Comparison Of Long-term Outcomes Research Articles

Comparison of angiographic result and long-term outcome in patients with in-stent restenosis treated with cutting balloon or with scoring balloon angioplasty.

Lesion preparation with a cutting (CB) or scoring balloon (SB) is often used in patients with in-stent restenosis (ISR). However, there are no comparative studies. We analyzed 81 patients (CB group: n = 38; SB group: n = 43) who had a calcified ISR from November 2019 to September 2021. The primary endpoint was strategy success (less than 20% residual stenosis); the secondary endpoints were major adverse cardiovascular events during the 1-year follow-up. Quantitative coronary angiography was performed to evaluate the strategy success. The patients in the CB group were more likely to have a severe calcified ISR (P = .001) and multiple stent layers (P = .001). A total of 4 patients (79.0%) reached the primary endpoint. Residual stenosis greater than 20% was more common in the CB group (39.5% vs 4.7%; P = .001). In the multivariate analysis, an effect of the intervention group on the achievement of the primary endpoint could be excluded (estimate 1.06; standard error 1.07; P = .322). The time interval of stent implantation prior to CB/SB (P = .007) and severe calcified ISR (P = .009) had a negative impact on reaching the primary endpoint. During the follow-up, there were no differences in rates of cardiac death (CB 2.5% vs. SB 1.2%; P = .598), acute myocardial infarction (CB 0% vs. SB 4.9%; P = .119), and target lesion failure (CB 3.7% vs SB 12.3%; P = .074). In our cohort, multivariate analysis showed that lesion preparation with CB or SB must be considered equivalent in terms of angiographic results. Factors like severe calcified ISR and the time interval of prior stent implantation negatively influenced the angiographic outcome.

Reexamining Transplant Outcomes in Acute Kidney Injury Kidneys Through Machine Learning.

Despite many people awaiting kidney transplant, kidney allografts from acute kidney injury (AKI) donors continue to be underutilized. We aimed to cluster kidney transplant recipients of AKI kidney allografts using an unsupervised machine learning (ML) approach. Using Organ Procurement and Transplantation Network-United Network for Organ Sharing (OPTN/UNOS) data, a consensus clustering cohort analysis was performed in 12356 deceased donor kidney transplant recipients between 2015 and 2019 in whom donors had a terminal serum creatinine ≥1.5mg/dL. Significant cluster characteristics were determined, and outcomes were compared. The median donor terminal creatinine was 2.2 (interquartile range [IQR] 1.7-3.3) mg/dL. Cluster analysis was performed on 12356 AKI kidney recipients, and three clinically distinct clusters were identified. Young, sensitized kidney re-transplant patients characterized Cluster 1. Cluster 2 was characterized by first-time kidney transplant patients with hypertensive and diabetic kidney diseases. Older diabetic recipients characterized Cluster 3. Clusters 1 and 2 donors were young and met standard kidney donor profile index (KDPI) criteria; Cluster 3 donors were older, more likely to have hypertension or diabetes, and meet high KDPI criteria. Cluster 1 had a higher risk of acute rejection, 3-year patient death, and graft failure. Cluster 3 had a higher risk of death-censored graft failure, patient death, and graft failure at 1 and 3 years. Cluster 2 had the best patient-, graft-, and death-censored graft survival at 1 and 3 years. Compared to non-AKI kidney recipients, the AKI clusters showed a higher incidence of delayed graft function (DGF, AKI: 43.2%, 41.7%, 45.3% vs. non-AKI: 25.5%); however, there were comparable long-term outcomes specific to death-censored graft survival (AKI: 93.6%, 93.4%, 90.4% vs. non-AKI: 92.3%), patient survival (AKI: 89.1%, 93.2%, 84.2% vs. non-AKI: 91.2%), and overall graft survival (AKI: 84.7%, 88.2%, 79.0% vs. non-AKI: 86.0%). In this unsupervised ML approach study, AKI recipient clusters demonstrated differing, but good clinical outcomes, suggesting opportunities for transplant centers to incrementally increase kidney utilization from AKI donors.

