Search Results (66)

Background: The advantage of employing multidisciplinary heart teams (MDHT) for the selection process of minimally invasive (MIS) mitral valve repair (MVr) and mitral valve replacement (MVR) has been previously substantiated. Here, we outline the contributions each member of the MDHT at our institution made during the intra-operative and peri-operative periods and describe their impacts on short-term outcomes. Patients and Methods: This is a single-center retrospective review of all 278 adult patients who underwent MIS MVR or MVr by a single surgeon at our institution between 2006 and 2023. The repair’s efficacy was assessed intraoperatively and at 1 year post-operation. The surgical technique involved a mini-thoracotomy and valve repair or replacement. Outcomes included post-operative mortality, complications, operative time, repair success rate, hospital length of stay (LOS), and post-operative ejection fraction. There was no control group, as all patients undergoing MIS MVR/MVr were treated within an MDHT model. Results: Delivery of regional anesthesia via paravertebral catheter (PVC) was associated with a statistically significant shorter hospital LOS (6.52 vs. 7.81 days, p = 0.028). Enhanced Recovery After Surgery (ERAS) implementation by nurses was associated with a potentially clinically important, although not statistically significant, reduction in LOS (6.7 vs. 10.1 days, p = 0.168). Introduction of the COR-KNOT^® DEVICE for securing annuloplasty sutures was associated with a statistically significant reduction in operative time (288 vs. 326 min, p < 0.001). Percutaneous cannulation, proctored by interventional cardiology in 2019, was associated with a decrease in lymphocele rate from 6.2% before 2019 to 0% after 2019. Conclusions: Initiatives implemented by our MDHT were associated with reduced post-operative LOS, shorter operative times, and lower incidence of post-operative complications. Full article

Coastal areas are strategically significant from an ecological, anthropic, and economic point of view, but they are also susceptible to forces causing inundations. Multiple forcings occurring in close succession in space and time amplify the effects of a single force and form a compound event. An example is an atmospheric disturbance that extends from the sea to the mainland, causing a sea storm and a river flood due to heavy rainfall. This condition can occur in geomorphological contexts where the sea and mountains are close to each other, and the river basins are small. Most research on compound events focuses on extreme events; detailed studies of compound events not associated with extreme events and generated by non-exceptional atmospheric disturbances are scarce. Furthermore, there are very few detailed studies focusing solely on compound river floods and sea storms. Consequently, this paper is focused on compound river floods and sea storms generated by atmospheric disturbances regardless of their exceptional or non-typical typology. This analysis includes their forcings, correlation, and effects and is carried out in Calabria, a region of Southern Italy that represents an interesting case study due to its geomorphological, climatic, and hydrological peculiarities, which favor the formation of compound events, and, due to the considerable anthropization of its coastal territories, increases their risk. The main findings concern confirming that the existence of this compound event between river floods and sea storms is generated by the same atmospheric disturbance, the geomorphological conditions under which it occurs, and the main driving forces behind it. Therefore, this study is only the first step in a more in-depth analysis that will also examine the quantitative aspects of these phenomena. This analysis is essential for the planning and management of coastal areas subject to compound events and for ensuring effective mitigation measures. Full article

