Better Long-term Outcomes In Patients Research Articles

The long-term outcome of CT-guided radiofrequency ablation of the peripheral branches of the trigeminal nerve in trigeminal neuralgia.

Radiofrequency thermocoagulation (RFTC) of the peripheral branches of the trigeminal nerve has been used for trigeminal neuralgia. However, the long-term outcomes of radiofrequency thermocoagulation have not been established. To evaluate the long-term efficacy of RFTC of peripheral branches in patients with refractory trigeminal neuralgia. A retrospective cohort study was conducted in a comprehensive medical center in China. Patients who underwent radiofrequency thermocoagulation of peripheral branches for refractory trigeminal neuralgia from May 2014 to March 2021 were included for analysis. A total of 84 patients with refractory trigeminal neuralgia underwent 105 procedures. BNI I-II which represents treatment success was achieved in 76/84 (90%) patients and 93/105 (89%) procedures. During follow-up, BNI I and II were maintained in 64/76 (84%), 40/73 (55%), 20/67 (30%), 17/65 (26%), 12/61 (20%), and 8/58 (14%) of patients at 1, 2, 3, 4, 5, and 6 years, after the first procedure, respectively. For all the 105 procedures, BNI I and II were maintained in 68/93 (73%), 41/89(46%), 22/82(27%), 15/79 (19%), 8/74 (11%), and 3/72 (4%) at 1, 2, 3, 4, 5, and 6 years, respectively. There is no significant difference between the first and repeat thermocoagulation in terms of immediate (90% vs. 81%, P=0.140) and long-term efficacies (24 months vs.18 months, P=0.266). Radiofrequency thermocoagulation resulted in better long-term outcomes in patients with typical purely paroxysmal pain (24 months vs. 11 months, P=0.033). Radiofrequency ablation of the peripheral branches of the trigeminal nerve might be a safe and effective method in the treatment of refractory trigeminal neuralgia.

Long-term clinical outcomes of robotic-assisted surgical coronary artery revascularisation.

Patients who are not candidates for traditional coronary artery bypass grafting (CABG) and amenable only for percutaneous coronary intervention (PCI) with stents can receive the "gold standard" left internal thoracic artery (LITA) to left anterior descending artery (LAD) anastomosis through robotic-assisted CABG and PCI to non-LAD coronary targets. We aimed to analyse clinical outcomes of robotic-assisted CABG. A total of 2,280 consecutive patients who had undergone robotic-assisted CABG between May 2005 and June 2021 were included in our study. Robotic-assisted LITA harvest was followed by LITA-LAD manual anastomosis through a 4 cm left thoracotomy. Hybrid coronary intervention (HCR) consists of stent implantation in a non-LAD coronary artery performed within 7 days after robotic-assisted LITA-LAD. We performed a propensity-adjusted analysis comparison after dividing all robotic-assisted CABG patients into three time periods: 2005-2010, 615 patients; 2011-2016, 904 patients; and 2017-2021, 761 patients. The mean age increased from 64.5 years in the first time period to 65.8 years in the second time period to 68.1 years in the third (p<0.0001). Operative time was progressively reduced in the three periods (6.4; 6.2; 5.5 hours; p<0.001). The incidence of conversion to sternotomy remained similar for each period (1.8%; 1.7%; 1.5%; p=0.53). Thirty-day mortality in the three periods included 9 (1.4%), 9 (1.0%), and 7 (0.9%) patients, respectively (p=0.91), while 8 (0.3%) patients had PCI with stents in the entire group. The mean follow-up for the entire population was 4.2 years. At follow-up, the rates of all-cause death, major adverse cardiac and cerebrovascular events, non-fatal stroke, and repeat revascularisation with stents were significantly decreased from the first to the last period (pË0.0001). Robotic-assisted CABG and HCR provides good long-term outcomes in patients who are not candidates for conventional CABG.

Association of Very Early Treatment Initiation With the Risk of Long-term Disability in Patients With a First Demyelinating Event.