Comparison of long-term outcomes of the Bentall procedure between patients with and without Marfan syndrome.

The Bentall procedure, using a composite valve graft, has become one of the standard therapies for aortic root disease. Patients with Marfan syndrome are prone to aortic annular dilatation and dissection and often undergo aortic root replacement, including the Bentall procedure. Therefore, this study aimed to compare the long-term outcomes of the Bentall procedure between Japanese patients with and without Marfan syndrome. Data from 294 patients who underwent the Bentall procedure over 37years were retrospectively analyzed. The study compared the data of patients with Marfan syndrome (n = 94) and those without it (n = 200). Patient characteristics, surgical techniques, and postoperative outcomes were evaluated. Statistical analyses were performed to identify risk factors associated with early mortality, late mortality, reoperation, and aortic root reoperation. The early mortality rate was 4.1%, with no significant difference between patients with and without Marfan syndrome. The long-term survival rates at 10, 20, and 30years were 81.0%, 66.5%, and 49.1%, respectively, with no significant between-group differences. Aortic reoperations were more frequent in patients with Marfan syndrome; however, the number did not differ significantly between the groups. Risk factors for late mortality included diabetes and coronary reimplantation with an inclusion technique. Aortic dissection, Marfan syndrome, and smoking were risk factors for aortic reoperation. Late mortality after the Bentall procedure was comparable between Japanese patients with and without Marfan syndrome although aortic reoperation was significantly frequent in patients with Marfan syndrome. Continuous monitoring and management, including the prevention of aortic dissection and dilation of residual aorta, are crucial for patients with Marfan syndrome undergoing the Bentall procedure.

Comparison of Long-Term Outcomes Achieved With Live Donor and Split Deceased Donor Liver Grafts in Pediatric Liver Transplantation.

The aim of the present study was to compare the outcomes of pediatric LT with left liver grafts, obtained either from a living donor (LD) or a split deceased donor (sDD). Retrospective single-center study from 2002 to 2022. All pediatric LT with left liver grafts (not including middle hepatic vein) from LD or sDD were included. Reduced grafts were not included. A total of 112 pediatric LT were performed: 58 with LD grafts and 54 with sDD grafts (17 split ex situ and 37 insitu). Donor characteristics were similar, apart from donor age (33 years in LD vs. 30 years in sDD, p = 0.03). Indications were similar with 55% biliary atresia in each group. Retransplantation was more frequently performed in the sDD group (2% vs. 15%, p = 0.01). Recipient age, weight, and PELD score at transplant were not significantly different between groups. Cold ischemia time was longer for sDD (158 min in LD vs. 390 min in sDD; p < 0.0001). Posttransplant peak ALT was higher with sDD grafts (1470 vs. 1063, p = 0.018), and hospital stay was longer with sDD grafts (27 vs. 21 days, p = 0.005). However, there was no difference between groups in terms of major morbidity (Dindo-Clavien grade ≥3), vascular and biliary complications, and 90-day mortality. Patient survival at 10 years was 93.1% for LD and 92.8% for sDD (p = 0.807). Graft survival at 10 years was 89.7% for LD and 83.1% for sDD (p = 0.813). Technically similar LD and sDD grafts achieve very similar postoperative and long-term outcomes with excellent patient and graft survival.

Optimizing Tinnitus Management: The Important Role of Hearing Aids with Sound Generators.

