Difference In Procedure Time Research Articles

Induction of supraventricular tachycardias in patients undergoing pulmonary vein isolation for paroxysmal atrial fibrillation is safe and reasonable.

Patients with atrial fibrillation (AF) may experience other supraventricular tachycardias (SVT) that can trigger AF and cause similar symptoms. The aim of this study was to assess the safety and effectivity of inducing SVT in patients undergoing catheter ablation (CA) for AF. In 61 patients with paroxysmal AF undergoing CA between January 2022 and March 2023, an electrophysiological study was performed after pulmonary vein isolation (PVI) to induce SVT. Induced arrhythmias were mapped and ablated. All patients were followed up at 3, 6, and 12 months after the procedure; seven-day ECG Holter monitoring was carried out 6 and 12 months after the procedure. In 24 patients (39%) an SVT was induced during the stimulation protocol. There was no significant difference in procedure time (P=0.408) or fluoroscopy dose (P=0.458) between patients with and without inducible arrhythmia. Further, none of the echocardiographic variables such as left atrial volume index (LAVI) (P=0.936), left ventricular ejection fraction (LVEF) (P=0.586), or right atrial (RA) area (P=0.716), differed significantly in these subgroups. Age was a significant factor in patients with arrhythmia inducibility compared with those without (64.5 ± 7.6 and 58.2 ± 10.5, P=0.04). SVT inducibility after successful PVI was 39%. Ablation of nonclinical arrhythmia is safe and did not prolong the total procedure or fluoroscopy time.

Traction-assisted endoscopic submucosal dissection of colonic lesions: a North American experience

Background and aimsTraction-assisted ESD (TA-ESD) is a proposed technique to improve the efficiency and efficacy of ESD. Multiple studies primarily from Asian centers yielded mixed results in terms of procedure time, en bloc resection rate and R0 resection rate in comparison to conventional ESD (C-ESD). We performed the first comparison of TA-ESD and C-ESD at a high-volume North American center. MethodsThis was a retrospective cohort matched study of all patients who underwent colonic ESD at a single center in the United States by a single operator. The study group were patients who underwent TA-ESD and were matched with a C-ESD case on a 1:1 basis based upon location within the colon, lesion size, and scope stabilization device usage. The baseline characteristics and procedure-related outcomes were compared between the groups. Results138 colonic ESD cases were included (69 TA-ESD, 69 C-ESD). There were no significant differences in the baseline characteristics between the groups. Mean procedure time was 91.0 min (SD 32.5) for TA-ESD and 85.4 min (SD 39.3) for C-ESD (p=0.36). En bloc resection was achieved in 69 (100%) of the TA-ESDs and 67 (97.1%) of the C-ESDs (p=0.15). R0 resection was achieved in 52 (75.4%) of the TA-ESDs and 48 (69.6%) of the C-ESDs (p=0.45). ConclusionWe did not show a significant difference in procedure time, en bloc resection, R0 resection, or adverse events. Further randomized prospective studies that are sufficiently powered and stratified by operator experience level are needed to further elucidate the utility of the technique.

Short-term outcomes of gastric per-oral endoscopic pyloromyotomy (G-POEM) then and now: a comparison analysis

Summary Background Gastric per-oral endoscopic pyloromyotomy (G-POEM) has been performed for 10 years in the treatment of refractory gastroparesis (Gp). Many studies from the early years of G‑POEM reported short-term outcomes with 60–80% clinical success. Notably, no recent studies have assessed short-term outcomes after a decade of experience with this procedure. In this study, we compare the short-term outcomes of our initial 16 patients undergoing G‑POEM 8 years ago with 16 of our recent patients undergoing G‑POEM. Patients and methods The initial 16 patients who underwent G‑POEM from 06/2015 to 07/2016 (group A; the first 16 G-POEM procedures QC performed) and 16 recent patients who underwent G‑POEM from 07/2021 to 01/2022 (group B; the first 16 procedures performed when QC moved to a different institution) were enrolled in the study. Patients’ demographics, clinical success, procedure time, and length of hospital stay were analyzed and compared between the two groups. All procedures were performed by a single advanced endoscopist (QC). Results Patients’ age, gender, and etiology of gastroparesis were similar between the two groups. There were no differences between the two groups in terms of short-term clinical outcomes. However, there was a significant difference in procedure time and the length of hospital stay between the two groups. There were no adverse events reported for either group A or group B. Conclusion For a single experienced advanced submucosal endoscopist, there were no differences in the short-term clinical outcomes of G‑POEM when comparing the initial timeframe of performing G‑POEM with that after 8 years of experience at the time of the study in a different institution. Notably, the procedure time and the length of hospital stay were significantly shorter after 8 years of practice.

Low-Voltage Area Ablation in Addition to Pulmonary Vein Isolation in Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis.