Background: The minimally invasive approach is increasingly recognized as the standard for surgical management of mitral valve disease. Advances in endoscopic visualization and surgical instrumentation have enhanced precision while minimizing trauma, improving both functional and esthetic outcomes. This study presents a single-center experience with total endoscopic mitral valve repair (MVR) performed using two- or three-dimensional video-assisted technology. Methods: Between October 2022 and September 2025, 239 patients underwent total endoscopic MVR at our institution. Demographic, operative, and postoperative data were collected and analyzed. Results: Median age was 63 years, with 64.4% male. Median logistic EuroSCORE and EuroSCORE II were 2.53 and 0.83, respectively. Most patients were NYHA class II (54.4%), and 47.7% had pulmonary hypertension. Mitral annuloplasty was performed in 99.2% of cases; 78.6% received Gore-Tex chordae, 6.3% underwent posterior leaflet resection, and 11.7% edge-to-edge repair. Conversion to sternotomy occurred in 0.4%. In-hospital mortality was 1.3%; stroke occurred in 0.4%. Postoperative atrial fibrillation developed in 26.8%, while major complications such as sepsis (2.1%) and renal failure requiring dialysis (1.3%) were infrequent. Median ventilation time was 5 h, ICU stay was 2 days, and hospital stay was 7 days. Pre-discharge echocardiography showed ≤mild regurgitation in 99.2%. Conclusions: Total endoscopic MVR using two- or three-dimensional video assistance is safe, feasible, and yields excellent clinical, functional, and cosmetic results, with low morbidity and rapid recovery. Full article

Background/Objectives: Acute bacterial endocarditis (ABE) is a frequent situation and continues to be a challenge. Mitral valve involvement during acute bacterial endocarditis is often the result of the spread of the endocarditic process from the adjacent aortic valve. Mitral involvement, on the other hand, could also be an expression of the initial localization of the bacteria. The best option for treating mitral ABE is still a matter of debate. Recent reports have shown satisfactory results with mitral reconstructive techniques in the treatment of mitral ABE. In this study, we present a comprehensive review of our 10-year institutional experience in the surgical management of acute mitral endocarditis with a focus on technical considerations, outcomes, and the durability of mitral valve repair in this high-risk population. Methods: We queried the institutional database, cross-referencing patients admitted with a diagnosis of “acute bacterial endocarditis” with patients undergoing surgical procedures for “valvular disease” at our division. Out of 1136 valvular procedures listed in our PACS database, 180 patients were admitted with a diagnosis of active acute endocarditis, and 46 included treatment of the mitral valve. We analyzed and compared short- and long-term follow-up (ranging from 3 to 141 months with a mean of 42 ± 38 months) of these 46 patients, dividing them into two groups: mitral valve repair (MVr) and mitral valve replacement (MVR). Results: 18 (40%) patients underwent reconstructive treatment of the mitral valve, and 28 (60%) underwent mitral valve replacement. Cumulative in-hospital mortality was 10% (5 pts, all from the MVR group), however, with no difference between the two groups. A shorter time gap from diagnosis to surgery (<10 days) was the only predictive factor for early mortality. A further 11 patients died during follow-up (2 from group A and 9 from group B). Long-term survival, on the other hand, was negatively influenced by MV surgical replacement (p = 0.0178), older patients’ age (>60 years), and urgent surgical procedures. Finally, patients with MVr also experienced a favorable postoperative event-free curve for endocarditis recurrence (p = 0.0260) and time elapsed before recurrence (p = 0.0438). Conclusions: Mitral valve repair in the case of active endocarditis could be a treatment associated with more favorable outcomes, providing that a complete eradication of infective tissue can be accomplished. Conservative treatment, when feasible, seems to offer favorable cumulative long-term outcomes. Full article

Glass fiber-reinforced polypropylene (PP/GF) is used widely in lightweight automotive applications, but it is affected adversely by fiber breakage and matrix degradation during recycling. This study investigates the effects of carbon nanofiber (CBNF) addition on the recyclability of PP/GF composites subjected to repeated extrusion. Homo-type PP was compounded with GF and CBNFs and was processed for up to nine extrusion cycles. Melt viscosity, fiber morphology, flexural properties, interfacial shear strength, and notched Charpy impact strength were evaluated. Neat PP showed a pronounced increase in the melt volume-flow rate (MVR) with cumulative cycles, indicating molecular degradation. By contrast, CBNF-containing composites exhibited superior viscosity stability, with MVR increasing only 2.9-fold after nine cycles compared with 5.4-fold for GF-only systems. Fiber length was well maintained (96–98% retention). The flexural strength and modulus were preserved, respectively, as greater than 92% and 95%. The interfacial shear strength remained stable, whereas the impact strength decreased moderately but retained 84% of its initial value. These results underscore that a slight addition of CBNFs (5 wt%) suppresses viscosity loss effectively and stabilizes mechanical performance, offering a viable strategy for sustainable recycling of PP/GF composites in transportation applications. Full article