Hearing aids (HAs), especially those with sound generators (SGs), are used in the management of tinnitus. However, their comparative efficacies and long-term outcomes remain unknown. Therefore, we investigated the efficacy and long-term outcomes of tinnitus therapy using various HA SG models. We retrospectively reviewed 666 patients with chronic tinnitus characterized by persistent symptoms for >6 months. At the initial visit, the patients received educational counselling on tinnitus (Utsunomiya method) and completed a comprehensive questionnaire comprising the tinnitus handicap inventory, a visual analog scale, the state-trait anxiety inventory, and the emotional intelligence scale. The scores were compared among various models of HA SGs and SGs. The patients underwent follow-ups for up to 2 years. Our results indicated that tinnitus retraining therapy using SGs and conventional HAs effectively managed chronic tinnitus. The prolonged use of HAs appeared to exacerbate tinnitus symptoms, emphasizing the superior long-term effectiveness of SG HAs, particularly ZEN (Widex ZEN, WS Audiology, Lynge, Denmark). Our findings indicate that HAs are useful in the first year, but their prolonged use may exacerbate tinnitus symptoms, whereas HA SGs are effective in the long term. Future studies should account for the variations in tinnitus treatment effects based on the type of sound employed.

Internal carotid artery stenosis – angioplasty with stenting or endarterectomy? A restrospective, single-center, observational study

Introduction: This study aimed to investigate the impact of carotid artery stenting(CAS) vs carotid artery endarterectomy(CEA) on outcomes in patients treated for unilateral internal carotid artery(ICA) stenosis.Methods: Between January-2021 and December-2021, 131-patients with stenosed unilateral internal carotid artery undergoing primary isolated internal carotid artery intervention were retrospectively analyzed. Patients were divided into two groups, those who underwent carotid endarterectomy(CEA) (n=87) and those who underwent carotid artery stenting(CAS)(n=44). Propensity score matching (PSM) selected 35 pairs and both groups were comparable for all baseline characteristics and well balanced.Results: In the unmatched cohort, CEA and CAS had comparable long-term outcomes in terms of mortality. Survival at 12, 24 and 36 months was 95.4% vs 95.5%, 92.0% vs 95.5% and 92.0% vs 95.5%, respectively(P Log-rank=0.47). However, CEA was associated with reduced incidence of stroke at follow-up. Freedom from stroke at 12, 24 and 36 months was 98.9% vs 90.9%, 97.6% vs 86.2% and 97.6% vs 86.2%, respectively(P Log-rank=0.011). In the matched cohort, CEA and CAS had comparable long-term outcomes in terms of mortality. Survival at 12, 24 and 36 months was 94.3% vs 94.3%, 91.4% vs 94.3% and 91.4% vs 94.3%, respectively(P Log-rank=0.65). However, CEA was associated with reduced incidence of stroke at follow-up. Freedom from stroke at 12, 24 and 36 months was 100% vs 91.4%, 100% vs 85.5% and 100% vs 85.5%, respectively(P Log-rank =0.024).Conclusions: The present PSM study showed that, in patients with isolated unilateral ICA stenosis, CEA was associated with reduced incidence of stroke compared to CAS.

Comparison of Angiographic Result and Long-Term Outcome in Patients With In-Stent Restenosis Treated With Cutting Balloon or With Scoring Balloon Angioplasty

Comparison of Angiographic Result and Long-Term Outcome in Patients With In-Stent Restenosis Treated With Cutting Balloon or With Scoring Balloon Angioplasty

Impact of Neoadjuvant Immunotherapy on Recurrence-Free Survival in Patients with High-Risk Localized HCC.

Surgical resection for localized HCC is typically only reserved for those with solitary tumors without vascular invasion. In this retrospective analysis, we show that neoadjuvant immunotherapy may allow high-risk patients, including those who are outside of standard resection criteria, to undergo successful margin-negative resection and achieve comparable long-term clinical outcomes compared with upfront resection. These findings highlight need for prospective studies on neoadjuvant immunotherapy in HCC.

Comparison of long-term outcomes of laparoscopic percutaneous internal ring suturing and classic open approach for inguinal hernia repair in children.

