Implant Success Rate Research Articles

Contrast-free left ventricular lead implantation for cardiac resynchronization therapy: a retrospective cohort study

Abstract Background Left ventricular lead (LVL) implantation can be challenging in Cardiac Resynchronization Therapy (CRT). Therefore, contrast is commonly used to visualize the coronary venous system. However, contrast use is correlated with substantial risks such as contrast-induced nephropathy and anaphylactic reaction. Case studies suggest feasibility of LVL implantation without coronary sinus (CS) venography. Purpose We aimed to compare the procedure characteristics, outcome, and safety of contrast-free and contrast-aided LVL implantation. Methods 346 LVL implantations performed between 2017 and 2019 were analyzed. 167 were contrast free (No-Contrast Group: NCG), and 179 were contrast-aided (Contrast Group: CG). The intervention duration, fluoroscopy duration, and radiation dose were evaluated. The primary outcome was procedural success. The secondary outcomes were LVL position, LVL threshold value, QRS duration and LVEF. Operative complications and lead revisions were surrogates for the intervention’s safety. Results The LVL implantation success rate varied from 62.9% in the NCG to 96.6% in the CG (Figure 1). Contrast-free interventions were associated with shorter procedure and fluoroscopy durations, and smaller radiation doses (100.8±41.0 vs 131.1±50.0min (p<0.01), 15.7±11.2 vs 26.0±17.5min (p<0.01) and 475.3±422.7 vs 897.3±779.1Gy.cm2 (p<0.01) respectively). The intraoperative LVL threshold values were equivalent (0.96±0.65 in the NCG vs 1.05±0.65V in the CG, TOST-p<0.01), and contrast use did not significantly influence the follow-up LVL threshold, QRS shortening and LVEF increase (1.11±0.55 vs 1.22±0.93V (p=0.62), -10.5±28.3 vs -13.2±26.3ms (p=0.16) and 2.3±8% vs 4.1±8.4% (p=0.40)). More intraoperative complications (CS dissection, perforation, mechanically-induced arrhythmia and other respiratory or circulatory problems) were observed during the contrast-aided procedures (9.5% in the CG versus 1.9% in the NCG, p=0.04). However, the postoperative complication rates (ICU admission, pericardial effusion, pneumothorax, infection and LVL revision) did not differ (9.5% in the NCG, 12.8% in the CG, p=0.55). In contrast-free LVL implantation failure cases, intraoperatively crossing over from the NCG to CG did not result in longer procedures or different intraprocedural complication rates (131.8±46.8 vs 131.1±50.0min in the CG (p=0.9) and 6.5% vs 9.5%, (p=0.6)). Conclusion Contrast-free LVL implantation was associated with shorter intervention and fluoroscopy durations and less radiation. Less intraoperative complications were observed without contrast, and the postoperative complication rate was similar to contrast-aided procedures. This technique was successful in almost 2/3 of the cases. In case of failure and crossover to contrast, the initial contrast free attempt did not result in more adverse events than in fully contrast-aided procedures. It is therefore reasonable to consider an initial contrast-free approach for CRT implantation.Compared groups

Abstract 11516: Micra vs Transvenous Pacemaker: A Comparative Systematic Review and Meta-Analysis

Background: Leadless pacemakers (LP) represent an emerging modality for treating bradyarrhythmias. We performed a meta-analysis and systematic review comparing safety and efficacy outcomes of Micra LP and transvenous pacemakers (TVP). Methods: A literature search was performed. The primary efficacy endpoints were successful implantation rate and acceptable capture threshold of <2V at 1 year. Primary safety outcomes were vascular injury, tamponade, device or lead dislodgement, pneumothorax, and major complications (needing intervention, prolonged hospital stay, readmission or death). A double-arm analysis was performed comparing LP and TVP. Data was pooled as mean differences (MD) or risk ratio (RR) including the 95% CI. Results: A total of 60 studies were included. There was no significant difference between the LP and TVP groups in terms of the rate of successful implantation (RR=1.02, P=0.95) and acceptable capture threshold (RR=0.90, P=0.11). LP was associated with a significantly lower incidence of major complications (RR = 0.54, [0.44, 0.67], P < 0.001) and dislodgment (RR= 0.31, [0.21, 0.46], P < 0.001). TVP had a significantly lower incidence of vascular injury (RR= 2.62, P=0.001) and a lower incidence of cardiac tamponade (RR= 2.29, P=0.001). There was no statistically significant difference regarding the incidence of infection (RR=0.76, P=0.6) and pneumothorax (RR= 0.58, P = 0.37). Conclusion: LP and TVP have equivalent implant success and long-term efficacy. LP had lower rates of major complications and dislodgement. TVP had lower rates of vascular injury and tamponade. Infection and pneumothorax rates were the same in both groups.

