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Abstract Background Del Nido cardioplegia was recently introduced to adult cardiac surgery with encouraging results. The effect of Del Nido cardioplegia in patients with low ejection fraction (EF) has not been thoroughly evaluated. The objective of this study was to assess the safety of Del Nido cardioplegia in adult patients with low EF compared to intermittent warm blood cardioplegia. Results During 2018 and 2019, 73 adult patients with an EF of ≤ 40% underwent cardiac surgery using Del Nido cardioplegia. The patients were compared to a historical cohort of consecutive patients with low EF who had intermitted warm blood cardioplegia (n = 81). Patients who had Del Nido cardioplegia had significantly lower EuroSCORE II (2.73 (1.7–4.1) vs. 4.5 (2.4–7.4), P = 0.004). There were no differences in creatinine clearance and preoperative echocardiographic data between the groups. Cardiopulmonary bypass and cross-clamp times were non-significantly lower with Del Nido cardioplegia. There were no differences in stroke and postoperative echocardiographic data between the groups. No hospital mortality was reported in both groups. Peak troponin levels were significantly higher in patients who had Del Nido cardioplegia (0.88 (0.58–1.47) vs. 0.7 (0.44–1.01) ng/dL; P = 0.01); however, after multivariable regression analysis, cardiopulmonary bypass time was the only predictor of postoperative troponin level (coefficient 0.005 (95% CI: 0.003–0.008); P < 0.001). ICU stay was significantly longer in patients who had Del Nido cardioplegia (4 (3–6) vs. 2(1–4) days, P < 0.001), while postoperative hospital stay did not differ between the groups. After multivariable regression, the use of intermittent warm blood cardioplegia was significantly associated with shorter ICU stay (coefficient − 1.80 (95% CI − 3.06 – -0.55); P = 0.01). Conclusions Prolonged ICU was reported with Del Nido cardioplegia; however, there were no differences in the duration of hospital stay and the clinical outcomes between the groups. Despite the proven efficacy of intermittent warm blood cardioplegia, the use of Del Nido cardioplegia might be safe in patients with low EF.

La naturaleza e importancia de la Dirección de Marketing en el sector terciario del Deporte en Zimbabwe es opaca y permanece bajo investigación. No existe un modelo integral de marketing deportivo, a pesar de que la Asociación de Educación Deportiva Terciaria en Zimbabue ha estado luchando para satisfacer las necesidades de sus clientes internos y externos. Las organizaciones del sector terciario deportivo se enfrentan a muchos retos, sobre todo en las áreas de la viabilidad financiera para hacerlo atractivo a los patrocinadores, a pesar de la escasa cobertura de los medios de comunicación, entre otras causas. Sin embargo, resultan ser ineficaces en términos de marketing en general, la realización de estudios de mercado para identificar las necesidades de los clientes. No existe un modelo integral de marketing deportivo para las asociaciones deportivas, aunque hay mucha demanda para su creación. La presente investigación analiza las estrategias que se pueden poner en marcha para dar aportar a estas asociaciones una ventaja competitiva. Los objetivos de la investigación han consistido en la revision de la naturaleza y eficacia de las estrategias de marketing deportivo que se utilizan por las asociaciones deportivas terciarias en Zimbabwe y la revision de la literature existente sobre el tema. El estudio adoptó un enfoque cualitativo y se realizó a fin de tener una visión más profunda de las asociaciones y su relación con grupos de interés commercial externos. En esta investigación, los datos se presentan en forma de tablas y gráficos, analizando los resultados de forma cualitativa, lo que permitió a los investigadores establecer posteriormente un analisis más cuantitativo. Se estableció como conclusions que las estrategias actuales de marketing utilizados por las asociaciones deportivas deben ser mejorados, recomendando principalmente el studio que adopten un modelo de enfoque estratégico de negocio en la gestión de sus asuntos. Abstract The nature and significance of Marketing Management in the Zimbabwe Tertiary Sports sector is opaque and remains under researched. A comprehensive model of sports marketing does not exist. Zimbabwe Tertiary Education Sports Associations have been struggling to meet the needs of their internal and external customers. Organisations in the Tertiary Sport sector are facing many challenges, primarily in the areas of financial viability, attractiveness to sponsors and lack of media coverage among others. These were found to be ineffective in terms of marketing in general and conducting market researches to identify customer needs. A comprehensive model of sports marketing for tertiary associations does not exist yet and there is need for it to be established. The research looks at the strategies that can be put in place to give the association a competitive advantage. The research objectives includes examining the nature and effectiveness of the sports marketing mix strategies used by Zimbabwean tertiary sports associations and identifying the sports marketing mix strategies used by Zimbabwean tertiary sports associations. Literature reviewed that it can be possible. The study adopted a qualitative approach. This was done so as to have a deeper insight of the associations and their link to external stakeholders. In this research data was presented in the form of tables and charts and analysis was done in qualitative form. This enabled the researcher to pick and analyse salient issues that could be analysed quantitatively. It was established that the current marketing mix strategies used by associations need to be improved on the findings. The study’s major recommendation is to make the associations adopt a strategic business model approach in the running of their affairs.