Inguinal hernia repair is one of the most common surgeries in children. Recently, the use of minimally invasive techniques for inguinal hernia repair has increased in children. Laparoscopic percutaneous internal ring suturing (PIRS) is a technique described for paediatric inguinal hernia repair. The primary objective of this study is to demonstrate the efficacy and reliability of PIRS in paediatric patients through a comparative analysis with an open method. Between January 2017 and June 2023, records of patients who underwent surgery for inguinal hernia were retrospectively reviewed. In total 126 patients were included in the study. They were divided into two groups: 33 patients underwent PIRS (group 1) and 93 patients underwent open repair (group 2). Operation time, cost and complications were compared. The mean age of the 126 patients was 3.23 ± 2.4 years. The mean unilateral operative time was 25.13 ± 5.32min in group 1 and 30.28 ± 4.73min in group 2, and there was a statistically significant difference in operative time (p < 0.001). Two patients in group 1 underwent surgery owing to patent processus vaginalis, whereas three patients in group 2 underwent surgery owing to metachronous hernia. There were no major complications such as bleeding requiring surgical intervention or conversion to an open approach during surgery in group 1. No recurrent hernia was observed in any of the 126 patients. PIRS offers a safe, easy-to-learn method with low complication rates. PIRS has a distinct advantage over open surgical repair because of its capacity to evaluate the contralateral inguinal ring.

Extracorporeal life support use in patients with bronchopulmonary dysplasia: A single center case series.

Preterm pediatric patients with bronchopulmonary dysplasia (BPD) represent a subgroup previously deemed high risk candidates for ECLS (extracorporeal life support) due to suspected high mortality or increased post ECLS morbidity. The aim of this study was to determine outcomes for patients with an established history of BPD who subsequently required ECLS. A single center retrospective review was performed between 01/2010-06/2022 for patients less than 2years of age, born prematurely (<32weeks) with a subsequent diagnosis of BPD, and who required ECLS for respiratory failure. Demographic and clinical data, including ECLS data, were collected. Speech, language, feeding/swallowing, cognitive, hearing, vision, or motor function deficits were obtained with a median follow up of 42months following discharge. Nineteen patients met criteria. The median birth weight and gestational age was 0.86kg (IQR 0.73, 1.0) and 26weeks (IQR 25, 27), respectively. The median chronological age at cannulation was 12.1months. The most common etiologies for respiratory failure requiring ECLS were viral (68.4%) and bacterial (21.1%) pneumonia. Survival to decannulation was 78.9% (15/19) and survival to hospital discharge was 63.2% (12/19). Amongst survivors to discharge, 42% (5/12) required new or additional home oxygen and 50% (6/12) were noted to have neurodevelopmental/behavioral concerns on follow up at 1year with 25% (3/12) with concerns beyond a year. Patients with underlying BPD who require ECLS have comparable mortality and long-term neurodevelopmental outcomes to non-BPD patients with respiratory failure. This information can be useful when considering ECLS candidacy and providing family counseling.

Comparison of Early Clinical and Long-Term Oncological Outcomes of Laparoscopic Versus Converted Rectal Cancer Resection: A Retrospective Cohort Study.

Aim The effects of conversion to open surgery during laparoscopic resection in rectal cancer on perioperative clinical and long-term oncological outcomes are still controversial. This study aimed to evaluate and compare the impact of conversion to laparoscopic resection for rectal cancer on perioperative and long-term oncological outcomes. Material and methods Between January 2019 and December 2023, 84 consecutive patients who underwent curative surgery for rectal cancer at a single academic center were evaluated retrospectively. Patients were classified and compared as the laparoscopic (LAP-G) and converted (CONV-G) groups. Perioperative, pathological, and long-term oncological outcomes were compared. Results Of the 84 consecutive patients included, 18 were converted to open surgery, leading to a 21.4% conversion rate. Intraoperative blood loss was higher in CONV-G (180 ml vs. 80 ml, p<0.001), but early clinical outcomes were similar in both groups. The median follow-up period was 23.5 (range 3-65) and 30.5 (range 6-61) months in the LAP-G and CONV-G, respectively, and recurrence occurred in 11 (16.7%) and 3 (16.6%) patients, respectively. Three-year overall survival was 96.9% and 89.4% (p=0.609) and 3-year disease-free survival was 92.4% and 83.3% (p=0.881) in LAP-G and CONV-G, respectively, and the results were similar. Conclusion Conversion from laparoscopic rectal resection to open surgery does not have a significant negative impact on morbidity and long-term oncological outcomes.