Background: Low-voltage area (LVA) ablation, in addition to pulmonary vein isolation (PVI), has been proposed as a new strategy in patients with atrial fibrillation (AF), but clinical trials have shown conflicting results. We performed a systematic review and meta-analysis to assess the impact of LVA ablation in patient undergoing AF ablation (PROSPERO-registered CRD42024537696). Methods: Randomized clinical trials investigating the role of LVA ablation in addition to PVI in patients with AF were searched on PubMed, Embase, and the Cochrane Library from inception to 22 April 2024. Primary outcome was atrial arrhythmia recurrence after the first AF ablation procedure. Secondary endpoints included procedure time, fluoroscopy time, and procedure-related complication rate. Sensitivity analysis including only patients with LVA demonstration at mapping and multiple subgroups analyses were also performed. Results: 1547 patients from 7 studies were included. LVA ablation in addition to PVI reduced atrial arrhythmia recurrence (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.52-0.81, p < 0.001) with a number needed to treat to prevent recurrence of 10. No difference in procedure time (mean difference [MD] -5.32 min, 95% CI -19.01-8.46 min, p = 0.45), fluoroscopy time (MD -1.10 min, 95% CI -2.48-0.28 min, p = 0.12) and complication rate (OR 0.81, 95% CI 0.40-1.61, p = 0.54) was observed. Consistent results were demonstrated when considering only patients with LVA during mapping and in prespecified subgroups for AF type (paroxysmal vs. persistent), multicentric vs. monocentric trial, and ablation strategy in control group. Conclusions: In patients with AF, ablation of LVAs in addition to PVI reduces atrial arrhythmia recurrence without a significant increase in procedure time, fluoroscopy time, or complication rate.

A Meta-Analysis Comparing General Anesthesia, Deep Sedation, and Conscious Sedation for Catheter Ablation of Atrial Fibrillation

Background: The optimal anesthesia strategy during catheter ablation of atrial fibrillation (AF) remains controversial. This meta-analysis compared general anesthesia, deep sedation, and conscious sedation in terms of procedural time and complications. Methods: Literature searches were conducted in PubMed, EMBASE, and Web of Science databases. Mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using fixed- and random-effect models on the basis of the heterogeneity among studies, as assessed by I2 statistics. The random-effect model was used when the heterogeneity was high (I2 &gt; 50%). Publication bias was evaluated through funnel plots and Egger's tests. Results: Sixteen studies were included in this study. No significant difference was observed in procedural time between the general anesthesia and conscious sedation groups (MD: –8.1479 minutes, 95% CI: from –27.6836 to 11.3878, seven studies). Deep sedation was associated with procedural time (MD: 131.8436 minutes, 95% CI: 99.6540–164.0332, eight studies). The rate of serious intraprocedural complications was 1.5% (95% CI: 1.2%–1.9%) with deep sedation (seven studies). Conscious/analog sedation had 26%–29% higher odds of perioperative complications than general anesthesia (OR: 1.2622, 95% CI: 1.0273–1.5507, nine studies). Significant heterogeneity was present across studies. Conclusions: This meta-analysis found no significant difference in procedural time between general anesthesia and conscious sedation for AF ablation. Deep sedation was associated with longer procedural time. Conscious sedation appeared to have a higher risk of perioperative complications than general anesthesia. Further randomized trials are warranted to determine the optimal anesthesia strategy.

AI-assisted colonoscopy in gastroenterology fellowship training: An interim analysis of a randomized controlled trial.

e15642 Background: Artificial intelligence (AI) assisted colonoscopy may increase adenoma detection rates (ADR) for endoscopists, but its role for trainees in learning endoscopy has not been delineated. This randomized control trial explores the impact of AI on ADR by year of fellowship and anatomical location. Methods: In a registered randomized controlled trial (NCT05423964), gastroenterology fellows were assigned to AI (GI Genius, Medtronic; Minneapolis, MN) vs. conventional colonoscopy(CC). We included all symptomatic or screening colonoscopies with adequate bowel prep by trainees (postgraduate year 4-6). Baseline demographics, polyp pathology, size in 5mm increments, and location, and ADR was collected and compared for AI versus CC arms. A multivariate regression was used to identify factors influencing ADR of the right colon. Results: Of 685 colonoscopies between March 15th to July 28th, 2023, a total of 381 procedures performed by 17 fellows met criteria. Patient characteristics were similar between arms. In the CC arm, there was no difference in ADR among fellow years (1st 39% vs. 2nd 33% vs. 3rd 36%, p = 0.63; Right colon: 1st 31% vs 2nd 21% vs 3rd 30%, P = 0.21). Within 2nd year fellows, there was higher ADR using AI vs. CC for screening colonoscopies (52% vs 17%, p = 0.025). In the right colon, ADR was significantly higher using AI vs. CC for screening alone colonoscopies within 1st and 2nd year fellows (1st 50% vs 13%, p = 0.04; 2nd 57% vs 9%, p &lt; 0.001). 2nd year fellows also increased ADR in the right colon using AI vs CC for symptomatic and screening colonoscopies (44% vs 21%, p = 0.001). There was no difference in procedural time with addition of AI, but a trend to longer withdrawal time. Multivariable logistic regression analysis also showed AI assisted colonoscopies was associated with enhanced ADR in right colon for trainees performing colonoscopy for symptomatic and screening (OR [95%CI]: 2 [1.3-3.3]) and screening alone (OR [95%CI]: 8.3 [2.5-26.6]). Conclusions: This randomized control trial shows AI assisted colonoscopies improve ADR, particularly in the right colon for postgraduate trainees. We propose a use case for AI assisted colonoscopy guiding targeted improvement of ADR in in the right colon which has been highlighted by the American Gastroenterology Association as an area of need. Clinical trial information: NCT05423964 . [Table: see text]

