Choice Of Prosthesis Research Articles

Hip Hemiarthroplasty: The Misnomer of a Narrow Femoral Canal and the Cost Implications.

ObjectiveHemiarthroplasty has been identified as the treatment of choice for displaced intracapsular femoral neck fractures. A modular prosthesis is sometimes preferred for its sizing options in narrow femoral canals, despite its higher cost and no advantage in clinical outcomes. Thus, in this study, we investigated the factors affecting surgeons’ choice of prosthesis, hypothesizing that modular hemiarthroplasty is overused for narrow femoral canals compared to monoblock hip hemiarthroplasty.MethodsA retrospective study of a regional level 1 trauma center was conducted. Patients who had sustained femoral neck fractures from March 2013 to December 2016 were included in this study. Inclusion criterion was modular hemiarthroplasty for a narrow femoral canal. A matched group of patients who underwent monobloc hemiarthroplasty (MH) was created through randomization. The main outcome measurements were sex, age, Dorr classification, and femoral head size. We measured the protrusion of the greater trochanter beyond the level of the lateral femoral cortex postoperatively. Modular hemiarthroplasty patients were templated on radiographs using TraumaCad for Stryker Exeter Trauma Stem (ETS®).ResultsIn total, 533 hemiarthroplasty procedures were performed, of which 27 were modular for a narrow femoral canal. The ratio of modular to monobloc was 1:18. Average head size was 46.7 mm ± 3.6 mm for monobloc and 44.07 ± 1.5 for modular (P= 0.001). There were four malaligned stems in the monobloc group versus 14 in the modular group (P= 0.008). Unsatisfactory lateralization was noted in 18 patients (7 mm ± 2.9 mm) in the modular group compared with 8 (4.7 mm ± 3.9 mm) in the monobloc group (P= 0.029). Dorr classification was A or B in 24 patients in the modular group and 18 in the monobloc group (P = 0.006). Templating revealed that modular was not required in 25 patients.ConclusionsAs per our findings, it was determined that patients with a narrow femoral canal intraoperatively should not receive modular hemiarthroplasty. This is especially true for female patients with small femoral head and narrow femoral canal dimensions (Dorr A and B). They would require extensive careful planning. Surgical techniques should be explored through education intraoperatively to achieve lateralization during femoral stem preparation. This may avoid prolonged anesthetic time and achieve potential cost savings.

Aortic and mitral bioprosthetic valve dysfunction: surgical or percutaneous solutions?

In the last years, there has been a trend to prefer biological prostheses, especially among young patients, with the aim to avoid anticoagulant treatment. Surgical tissue valves have so far demonstrated their solid long-term durability. However, younger age has been identified as one of the main risk factors for developing structural valve deterioration (SVD). As a consequence, the proportion of subjects at risk for valve dysfunction will constantly rise in the near future. However, while surgical reintervention has always been considered the gold standard for treatment of prosthesis deterioration, the introduction of transcatheter heart valves could offer new therapeutical options, particularly among high-risk patients, aiming a second less invasive chance. The recent standardization of valve durability definitions will soon allow a more comprehensive understanding of the mechanism underlying SVD and guide the choice of prosthesis for patients needing valve replacement.