Age of First Exposure to Contact Sports Is Not Associated With Worse Later-In-Life Brain Health in a Cohort of Community-Dwelling Older Men.

To evaluate whether early age of first exposure to contact sports (AFE-CS) is associated with worse long-term brain health outcomes. A cross-sectional, survey study of older men with a history of contact sport participation was completed. Tertiary care facility. A cohort of community-dwelling older men dichotomized by using AFE-CS (<12 years vs ≥12 years). Independent variables included a dichotomized group of AFE-CS (<12 years vs ≥12 years). Brain health outcomes measured by depression, anxiety, cognitive difficulties, and neurobehavioral symptoms. Endorsements of general health problems, motor symptoms, and psychiatric history were also collected. Age of first exposure groups was compared using t tests, χ2 tests, and multivariable linear regressions, which included the following covariates: age, number of prior concussions, and total years of contact sport. Of 69 men aged 70.5 ± 8.0 years, approximately one-third of the sample (34.8%) reported AFE-CS before age 12 years. That group had more years of contact sports (10.8 ± 9.2 years) compared with those with AFE-CS ≥12 (5.6 ± 4.5 years; P = 0.02). No differences were found after univariate testing between AFE-CS groups on all outcomes (P-values >0.05). Multivariable models suggest that AFE-CS is not a predictor of depression or anxiety. Those in the AFE-CS <12 group had fewer cognitive difficulties (P = 0.03) and fewer neurobehavioral symptoms (P = 0.03). Those with AFE-CS <12 to contact sports did not have worse long-term brain health outcomes compared with those with AFE-CS ≥12. Individuals with AFE-CS <12 had significantly lower British Columbia Cognitive Complaints Inventory and Neurobehavioral Symptom Inventory scores compared with those with AFE-CS ≥12. The benefits of earlier AFE-CS may outweigh the risks of head strikes and result in comparable long-term brain health outcomes.

Long-Term Comparative Effectiveness of Transcatheter Aortic Valve Replacement (TAVR) Versus Surgical Aortic Valve Replacement (SAVR) in High-Risk Aortic Stenosis Patients: A Meta-Analysis

Transcatheter aortic valve replacement (TAVR) has become an alternative to surgical aortic valve replacement (SAVR) for high-risk patients with severe aortic stenosis (AS). This meta-analysis aims to compare the long-term outcomes of TAVR and SAVR in this population. A systematic search of PubMed, Embase, and the Cochrane Library was conducted up to December 2023. Randomized controlled trials (RCTs) and observational studies comparing TAVR and SAVR with a minimum follow-up of one year were included. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular mortality, stroke, myocardial infarction (MI), and rehospitalization. Twenty-three studies involving 15,482 patients (TAVR=7,785, SAVR=7,697) were included. The mean follow-up period was 3.2 years (range 1-5 years). There was no significant difference in all-cause mortality between TAVR and SAVR (Hazard Ratio [HR] 1.02, 95% CI 0.95-1.09, p=0.63). Similarly, there were no differences in cardiovascular mortality (HR 1.05, 95% CI 0.96-1.15, p=0.28), stroke (HR 0.98, 95% CI 0.87-1.10, p=0.75), or MI (HR 0.94, 95% CI 0.82-1.08, p=0.39). However, TAVR was associated with a lower rate of rehospitalization (HR 0.85, 95% CI 0.78-0.93, p=0.001). TAVR is a viable alternative to SAVR in high-risk patients with AS, demonstrating comparable long-term survival and safety outcomes. The reduced rehospitalization rate associated with TAVR may be an important consideration for these patients.

