Background: Currently, mitral valve replacement is the primary method of reintervention for patients with rheumatic heart disease (RHD) after percutaneous mitral balloon commissurotomy (PMBC). This study aims to investigate the feasibility of mitral valve repair in such patients and report its therapeutic outcomes compared to mitral valve replacement.

Methods: Data from patients with previous PMBC who underwent mitral valve surgery as disease progression between January 2011 and August 2023 were retrospectively analyzed. The patients were divided into two groups: the repair group and the replacement group. The stabilized inverse probability of treatment weighting (SIPTW) method was used to balance baseline characteristic differences between the two groups. Clinical outcomes investigated included freedom from mitral valve reoperation and overall survival. Survival curves were generated with the Kaplan-Meier (K-M) method, and differences between groups were compared using the Log-rank test.

Results: A total of 210 patients were included in this study (32 in the repair group and 178 in the replacement group), with an average age of 56.6±10.0 years. After SIPTW, the baseline characteristics between the two groups were comparable. The median follow-up time for the entire cohort was 75.6 months. K-M analysis, adjusted for SIPTW, showed no significant differences between the two groups in terms of freedom from mitral valve reoperation and overall survival (Log-rank P=0.07 and 0.36, respectively).

Conclusions: According to our results, even if patients with RHD have previously undergone PMBC, there is still a possibility of mitral valve repair in suitable patients, with good clinical outcomes.

Keywords: Rheumatic heart disease (RHD); percutaneous mitral balloon commissurotomy (PMBC); mitral valve repair; mitral valve replacement

Background: Although coronavirus disease 2019 (COVID-19) is no longer classified as a Public Health Emergency of International Concern by World Health Organization, its global impact persists. Data on its impact in lung transplant recipients (LTRs) from China remain limited. This study aims to share clinical experiences and provide insights into managing LTRs with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Methods: We conducted a study on LTRs with COVID-19 caused by the Omicron variant from November 17, 2022, to May 1, 2023. Clinical information was gathered retrospectively through electronic medical records, questionnaires, or follow-up telephone calls.

Results: A total of 227 LTRs were reviewed for infection with Omicron variant. After excluding 49 cases without confirmed SARS-CoV-2 infection, this left a final cohort of 178 infected LTRs, accounting for an infection rate of 78.4% (178/227). Of the patients, 50% (89/178) required hospitalization, with an average hospital stay of 16 days [interquartile range (IQR): 9.5–25.5 days]. Of the 89 hospitalized patients, 41.6% (37/89) eventually progressed to severe or critical disease, forming the severe/critical group (S/C group), while the remaining 58.4% (52/89) had mild or moderate disease (M/M group). In comparison to the M/M group, the S/C group had higher C-reactive protein (CRP) (59.6 vs. 16.8 mg/L, P<0.001), Erythrocyte sedimentation rate (45.5 vs. 22.5 mm/h, P=0.005) and D-dimer level (1.09 vs. 0.65 mg/L, P=0.01), but lower CD4⁺ T lymphocytes count (217 vs. 427 cells/µL, P=0.004). The S/C group had significantly higher rates of combined pulmonary bacterial infection (67.6% vs. 38.5%, P=0.006) and pulmonary fungal infection (73.0% vs. 38.5%, P=0.001) during the course of COVID-19, nearly double that of the M/M group. In a multivariate logistic analysis, elevated CRP (>41.8 mg/L), combined pulmonary fungal infection, and interstitial lung disease (ILD) as primary disease emerged as high-risk factors for developing the severe disease phenotype following Omicron variant infection in LTRs, with respective odds ORs values of 4.23 [95% confidence interval (CI): 1.68–11.23], 4.76 (95% CI: 1.59–15.64), and 5.13 (95% CI: 1.19–29.17). Receiver operating characteristic (ROC) curve analysis showed that CD4⁺ T lymphocyte count may be a strong marker for predicting death. At a cutoff of 404 cells/µL, sensitivity was 0.509, specificity 0.999, and area under the curve (AUC) was 0.806 (95% CI: 0.678–0.934). Ultimately, 13 recipients succumbed to COVID-19 related respiratory failure or secondary multiple organ dysfunction, resulting in an overall mortality rate of 7.3% (13/178).

Conclusions: LTRs are at high risk of secondary lung infections after Omicron. Key risk factors for severe disease include CRP >41.8 mg/L, ILD as primary disease, and pulmonary fungal infection. CD4+ T lymphocyte count may predict mortality risk in LTRs with COVID-19.

Keywords: Lung transplantation; Omicron; coronavirus disease 2019 (COVID-19); coronavirus; risk factor

Background: Cone-beam computed tomography (CBCT)-guided bronchoscopy is increasingly utilized for diagnosing peripheral pulmonary lesions (PPLs). We carried out the meta-analysis for assessing the efficacy and safety of CBCT-guided bronchoscopy for PPLs.

Methods: An extensive search in several databases was conducted to identify relevant articles. We evaluated the quality of studies with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The pooled diagnostic yield (DY) and adverse event rate with the 95% confidence interval (CI) were computed. Subgroup analyses were performed according to additional use of navigation, use of radial endobronchial ultrasound (rEBUS), use of fixed or mobile CBCT, whether computed tomography (CT) spin was performed before biopsy to affirm tool-in-lesion, use of rapid onsite cytologic examination (ROSE), strictness of the definition of DY, and study design. Further analysis was performed to explore the association between odds of diagnosis with CBCT guided bronchoscopy and PPLs characteristics (>20 vs. ≤20 mm, non-upper lobe vs. upper lobe, with bronchus sign vs. without bronchus sign, and solid vs. non-solid) as well as sampling methods (forceps vs. fine needle aspiration, forceps vs. cryoprobe sampling). The pooled odds ratio (OR) and 95% CI were calculated. The significance level was set at 0.05. All analyses were performed by using meta package in R version 4.3.2.

Results: We included 23 studies involving 1,769 patients and 1,863 PPLs in the meta-analysis. The overall pooled DY of CBCT-guided bronchoscopy was 80.2% (95% CI: 76.0–84.1%). Subgroup analysis showed that the DY was highest when CBCT was used with robotic-assisted navigation bronchoscopy (pooled DY 87.5%; 95% CI: 81.5–92.4%), the DY was 78.9% (95% CI: 70.8–85.9%) when CBCT was used alone without other navigation techniques. Lesion size >20 mm, presence of bronchus sign and solid lesions were associated with significant increase in the odds of diagnosis with CBCT-guided bronchoscopy. Pooled adverse event rate was 2.3% (95% CI: 1.2–3.6%).

Conclusions: CBCT-guided bronchoscopy is a safe technique with high DY in diagnosing PPLs.

Keywords: Cone-beam computed tomography (CBCT); bronchoscopy; peripheral pulmonary lesions (PPLs); diagnostic yield (DY)