Feasibility of catheter ablation with zero-fluoroscopy in congenital heart disease

Abstract Background Catheter ablation (CA) with zero and near-zero fluoroscopy has been shown to be safe and effective in patients (pts) without structural heart disease, but there are limited data regarding CA in congenital heart disease (CHD). Aim Our aim was to compare the safety and outcome of zero-fluoroscopy (ZF) and fluoroscopy (non-ZF) CA of CHD pts. Methods This is a single-center retrospective study of CHD pts who underwent CA at our center between 2006-2020. The ZF and non-ZF groups were compared for the complexity of anatomy, arrhythmia substrate, difficulties of vascular access, transseptal or transbaffle puncture, intracardiac pacemaker/ICD, procedural parameters, complications, and acute outcome. Near-ZF CAs (effective dose ≤1 mSv) were assigned to the ZF group. Results The ZF group included 22 pts (age: 22±13 years) and the non-ZF group 48 pts (age: 31±12 years). The distribution of CHD anatomical complexity (mild/moderate/severe) was 18.2%-68.2%-13.6% in the ZF group and 14.6%-68.7%-16.7% in the non-ZF group. Arrhythmia diagnoses were focal atrial tachycardia (ZF: 4.6%), atrial flutter (ZF: 45.4%, non-ZF: 75.0%), atrioventricular reentry tachycardia (AVRT) via manifest accessory pathway (AP) (ZF: 31.8%, non-ZF: 10.4%), AVRT via concealed AP (ZF: 4.6%, non-ZF: 8.3%), and atrioventricular nodal reentry tachycardia (ZF: 13.6%, non-ZF: 6.3%). Difficulties in vascular access occurred in 4.5% of the ZF group and 18.8% of the non-ZF group (p=0.10). The rate of transseptal/transbaffle puncture was significantly higher in the non-ZF group (22.9% vs. 4.6%, p=0.04). In the ZF group 13.6% and in the non-ZF group 20.8% of pts had pacemaker or ICD (p=0.22). Electroanatomical mapping was used in all CAs in both groups. There was no significant difference in procedure time, ablation time and the number of radiofrequency applications (ZF group: 169±53 min, 1205±906 sec, 28±15 vs. non-ZF group: 203±74 min, 1459±940 sec, 34±16, p&amp;gt;0.05). The acute success rate was 100% in both groups. No complications occurred in any group. Conclusion Zero fluoroscopic CA was feasible in 1/3 of the pts with CHD and as safe and effective as fluoroscopic ablation. No significant differences were found in the non-fluroscopy related procedural data between the two groups.

Feasibility and safety of cavotricuspid isthmus ablation using exclusive intracardiac echocardiography guidance: a proof-of-concept, observational trial

Abstract Introduction Catheter ablation is the preferred treatment for typical atrial flutter (AFl), although it can pose challenges due to anatomical abnormalities. The integration of 3D electroanatomical mapping systems (EAMS) has notably diminished the need for fluoroscopy in AFl ablation procedures. Intracardiac echocardiography (ICE) has also demonstrated advantages in reducing radiation exposure during AFl ablation. Nevertheless, there is a lack of evidence on the feasibility of ICE-guided, zero-fluoroscopy AFl ablation without the use of EAMS. Methods In this prospective study, we enrolled 80 patients with CTI-dependent AFl. The initial 40 patients underwent ablation guided by standard fluoroscopy along with ICE (Standard ICE group), whereas the remaining 40 patients underwent zero-fluoroscopy ablation exclusively using ICE (Zero ICE group). Procedure outcomes, including acute success, procedural duration, fluoroscopy duration, radiation dose, and any associated complications, were compared between the groups. Results Both groups achieved a 100% acute success rate. In the Zero ICE group, the zero-fluoroscopy approach was successfully executed in 39 out of 40 cases (97.5%). There were no significant differences in procedure time (55.5 (46.5; 66.8) min vs. 51.5 (44.0; 65.5), p=0.50) and puncture to first ablation time (18 (13.5; 23) min vs. 19 (15; 23.5) min, p=0.50) between the groups. The Zero ICE group had significantly lower fluoroscopy time (57 (36.3; 90) sec vs. 0 (0; 0) sec, p&amp;lt;0.001) and dose (3.17 (2.27; 5.63) mGy vs. 0 (0; 0) mGy, p&amp;lt;0.001 compared to the Standard ICE group. Total ablation time was longer in the Standard ICE group (597 (447; 908) sec vs. 430 (260; 750), p=0.02), but total ablation energy (22458 (14836; 31116) Ws vs. 17043 (10533; 29302) Ws, p=0.10) did not differ significantly. First-pass bidirectional conduction block of the CTI and acute reconnection rates were comparable between the groups. No complications or recurrences were noted during the follow-up period. Conclusion ICE-guided, zero-fluoroscopy CTI ablation for AFl using only ICE is feasible and safe. This method effectively eliminates radiation exposure without compromising procedural duration, total ablation time, or acute success rates.isthmus ablation by ICE