The Inflammatory Response and Long-Term Outcomes Between Open and Laparoscopic Pancreatoduodenectomy:A Propensity-Matched Single-Institution Study.

Background: In recent years, although laparoscopic pancreatoduodenectomy (LPD) has experienced rapid development both domestically and internationally, however, there are still varying opinions toward LPD. Methods: From January 2020 to July 2022, the data were collected. We compared the inflammatory response at various postoperative time points and evaluated long-term outcomes between the two groups. Results: In the early stage, the LPD group exhibited lower values of white blood cells, C-reactive protein, neutrophils, and platelets after surgery compared with open pancreatoduodenectomy (OPD) (P all<0.05). However, no statistically significant differences were observed in terms of procalcitonin, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio. Before propensity score matching, no statistical significance was observed between two groups, whether in terms of disease-free survival (DFS) (P = .406) or overall survival (OS) (P = .851). However, to further control for confounding factors, propensity score matching was used. The analysis revealed that DFS still showed no significant difference (P = .928), but, in the term of OS, a statistical significance was observed between the two groups. Conclusion: LPD demonstrates a comparable long-term outcomes to OPD and even slightly superior OS. Moreover, the LPD group exhibits a lower inflammatory response during early postoperative period.

Autoimmune hepatitis with confluent necrosis indicates severe liver injury but responds well to standard immunosuppressive therapy.

We aimed to study the effects of different extensive confluent necrosis on complete biochemical remission, side effects of immunosuppressants, and outcomes in patients with autoimmune hepatitis (AIH). Patients with liver biopsy, receiving standard immunosuppressive therapy (IST), and regular follow-up were retrospectively recruited. Demographic and clinicopathological characteristics between Ishak confluent necrosis scores ≤4 (the non-severe AIH group) and ≥5 (the severe AIH group) were compared. The Kaplan-Meier Survival analysis, Cox regression analysis, and log-rank test were performed. Bilateral p<0.05 was considered statistical significance. One hundred and forty-two patients were enrolled, the median age was 56.0, and 83.8% were female. There were no significant differences in aminotransferases and immunological markers between the two groups. Patients in the severe AIH group had significantly worse liver synthetic function, a higher proportion of cirrhosis, and histologically a higher degree of portal inflammation, interface hepatitis, fibrosis stage, and a higher histological activity index score (all p<0.05). Patients in the severe AIH group had a lower response than the other group after four weeks (57.1% vs. 86.3%, p=0.002). However, differences in complete biochemical remission (CBR) were insignificant. Eight patients experienced end-point events. Kaplan-Meier survival analysis showed no significant difference between the two groups (p=0.343). For adverse effects of IST, patients in the severe group tended toward a higher incidence of corticosteroid adverse effects without statistical significance. Our study indicated that patients with histologically severe confluent necrosis (Ishak score≥5) had significantly worse liver synthetic function and a higher degree of liver fibrosis before IST. Compared with their counterparts, this subgroup of patients showed delayed biochemical response but eventually comparable CBRs, side effects, and long-term outcomes.

Long-Term Outcomes of Conservative versus Surgical Management of Dental Caries

ABSTRACT Introduction: The management of dental caries presents challenges for oral health professionals, with options including conservative and surgical interventions. However, debate persists regarding the long-term efficacy of these strategies. Methods: This retrospective cohort research involved 500 subjects diagnosed with dental caries at the University Dental Clinic between January 1, 2018, and December 31, 2020. Data on demographics, dental history, treatments, and follow-up were collected from patient records. Subjects were categorized into conservative and surgical groups based on treatment received. Outcome measures included tooth survival, caries recurrence, and patient satisfaction. Results: The research included 300 subjects, with 60% under conservative management and 40% under surgical management. Demographics were comparable between groups, and both groups showed similar outcomes in tooth survival, caries recurrence, and patient satisfaction. Statistical analysis revealed no significant differences in these outcomes between groups. Conclusion: Conservative and surgical management approaches demonstrate comparable long-term outcomes in treating dental caries, emphasizing the importance of personalized treatment decisions. Further research with larger samples and prospective designs is needed to validate these findings and guide evidence-based practice in dental caries management.