S3682 Management of Right-Sided Carcinoid Heart Failure

Introduction: Carcinoid heart disease is a rare disease affecting around 20% of patients with carcinoid syndrome. It is considered a result of high circulating serotonin levels depositing into heart valves. The characterized symptoms of carcinoid syndrome are vasomotor flushing, gastrointestinal hypermotility and cardiac involvement. Right heart valve disorders increase morbidity and mortality due to right heart failure complications of fluid overload. This case presents a 48 year old woman with new findings on echocardiogram compatible with right heart failure. Case Description/Methods: A 48 year old woman with a past medical history of hypothyroidism presented with shortness of breath for the last month. No productive cough, no sick contacts, no fevers or chills. Endorses diffuse redness on her face and right arm. Antistreptolysin A returned positive and completed a 10 day course of cephalexin without relief. Other related symptoms were abdominal distress, nonbloody diarrhea and tachycardia. She lost approximately 30 pounds in the last 2 months due to chronic diarrhea. Recent celiac serology testing has been negative. CT Abdomen and Pelvis with contrast shows a prominent, speculated nodal mass at the root of the mesentery with focal nodular thickening of the duodenal wall. 5-HIAA returned at 40mg/24h (Reference < 30 mg/24hr). Echocardiogram revealed grade 1 diastolic dysfunction, preserved ejection fraction and moderate tricuspid regurgitation. Lasix was started for diuresis along with octreotide to calm down the systemic 5-HIAA surge. She will be followed up outpatient for surgical evaluation. Discussion: Carcinoid heart disease is caused by the deposition of pearly fibrotic plaques into the endocardium of right sided valves leading to multiple patterns of severe valve dysfunction. Plaque formation causes leaflet thickening, and fusion of the valves. Echocardiography remains a reliable method for the definitive diagnosis. Valve replacement is currently the gold standard treatment for symptomatic carcinoid valve disease. However, debates remain in terms of the choice of heart valve prosthesis. The surgical indications of carcinoid heart disease are symptomatic right ventricular failure, severe valvular dysfunction and systemic venous pressure elevation. Contraindications are end-stage metastatic disease poorly controlled carcinoid symptoms despite octreotide therapy medical management. This case highlights the rare syndrome of carcinoid heart disease with follow up surgery in the outpatient..

Valoración física, funcional y audiológica del anciano para proceder a la adaptación protésica

En el anciano, concurren dos situaciones una, su necesidad de oír ante el aislamiento social que le produce la sordera y otra, la decepción que le provocan, los resultados negativos obtenidos en la adaptación protésica que no alcanzan los objetivos previstos por él, lo que le obliga a no utilizar la prótesis. Este trabajo pretende en primer lugar, que la coincidencia de estas dos situaciones no se produzca, y en segundo lugar concienciar a los audioprotesistas de que la adaptación protésica es mucho más que una simple transacción comercial, que el audioprotesista esta tratando mas a un paciente que a un cliente y que su labor profesional debe estar enfocada a solucionar protésicamente una patología auditiva basándose en criterios objetivos y científicos. Para ello hemos protocolizado la recopilación de datos para facilitar al audioprotesista, su estudio y toma de decisiones. Esto es lo que nos permite conocer al anciano, no solo en cuanto a su patología auditiva, sino también en cuanto a sus necesidades de convivencia y grado de bienestar deseable, lo que a su vez nos permite actuar correctamente en la elección de la prótesis y del oído a aparellar. Los resultados siempre serán agradables, tanto si no se le realiza una adaptación, ya que estamos en condiciones de explicarle las causas y su porque, lo que satisface al anciano que no se siente engañado, como si se le realiza la adaptación ya que ve cumplidos sus objetivos de forma gratificante.

Prosthesis choice for surgical treatment of left-sided native valve infective endocarditis: Determinants and impact on outcomes

Surgical treatment is required in approximately half of the patients with infective endocarditis (IE) because of severe complications. To date there is no recommendation favoring a specific valve substitute for IE treatment and accordingly there is a wide variation in routine surgical management of these patients. The purpose of this study is to describe surgical practices in our center and to investigate the impact on clinical outcomes. All patients with native valve left-sided IE, who underwent valve replacement surgery with a mechanical or biological prosthesis in our institution between 1 January 2006 and 31 December 2018 were enrolled in this retrospective study. A total of 303 patients were included (mean age = 58 years, 80% men). Patients in whom a biological valve was chosen (64%, n = 194) were older and had more comorbid conditions compared to patients who received a mechanical valve (36%, n = 109). In hospital mortality was respectively 19% ( n = 36) in the bioprosthesis group avec 3% ( n = 3) in the mechanical valve group ( P < 0.0001). The mortality rates at 1 and 3 years were 35% and 41% in the biological valve group, these rates were 8% and 15% in the mechanical valve group. Factors associated to in hospital and mid term mortality were age, comorbid conditions, hemodynamic failure, a double valve replacement or associated bypass surgery. The type of the implanted valve substitute was not independently associated with mortality. For surgical management of IE, a biological valve is the most used valve substitute in our institution. Mechanical valves seem to be implanted in a very selected and low-risk patient subgroup. The valve substitute does not appear to be related to in hospital nor to midterm mortality rates.