Early treatment is associated with better long-term outcomes in patients with a first demyelinating event and early multiple sclerosis (MS). However, magnetic resonance (MR) findings are not usually integrated to construct propensity scores (PSs) when evaluating outcomes. We assessed the association of receiving very early treatment with the risk of long-term disability including an MR score (MRS) in patients with a first demyelinating event. We included 580 patients with a first demyelinating event prospectively collected between 1994 and 2021, who received at least 1 disease-modifying drug (DMD). Patients were classified into tertiles according to the cohort's distribution of the time from the first demyelinating event to the first DMD: first tertile (FT) or very early treatment (6 months; n = 194), second tertile (6.1-16 months, n = 192), and third tertile (TT) (16.1 months, n = 194). A 5-point MRS was built according to the sum of the following indicators: ≥9 brain lesions (1 point); ≥1 infratentorial lesion (1 point); ≥1 spinal cord (SC) lesion (1 point); ≥1 contrast-enhancing (CE) brain lesion (1 point); and ≥1 CE SC lesion (1 point). PS based on covariates and the MRS was computed for each of the outcomes. Inverse PS-weighted Cox and linear regression models assessed the risk of different outcomes between tertile groups. Finally, to confirm the role of MR in treatment decision, we studied the time elapsed from the first demyelinating event to treatment initiation according to the MRS in all patients with radiologic available information, renamed as raw-MRS. Very early treatment decreased the risk of reaching Expanded Disability Status Scale 3.0 (hazard ratio [HR] 0.55, 95% CI 0.32-0.97), secondary progressive MS (HR 0.40, 95% CI 0.19-0.85), and sustained disease progression at 12 months after treatment initiation (HR 0.50, 95% CI 0.29-0.84), when compared with patients from the TT group. Patients from the FT group had a lower disability progression rate (β estimate -0.009, 95% CI -0.016 to -0.002) and a lower severe disability measured by the Patient-Determined Disease Step (β estimate -0.52, 95% CI -0.91 to -0.13) than the TT group. Finally, there was a 62.4% reduction in the median time between the first demyelinating event and the first-ever treatment initiation from patients displaying a raw-MRS 1 to patients with a raw-MRS 5. Using PS models with and without MRS, we showed that treatment initiation at very early stages is associated with a reduction in the risk of long-term disability accrual in patients with a first demyelinating event. This study provides Class III evidence that earlier treatment of patients with MS presenting with a first demyelinating event is associated with improved clinical outcomes.

Long-term treatment outcome and mutational analysis of patients on third-line antiretroviral therapy in programmatic conditions.

In low- and middle-income countries where most patients receive standardized third-line ART through national programmes, real-world data are scarce. This study was done to assess the long-term survival, and virological and mutational outcomes of people living with HIV receiving third-line ART between July 2016 and December 2019 in an ART centre in India. Eighty-five patients were started on third-line ART. Genotypic resistance testing to identify drug resistance mutations in the integrase, reverse transcriptase and protease genes was done at the start of third-line therapy, as well as in those who did not attain virological suppression after 12 months of therapy. Survival was 85% (72/85) at 12 months and 72% (61/85) at the end of follow-up in March 2022. Virological suppression was present in 82% (59/72) and 88% (59/67) at 12 months and at the end of follow-up, respectively. Five out of 13 patients who had virological failure at 12 months showed virological suppression at the end of the study. At the start of third-line therapy, 35% (14/40) and 45% (17/38) of patients had major integrase- and protease-associated mutations, respectively, even though they had never been on integrase inhibitor-based regimens. At 1 year follow-up, among those failing third-line therapy, 33% (4/12) of patients had major integrase mutations, but none had major protease mutations. This study demonstrates good long-term outcome in patients on standardized third-line ART in programmatic conditions with very few mutations in those failing the therapy.

Propensity-Matched Study of Early Cardiac Rehabilitation in Patients With Acute Decompensated Heart Failure.