Endoscopic Resections for Barrett's Neoplasia: A Long-Term, Single-Center Follow-Up Study.

Background and Objectives: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are both well-established and effective treatments for dysplasia and early cancer in Barrett's esophagus (BE). This study aims to compare the short- and long-term outcomes associated with these procedures in treating Barrett's neoplasia. Materials and Methods: This single-center retrospective cohort study included 95 patients, either EMR (n = 67) or ESD (n = 28), treated for Barrett's neoplasia at Sahlgrenska University Hospital between 2004 and 2019. The primary outcome was the complete (en-bloc) R0 resection rate. Secondary outcomes included the curative resection rate, additional endoscopic resections, adverse events, and overall survival. Results: The complete R0 resection rate was 62.5% for ESD compared to 16% for EMR (p < 0.001). The curative resection rate for ESD was 54% versus 16% for EMR (p < 0.001). During the follow-up, 22 out of 50 patients in the EMR group required additional endoscopic resections (AERs) compared to 3 out of 21 patients in the ESD group (p = 0.028). There were few adverse events associated with both EMR and ESD. In both the stratified Kaplan-Meier survival analysis (Log-rank test, Chi-square = 2.190, df = 1, p = 0.139) and the multivariate Cox proportional hazards model (hazard ratio of 0.988; 95% CI: 0.459 to 2.127; p = 0.975), the treatment group (EMR vs. ESD) did not significantly impact the survival outcomes. Conclusions: Both EMR and ESD are effective and safe treatments for BE neoplasia with few adverse events. ESD resulted in higher curative resection rates with fewer AERs, indicating its potential as a primary treatment modality. However, the survival analysis showed no difference between the methods, highlighting their comparable long-term outcomes.

Long-term outcomes of great saphenous vein harvest techniques for infrainguinal arterial bypass in a Medicare-matched registry database

ObjectiveLong-term outcomes for harvesting techniques for great saphenous vein (GSV) and its impact on the outcomes of infrainguinal arterial bypass remains largely unknown. Endoscopic GSV harvesting (EVH) has emerged as a less invasive alternative to conventional open techniques. Using the Vascular Quality initiative Vascular Implant Surveillance & Interventional Outcomes Network (VQI-VISION) database, we compared the long-term outcomes of infrainguinal arterial bypass using open and endoscopic GSV harvest techniques. MethodsPatients who underwent infrainguinal GSV bypass between 2010 and 2019 were identified in the VQI-VISION Medicare linked database. Long-term outcomes of major/minor amputations, and reinterventions up to 5 years of follow-up were compared between continuous incisions, skip incision, and EVH, with continuous incisions being the reference group. Secondary outcomes included 30- and 90-day readmission, in addition to surgical site infections and patency rates at 6 months to 2 years postoperatively. Survival analysis using Kaplan-Meier curves and Cox regression hazard models were utilized to compare outcomes between groups. To adjust for multiple comparisons between the study groups, a P value of 2.5% was considered significant. ResultsAmong the 8915 patients included in the study, continuous and skip vein harvest techniques were used in 44.4% and 43.4% of cases each, whereas 12.3% underwent EVH. The utilization of EVH remained relatively stable at around 12% throughout the study period. Compared with GSV harvest using continuous incisions, EVH was associated with higher rates of reintervention at 1 year (46.5% vs 41.3%; adjusted hazard ratio [aHR], 1.22; 95% confidence interval [CI], 1.06-1.41; P = .01]. However, no significant difference was observed between EVH and continuous incisions, and between skip and continuous incisions in terms of long-term reintervention or major and minor amputations on adjusted analysis. Compared with continuous incision vein harvest, both EVH and skip incisions were associated with lower surgical site infection rates within the first 6 months post-bypass (aHR, 0.53; 95% CI, 0.35-0.82 and aHR, 0.68; 95% CI, 0.53-0.87, respectively). Loss of primary, primary-assisted, and secondary patency was higher after EVH compared with continuous incision vein harvest. Among surgeons performing EVH, comparable long-term outcomes were observed regardless of low (<4 cases/year), medium (4-7 cases/year), or high procedural volumes (>7 cases/year). ConclusionsDespite higher 1-year reintervention rates, EVH for infrainguinal arterial bypass is not associated with a significant difference in long-term reintervention or amputation rates compared with other harvesting techniques. These outcomes are not influenced by procedural volumes for EVH technique.