Evaluation and Management of Aortic Stenosis in Chronic Kidney Disease: A Scientific Statement From the American Heart Association.

Aortic stenosis with concomitant chronic kidney disease (CKD) represents a clinical challenge. Aortic stenosis is more prevalent and progresses more rapidly and unpredictably in CKD, and the presence of CKD is associated with worse short-term and long-term outcomes after aortic valve replacement. Because patients with advanced CKD and end-stage kidney disease have been excluded from randomized trials, clinicians need to make complex management decisions in this population that are based on retrospective and observational evidence. This statement summarizes the epidemiological and pathophysiological characteristics of aortic stenosis in the context of CKD, evaluates the nuances and prognostic information provided by noninvasive cardiovascular imaging with echocardiography and advanced imaging techniques, and outlines the special risks in this population. Furthermore, this statement provides a critical review of the existing literature pertaining to clinical outcomes of surgical versus transcatheter aortic valve replacement in this high-risk population to help guide clinical decision making in the choice of aortic valve replacement and specific prosthesis. Finally, this statement provides an approach to the perioperative management of these patients, with special attention to a multidisciplinary heart-kidney collaborative team-based approach.

Effect of Aortic Valve Type on Patients Who Undergo Type A Aortic Dissection Repair

Aortic valve replacement (AVR) is common in the setting of type A aortic dissection (TAAD) repair. Here, we evaluated the association between prosthesis choice and patient outcomes in an international patient cohort. We reviewed data from the International Registry of Acute Aortic Dissection (IRAD) interventional cohort to examine the relationship between valve choice and short- and mid-term patient outcomes. Between January 1996 and March 2016, 1290 surgically treated patients with TAAD were entered into the IRAD interventional cohort. Of those, 364 patients undergoing TAAD repair underwent aortic valve replacement (AVR; mean age, 57 years). The mechanical valve cohort consisted of 189 patients, of which 151 (79.9%) had a root replacement. The nonmechanical valve cohort consisted of 5 patients who received homografts and 160 patients who received a biologic AVR, with a total of 118 (71.5%) patients who underwent root replacements. The mean follow-up time was 2.92 ± 1.75 years overall (2.46 ± 1.69 years for the mechanical valve cohort and 3.48 ± 1.8 years for the nonmechanical valve cohort). After propensity matching, Kaplan-Meier estimates of 4-year survival rates after surgery were 64.8% in the mechanical valve group compared with 74.7% in the nonmechanical valve group (p = 0.921). A stratified Cox model for 4-year mortality showed no difference in hazard between valve types after adjusting for the propensity score (p = 0.854). A biologic valve is a reasonable option in patients with TAAD who require AVR. Although this option avoids the potential risks of anticoagulation, long-term follow up is necessary to assess the effect of reoperations or transcatheter interventions for structural valve degeneration.