The impact of early implementation of cardiac rehabilitation (CR) in heart failure (HF) patients remains to be elucidated. This study sought to determine whether CR during HF hospitalization could improve prognostic outcomes in patients with acute decompensated HF. We analyzed patients with HF enrolled in the JROADHF (Japanese Registry of Acute Decompensated Heart Failure) registry, a retrospective, multicenter, nationwide registry of patients hospitalized for acute decompensated HF. Eligible patients were divided into 2 groups according to CR during hospitalization. The primary outcome was a composite of cardiovascular death or rehospitalization due to cardiovascular event after discharge. The secondary outcomes were cardiovascular death and cardiovascular event rehospitalization. Out of 10 473 eligible patients, 3210 patients underwent CR. Propensity score matching yielded 2804 pairs. Mean age was 77±12 years and 3127 (55.8%) were male. During a mean follow-up of 2.8 years, the CR group had lower incidence rates of the composite outcome (291 versus 327 events per 1000 patient-years; rate ratio, 0.890 [95% CI, 0.830-0.954]; P=0.001) and rehospitalization due to cardiovascular event (262 versus 295 events per 1000 patient-years; rate ratio, 0.888 [95% CI, 0.825-0.956]; P=0.002) than the no CR group. In-hospital CR was associated with an improvement in Barthel index for activities of daily living (P=0.002). Patients with very low Barthel index at admission were benefited by CR in comparison with patients with independent Barthel index (very low; hazard ratio, 0.834 [95% CI, 0.742-0.938]: independent; hazard ratio, 0.985 [95% CI, 0.891-1.088]; P for interaction=0.035). CR implementation during hospitalization was associated with better long-term outcomes in patients with acute decompensated HF. These data support the need for a randomized, controlled, adequately powered trial to definitively test the role of early physical rehabilitation in hospitalized patients with HF.

Cardiovascular surgery in very low birth weight (≤ 1500g) neonates.

Low birth weight and prematurity are known risks of increased morbidity and mortality with undergoing cardiovascular surgery. Our aim was to review the outcomes of very low birth weight (≤ 1500 g) patients who have undergone cardiovascular surgery. A retrospective review was performed for 32 very low birth weight (≤ 1500 g) patients who underwent cardiovascular surgery from 2004 to 2021 in our institution. Fifteen patients weighting ≤ 1500 g at surgery (≤ 1500 g group) were compared to 17 patients born with a weigh ≤ 1500 g and weighting between 1500 g and 2500 g at surgery (>1500 g to ≤ 2500 g group) in this study. In-hospital mortality was 33% (5/15) in ≤ 1500 g group and 24% (4/17) in > 1500 g to ≤ 2500 g group (p = 0.55). All patients with simple biventricular lesion survived following full repair. The occurrence of postoperative intracerebral haemorrhage was significantly higher in those operated at weight ≤ 1500 g than those weighting >1500 g to ≤ 2500 g (40% vs 0%; p = 0.01). The 1- and 3-year survival rates were 66.0 ± 12.4% and 46.2 ± 14.8% in ≤ 1500 g group and 76.5 ± 10.3% and 70.6 ± 11.1% in > 1500 g to ≤ 2500 g group (Log-rank p = 0.12). Cardiac surgery for very low birth weight neonate resulted in a high early and late mortality. Early surgery is only acceptable for simple biventricular lesion if needed. Delayed surgery seems to provide better long-term outcomes in patients with complex lesions. Alternative strategies to neonatal cardiopulmonary bypass should be investigated in patients with complex biventricular and single ventricle lesions.