Comparison of Long-Term Clinical Outcomes and Costs Between Transesophageal Echocardiography-Guided and X-ray-Guided Percutaneous Atrial Septal Defect Closure in Children.

This study aimed to compare the long-term clinical outcomes and costs between using either transesophageal echocardiography (TEE) or X-ray fluoroscopy for Percutaneous atrial septal defect (ASD) closure in children. An analysis was conducted on clinical data from children undergoing TEE-guided (n = 168) and X-ray-guided (n = 139) percutaneous ASD closure. Demographic characteristics, technical indices, acute complications, follow-up outcomes, and costs were compared between the groups. The results are that TEE-guided closure demonstrated shorter surgical times (20.3 ± 7.6min vs. 32.8 ± 7.9min, P < 0.001) and lower procedural costs ($3093.3 ± 451.5 vs. $3589.1 ± 219.4, P < 0.001) compared to X-ray guidance. Initial successful closure rates were similar between the groups (TEE: 98.2%, XR: 97.1%, P = 0.691). TEE guidance also resulted in fewer acute complications and reduced radiation exposure. TEE-guided percutaneous ASD closure offers advantages in terms of shorter surgical times, lower procedural costs, and reduced radiation exposure compared to X-ray guidance. These findings support the preference for TEE guidance in pediatric ASD closure procedures, with potential implications for improving patient outcomes and reducing healthcare costs.

Laparoscopic versus open total gastrectomy for T4a gastric cancer: a propensity score-matched analysis of long-term outcomes.

Evidence of implementation of laparoscopic total gastrectomy (LTG) for surgical T4a stage (sT4a) gastric cancer (GC) remains inadequate. This study aimed to compare short- and long-term outcomes of LTG versus open total gastrectomy(OTG) for sT4a GC. This retrospective cohort study was conducted using data from patients with sT4a GC underwent total gastrectomy from 2014 to 2020. Short-term outcomes included operative characteristics and postoperative complications. Long-term oncological outcomes focused on 3-, and 5-year overall survival (OS) and disease-free survival (DFS). Propensity score matching (PSM) was applied to reduce potential biases in baseline characteristics between groups. There was a total of 161 patients, in which 96 underwent LTG and 65 underwent OTG. After PSM, both groups consisted of 51 patients each, with balanced baseline characteristics. There were no significant differences between the two groups regarding blood loss, length of proximal resected margin, postoperative hospital stays, and overall and major postoperative complications. Most of the complications were classified as minor according to the Clavien-Dindo classification. Operating time was significantly longer in the LTG group (mean: 257min vs. 231min, p = 0.006). LTG was superior to OTG groups in time to flatus (mean: 3.0 days vs 3.9 days, p < 0.001). Five-year OS and DFS rates were similar between the two groups (44% and 33% vs. 43% and 28% in the LTG and OTG groups, respectively). Our findings indicate that LTG is a feasible and safe technique, exhibiting comparable long-term oncological outcomes to OTG for sT4a GC. LTG may be an acceptable alternative to OTG for the treatment of sT4a GC.