Cardiovascular Journal of Africa: Vol 32 No 5 (SEPTEMBER/OCTOBER 2021)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 5, September/October 2021 286 AFRICA … continued from page 283 changes from mid- to late life, said Yaffe. ‘We also feel it’s very important to investigate disparities in these relationships by race and ethnic groups,’ she said. Medscape Medical News reports that commenting on the findings Dr Clinton Wright, director of the division of clinical research and associate director of the National Institute of Neurological Disorders and Stroke, noted that it’s ‘very important to have this type of data measuring vascular risk factors as early as possible in life and following people for cognitive outcomes.’ The study findings suggest that the presence of vascular risk factors in early adulthood and mid-life are important, he added. ‘They used a global measure of general cognition and a test of processing speed to measure cognition, so while suggestive of cognitive status at follow up, performance on these tests is not equivalent to a diagnosis of cognitive impairment or dementia,’ he noted. The researchers used imputation to estimate the effect of the presence of risk factors during early adult life on cognition in late life. Although they found that imputed early-life vascular risk factors were associated with greater late-life cognitive decline, ‘it is very important to realise that no one that was in the young-adult category was followed until late life,’ said Wright. Because treatment of modifiable vascular risk factors can prevent vascular and related cognitive outcomes, it is important to know how early these risk factors start to have an effect. ‘Since this study is not a clinical trial and is observational and is a pooled analysis of multiple studies where people were not followed from young adult to late life, more data from longitudinal studies are necessary to confirm these findings,’ said Wright. ‘But we may never have a definitive trial, since it is not practical to study large groups of people for decades in the context of a treatment trial.’ One question for future study concerns how the presence of risk factors during early adulthood, including the intensity and duration of these risk factors, affects hard cognitive outcomes, such as mild cognitive impairment and dementia, saidWright. Another question to investigate is how social determinants of health and access to care modify or moderate the effects of these risk factors in different populations and racial and ethnic groups. Source: MedicalBrief 2021 apparatus can be preserved and valve–ventricular interaction created. However, an expanded tricuspid annulus should be excised during tricuspid valvoplasty, and the native valve leaflets, which may hamper the prosthesis from working properly, should be excised and the rest should be plicated to the annulus of the tricuspid valve, rather than preserving all the leaflets. Pre-operative echocardiography should be carefully executed to acquire a better view of the native valve, and postoperative echocardiography can be used to check the surgical outcome. Lijie Jiang, Xueshan Zhao and Jiao Li contributed equally to the article. References 1. Wang TKM, Griffin BP, Miyasaka R, Xu B, Popovic ZB, Pettersson GB, et al . Isolated surgical tricuspid repair versus replacement: meta- analysis of 15 069 patients. Open Heart 2020; 7 : e001227. 2. Nakano K, Ishibashi-Ueda H, Kobayashi J, Sasako Y, Yagihara T. Tricuspid valve replacement with bioprostheses: long-term results and causes of valve dysfunction. Ann Thorac Surg 2001; 71 (1): 105–109. 3. Alqahtani F, Berzingi CO, Aljohani S, Hijazi M, Al‐Hallak A, Alkhouli M. Contemporary trends in the use and outcomes of surgical treatment of tricuspid regurgitation. J Am Heart Assoc 2017; 6 (12): e007597. 4. Ushijima T, Fujita S, Shingu N, Nakata Y, Matsuyama S, Kimura S, et al. Aortic root morphology can cause early bioprosthetic valve failure of externally mounted pericardial bioprosthesis. Gen Thorac Cardiovasc Surg 2020; 69 (1): 107–109. 5. Moutakiallah Y, Aithoussa M, Atmani N, Seghrouchni A, Moujahid A, Hatim A, et al . Reoperation for isolated rheumatic tricuspid regurgita- tion. J Cardiothorac Surg 2018; 13 : 1.