Abstract 9459: Bariatric Surgery Improves Mortality in Patients With Heart Failure

Introduction: Bariatric surgery has been associated with decreased adverse cardiovascular outcomes. There is a paucity of data regarding long-term outcomes in patients with heart failure who underwent bariatric surgery. Hypothesis: Bariatric surgery is associated with better long-term outcomes in patients with heart failure and BMI≥40. Methods: Using ICD-10 codes, we identified patients with heart failure and BMI≥40 from 2016 to 2021 by using the TriNetx diamond network which includes data from ambulatory and primary care electronic medical records, medical claims from claims clearinghouses, and patient medication data from pharmacy claims around the USA. The patient population was divided in 2 groups, those who underwent a bariatric surgery procedure versus those who did not. Subgroup analysis of patients with systolic and diastolic heart failure was also performed. Propensity score matching was used to equilibrate for approximately 90 variables. The outcomes were measured from 3 months up to 5 years after the index event. Results: A total of 2,896 patients were included in each cohort, 63% were females. Patients with heart failure and BMI ≥ 40 kg/m2 that underwent bariatric surgery had approximately 67% lower likelihood of mortality (OR 0.336, P&lt;0.0001), 50% lower incidence of atrial fibrillation (OR 0.504, P&lt;0.0001), 45% less ventricular tachycardia (OR0.556, P0.0014), 43% less AMI (OR 0.578, P 0.0148), and 30% less cerebral ischemia (OR 0.708, P0.043). On subgroup analysis, similar outcomes were seen in patients with systolic heart failure except for cerebral ischemia which did not have a significant association. In patients with diastolic heart failure, only mortality and atrial fibrillation had lower incidences after bariatric surgery. Conclusions: Bariatric surgery is associated with decreased mortality and cardiovascular outcomes in patients with heart failure and BMI≥40. Prospective and/or randomized studies are required to prove these results.

How diabetes alters the prognosis of patients with heart failure and the impact of therapies

The mechanisms causing diabetes and heart failure are inextricably linked, as are the prognostic outcomes seen in these two complex disease processes. Treating both conditions together is absolutely vital to bring about the best long-term outcomes for patients. We have strong evidence-based therapies which have been shown to successfully treat both these conditions with improved prognosis and patient outcomes. The more recent development of SGLT2 inhibitors have further enhanced this clear clinical benefit for heart failure and diabetes combined. This is an exciting area of rapidly expanding research and further trials looking at these benefits are underway.

Rib Plating as an Effective Approach to Managing Traumatic Rib Injuries: A Review of the Literature.

Timely repair is essential to maximizing outcomes in patients with traumatic rib injuries, whether in the presence or absence of flail chest (FC) or existing as single or multiple rib fractures (MRF), due to its high morbidity and mortality rate. This review focuses primarily on the plating system as an effective surgical approach to stabilizing these injuries. Literature was surveyed using the Google Scholar, PLOS One, and PubMed search engines between August 2021 and April 2022. A total of 34 articles were included herein, and primary and secondary outcomes were assessed. The primary outcomes of interest were intensive care unit length-of-stay (ICU LOS), hospital length-of-stay (HLOS), ventilatory requirements, and mortality rate. The secondary outcomes of interest were postoperative pain level and postoperative complications. The majority of the studies included herein reported lower ICU LOS, HLOS, and ventilation requirements in surgical patients when compared to conservatively managed patients. However, variables such as the presence or absence of FC also impacted outcomes in certain studies. Mortality rate and postoperative pain were largely underreported in the selected studies, but limited data from these studies suggest that these outcomes tend to be lower in surgical patients compared to those treated conservatively. When present, postoperative complications were often less severe amongst surgical patients compared to conservatively managed patients. Results further suggest that surgical repair is associated with lower pain severity as early as 72 hours postop. Likewise, findings suggest that early rib fracture stabilization is superior to late stabilization and often yields a sooner return to a baseline health status. Few studies report little to no statistical difference in primary and secondary outcomes between operative and conservative treatment. However, there is greater evidence that suggests the contrary, with better short-term and potential for better long-term outcomes in patients who undergo rib fixation.

