Introduction; - Objective: The latest porcine aortic valve bioprosthesis employs a thin frame to facilitate implant and to maximize effective orifice area (EOA) to external diameter ratio. The aim of this study was to evaluate early hemodynamics in this bioprosthesis by label size. Methods: From 8/2023 to 8/2025, 197 adults underwent surgical aortic valve replacement with this valve. A non-linear mixed-effects regression model was used to estimate temporal trend of mean gradient after implant. Raw values of 19 mm valves are reported due to limited sample size. Results: Implanted valves were label size 19 mm (n=5), 21 mm (n=36), 23 mm (n=88), and 25 mm (n=68). Root enlargement was performed in 2/5 (40%), 6/36 (17%), 3/88 (3.4%) and 2/68 (2.9%) patients in each respective label size. The mean body surface area (BSA) was 1.7, 2.0, 2.0, and 2.2 m2, respectively. For each size, EOA was 1.4, 1.5, 1.7 and 2.4 cm2. Early trans-prosthesis gradients were 13, 11, 9, and 8 mmHg for each valve size and remained stable at early follow-up. In each group, 0/5 (0%), 5/36 (14%), 1/88 (1.1%), and 0/68 (0%) patients were classified as having severe prosthesis-patient mismatch with EOA/BSA <0.65 cm2/m2, and their average early gradients were 12 and 10 mmHg for label sizes 21 and 23 mm. Conclusions: The latest porcine aortic valve bioprosthesis functions as designed, with early hemodynamics favorable compared to other valves in the current market even at small size. Even In patients with severe presumed prosthesis-patient mismatch and normal left ventricular systolic function, trans-prosthesis gradients remained low.       .

Background: - diabetes mellitus is a group of metabolic disorders characterized by hyperglycemia. Complex combinations between environmental and genetic factors cause various types of diabetes mellitus. Complications from diabetes mellitus, such as cardiac autonomic neuropathy, are common. Unbalanced autonomic function, which manifests as cardiac autonomic neuropathy, is a significant predictor of cardiovascular events in the diabetic patients. Objectives: to study the prevalence of cardiac autonomic neuropathy in patients with type 2 diabetes mellitus with peripheral neuropathy in a tertiary care teaching hospital. Methodology: observational cross-sectional hospital-based study done in 131 type 2 diabetes mellitus patients who presented to the general medicine outpatient and inpatient departments of a tertiary care teaching hospital of central kerala from december 2020 to april 2022. The data was entered in ms excel sheet and was analyzed using spss software. Results: in the present study the mean age was 62.24 years. Among participants, 96.2% had hba1c levels above 6.5%. Mean duration of living with diabetes is13.40 years. We observed that 65.6% of the patients in our study population had cardiac autonomic neuropathy. Despite having peripheral neuropathy,34.4% of participants exhibited normal cardiac sympathetic and parasympathetic function. Conclusion: The mean age in this study was 62.24 years with standard deviation of 7.653. Out of 130 patients, 51.1% were females and 48.9% were males. The mean duration of diabetes was 13.40 years with standard deviation of 7.418. Among this, 47.3% were up to 10 years duration, 39.7% were between 11 and 20 years and 13% were with duration of diabetes more than 20 years. The prevalence of CAN is 65.6% in our study population. CAN was found in 86 patients out of 131 study population with different grades of severity. 20.6% patients have mild, 23.7% have moderate and 55.7% have severe peripheral neuropathy. Patients with peripheral neuropathy are prone for developing cardiac autonomic neuropathy. As severity of peripheral neuropathy increases, severity cardiac neuropathy also increases. Cardiac autonomic neuropathy is a frequent and life-threatening complication of diabetes mellitus. This study emphasizes the importance of prevention and control diabetes in order to prevent these life complications.