Objectives: To optimise surgical treatment of mitral valve disease (MVD), a better understanding of gender-based differences is required. In this study, we analyse the gender-based differences among patients undergoing mitral valve surgery. Methods: Between January 2019 and December 2024, 809 consecutive patients were admitted to our centre for surgery for MVD. We analysed the patient characteristics, surgical details, postoperative and short-term outcomes of these patients. Results: Females (31.8%) undergoing mitral valve (MV) surgery were older (p < 0.001). Females had a higher rate of atrial fibrillation (p < 0.001), Rheumatoid arthritis (RA) (p = 0.002) and malignancy (p = 0.030). Furthermore, females were more often admitted to the intensive care unit (ICU) preoperatively (p = 0.037). Among these patients, 419 patients underwent isolated MV surgery. Furthermore, males underwent minimally invasive MV surgery more often (p = 0.004). Females had higher rates of combined MVD (p < 0.001) and combined MS (p < 0.001). Males had higher rates of severe mitral regurgitation (MR) (p = 0.041) and Left Atrium (LA) dilation (p = 0.004). Females exhibited higher rates of severe Tricuspid Regurgitation (TR) (p = 0.032) and pulmonary hypertension (p < 0.001). males had higher rates of posterior mitral leaflet (PML) prolapse (p < 0.001) and Flail leaflets (p < 0.001). Males underwent mitral valve repair (MVr) more often (p = 0.002). Early MACCE were reported in 5.1% of the patients. Freedom from major adverse cardiac and cerebrovascular events (MACCE) was comparable at 1 year and three years (p = 0.548). Prognosis and freedom from events were comparable between genders. Conclusions: Mitral valve disease presents differently across genders. There exist fundamental differences in the pathophysiological processes and presentation of mitral valve disease. Mitral valve surgery can be carried out with low mortality and morbidity rates irrespective of gender. Full article

Traditional thermal concentration processes for LiCl, such as multi-effect evaporation and mechanical vapor recompression (MVR), suffer from drawbacks including high energy consumption and severe equipment corrosion. However, electrodialysis (ED) technology offers several advantages in the concentration process, including high efficiency, energy conservation, selective separation, and the absence of phase-change requirements. This study presents an innovative two-level ED process for efficient LiCl concentration, addressing the limitations of conventional thermal methods. Through systematic small-scale and scale-up experiments, we developed an optimized process achieving exceptional performance. The system attained Li⁺ concentrations of 22.17 g/L in the concentrated solution and 21.17 g/L in the recycled dilute solution, while reducing residual Li⁺ in discharge water to just 1.08 g/L. Remarkably, the process demonstrated significant energy efficiency, with a total consumption of only 85.22 kWh/t LiCl and a minimal water migration amount of 4.21 L/(m²·h). Economic analysis revealed substantial cost savings of 14.66 USD/t LiCl compared to traditional evaporation methods. These findings establish ED as a technically and economically viable solution for industrial LiCl concentration, offering both high efficiency and environmental benefits. Full article

Pedestrian wind comfort is a critical factor in the design of sustainable and livable dense urban areas. This study systematically investigates the effects of surrounding building height and wind incidence angle on pedestrian-level wind conditions, analyzing a nine-building arrangement through validated Computational Fluid Dynamics (CFD) simulations. Scenarios included neighborhood heights varying from 0L to 6L and wind angles from 0° to 45°. The results reveal that wind angles aligned with urban canyons (0° case) induce a strong Venturi effect, creating hazardous conditions with Mean Velocity Ratio (MVR) peaks reaching 3.42. Conversely, an oblique 45° angle mitigates high speeds by promoting flow recirculation. While increasing neighborhood height generally intensifies channeling, the study also highlights that even an isolated building (0L case) can generate hazardous localized velocities due to flow separation around its corners. The Overall Mean Velocity Ratio (OMVR) analysis identifies that, among the studied cases, a 2L neighborhood height is the most tolerable configuration, striking a balance between sheltering and channeling effects. Ultimately, these findings highlight for urban planners the importance of analyzing diverse geometric configurations and wind scenarios, reinforcing the value of CFD as an essential tool for designing safer and more comfortable public spaces. Full article