Combined treatment with medial unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction is effective on long-term follow-up

PurposeThe purpose of the present study was to evaluate the long-term outcome of combined medial unicompartmental knee arthroplasty (UKA) and anterior cruciate ligament reconstruction (ACLR). The authors hypothesized that the combined procedure leads to good long-term outcome in patients with isolated medial knee osteoarthritis (OA) and anterior cruciate ligament (ACL) deficiency.MethodsTwenty-three patients with ACL deficiency and concomitant medial knee OA were treated from 2008 to 2016 with a combined UKA (Oxford Partial Knee) and ACLR using a hamstring tendon autograft. The follow-up assessment included VAS pain score, Lysholm score, Oxford Knee Score (OKS), American Knee Society scores (AKSS), International Knee Documentation Committee (IKDC 2000), Tegner and UCLA activity scores. Instrumented laxity test was done using the KT-1000 arthrometer. Survivorship analysis was performed using the Kaplan–Meier method. Implant loosening and disease progression was assessed by conventional radiography.ResultsAverage follow-up duration was 10 years (6–14.5). VAS, Lysholm, Tegner and UCLA scores improved significantly. OKS, AKSS and IKDC 2000 showed excellent results on follow-up. Implant survivorship was 91.4% at 14.5 years. There were 2 revisions with conversion to total knee arthroplasty at 6 and 12 years postoperatively due to trauma and disease progression, respectively. There were no radiological or clinical signs of instability or disease progression in any of the remaining knees. The side-to-side difference using the KT-1000 arthrometer was insignificant.ConclusionsUKA combined with ACLR is an effective therapeutic option with good outcome and return to sport rate on the long-term.Level of evidenceIV.

Seropositive Neuromyelitis Optica in a Case of Undiagnosed Ankylosing Spondylitis: A Neuro-Rheumatological Conundrum

Seropositive Neuromyelitis Optica in a Case of Undiagnosed Ankylosing Spondylitis: A Neuro-Rheumatological Conundrum

Favourable arterial, tissue-level and venous collaterals correlate with early neurological improvement after successful thrombectomy treatment of acute ischaemic stroke

Background and purposeEarly neurological improvement (ENI) after thrombectomy is associated with better long-term outcomes in patients with acute ischaemic stroke due to large vessel occlusion (AIS-LVO). Whether cerebral collaterals influence...

Cystinosis in Pediatric Renal Transplant Recipients: A Case-Control Study From Kuwait.

Cystinosis is the most frequent cause of the inherited renal Fanconi syndrome and is also potentially treatable. In this study, we have reported our single-center experience of the longterm outcomes of kidney transplant in patients with cystinosis. Pediatric patients with cystinosis (n = 17) were compared with a matched control group without cystinosis (n = 126). The 2 groups were compared with regard to demographic data, posttransplant complications, and graft and patient outcomes. Most patients with cystinosis were male teenagers (52.9%) with comparable mean age (12.4 ± 4.1 vs 14 ± 3.1 years) versus the group without cystinosis. The 2 study groups were comparable with regard to type of dialysis, type of donor, blood group, and pretransplant comorbidities (P > .05). Patients with cystinosis received significantly more potent induction therapy (P < 0.05), but both groups were maintained on comparable immunosuppressive regimens (mostly tacrolimus based) (P > .05). Most grafts in both groups displayed immediate graft function. The percentage of patients with cystinosis with primary graft function was significantly higher than the percentage of those patients without cystinosis who had primary graft function (P = .024); this was associated with a relatively lower baseline creatinine level, although this was not significant (P > .05). Posttransplant complications, especially posttransplant diabetes, cytomegalovirus viremia, or BK nephropathy, were comparable (P > .05). Moreover, patient and graft survival rates were similar in the 2 groups (P > .05). Under standard immunosuppression, renal transplant and cysteamine therapy were safe with good long-term outcomes in patients with cystinosis. Studies that can include more patients and that have longer follow-up are needed to better understand the nature of this genetic disease and to discover the best treatment options.

Endoscopic Submucosal Dissection for Gastric Tube Carcinoma after Esophagectomy Contributes to Long-Term Outcomes.