Schwellkörperimplantate

The insertion of apenile prosthesis (PP) is adefinitive treatment option for erectile dysfunction (ED), induratio penis plastica, after phalloplasty or priapism. The aim is a"normal" erection with the possibility of asatisfactory sexual life. The costs of the operation are covered by the health insurance. In addition, manual dexterity, concomitant diseases and possible contraindications should be considered preoperatively. While semirigid PPs are simply aligned in the desired position when used, inflatable PPs must be activated and deactivated via apump. In addition to injury to local structures and postoperative infections, long-term complications such as mechanical implant failure or an undesirable cosmetic result may also occur. Careful patient selection and adetailed counselling and information session are therefore of decisive importance. Implantation is performed in the supine or lithotomy position via an infrapubic or penoscrotal approach. PPs should not be implanted if cutaneous, systemic or urinary tract infections are present. Inflatable PPs are preferred by most patients as they come closest to a"natural" erection. APP offers one of the highest satisfaction rates among treatment options, regardless of indication, and is highly rated by patients and their partners across models due to product reliability. Differences between the models of the various manufacturers could not be demonstrated. The choice of prosthesis should therefore be adapted to the patient's individual requirements and health conditions.

Predictors of Use and Outcomes of Mechanical Valve Replacement in the United States (2008-2017).

BackgroundContemporary nationwide data on the use, predictors, and outcomes of mechanical valve replacement in patients less than 70 years of age are limited.Methods and ResultsWe identified hospitalizations for aortic valve replacement (AVR) or mitral valve replacement (MVR) in the Nationwide Inpatient Sample between January 1, 2008, and December 31, 2017. The study's end points included predictors of mechanical valve replacement and risk‐adjusted in‐hospital mortality. Among 253 100 hospitalizations for AVR, the use rate of mechanical prosthesis decreased from 45.3% in 2008 to 17.0% in 2017. Among 284 962 hospitalizations for MVR, mechanical prosthesis use decreased from 59.5% in 2008 to 29.2% in 2017 (P for trend<0.001). In multilogistic regression analyses, female sex, prior sternotomy, prior defibrillator, and South/West geographic location were predictive of mechanical valve use. The presence of bicuspid valve was a negative predictor of mechanical AVR (odds ratio [OR], 0.68; 95% CI, 0.66–0.69; P<0.001), whereas mitral stenosis was associated with higher mechanical MVR (OR, 1.28; 95% CI, 1.22–1.33; P<0.001). Unadjusted in‐hospital mortality decreased over time with AVR but not with MVR, regardless of prosthesis choice. Using years 2008 and 2009 as a reference, risk‐adjusted mortality also decreased over time with AVR but did not decrease after MVR.ConclusionsThere is a substantial decline in the use of mechanical valve replacement among patients aged ≤70 years in the United States. Long‐term durability data on bioprosthetic valve replacement are needed to better define the future role of mechanical valves in this age group.

Post hoc patient satisfaction with the choice of valve prosthesis for aortic valve replacement: results of a single-centre survey.

Our goal was to examine post hoc patient satisfaction and the decision-making process of choosing a prosthesis for aortic valve replacement (AVR). We surveyed 113 patients who were operated on for AVR at 60-70 years of age, including 74 patients with a mechanical valve (MECH) and 39 with a bioprosthesis (BIO). The study focused on quality of life and the decision pathway in relation to prosthesis choice and valve-related complications. Decisional conflict was defined as the post hoc uncertainty perceived by patients regarding their choice of prosthesis. The survey was performed at a median of 5.2 (3.2-8.1) years after the AVR. Patients with a biological valve were older (BIO: 68.4 years [66.2-69.4] vs MECH: 63.9 [61.9-66.7]; P < 0.001). Global post hoc satisfaction with prosthesis choice was high in both groups (MECH: 95.9%; BIO: 100%), and 85.1% (MECH) and 92.3% (BIO) of them would repeat their choice. Conflict about their decision was equal (MECH: 30.3%; BIO: 32.6%) for different reasons: MECH patients experienced more anticoagulation-related inconvenience (25.9% vs 0%), fear of bleeding (31.1% vs 0%) and prosthesis noise (26.2% vs 0%), whereas more BIO patients feared prosthesis failure (39.7% vs 17.4%) or reoperation (43.5% vs 18.1%). Active involvement in the decision (odds ratio 0.37, 95% confidence interval 0.16-0.85; P = 0.029) and adequate information about the prosthesis (odds ratio 0.34, 95% confidence interval 0.14-0.86; P = 0.020) decreased the risk of conflict about the decision. Although 30% of the responders showed a decisional conflict related to prosthesis-specific interferences, global patient satisfaction with the prosthesis choice for AVR is excellent. Increasing the patient's involvement in the prosthesis choice through shared accountability and improved information is recommended to decrease the choice-related uncertainty.