The challenge of transseptal access for catheter ablation of left-sided arrhythmia substrate in infants and small children under 6 years of age

Abstract Background Young age and small cardiac dimensions are increased risk factors for catheter ablation (CA), therefore ablation below 15 kg should be recommended only in selected drug-refractory cases. The need for a transseptal puncture (TSP) may be an additional risk factor. Persistent foramen ovale (PFO) in infants can mitigate this risk and paradoxically, decrease the complication rate in the very young. Purpose This study aimed to compare the results of left-sided CA in infants under 1 year and in children between 1-6 years of age. Methods Between January 2010 and September 2023, 1703 pediatric CAs were performed, of which 17 left-sided ablations in children under 6 years without structural heart disease were retrospectively evaluated. CA results below 1 year and between 1-6 years of age were compared in terms of body size, procedural parameters, left atrial (LA) access, complication, and success rate. Results The patient group below 1 year (Group 1, n=5) has a mean age=0.13±0.03 years, mean body weight=3.6±1.1 kg, mean height=52.3±3.6 cm. Patients between 1-6 years (Group 2, n=12) have mean age=5.0±1.1 years, mean body weight=17.9±2.2 kg, mean height=111.2±7.4 cm. The arrhythmia substrate was an overt pathway in 3 pts (17.6%), concealed accessory pathway in 7 pts (41.2%), and focal LA tachycardia in 7 pts (41.2%). Foramen ovale was persistent in all 5 children in Group 1 and TSP was not required. In Group 2, only 2 pts (16.7%) had PFO, and, all other procedures required TSP. TSP was successful in 9/10 cases (90%). No complications related to LA access or other adverse events occurred in Group 1. In Group 2, there was one case of pericardial effusion that spontaneously regressed and one case of mechanical-induced advanced AV block that resolved after six days. There were no significant differences in procedure time, fluoroscopic time, and radiation dose between the two groups (Group 1: 126.4±47.0 min, 6.4±4.5 min, 4.0±5.3 cGycm2 vs. Group 2: 162.6±49.2 min, 7.9±9.4 min, 9.0±12.4 cGycm2, p&amp;gt;0.05). All CAs were performed with RF energy. The acute success rate of the procedures was 100%. Conclusion CA of left-sided arrhythmias in infants and small children may offer a safe and effective therapeutic option in selected cases. The high prevalence of PFO may explain the paradoxically less complication under 1 year of age.

Comparative Effectiveness of Intravascular Ultrasound Versus Angiography in Abdominal and Thoracic Endovascular Aortic Repair: Systematic Review and Meta-Analysis

The effectiveness of intravascular ultrasound (IVUS) with angiography compared with angiography-guidance alone in the treatment of aortic conditions, such as dissections, aneurysms, and blunt traumatic injuries, remains unclear. This systematic review and meta-analysis evaluates the current literature for IVUS use during thoracic (TEVAR) and abdominal (EVAR) endovascular aortic repair. A comprehensive search of MEDLINE, EMBASE, and Cochrane CENTRAL databases was conducted in March 2024 adhering to the PRISMA guidelines. Studies comparing outcomes of TEVAR/EVAR with and without IVUS were identified. The outcomes of interest included contrast volume, fluoroscopy and procedural time, perioperative endoleak, and reinterventions and all-cause mortality during follow-up. Data with 95% confidence intervals (CIs) were extracted. Pooled analysis was performed using a random-effect model. Subgroup analysis was performed stratified by the condition being treated. Risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies. A total of 4219 patients (n=2655 IVUS and n=1564 non-IVUS) from 9 observational studies were included. The IVUS group exhibited a reduction in contrast agent volume (weighted mean difference (WMD) [95% CI] = -34.65 mL [-54.73, -14.57]) and fluoroscopy time (WMD [95% CI] = -6.13 min [-11.10, -1.15]), with no difference in procedural time. The perioperative type I and III endoleak occurrence were similar (RR [95% CI] = 2.36 [0.55-10.11], RR [95% CI] = 0.72 [0.09-5.77], respectively). Reintervention and mortality during follow-up were comparable (HR [95% CI] = 0.80 [0.33-1.97], HR [95% CI] = 0.75 [0.47-1.18], respectively). All the included studies had low risks of bias. In conclusion, this meta-analysis provides evidence that IVUS enables the safe deployment of TEVAR/EVAR with reduced contrast agent less radiation exposure.