The incidence of gastric tube carcinoma (GTC) after esophagectomy for esophageal carcinoma has increased in recent years. Surgical removal of the reconstructed gastric tube is associated with high mortality, and endoscopic submucosal dissection (ESD) is a promising alternative. There are limited reports of ESD for GTC. This study investigated the efficacy and safety of ESD in GTC. This single-center retrospective study examined patients who underwent ESD for GTC after esophagectomy at our institution between 2003 and 2018. The curability of GTC with ESD was evaluated histologically according to the Japanese Gastric Cancer Treatment Guidelines. Patient characteristics and procedural and long-term outcomes were analyzed. Overall, 31 patients (29 men and 2 women; median age, 73 years) with 45 GTC lesions underwent ESD. The mean period between primary esophagectomy and the diagnosis of GTC was 10.6 years. Bleeding during ESD was noted in two patients (6.5%). No other adverse or fatal events such as perforation were noted. Complete resection and curative resection were documented in 80.6% and 48.4% of cases, respectively. The 3-year and 5-year overall survival rates were 67.6% and 47.7%, respectively. The 3-year and 5-year disease-specific survival rates were 100% and 92.9%, respectively. One patient died of GTC, and fourteen patients died of other diseases, including primary carcinoma in five cases. ESD was safe and provided good long-term outcomes in patients with GTC. Regular long-term gastroscopy is required for the early detection of GTC. Patients with GTC after esophagectomy for esophageal carcinoma have a high risk of other primary carcinomas or comorbidities after ESD.

Cardiac MRI predictors of good long-term outcomes in patients with repaired TOF

Risk stratification in patients with repaired tetralogy of Fallot (rTOF) have focused on poor clinical outcomes while predictors of a benign clinical course have not been characterized. The goal of this study was to Identify cardiac magnetic resonance (CMR) markers of a good clinical course late after TOF repair. Clinical and CMR data from the International Multicenter TOF Registry (INDICATOR) were analyzed. The primary outcome was time to the earliest occurrence of a composite of death, aborted sudden death, and sustained ventricular tachycardia (VT). The secondary outcome was time to the earliest occurrence of atrial arrhythmia, nonsustained VT, and NYHA class >II. Multinomial regression was used to identify predictors of the 3-category outcome: (a) good outcome, defined as freedom from the primary AND secondary outcomes at age 50 years; (b) poor outcome, defined as presence of the primary outcome before age 50 years; and (c) intermediate outcome, defined as not fulfilling criteria for good or poor outcomes. Among 1088 eligible patients, 96 had good outcome, 60 experienced poor outcome, and 932 had intermediate outcome. Patients were age 25.8±10.8 years at the time of the index CMR. Median follow-up was 5.8 years (IQR 3.0, 9.9) after CMR in event-free patients. By univariate analysis, smaller right ventricular (RV) end-systolic and end-diastolic volume index, smaller left ventricular end-systolic volume index, higher right and left ventricular ejection fraction, lower right and left ventricular mass index, and lower left ventricular mass/volume ratio were associated with good outcome. Multivariable modeling identified higher RV ejection fraction (OR 2.38 per 10% increase, P=.002) and lower RV mass index (OR 1.72, per 10 g/m2 decrease, P=.002) as independently associated with good outcome after adjusting for age at CMR. Classification and regression tree analysis identified important thresholds associated with good outcome that were specific to patients age ≥37 years at the time of CMR; these were RV ejection fraction ≥42% and RV mass index <39 g/m2. Adults with rTOF and no more than mild RV dysfunction combined with no significant RV hypertrophy are likely to be free from serious adverse clinical events into their sixth decade of life and may require less frequent cardiac testing.

