clamp. This technique is useful when multiple anastomoses in the ascending aorta leave no room for the application of a vascular clamp. Three patients in whom this technique was used are reported.