Metaverse Recordings (MVRs), screen recordings of user experiences in virtual environments, represent a mostly underexplored field. This article addresses the integration of MVR and Multimedia Information Retrieval (MMIR). Unlike conventional media, MVRs can include additional streams of structured data, such as Scene Raw Data (SRD) and Peripheral Data (PD), which capture graphical rendering states and user interactions. We explore the technical facets of recordings in the Metaverse, detailing diverse methodologies and their implications for MVR-specific Multimedia Information Retrieval. Our discussion not only highlights the unique opportunities of MVR content analysis, but also examines the challenges they pose to conventional MMIR paradigms. It addresses the key challenges around the semantic gap in existing content analysis tools when applied to MVRs and the high computational cost and limited recall of video-based feature extraction. We present a model for MVR structure, a prototype recording system, and an evaluation framework to assess retrieval performance. We collected a set of 111 MVRs to study and evaluate the intricacies. Our findings show that SRD and PD provide significant, low-cost contributions to retrieval accuracy and scalability, and support the case for integrating structured interaction data into future MMIR architectures. Full article

Extending the recovery ratio (RR) of brackish water reverse osmosis (RO) plants to zero liquid discharge (ZLD, i.e., ≥95%) is vital, particularly inland, where the cost of safe retentate disposal is substantial. Various suggestions appear in the literature; however, many of these are impractical in the real world. Often, the limiting parameter that determines the maximal recovery is the SiO₂ concentration that develops in the RO retentate and the need to further desalinate the high osmotic pressure retentates produced in the process. This work combines well-proven treatment schemes to attain RR ≥ 95% at a realistic cost. The raw brackish water undergoes first a 94% recovery nanofiltration (NF) step, whose permeate undergoes a further 88-RR RO step. To increase the overall RR, the retentate of the 1st RO step undergoes SiO₂ removal performed via iron electro-dissolution and then a 2nd, 43% recovery, RO pass. The retentate of this step is combined with the NF retentate, and the mix is treated with mechanical vapor recompression (MVR) (RR = 62.7%). The results show that >95% recovery can be attained by the suggested process at an overall cost of ~USD 0.70/m³. This is ~60% higher than the USD 0.44/m³ calculated for the baseline operation (RR = 82.7%), making the concept feasible when either the increase in the plant’s capacity is regulatorily requested, or when the available retentate discharge method is very costly. The cost assessment accuracy was approximated at >80%. Full article