Abstract 10980: Long-Term Clinical Outcomes of Continuous Statin Therapy in Patients with Deferral of Coronary Intervention Based on Fractional Flow Reserve

Background: The optimal medication therapy for patients with angiographically intermediate coronary artery stenosis in whom revascularization was deferred by fractional flow reserve (FFR) remains to be fully established. The aim of this study was to investigate the long-term outcomes of continuous statin therapy in those patients. Methods: This sub-analysis of the J-CONFIRM registry (Long-Term Outcomes of Japanese Patients With Deferral of Coronary Intervention Based on Fractional Flow Reserve in Multicenter Registry) included 1113 patients who have completed 2-year follow-up and were divided into 2 groups according to continuation of statin treatment. Landmark analyses were performed that compared treatments during the follow-up period between 2 years and 5 years to assess the composite endpoints, including target vessel failure and non-cardiac death in the Cox proportional hazard regression with mixed effects account for institutional variety and inverse probability of treatment weighting (IPTW) analyses. Target vessel failure was defined as cardiac death, target-vessel related myocardial infarction, and clinically driven target vessel revascularization. Results: By the start of the landmark at 2-year, 681 (61.2%) patients had continued the statin, whereas 432 (38.8%) had not continued. Composite endpoint was observed in 68 (10.0%) patients with continuous statin and 54 (12.5%) in those with discontinuous statin. The multivariate mixed effects Cox regression model and IPTW adjusted for baseline characteristics, comorbidity, FFR value, culprit vessel, and medication revealed that the continuous statin was not associated with a low risk of composite endpoint (HR: 0.81, 95% CI: 0.54 to 1.21, HR: 0.81, 95% CI: 0.62 to 1.05, respectively). Subgroup analysis showed significant interaction between sex, prior myocardial infarction (pMI) and the continuous statin, indicating that the continuous statin therapy was associated with a low risk of composite endpoint in male (HR: 0.62, 95% CI: 0.41, 0.93) and patients with pMI (HR: 0.42, 95% CI 0.22, 0.82). Conclusions: The present study showed that continuous statin therapy was not associated with better long-term outcomes in patients with deferral of coronary intervention based on FFR.

Abstract 11671: Inpatient Cardiac Rehabilitation After Hospitalization for Acute Decompensated Heart Failure is Associated With Reduced Cardiovascular Events

Introduction: The effects of cardiac rehabilitation during acute decompensated heart failure (HF) hospitalization remain to be elucidated. This study sought to determine whether inpatient cardiac rehabilitation after HF hospitalization could improve outcomes in HF patients. Methods: We analyzed HF patients enrolled in the Japanese Registry Of Acute Decompensated Heart Failure (JROAD-HF), a national database of HF. Eligible patients were divided into two groups according to the inpatient cardiac rehabilitation. The primary outcome was the composite of cardiovascular death or re-hospitalization due to cardiovascular event after discharge. The secondary outcomes were cardiovascular death and re-hospitalization due to cardiovascular event. Results: Out of 10,473 eligible patients, 3,210 patients underwent cardiac rehabilitation. Propensity score matching yielded 2,635 pairs. The mean age was 77.2 years and 2,927 (55.5%) was male. Ischemic heart disease was accounted for 28.8% and the mean left ventricular ejection fraction was 45.2 ± 17.1. During a mean follow-up of 2.8 years, the cardiac rehabilitation group had a lower incidence rate of the composite of cardiovascular death or re-hospitalization due to cardiovascular event (284.0 vs. 311.7 events per 1000 patient-years; rate ratio [RR] 0.89; 95% confidence interval [CI] 0.83-0.96; P = 0.003), and re-hospitalization due to cardiovascular event (255.4 vs. 283.9 events per 1000 patient-years; RR 0.90; 95% CI 0.83-0.97; P = 0.007) than the no cardiac rehabilitation group. Cardiovascular death was not different between groups (71.0 vs. 75.5 events per 1000 patient-years; RR 0.94; 95% CI 0.83-1.06; P = 0.31). Cubic spline analysis showed that patients with lower Barthel index were benefited by cardiac rehabilitation. Conclusions: The implementation of cardiac rehabilitation during HF hospitalization was associated with better long-term outcomes in patients with HF.