Female gender is a risk factor in several cardiac surgery risk stratification systems. This study explored the differences in the outcomes following triple heart valve surgery in men vs women. The study included 250 patients (males n = 101; females n = 149) who underwent triple valve surgery from 2009 to 2020. BMI (body mass index) was higher in females (29.6 vs 26.5 kg/m 2 , P < .001), and diabetes was more common in males (44 vs 42%, P = .012). The ejection fraction was higher in females (55 vs 50%, P < .001). The severity of mitral valve stenosis and tricuspid valve regurgitation was significantly greater in females (33.11 vs 27.72%, P = .003 and 44.30 vs 19.8%, P < .001, respectively). Mitral valve replacement was more common in females ( P < .001), and they had lower concomitant coronary artery bypass grafting ( P = .001). Bleeding and renal failure were lower in females ( P = .021 and <0.001, respectively). Hospital mortality, readmission, and reintervention were not significantly different between genders. By multivariable analysis, male gender was a risk factor for lower survival [HR (hazard ratio): 2.18; P = .024]. Triple valve surgery can be performed safely in both genders, with better long-term survival in females. Female gender was not a risk factor in patients undergoing triple valve surgery., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: We studied the effect of tricuspid valve (TV) surgery combined with surgical ventricular restoration (SVR) on operative outcomes, rehospitalization, recurrent tricuspid regurgitation, and survival of patients with ischemic cardiomyopathy. Additionally, surgery was compared to conservative management in patients with mild or moderate tricuspid regurgitation. To the best of our knowledge, the advantage of combining TV surgery with SVR in patients with ischemic cardiomyopathy had not been investigated before., Methods: This retrospective cohort study included 137 SVR patients who were recruited from 2009 to 2020. Patients were divided into two groups - those with no concomitant TV surgery (n=74) and those with concomitant TV repair or replacement (n=63)., Results: Extracorporeal membrane oxygenation use was higher in SVR patients without TV surgery (P=0.015). Re-exploration and blood transfusion were significantly higher in those with TV surgery (P=0.048 and P=0.037, respectively). Hospital mortality occurred in eight (10.81%) patients with no TV surgery vs. five (7.94%) in the TV surgery group (P=0.771). Neither rehospitalization (log-rank P=0.749) nor survival (log-rank P=0.515) differed in patients with mild and moderate tricuspid regurgitation in both groups. Freedom from recurrent tricuspid regurgitation was non-significantly higher in mild and moderate tricuspid regurgitation patients with no TV surgery (P=0.059). Conservative management predicted the recurrence of tricuspid regurgitation., Conclusion: TV surgery concomitant with SVR could reduce the recurrence of tricuspid regurgitation; however, its effect on the clinical outcomes of rehospitalization and survival was not evident. The same effects were observed in patients with mild and moderate tricuspid regurgitation.