Short-term safety and feasibility of a practical approach to combined atrial and ventricular physiological pacing: An initial single-center experience

Traditional right atrial appendage (RAA) pacing accentuates conduction disturbances as opposed to Bachmann bundle pacing (BBP). The purpose of this study was to evaluate the feasibility, efficacy, and safety of routine anatomically guided high right atrial septal (HRAS) pacing with activation of Bachmann bundle combined with routine left bundle branch area pacing (LBBAP). This retrospective single-center study included 96 consecutive patients who underwent 1 of 2 strategies: physiological pacing (PP) (n = 32) with HRAS and LBBAP leads and conventional pacing (CP) (n = 64) with traditional RAA and right ventricular apical leads. Baseline characteristics, sensing, pacing thresholds, and impedances were recorded at implantation and follow-up. The PP and CP cohorts were of similar age (74.2 ± 13.8 years vs 73.9 ± 9.9 years) and sex (28.1% vs 40.6% female). There were no differences in procedural time (95.0 ± 31.4 minutes vs 86.5 ± 33.3 minutes; P = .19) or fluoroscopy time (12.1 ± 4.5 minutes vs 12.3 ± 13.5 minutes; P = .89) between cohorts. After excluding patients who received >2 leads, these parameters became significantly shorter in the CP cohort. The PP cohort exhibited higher atrial pacing thresholds (1.5 ± 1.1 mV vs 0.8 ± 0.3 mV; P <.001) and lower p waves (1.8 ± 0.8 mV vs 3.8 ± 2.3 mV; P <.001) at implantation and at follow-up. In the PP cohort, 72% of implants met criteria for BBP; of the ventricular leads, 94% demonstrated evidence of LBBAP. One lead-related complication occurred in each cohort. Routine placement of leads in the HRAS is a feasible and safe alternative to standard RAA pacing, allowing for BBP in 72% of patients. HRAS pacing can be combined with LBBAP as a routine strategy.

Prospective comparison of two methods for correct ureteral stent placement in pediatric laparoscopic pyeloplasty

Ureteral stent placement during laparoscopic pyeloplasty is a common procedure in pediatric patients. Although an apparently safe maneuver, ascending placement of the stent can lead to complex removal or repositioning reinterventions. In this study we compare two methods for intraoperative verification of correct positioning. Prospective observational study collecting data on laparoscopic pyeloplasties in pediatric patients in our center over three years. We carried out descriptive and univariate comparative analyses. Data were compared between ultrasound and reflux visualized by the catheter after intraoperative salineinjection into the bladder through the urethral catheter. We recorded time to catheter visualization in both ultrasonography and in reflux from the start of bladder instillation, as well as bladder volume at the time of placement verification with each method. Data were collected from 20 patients (15 male and 5 female) with a median age of 48 months. Pyeloplasty was successful in 100% of the sample (as observed by ultrasound and MAG-3), while one patient had postoperative leak requiring nephrostomy placement. Correct distal positioning of the ureteral stent could be verified by intraoperative ultrasound and reflux in all cases. Using reflux, the bladder volume needed to verify correct positioning exceeded the age-related maximum in half the cohort, while on ultrasound, the stent was visualized in the bladder without reaching the maximum bladder capacity for age in any case (p=0.02 comparing percentages). Likewise, mean time to verification was lower with ultrasound than with reflux (61.8s versus 115s), but without these differences reaching statistical significance (p=0.14). The present study is the first to compare two methods to verify the correct positioning of the ureteral stent in laparoscopic pyeloplasties in pediatric patients. Our results show that both intraoperative ultrasound and visualization of reflux are useful methods, although ultrasound requires a lower volume of saline instilled through the bladder catheter for verification. This work can be very useful for the daily clinical practice of urologists and pediatric surgeons. Both intraoperative ultrasound and visualization of reflux are useful methods to verify the correct positioning of the ureteral stent in laparoscopic pyeloplasty of pediatric patients. With ultrasound, a smaller volume is required to check for reflux. Although ultrasound is faster for verification, there are no differences in procedural times.

Comparison of Ultrasound-guided Bilateral Anterior Quadratus Lumborum Block at the Lateral Supra-arcuate Ligament with Conventional Epidural Block in Patients Undergoing Laparoscopic Radical Gastrectomy: A Randomized Controlled Study

