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Infective endocarditis remains a medical challenge among urgent cases of cardiac disease. Multi-valvular endocarditis is uncommon and simultaneous right and left-sided valvular involvement, particularly affecting the pulmonary valve, is scarcely reported. A rare case of a patient with subacute myelodysplastic syndrome, who presented with endocarditis involving both aortic and pulmonary valves, complicated with new-onset heart failure, is described. The patient presented prompt recovery of both right and left ventricular function after combined aortic and pulmonary valve replacement. [ABSTRACT FROM AUTHOR]

Lung cancer is the most commonly occurring cancer in men and the third most commonly occurring cancer in women. Contrary to other cancers, lung cancer often occurs in patients with comorbidities that can prevent the realisation of some treatments. The recommended treatment for patients presenting with stage I non-small cell lung cancer (NSCLC) is an anatomical surgical resection-lobectomy- and a systematic lymph node dissection. Many patients are, however, unfit to undergo surgery and consequently they often do not receive any curative therapy. This involves the elderly patients or patients with many co-morbidities. When an elderly patient with co-morbidities comes to the thoracic surgeon with early-stage lung cancer, if he is healthy and in good general condition he is taken to the operating room and undergoes lobectomy and lymph node dissection. If he is vulnerable and appropriate treatment is considered high risk he is treated with alternative therapies. SBRT is important alternative therapy. Stereotactic body radiation therapy (SBRT), interchangeably known as stereotactic ablative radiotherapy (SABR) is a modality that delivers ablative doses of radiation to extra-cranial targets with a degree of precision and accuracy above what can be reasonably achieved with conventionally fractionated external beam radiotherapy. Additionally, SBRT as a noninvasive therapy offers an attractive option for patients who are opposed to a surgical option. But questions have arisen regarding the suitability of SBRT for medically operable patients. Data from new trials are needed more than ever to inform and guide our multidisciplinary decisions for patients with earlystage NSCLC who are fit enough to undergo lung cancer surgery but may instead be more interestedin SBRT. In any case, good cooperation between surgeons and radiotherapists is of particular importance for the better treatment of these vulnerable patients. [ABSTRACT FROM AUTHOR]

Background: The emergence of catheter-based techniques questioned existing treatment strategies for patients with aortic stenosis. The increasing effectiveness of transcatheter aortic valve implantation therapies justifies a renewed evaluation of the results in terms of survival rate as well as the quality of life (QoL) after surgical aortic valve replacement (SAVR) in the elderly. The aim of this study is the assessment of QoL in octogenarians undergoing isolated SAVR.Methods: A retrospective observational and descriptive study between January 2015 and January 2018, was conducted. Eighty-four Caucasians patients over 80 years of age undergoing aortic valve replacement in a single unit were, finally, followed-up. The patients' medical records were reviewed and QoL after a median 22-month follow-up time was evaluated by administering the EQ-5D questionnaire on the telephone.Results: Mean European System for Cardiac Operative Risk Evaluation II was 2.1%. The 30-day mortality was 0% and the 1-year mortality was 3.6%. On the assessment of QoL within mean follow-up time of 22 months, performed in 81 patients (survivors), a remarkable improvement was recorded in 76.5% of patients (62 patients), while 12.3% (10 patients) reported aggravation of their health status and 11.1% (9 patients) had no change.Conclusions: Mortality rates after SAVR can be kept at very low levels, especially in experienced high-volume centers, even in the elderly. Furthermore, it must be pointed out that the majority of these patients achieve a good functional status and a satisfactory QoL after the operation. Therefore, SAVR should not be withheld on the grounds of age alone. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate which treatment method for abdominal aortic aneurysm (AAA), endovascular or open repair, has better outcomes in young patients., Materials and Methods: A systematic review was conducted to identify observational studies or randomized controlled trials (RCTs) that compared endovascular and open repair of intact AAA in young patients. MEDLINE, EMBASE, and CENTRAL were searched up to March 2022 using the Ovid interface. The risk of bias was assessed with the Newcastle-Ottawa scale (NOS), with a maximum score of 9, or version 2 of the Cochrane risk of bias tool. The certainty of evidence was assessed with the GRADE framework. Primary outcomes were perioperative, overall, and aneurysm-related mortality. Secondary outcomes were reintervention, hospital length of stay, and perioperative complications. Effect measures in syntheses were the odds ratio (OR), risk difference (RD), mean difference (MD), or hazard ratio (HR) and were calculated with the Mantel-Haenszel or inverse variance statistical method and random-effects models., Results: Fifteen observational studies and 1 RCT were included, reporting a total of 48 976 young patients. Definitions of young ranged from 60 to 70 years. The median score on the NOS was 8 (range: 4-9), and the RCT was judged to be high risk of bias. The perioperative mortality was lower after EVAR (RD: -0.01, 95% CI: -0.02 to -0.00), but the overall and aneurysm-related mortality was not significantly different between EVAR and open repair (HR: 1.38, 95% CI: 0.81 to 2.33; HR: 4.68, 95% CI: 0.71 to 31.04, respectively), as was the hazard of reintervention (HR: 1.50, 95% CI: 0.88 to 2.56). The hospital length of stay was shorter after EVAR (MD: -4.44 days, 95% CI: -4.79 to -4.09), and the odds of cardiac (OR: 0.22, 95% CI: 0.13 to 0.35), respiratory (OR: 0.17, 95% CI: 0.11 to 0.26), and bleeding complications were lower after EVAR (OR: 0.26, 95% CI: 0.11 to 0.64). The level of evidence was low or very low., Conclusion: Patient preferences and perspectives should be considered during shared decision-making process considering the available evidence. EVAR may be considered in young and fit patients with a suitable anatomy., Protocol Registration: PROSPERO, CRD42022325051., Clinical Impact: Uncertainty surrounds the optimal treatment strategy for abdominal aortic aneurysm in young patients. Meta-analysis of some 48,976 young patients showed that endovascular aneurysm repair (EVAR) has a lower perioperative mortality and morbidity and a shorter hospital and intensive care unit stay than open surgical repair, but the overall and aneurysm-related mortality in the short to medium term are not significantly different between EVAR and open repair. EVAR can be considered in young patients.