Background: Tricuspid valve repair (TVr) is the recommended approach for managing tricuspid regurgitation; however, there is a concern about the long-term durability of the repair. Therefore, this study aimed to compare the long-term outcomes of TVr versus tricuspid valve replacement (TVR) in a matched cohort of patients., Methods: This study included 1161 patients who underwent tricuspid valve (TV) surgery from 2009 to 2020. Patients were grouped according to the procedure into two groups: patients who underwent TVr ( n  = 1020) and patients who underwent TVR (n = 159). The propensity score identified 135 matched pairs., Results: Renal replacement therapy and bleeding were significantly higher in the TVR group compared to the TVr group both before and after matching. Thirty-day mortality occurred in 38 (3.79%) patients in TVr group versus 3 (1.89%) in the TVR group ( P  ≤ 0.001) but was not significant after matching. After matching, TV reintervention (hazard ratio (HR): 21.44 (95% CI: 2.17-211.95); P   =  0.009) and heart failure rehospitalization (HR: 1.89 (95% CI: 1.13-3.16); P   =  0.015) were significantly higher in the TVR group. There was no difference in mortality in the matched cohort (HR: 1.63 (95% CI: 0.72-3.70); P   =  0.25)., Conclusions: TVr was associated with lower renal impairment, reintervention, and heart failure rehospitalization than replacement. TVr remains the preferred approach whenever feasible.

Background: The influence of the etiology of mitral valve (MV) lesion on outcomes of concomitant repair for functional tricuspid regurgitation (TR) is not well studied. Our objectives were to compare long-term survival and TR recurrence after tricuspid valve (TV) repair concomitant with surgery for rheumatic versus degenerative MV disease., Methods: We included 480 patients who had concomitant MV and TV surgery from 2009 to 2019. We grouped the patients into Group 1 (n = 345; rheumatic MV) and Group 2 (n = 135; degenerative MV). Propensity score matching identified 104 matched pairs., Results: There was no significant difference in survival between groups before (p = .46) or after matching (p = .09). There was no difference in the recurrence of moderate TR (subdistributional hazard ratio [SHR]: 1.22 [0.77-1.95], p = .40). Recurrent TR was significantly associated with the preoperative TR grade (SHR: 1.8 [1.5-2.16], p < .001); body mass index (SHR: 1.05 [1.03-1.08], p < .001), and the use of flexible versus rigid TV prosthesis (SHR: 0.64 [0.41-0.99], p = .042). Recurrence of TR was higher with MV replacement compared with repair (SHR: 1.69 [1.03-2.78], p = .038). The change in the degree of TR did not differ between groups before matching (OR: 0.77 [0.56-1.04], p = .09) or after matching (OR: 0.98 [0.67-1.44]; p = .93)., Conclusion: Outcomes of concomitant TR repair were comparable in rheumatic and degenerative mitral pathology. Type of the TV prosthesis and TR grade affected TR recurrence. MV repair could be associated with a lower recurrence of TR compared with replacement., (© 2022 Wiley Periodicals LLC.)

Background: The ideal tricuspid valve annuloplasty (TVA) prosthesis is controversial. This study aimed to compare the effect of rigid versus flexible TVA prostheses on long-term outcomes after repair of functional tricuspid regurgitation (FTR)., Methods: We included 713 patients who had repair of FTR from 2009 to 2017. Patients were divided into 2 groups according to the type of TVA prosthesis. Group 1 (n = 104) included patients who had repair using rigid rings; group 2 (n = 609) included patients with flexible bands. Median age was 53.5 years (25th through 75th percentiles; range, 42.5-62 years) in group 1 versus 56 years (range, 45-65 years) in group 2 (P = .11). Propensity score matching identified 91 matched pairs for comparison., Results: In the matched pairs, operative mortality was identical (4 in both groups [4.4%]; P ˃ .99). Median follow-up was 55 months (range, 28-83 months). The cumulative incidence of moderate or higher tricuspid regurgitation (TR) in the presence of death as a competing risk was higher in group 2 (subdistribution hazard ratio = 1.63, P = .019; and subdistribution hazard ratio = 1.6, P = .099 before and after matching, respectively). There was a trend of higher pacemaker insertion in group 1 (7 [7.69%] versus 3 [3.3%]; P = .34), which did not reach statistical significance after matching. There was no significant change in the degree of TR over time between groups (odds ratio = 1.21, P = .53; and odds ratio = 1.75, P = .21 before and after matching, respectively)., Conclusions: Both types of TVA prostheses had comparable efficacy in managing FTR; however, freedom from moderate or more TR was higher in the rigid ring group., (Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