Abstract Background: To test the novel ultrasound (US)-guided bilateral anterior quadratus lumborum block (QLBA) at the lateral supra-arcuate ligament (supra-LAL) technique combined with postoperative intravenous analgesia was a viable alternative approach of conventional thoracic epidural analgesia (TEA) for laparoscopic radical gastrectomy (LRG). Methods: Three hundred and four patients scheduled for LRG were randomized 1:1 into QLBA group: receiving a novel pathway of US-guided bilateral QLBA at the supra-LAL before general anesthesia (GA) and patient-controlled intravenous analgesia (PCIA) after surgery, and TEA group: receiving TEA before GA and patient-controlled epidural analgesia following surgery. The difference in procedure time between the treatment groups was set as the primary endpoint. Results: Compared to TEA, procedure time was significantly shorter in the QLBA group (13.19 ± 0.78 vs. 15.65 ± 3.49, P = 0.001). At 5–10 min after block, QLBA group achieved more dermatomes coverage of cold sensory block with both P &lt; 0.001 and less influence on mean artery pressure. Intraoperative consumption of propofol and remifentanil were comparable between the two groups (1116.21 ± 199.76 vs. 1166.45 ± 125.31 ug, P = 0.245 and remifentanil 1.83 ± 0.41 vs. 1.81 ± 0.37 ng, P = 0.988). However, the QLBA group was associated with less intraoperative consumption of norepinephrine and atropine, shorter time to urinary catheter removal, and out-of-bed activity. No significant difference in extubation time, pain scores at rest and exercising across all time points postoperation was observed between two groups. Conclusion: Compared with conventional TEA, the novel technique combined with PCIA was an equivalent effective multimodal analgesic protocol for LRG. There were some advantages of technical simplicity with shorter procedure time, wider anesthetized dermatomes, less influence on intraoperative hemodynamic variables, fewer postoperative adverse events, and improved several sensible parameters of postoperative recovery. Trial Registration: The study was registered in the Chinese Clinical Trial Registry on November 02, 2022 (ChiCTR2200065325).

Assessing Radiation Exposure and Contrast Agent Utilization: A Comparative Analysis of the Woven EndoBridge Device and Stent-Assisted Coil Embolization for Managing Unruptured Wide-Neck Bifurcation Aneurysms.

In this study, we determined whether there were significant differences in procedure time, radiation dose, fluoroscopy time, and total contrast media dose when unruptured wideneck bifurcation aneurysms (WNBAs) were treated with the Woven EndoBridge (WEB) device and stent-assisted coil (SAC) embolization. The WEB device and SAC embolization (14:17) were used to treat 31 cases of internal carotid artery bifurcation, anterior communicating artery, middle cerebral artery bifurcation, and basilar bifurcation aneurysms between August 2021 and December 2022. The procedure time, radiation dose, fluoroscopy time, and total contrast medium dose between the 2 treatment groups were compared and analyzed. In the WEB device group, the results between operators were compared, and the follow-up radiologic outcomes were investigated. The procedure and fluoroscopy times were significantly shorter in the WEB device group. Radiation and total contrast media dose were also significantly smaller in the WEB device, but there was no significant difference in results between operators. The follow-up radiological outcome showed adequate occlusion in 83.3% (10/12) of cases. The WEB device can be used as an alternative treatment method among the available endovascular treatment methods for WNBAs to reduce radiation exposure and the dose of contrast media when used adequately with appropriate indications.

Extent of cardiac damage and hospitalization burden in patients undergoing transcatheter aortic valve replacement.

Cardiac damage has gained increasing attention as a valid prognostic marker of mortality after transcatheter aortic valve replacement (TAVR). However, studies investigating the possible association between cardiac damage and hospitalization burden in TAVR patients are lacking. This study aimed to investigate the impact of baseline cardiac damage on the hospitalization burden before, during, and after TAVR in an all-comers population. All consecutive patients who underwent TAVR between 2016 and 2020 were included. Electronic medical records of all patients were examined to validate cardiovascular (CV) and heart failure (HF) related hospitalizations from 6 months before to 1 year after TAVR. Baseline cardiac damage was defined according to the staging classification by Généreux et al. RESULTS: Among 1397 TAVR patients, 94 (6.7%) had stage 0, 368 (26.4%) stage 1, 736 (52.7%) stage 2, 115 (8.2%) stage 3, and 84 (6.0%) stage 4 cardiac damage. Patients with more advanced cardiac damage at baseline had more HF hospitalizations within 6 months before TAVR (p < 0.01) and with a longer length of stay (LoS) (p < 0.01). Regarding the index TAVR admission, there was no difference in procedure time (p = 0.26) or LoS (p = 0.18) between groups. Still, TAVR patients with more advanced baseline cardiac damage had a higher risk of CV and HF rehospitalization after TAVR (p < 0.05). Baseline cardiac damage in patients undergoing TAVR has an impact on the pre- and post-procedural cardiovascular hospitalization burden. However, the cardiac damage status does not affect the TAVR procedure time or index TAVR admission length of stay.

High-Frequency Jet Ventilation Versus Spontaneous Respiration for Percutaneous Cryoablation of Lung Tumors: Comparison of Adverse Events and Procedural Efficiency.