Propensity matched long-term analysis of mechanical versus stentless aortic valve replacement in the younger patient.

The choice of prosthesis for aortic valve replacement (AVR) in younger patients remains controversial. Stentless AVR was introduced 3 decades ago, with the aim of better haemodynamics and durability than stented xenografts. The objective of this analysis was to compare the long-term outcomes to mechanical prostheses in younger patients (age ≤60 years). All adult patients who underwent AVR due to aortic valve stenosis and/or insufficiency between 1993 and 2002 were identified. After the exclusion of patients with congenital heart defects, aortic dissections and Ross-procedures, 158 patients with stentless valves and 226 patients with bi-leaflet mechanical valves were finally included in this analysis. Sixty-six patient pairs could be included in a propensity matched analysis. Mortality and morbidity including stroke, bleeding, endocarditis and reoperation were analysed. Group baseline characteristics and operative data did not differ significantly after propensity matching. Hospital mortality was 0.0% in the stentless and 1.5% in the mechanical group. Total patient years/median follow-up was 2029.1/15.4 years (completeness: 100.0%, range: 0-25 years). After 20 years, actuarial survival was 47.0 ± 6.4% in the stentless and 53.3 ± 6.6% in mechanical group (P = 0.69). Bleeding, endocarditis and stroke occurred rarely and did not differ significantly between groups. After 20 years, actuarial overall freedom-from-reoperation was 45.1 ± 8.2% in the stentless group and 90.4 ± 4.1% in the mechanical group (P < 0.001). Hospital mortality while reoperation was 7.4% in the stentless group and 0% in the mechanical group (P = 1.0). Long-term morbidity and mortality of stentless and mechanical aortic valves were statistically not different besides a significantly higher reoperation rate after stentless AVR combined with a probably higher risk of in-hospital mortality. Thus, mechanical AVR should remain the procedure of choice in younger patients.

Порівняльна характеристика використання знімних та незнімних апаратів-протезів для заміщення дефектів зубних рядів у дітей в період змінного прикусу

Порівняльна характеристика використання знімних та незнімних апаратів-протезів для заміщення дефектів зубних рядів у дітей в період змінного прикусу

Hip Joint Contact Loading and Muscle Forces During Running With a Transtibial Amputation.

People with unilateral transtibial amputations (TTA) have greater risks of bilateral hip osteoarthritis, related to asymmetric biomechanics compared to people without TTA. Running is beneficial for physical health and is gaining popularity. However, people with TTA may not have access to running-specific prostheses (RSPs), which are designed for running, and may instead run using their daily-use prosthesis (DUP). Differences in joint loading may result from prosthesis choice; thus, it is important to characterize changes in peak and impulsive hip joint contact loading during running. Six people with and without TTA ran at 3.5 m/s while ground reaction forces, kinematics, and electromyography were collected. People with TTA ran using their own RSP and DUP. Musculoskeletal models incorporating prosthesis type of each individual were used to quantify individual muscle forces and hip joint contact forces (HJCFs) during running. People using RSPs had smaller bilateral peak hip joint contact forces compared to when wearing DUPs during stance and swing, and a smaller impulse over the entire gait cycle. Greater amputated leg peak hip joint contact forces for people wearing DUPs compared to RSPs occurred with greater forces from the ipsilateral gluteus maximus during stance. People with TTA also had greater bilateral peak hip joint contact forces during swing compared to people without TTA, which occurred with greater peak gluteus medius forces. Running with more compliant RSPs may be beneficial for long-term joint health by reducing peak and impulsive hip loading compared to DUPs.