Obesity paradox in patients with chronic total occlusion of coronary artery.

Obesity is associated with metabolic syndrome which increases further risk of coronary artery disease and adverse cardiovascular events. Impact of body mass index (BMI) on long-term outcome in patients with coronary chronic total occlusion (CTO) is less clear. From January 2005 to November 2020, a total of 1301 patients with coronary angiographic confirmed CTO were enrolled in our study. Patients were divided into two groups: low BMI group: 18-24.99kg/m2 and high BMI group ≥25kg/m2 . Clinical outcomes were 3-year all-cause mortality, 3-year cardiovascular mortality and 3-year non-fatal myocardial infarct. During the 3-year follow-up period, all-cause mortality was significantly higher in patients with low BMI group compared to those in high BMI groups (14% vs. 6%, p=.0001). Kaplan-Meier analysis showed patients with high BMI groups had significant better survival compared with those in low BMI group (p=.0001). In multivariate analysis, higher BMI was independently associated with decreased risk of 3-year all-cause mortality (Hazard ratio [HR]: 0.534; 95% confidence interval [CI]: 0.349-0.819, p=.004) after controlling for age, renal function, prior history of stroke, coronary artery bypass graft, co-morbidities with peripheral arterial disease, heart failure and revascularization status for CTO. In propensity-matched multivariate analysis, high BMI remained a significant predictor of 3-year all-cause mortality (HR, 0.525; 95% CI, 0.346-0.795, p=.002). Higher BMI was associated with better long-term outcome in patients with coronary CTO.

Cemented acetabular component with femoral neck autograft for acetabular reconstruction in Crowe type III dislocated hips.

AimsVarious surgical techniques have been described for total hip arthroplasty (THA) in patients with Crowe type III dislocated hips, who have a large acetabular bone defect. The aim of this study was to evaluate the long-term clinical results of patients in whom anatomical reconstruction of the acetabulum was performed using a cemented acetabular component and autologous bone graft from the femoral neck.MethodsA total of 22 patients with Crowe type III dislocated hips underwent 28 THAs using bone graft from the femoral neck between 1979 and 2000. A Charnley cemented acetabular component was placed at the level of the true acetabulum after preparation with bone grafting. All patients were female with a mean age at the time of surgery of 54 years (35 to 68). A total of 18 patients (21 THAs) were followed for a mean of 27.2 years (20 to 33) after the operation.ResultsRadiographs immediately after surgery showed a mean vertical distance from the centre of the hip to the teardrop line of 21.5 mm (SD 3.3; 14.5 to 30.7) and a mean cover of the acetabular component by bone graft of 46% (SD 6%; 32% to 60%). All bone grafts united without collapse, and only three acetabular components loosened. The rate of survival of the acetabular component with mechanical loosening or revision as the endpoint was 86.4% at 25 years after surgery.ConclusionThe technique of using autologous bone graft from the femoral neck and placing a cemented acetabular component in the true acetabulum can provide good long-term outcomes in patients with Crowe type III dislocated hips.Cite this article: Bone Joint J 2021;103-B(2):299–304.

Cervical Myelopathy: An Update on Posterior Decompression.

This was a narrative review. The aim was to discuss current methods and review updated outcome studies regarding posterior decompression in the management of cervical myelopathy. Progressive myelopathy in the cervical segments is an indication for urgent surgical management. Although nonoperative treatment is an option in mild to moderate cases, the majority of patients will experience deterioration in neurological function requiring surgical decompression. A review of the literature was performed using PubMed to provide updated information regarding posterior cervical decompression in the management of myelopathy. There are numerous studies comparing outcome data between cervical laminectomy and fusion with laminoplasty. While each technique has advantages and disadvantages, both provide adequate decompression and good long-term outcomes in patients meeting appropriate criteria. Posterior decompression is an important approach for spine surgeons to have in their toolkits when treating cervical myelopathy.