The chemical composition of snow provides insights on atmospheric transport of anthropogenic contaminants at different spatial scales. In this study, we assess how human activities influence the concentration of elements in the Andean mountain snow along a latitudinal transect throughout Chile. The concentration of seven elements (Al, Cu, Fe, Li, Mg, Mn and Zn) was associated to gaseous and particulate contaminants emitted at different spatial scales. Our results indicate carbon monoxide (CO) averaged at 20 km and nitrogen oxide (NOx) at 40 km as the main indicators of the chemical elements analyzed. CO was found to be a significant predictor of most element concentrations while concentrations of Cu, Mn, Mg and Zn were positively associated to emissions of NOx. Emission of 2.5 μm and 10 μm particulate matter averaged at different spatial scales was positively associated to concentration of Li. Finally, the concentration of Zn was positively associated to volatile organic compounds (VOC) averaged at 40 km around sampling sites. The association between air contaminants and chemical composition of snow suggests that regions with intensive anthropogenic pollution face reduced quality of freshwater originated from glacier and snow melting., (© 2021. The Author(s).)

Background: The clinical use of transcatheter mitral valve repairis growing. We aimed to compare the clinical and echocardiographic outcomes after transcatheter mitral valve repair using the edge-to-edge technique in patients with functional and degenerative mitral regurgitation (MR). Furthermore, we correlated the clinical and echocardiographic measurements., Methods: The study included 111 patients who underwent the MitraClip procedure from 2012 to 2018. The patients were divided into two groups according to the etiology; functional mitral regurgitation (FMR) (n = 88; 79.28%) and degenerative mitral regurgitation (DMR) (n = 23; 20.72%)., Results: Advanced age (p = 0.002) and FMR (p = 0.001) increased coronary care unit stay, and history of heart failure hospitalization (p = 0.003). Advanced age (p = 0.022) and FMR (p < 0.001) also increased the duration of hospital stay. Severe renal impairment [hazard ratio (HR): 2.6; p < 0.001], female gender (HR: 3.9; p = 0.005), and history of stroke (HR: 5.6; p = 0.065) decreased survival, while post-procedure diuretics improved survival (HR: 0.3; p = 0.024). Moderate residual MR [sub-distribution hazard ratio (SHR): 4.1; p = 0.011], lower EuroSCORE (SHR: 0.9; p = 0.013), and lack of β-blockers (SHR: 0.2; p = 0.034) were predictors of MR recurrence. There were no significant correlations between NYHA class and pulmonary artery pressure (PASP) (p = 0.896), end-systolic (p = 0.856), and end-diastolic diameters (p = 0.965). There were significant improvements in left ventricular dimensions and PASP after MitraClip. However, these changes were not maintained over time. The grade of MR significantly improved after the procedure (p = 0.001), with no difference between groups (p = 0.89)., Conclusions: The MitraClip procedure showed positive results in terms of sustainable symptomatic relief, although this finding was not reflected in left ventricular dimensions. The technique is equally effective in FMR and DMR.

In this work, the suitability of a new polymer family has been investigated as capillary coatings for the analysis of peptides and basic proteins by CE. This polymer family has been designed to minimize or completely prevent protein-capillary wall interactions and to modify the EOF. These coating materials are linear polymeric chains bearing as side cationizable moiety a dentronic triamine derived from N,N,N',N'-tetraethyldiethylenetriamine (TEDETA), which is linked to the backbone through a spacer (unit labeled as TEDETAMA). Four different polymers have been prepared and evaluated: a homopolymer which comprised only of those cationizable repetitive units of TEDETAMA, and three copolymers that randomly incorporate TEDETAMA together with neutral hydrosoluble units of N-(2-hydroxypropyl) methacrylamide (HPMA) at different molar percentages (25:75, 50:50 and 75:25). It has been demonstrated that the composition of the copolymers influences the EOF and therefore the separation of the investigated biopolymers. Among the novel polymers studied, poly-(TEDETAMA-co-HPMA) 50:50 copolymer was successfully applied as coating material of the inner capillary surface in CE-UV and CE-MS, providing EOF reversing together with fast and efficient baseline separation of peptides and basic proteins. Finally, the feasibility of the polymer-coated capillary was shown through the analysis of lysozyme in a cheese sample., (© 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)