BACKGROUND. High-frequency jet ventilation (HFJV) facilitates accurate probe placement in percutaneous ablation of lung tumors but may increase risk for adverse events, including systemic air embolism. OBJECTIVE. The purpose of this study was to compare major adverse events and procedural efficiency of percutaneous lung ablation with HFJV under general anesthesia to spontaneous respiration (SR) under moderate sedation. METHODS. This retrospective study included consecutive adults who underwent CT-guided percutaneous cryoablation of one or more lung tumors with HFJV or SR between January 1, 2017, and May 31, 2023. We compared major adverse events (Common Terminology Criteria for Adverse Events grade ≥ 3) within 30 days postprocedure and hospital length of stay (HLOS) of 2 days or more using logistic regression analysis. We compared procedure time, room time, CT guidance acquisition time, CT guidance radiation dose, total radiation dose, and pneumothorax using generalized estimating equations. RESULTS. Overall, 139 patients (85 women, 54 men; median age, 68 years) with 310 lung tumors (82% metastases) underwent 208 cryoablations (HFJV, n = 129; SR, n = 79). HFJV showed greater rates than SR for the treatment of multiple tumors per session (43% vs 19%, respectively; p = .02) and tumors in a nonperipheral location (48% vs 24%, p < .001). Major adverse event rate was 8% for HFJV and 5% for SR (p = .46). No systemic air embolism occurred. HLOS was 2 days or more in 17% of sessions and did not differ significantly between HFJV and SR (p = .64), including after adjusting for probe number per session, chronic obstructive pulmonary disease, and operator experience (p = .53). Ventilation modalities showed no significant difference in procedure time, CT guidance acquisition time, CT guidance radiation dose, or total radiation dose (all p > .05). Room time was longer for HFJV than SR (median, 154 vs 127 minutes, p < .001). For HFJV, the median anesthesia time was 136 minutes. Ventilation modalities did not differ in the frequencies of pneumothorax or pneumothorax requiring chest tube placement (both p > .05). CONCLUSION. HFJV appears to be as safe as SR but had longer room times. HFJV can be used in complex cases without significantly impacting HLOS of 2 days or more, procedure time, or radiation exposure. CLINICAL IMPACT. Selection of the ventilation modality during percutaneous lung ablation should be based on patient characteristics and anticipated procedural requirements as well as operator preference.

Safety and efficacy of side-by-side versus stent-in-stent stenting for malignant hilar biliary obstruction: a systematic review and meta-analysis.

Stenting of the malignant hilar biliary obstruction (MHBO) area for bile drainage is challenging. Bilateral stenting techniques of stent-in-stent (SIS) and stent-by-stent (SBS) have shown promising results. This study evaluates the efficacy of different stenting methods for MHBO. A meta-analysis was performed to determine the efficacy of SIS and SBS stenting strategies for MHBO. Medical databases such as PubMed, Web of Science, Embase, and Scopus, were searched up to August 2023. We selected eligible studies reporting the data on technical and clinical success, adverse events, and incidence of re-obstruction (RO) of SBS and SIS groups in MHBO patients. We compared the outcomes of SBS and SIS groups. A total of 9 studies comparing the data of 545 patients (268 in the SBS group and 277 in the SIS stenting group) were analyzed. There was no significant difference (p > 0.05) in the odds ratio (OR) of Re-obstruction (RO) 0.87 (95% confidence interval (95% CI) 0.6-1.25), technical success 0.58 (95% CI 0.16-2.11), clinical success 1.13 (95% CI 0.62-2.07), and adverse events 1.53 (95% CI 0.88-2.64). The mean difference in procedure time was -12.25 min (95% CI -18.39, -6.12), and the hazard ratio of stent patency was 1.22 (95% CI 1.01-1.47), favoring SBS, with high heterogeneity (I 2 = 94%). There was no significant difference in HR for survival 1.05 (95% CI 0.95-1.16) with high heterogeneity (I 2 = 84%). Compared with SIS, SBS showed better stent patency with comparable technical and clinical success and adverse events. The registration number for this study on PROSPERO is CRD42024523230.

Rapid brain MRI for image-guided ventricular catheter placement in pediatric patients: protocol and preliminary clinical outcomes.

Neuronavigation is a useful adjunct for catheter placement during neurosurgical procedures for hydrocephalus or ventricular access. MRI protocols for navigation are lengthy and require sedation for young children. CT involves ionizing radiation. In this study, the authors introduce the clinical application of a 1-minute rapid MRI sequence that does not require sedation in young children and report their preliminary clinical experience using this technique in their pediatric population. All patients who underwent ventricular catheter placement at a children's hospital using a rapid noncontrast MRI protocol, standard MRI, or head CT from July 2021 to August 2023 were included. Type of procedure, etiology of hydrocephalus, ventricle configuration and size, morphology of ventricles, need for adjunctive intraoperative ultrasound, duration of procedure, accuracy of catheter placement, and need for proximal revision within 90 days were retrospectively recorded and compared across imaging modalities. Sixty-eight patients underwent 83 procedures: 21 underwent CT navigation, 29 standard MRI, and 33 rapid MRI. Patients who received standard MRI more often had tumor etiology, while those who underwent CT and rapid MRI had posthemorrhagic etiology (χ2 = 13.04, p = 0.042). Intraoperative ultrasound was required for 1 patient in the standard MRI group and 1 patient in the CT group. There was no difference in procedure time across groups (p = 0.831). On multivariable analysis, procedure time differed by procedure type, where external ventricular drain placement and proximal revision were faster (p < 0.001 and p < 0.028, respectively). Proximal revision due to obstruction within 90 days occurred in 3 cases (in the same patient with complex loculated hydrocephalus) in the rapid MRI group and 2 cases in the CT group. Although this study was not powered for statistical inference, the authors report on the clinical use of a 1-minute rapid MRI sequence for neuronavigation in hydrocephalus or ventricular access surgery. There were no instances in which intraoperative ultrasound was required as an adjunct for procedures navigated with rapid MRI, and intraoperative time did not differ from that of standard navigation protocols.