Impact of Mechanical Aortic Prostheses in hospital stay and anticoagulation related complications

Objective: Use of mechanical valves requires long-term anticoagulation, which carries additional risks of bleeding and thrombosis. The aim of the study was to investigate the impact of anticoagulation on length of postoperative stay and the incidence of anticoagulation-related complications. Methods: A multicentre study of prospectively collected data, including all patients below 65 years of age undergoing aortic valve replacement (± concomitant non-valvular procedures) was performed. Exclusion criteria included preoperative atrial fibrillation and other indications for anticoagulation, previous cardiac surgery, emergency operations and infective endocarditis. Primary end-points were length of hospital stay and anticoagulation-related complications within 6 weeks of discharge. Results: A total of 1973 patients were included over a 5-year period from 5 centres in the UK. Mean patient age was 59 years (range 17-65 years). Mechanical valves were implanted in 52% of patients. The use of mechanical prostheses was associated with significantly prolonged postoperative stay (median of 7 vs. 6 days with bioprosthesis, p 8 days; OR 1.55, 95% CI 1.27-1.90, p < 0.001). On subanalysis, 1.4% of patients with mechanical prosthesis required readmission for anticoagulation-related complications within 6 weeks of discharge (including late tamponade). An additional 2% required repeated hospital attendance for INR stabilisation. Conclusion: Use of mechanical valves in patients below 65 years of age is associated with both increased hospital stay and anticoagulation-related complications compared to bioprosthesis. The clinical and health economic implications of prosthesis choice should be considered by both the heart team and patient.

DSC examination of cartilage damage of patients undergoing shoulder replacement

Shoulder replacement is a viable surgical treatment for comminuted proximal humerus fractures and shoulder osteoarthritis. Proper evaluation of hyaline cartilage is essential for the right choice of prosthesis; however, there are only a limited number of studies available investigating the cartilage of glenohumeral joint of patients undergoing shoulder replacement. We hypothesized that differential scanning calorimetry (DSC) could determine the grade of cartilage damage in patients undergoing reversed shoulder replacement, providing insights into the structural changes of the human cartilage samples. Sample of hyaline cartilage of glenohumeral joint was harvested during reversed shoulder replacement of orthopaedic and trauma patients. Thermal parameters were measured using DSC, and radiological examination of glenohumeral joint was also done prior to surgery. We have found that changes in thermal characteristics and DSC scans clearly indicate the severity of osteoarthritis and cartilage damage. The denaturation temperature range and the half-width of the heat flow curves were significantly wider in the orthopaedic samples compared to the control and traumatic ones. The calorimetric enthalpy (ΔHcal) exhibited significant differences in both pathologic samples, compared to the control. The melting temperatures (Tm) show that structural change caused by orthopaedic condition is greater than the effect of traumatic. Therefore, differential scanning calorimetry could help to determine the grade of cartilage damage in orthopaedic and trauma patients undergoing reversed shoulder replacement.

Assessment of aortic annulus dimensions for transcatheter aortic valve replacement (TAVR) with high-pitch dual-source CT: Comparison of systolic high-pitch vs. multiphasic data acquisition