Background: Obstructive sleep apnea (OSA) is a prevalent but frequently underdiagnosed comorbidity in patients undergoing cardiac surgery, including coronary artery bypass grafting (CABG), aortic valve replacement (AVR), and mitral valve repair or replacement (MVR). This systematic review and meta-analytic synthesis investigates the relationship between OSA and postoperative morbidity and mortality, with particular attention to the predictive utility of established screening instruments. Methods: A systematic search of the PubMed database was conducted (April 2025), identifying 724 articles published in the last ten years. Seventeen primary studies met the inclusion criteria for qualitative synthesis, and four additional studies were included in the meta-analyses. Outcomes assessed included atrial fibrillation, major adverse cardiac and cerebrovascular events (MACCE), acute kidney injury (AKI), respiratory complications, pneumonia, hospital length of stay (LOS), and mortality. Risk of bias was assessed qualitatively based on study design and reporting limitations. This review was registered in the PROSPERO database under registration number CRD420251049574. Results: Meta-analyses demonstrated significantly elevated odds of atrial fibrillation (OR = 2.44, 95% CI: 1.46–4.07), major adverse cardiac and cerebrovascular events (OR = 2.06, 95% CI: 1.61–2.63), acute kidney injury (OR = 2.24, 95% CI: 1.67–3.01), and respiratory complications (OR = 1.15, 95% CI: 1.05–1.25) among patients with OSA. Additionally, OSA was associated with a significantly prolonged hospital length of stay (standardized mean difference [SMD] = 0.62, 95% CI: 0.46–0.78) and a marginal increase in pneumonia risk (OR = 1.07, 95% CI: 1.00–1.15). Evidence regarding stroke, intensive care unit (ICU) stay, and mortality was inconsistent or underpowered. Conclusions: Across core outcomes, findings were consistent across multiple studies involving a large patient population. Obstructive sleep apnea is a clinically consequential risk factor in cardiac surgery, associated with increased perioperative complications and prolonged hospitalization. These findings support the integration of routine OSA screening into preoperative risk assessment protocols. Further prospective, multicenter trials are warranted to assess the efficacy of perioperative management strategies, including continuous positive airway pressure (CPAP) therapy, in improving surgical outcomes. Full article

The precipitation process of rare earth from a rare earth chloride solution using magnesium bicarbonate yields a dilute magnesium chloride (MgCl₂) solution. The dilute MgCl₂ solution can only be concentrated to a maximum concentration of about 70 g/L by conventional reverse osmosis (RO), which is insufficient for recycling. Low-salt-rejection reverse osmosis (LSRRO) allows for a higher concentration of brine while operating at moderate pressures. However, research on LSRRO for the concentration of MgCl₂ solution is still at an initial stage. In this study, polyamide RO membranes were treated with sodium hypochlorite (NaClO) to prepare low-salt-rejection membranes. The effects of NaClO concentration, pH, and chlorination time on the membrane properties were investigated. Under alkaline chlorination conditions, the membrane’s salt rejection decreased, and water flux increased with increasing NaClO concentration and chlorination time. This can be explained by the hydrolysis of polyamide in the alkaline solution to form carboxylic acids and amines, resulting in a decrease in the crosslinking degree of polyamide. The low-salt-rejection membrane was prepared by exposing it to a NaClO solution at a concentration of 15 g/L and a pH of 11 for 3 h, and the salt rejection of MgCl₂ was 50.7%. The MgCl₂ solution with a concentration of 20 g/L was concentrated using multi-stage LSRRO at the pressure of 5 MPa. The concentration of the concentrated brine reached 120 g/L, which is 87% higher than the theoretical maximum concentration of 64 g/L for conventional RO at the pressure of 5 MPa. The specific energy consumption (SEC) was 4.17 kWh/m³, which decreased by about 80% compared to that of mechanical vapor recompression (MVR). This provides an alternative route for the efficient concentration of a diluted MgCl₂ solution with lower energy consumption. Full article

Objectives: New generations of annuloplasty rings are designed to combine structural support with enhanced flexibility, allowing for better adaptation to the dynamic nature of the mitral annulus. This study investigated the early clinical and echocardiographic outcomes of minimally invasive mitral valve repair (MI-MVr) with a new semi-rigid open ring (PhysioFlex, annuloplasty ring, Edwards Lifesciences, Irvine, CA, USA). Methods: A total of 150 consecutive patients who underwent MI-MVr for severe degenerative mitral regurgitation (DMR) using the PhysioFlex annuloplasty ring between June 2021 and April 2024 were included in the study. Preoperative, intraoperative, and postoperative data were collected for the entire population. A three-dimensional mitral valve reconstruction analysis was performed across the entire cohort using a semi-automated software package (4D Mitral Valve Analysis; Tomtec Imaging Systems, Munich, Germany). Results: The median age was 59 (50–67) years and 25.3% patients were female. The median Euroscore II and left ventricular ejection fraction were 0.72 (0.56–0.99) and 60% (55–65), respectively. The median implanted ring size was 34 mm (32–36). The entire cohort was discharged with no residual mitral regurgitation greater than mild and a median mean transmitral pressure gradient of 2.4 mmHg (2–3). The median hospitalization time was 7 days (6–11) and in-hospital mortality occurred in 1 (0.7%) patient. Conclusions: MI-MVr was safely performed using the novel semi-rigid partial PhysioFlex ring in the DMR patient cohort with favorable early results. The PhysioFlex annuloplasty ring may be used as an alternative to complete rings in MI-MVr. Further research is needed to conduct comparisons with other currently available annuloplasty rings. Full article