Abstract 15585: Robotic versus Manual Percutaneous Coronary Intervention: An Updated Systematic Review and Meta-Analysis

Introduction: Robotic percutaneous coronary intervention (PCI), a recent development in managing coronary artery disease, offers potential advantages such as enhanced precision, stability, and radiation protection over traditional manual PCI. Despite these promises, a comprehensive and current comparison of safety and effectiveness between these methods remains to be established. Hypothesis: This study aims to evaluate and compare the outcomes of robotic and manual PCI. Methods: A comprehensive search of electronic databases, including PubMed, EMBASE, and the Cochrane Library, was carried out up to May 2023, aiming to identify studies comparing robotic and manual PCI. The primary outcomes were major cardiovascular events and myocardial infarction rates, and secondary outcomes included contrast volume used (in mL), procedural time (in minutes), and fluoroscopy time (in minutes). Relative risk (RR) for categorical outcomes and mean difference for continuous outcomes were calculated using a random-effects model. All statistical analyses were performed using R software (version 4.0.3) with the metafor and meta packages. Results: Our search strategy identified eight studies, including 2339 patients (703 in the robotic group and 1636 in the manual group). The pooled RR of major cardiovascular events was 0.91 (95% CI: 0.48-1.70, P=0.76, I2=0%), and myocardial infarction rate was 0.88 (95% CI: 0.43-1.83, P=0.73, I2=0%), indicating no significant difference between robotic and manual PCI. Notably, robotic PCI was associated with a statistically significant mean reduction in the contrast volume of -14.28 mL (95% CI: -23.65 to -4.93, P&lt;0.01, I2=0%). However, the differences in procedural time and fluoroscopy time did not reach statistical significance, with 2.73 minutes (95% CI: -4.71 to 10.17, P=0.47, I2=62%) and -2.15 minutes (95% CI: -4.35 to 0.05, P=0.06, I2=51%) respectively. Conclusions: Compared to its manual counterpart, this study highlights that robotic PCI significantly decreases contrast volume use while maintaining similar outcomes in other procedural parameters. This underscores robotic PCI's potential in interventional cardiology, also indicating the need for more high-quality trials for long-term outcome confirmation.

Abstract 11697: Combined-Energy Pulmonary Vein Isolation and Posterior Wall Isolation for Persistent Atrial Fibrillation: Results of a 3-year Follow-Up

Introduction: Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for paroxysmal atrial fibrillation (AF), but the optimal ablation strategy for persistent AF (PsAF) remains controversial. Hypothesis: The purpose of this study was to investigate whether combined-energy cryoballoon (CB) PVI and radiofrequency (RF) left atrial posterior wall isolation (LAPWI) at index ablation of PsAF yields higher success than PVI alone. Methods: Patients with persistent AF (n = 186) who underwent catheter ablation between 2016 and 2019 at a single large academic medical center were retrospectively reviewed. Patients with congenital heart disease or prior left atrial ablation or surgery were excluded. Combined-energy ablation (n=92) consisted of CB antral PVI followed by RF roof and floor lines to achieve LAPWI, along with isolation inside the box as needed. The control group had PVI only (n=94) with either CB (n=57) or RF (n=37). The primary endpoint was 12-, 24-, and 36-month freedom from any documented atrial tachyarrhythmia over 30 seconds after a 90-day blanking period following catheter ablation, compared by Kaplan-Meier analysis. Secondary endpoints included AF burden, procedural parameters, and complications. Results: The primary endpoint of 12-month freedom from any atrial tachyarrhythmia was higher for the combined-energy group vs the control group (79.1% vs 58.2%, p = 0.009). This improvement was sustained at 24 months (63.0% vs 45.8%) and at 36 months (60.3% vs 43.1%) and remained significant after adjustment for clinical covariates (adjusted HR 0.45, 95% confidence interval 0.22-0.95; p = 0.03). There was no significant difference in procedure time or complication rates, however fluoroscopy time was shorter with combined-energy ablation (p&lt;.001). Conclusions: In this single center experience, combined-energy CB-PVI and RF-LAPWI was associated with reduced AF recurrence compared to PVI with a single energy source.