ObjectivesTo evaluate a systolic ECG-gated high-pitch aortoiliac computed tomography (CT) angiography for planning transcatheter aortic valve implantation (TAVI). MethodsPatients referred for TAVI underwent a combined CT imaging with retrospective, multiphasic ECG-gating of the heart and systolic ECG-gated high-pitch aortoiliac CT angiography. Consecutive patients were retrospectively included in this study group. Heart rate (HR) and heart rate variability (HRV) were assessed during the high-pitch ECG prediction phase. Aortic annulus area (AAA) was planimetrically quantified on both datasets. While only one moment of cardiac cycle was available for measurements in the high-pitch CT, the point of time in the multiphasic CT was chosen, where AAA yielded maximum size. Hypothetical prosthesis sizing was compared between multiphasic vs. high-pitch CT. ResultsAmong 61 patients (44.2 % men, mean age: 83.3 ± 5.5 years) average heart rate and HRV were 71.0 ± 13.4 bpm and 7.3 ± 8.5 bpm. 20 patients (32.7 %) had atrial fibrillation at the time of image acquisition. There was a strong correlation of AAA as derived from multiphasic vs. the high-pitch CT (r = 0.98). The difference in AAA was 10.5 ± 17.1mm2 (455.1 ± 83.0 mm2 for multiphasic vs. 444.5 ± 87.2 mm2 for high-pitch CT) and did not reach statistical significance (p = 0.08). Hypothetical prosthesis sizing showed an agreement in 55 of 61 patients (90.2 %). A sizing based on the high-pitch CT resulted in smaller prosthesis choice in 6 patients, all of them suffering from atrial fibrillation. Mean effective radiation dose was 10.9 ± 6.1 mSv for cardiac CTA and 4.1 ± 1.0 mSv for high-pitch CTA. ConclusionFor patients with sinus rhythm, systolic high-pitch aortoiliac CTA provides adequate prosthesis size selection as compared with multiphasic ECG-gated cardiac CTA and may result in significantly reduced radiation exposition.

Bioprosthetic or mechanical heart valves: prosthesis choice for borderline patients?-Results from 9,616 cases recorded in Polish national cardiac surgery registry.

BackgroundIn middle-aged patients undergoing aortic valve replacement (AVR), the selection of prosthesis type is a complex process. Current guidelines do not unequivocally indicate the type of prosthesis (bioprosthetic or mechanical) recommended for patients between 60–70 years of age. The aim of the study was to present the trends in AVR prosthesis selection in borderline patients over a 10-year period, based on real-life registry data.MethodsThe study population comprised of 9,616 consecutive patients aged between 60–70 years, who underwent isolated AVR between 2006 and 2016 in all cardiac surgery departments in Poland. Data were extracted from the Polish National Registry of Cardiac Surgery.ResultsAmong 27,797 consecutive AVR procedures, patients aged 60–70 years represented 34.6% of the population operated on. From 2006 to 2016, bioprosthetic valves (BVs) were implanted in 53.9% cases, (and) mechanical valves (MVs) in 42.1%. The proportion of different valve types changed in time: from 77.5% of MVs vs. 22.5% of BVs in 2006 to 23.2% of MVs vs. 76.8% of BVs in 2016 (P<0.001). The most commonly implanted BV was the Hancock II (used in 36.4% of BV implantations), the most commonly used MV was the Saint Jude Mechanical prosthesis (implanted in 36.4% of MV implantation cases). A multivariable model identified smaller annulus [OR (95% CI) 0.89 (0.86–0.92), P<0.001], atrial fibrillation [OR (95% CI) 1.32 (1.05–1.67), P=0.017], male sex [OR (95% CI) 1.47 (1.24–1.74), P<0.001] and year of implantation [OR (95% CI) 0.75 (0.71–0.79), P<0.001] as predictors of MV implantation.ConclusionsPatients aged 60–70 years represent more than one-third of all AVR patients. Between 2006 and 2016, the proportion of implanted prostheses has changed dramatically. In 2016 BVs were implanted in nearly 75% of AVR cases, three times more often than in 2006.