Objective: The totally endoscopic approach is on the rise to become the new standard in mitral valve surgery. The aim of this study was to develop a morphometric measurement tool for educational purposes to predict operability with low conversion and high repair rates. Methods: From January 2020 to March 2023, 64 patients underwent totally endoscopic mitral valve repair (TE-MVR). Of these, 15 patients were deemed to be unsuitable for TE-MVR due to narrow space and/or anticipated complex repair techniques and underwent repair through sternotomy (MVR-open). Angio-CT scanning was performed for preoperative planning and measurements of the following: the distance between the sternum and the spine (DSS), the distance between the skin incision and the anterior anulus of the mitral valve (DNM) and the intercostal space at the level of the skin incision (ICS). Results: The repair rate for all patients was 98.7%. In the TE-MVR group, the conversion rate to sternotomy was 3.1%. The 30-day survival was 100%. The DSS was 130.4 ± 18.8 mm and 108.1 ± 17.3 mm, and the DSM 70.7 ± 12.1 mm and 58.5 ± 13.6 mm in the TE-MVR and MVR-open, respectively (p < 0.001). Twenty-one TE-MVR patients were found to be technically demanding due to friction and less freedom to move the instruments. The composite morphometric parameter DSS plus 4xICS minus DNM was 53.3, 39.8 and 25.6 for TE-TMReasy, TE-TMRdemanding and MVR-open, respectively (p < 0.05 and p < 0.01). Conclusions: Surgical skills and a long history of expertise are mandatory to achieve excellent results with a low conversion and high repair rate. The composite morphometric parameter may be an easy tool for educational demands to predict the ease and feasibility of TE-MVR. Full article

Background: The optimal surgical management of ischemic mitral regurgitation (IMR)—mitral valve repair (MVr) versus mitral valve replacement (MVR)—remains controversial, with limited evidence on long-term outcomes. This study aimed to compare the outcomes of MVr and MVR in patients with IMR, focusing on survival and recurrence of mitral regurgitation. Additionally, survival was compared based on preoperative characteristics. Methods: A retrospective cohort analysis was conducted at a tertiary referral center and included 759 patients who underwent surgery for IMR between 2009 and 2021. Propensity score matching identified 140 matched pairs. The outcomes assessed included hospital mortality, long-term survival, recurrence of mitral regurgitation, mitral valve reintervention rates, and echocardiographic changes over time. Results: In the matched cohort, no significant differences were observed in hospital mortality (10% for MVr vs. 10.7% for MVR, p > 0.99) or long-term survival (p = 0.534). However, MVr was associated with a higher rate of recurrent moderate or higher mitral regurgitation (29.04% vs. 10.37%, p < 0.001) compared to MVR. The mitral valve reintervention rates did not differ significantly between the groups. Echocardiographic follow-up revealed significant improvements in left ventricular function and dimensions, with no significant differences between the groups. A subgroup analysis revealed no difference in survival according to the age, gender, ejection fraction, EuroSCORE category, or right ventricular function between the MVr and MVR patients. Conclusions: MVr and MVR for IMR yielded comparable survival rates, but MVr was associated with a higher risk of recurrent MR. The efficacy of both surgical approaches across diverse patient populations was comparable, reinforcing the need for individualized decision-making based on other clinical and anatomical considerations. Full article