Evaluation of possible reasons for not opting for fixed dental prosthesis: Patient and Practitioner Perspective

With recent trends towards oral hygiene practices, the need for prosthetic rehabilitation has increased. There has been an increased spread of knowledge regarding the same as well as an increase in treatment options for the same. Epidemiological studies have shown that the anterior mandibular teeth usually are retained for the longest period, and the canines are the most persistent. Prosthetic rehabilitation of extracted teeth is important, and the choice of appropriate prosthesis is even more critical. There has been an increasing trend in the usage of removable options. The study aims to assess the different reasons to opt for a removable prosthesis than a fixed prosthesis. Retrospective data of 186 patients were obtained and segregated. Inclusion criteria included that they should be between 18 – 40 years, undergone removable denture therapy and should have visited during the period of the study. The data were tabulated, and the same was analyzed using SPSS by IBM version 20. The frequencies and cross-tabulations were performed, followed by correlation and association using the chi square test to check the correlation between the different variables. The results, thus obtained, were analyzed. Males (54.8%) undergo removable therapy more than females. Most common arch is upper arch (59.1%), the most common reason is to use a temporary denture (37.6%) Correlation seen between Arch and reason for not opting for FPD (p &lt;0.05). The present study has revealed a lacuna in knowledge among patients and practitioners—further studies and programmes to be done to improve knowledge and help society.

Similarity measures and attribute selection for case-based reasoning in transcatheter aortic valve implantation.

In a clinical decision support system, the purpose of case-based reasoning is to help clinicians make convenient decisions for diagnoses or interventional gestures. Past experience, which is represented by a case-base of previous patients, is exploited to solve similar current problems using four steps—retrieve, reuse, revise, and retain. The proposed case-based reasoning has been focused on transcatheter aortic valve implantation to respond to clinical issues pertaining vascular access and prosthesis choices. The computation of a relevant similarity measure is an essential processing step employed to obtain a set of retrieved cases from a case-base. A hierarchical similarity measure that is based on a clinical decision tree is proposed to better integrate the clinical knowledge, especially in terms of case representation, case selection and attributes weighting. A case-base of 138 patients is used to evaluate the case-based reasoning performance, and retrieve- and reuse-based criteria have been considered. The sensitivity for the vascular access and the prosthesis choice is found to 0.88 and 0.94, respectively, with the use of the hierarchical similarity measure as opposed to 0.53 and 0.79 for the standard similarity measure. Ninety percent of the suggested solutions are correctly classified for the proposed metric when four cases are retrieved. Using a dedicated similarity measure, with relevant and weighted attributes selected through a clinical decision tree, the set of retrieved cases, and consequently, the decision suggested by the case-based reasoning are substantially improved over state-of-the-art similarity measures.

Reliability and Influence on Decision Making of fully-automated vs. semi-automated Software Packages for Procedural Planning in TAVI

Precise procedural planning is crucial to achieve excellent results in patients undergoing Transcatheter aortic valve implantation (TAVI). The aim of this study was to compare the semi-automated 3mensio (3 m) software to the fully-automated HeartNavigator3 (HN) software. We randomly selected 100 patients from our in-house TAVI-registry and compared aortic annulus and perimeter as well as coronary distances between 3m-measurements and post-hoc HN-measurements. Finally, we retrospectively simulated prosthesis choice based on HN-measurements and analyzed the differences compared to routinely used 3 m based strategy. We observed significant differences between the two software packages regarding area (3 m 464 ± 88 mm², HN 482 ± 96 mm², p < 0.001), perimeter (3 m 77 ± 7 mm, HN 79 ± 8 mm, p < 0.001) and coronary distances (LCA: 3 m 13 ± 3 mm, HN 12 ± 3 mm, p < 0.001; RCA: 3 m 16 ± 3 mm, HN 15 ± 3 mm, p < 0.001). Prosthesis choice simulation based on newly obtained HN-measurements would have led to a decision change in 18% of patients, with a further reduction to 4% following manual adjustment of HN-measurements. The fully-automatic HN-software provides higher values for annular metrics and lower annulus-to-coronary-ostia distances compared to 3m-software. Measurement differences did not influence clinical outcome. Both, the HN-software and the 3m-software are sophisticated, reliable and easy to use for the clinician. Manual adjustment of HN-measurements may increase precision in complex aortic annulus anatomy.