Investigating the Long-Term Success and Complication Rates of Zirconia Dental Implants: A Prospective Clinical Study.

Zirconia dental implants have gained attention due to their biocompatibility and aesthetics. However, research on their extended success and complication rates is limited. A prospective clinical study involved the placement of 30 zirconia dental implants in patients requiring tooth replacement. The implants were followed up for five years. Success was defined as the implant remaining stable and functional. Complications, including peri-implant mucositis and peri-implantitis, were monitored. Statistical analysis included descriptive statistics, Chi-square test, and P-values were set at P < 0.05. The long-term success rate of zirconia dental implants was found to be 93.3%. Among the 30 implants, only 2 exhibited failure. The most common complication was peri-implant mucositis, occurring in 16.7% of implants. Notably, the incidence of peri-implantitis was limited, observed in 6.7% of implants. Statistical analysis showed significant associations between implant failure and smoking (P = 0.021). Zirconia dental implants demonstrated a high long-term success rate of 93.3% over five years. Peri-implant mucositis was the predominant complication, with a relatively low occurrence of peri-implantitis. The findings underscore the potential of zirconia implants for reliable dental implantation. Addressing modifiable risk factors, such as smoking, could further enhance implant success. Continued research is recommended to validate and expand upon these outcomes.

Embryo Condition Media Collected from Polycystic Ovary Syndrome Patients with Abdominal Obesity Can Increase The Decidualization Potential of Healthy Endometrial Stromal Cells.

Polycystic ovary syndrome (PCOS) is a common endocrinological disorder associated with abdominal obesity (AO) and some reproductive complications including low pregnancy rate. Embryo-endometrium cross-talk has a key role in successful embryo implantation and subsequent normal pregnancy rate. The primary objective of this study is to evaluate the decidualization potential of endometrial stromal cells (ESCs) using the embryo condition media (ECM) collected from PCOS patients with AO, compared to ECM of those patients without AO. In this experimental study, we measured the capacity of ECM collected from PCOS patients with or without AO for decidualization induction in healthy ESCs after coculture. A total number of 53 embryos from 40 couples belonging to PCOS with AO, PCOS without AO, nonPCOS with AO, and nonPCOS without AO patients, were included in our study. The embryosof four groups were single-cultured up to the blastocyst stage. Their ECM (45λ/well) were pooled and added to healthy ESCs monolayer culture media to investigate their effects on decidualization potential via gene (PRL, IGFBP1, IL1-β, HOXA10, IL-6 and TNF-α) and protein (PRL, IGFBP1, IL1-β) expression analysis and ESCs migration assay. The morphological analysis, migration assay (P≤0.0321), protein (P≤0.0139) and gene expression analysis showed PCOS with AO accounted for the highest gene (PRL, IGFBP1, IL1-β, HOXA10, IL-6, TNF-α) and protein markers (PRL, IGFBP1, IL1-β) (P≤0.05). NonPCOS individuals without AO had the lowest level of both gene and protein decidualization markers (P≤0.05). Considering decidualization as an inflammatory process, a higher level of decidualization markers was associated with a higher inflammatory status created by AO and PCOS, separately. Inflammation may disrupt the process of inflammatory to anti-inflammatory phase required for prevention of pregnancy loss, this could explain the high rate of abortion in these cases.

Abstract 16264: Safety and Efficacy Outcomes of Micra Leadless Pacemakers: An Updated Systematic Review and Meta-Analaysis

Background: The Micra leadless pacemaker (LP) is a novel pacing technology that has revolutionized the management of bradyarrhythmias and eliminated the need for intra-cardiac leads. A meta-analysis was performed to assess the long term safety and efficacy outcomes of the LP. Methods: We included a total of 60 studies. Data was analyzed to calculate outcomes in the pooled proportion of patients undergoing LP implant. Primary efficacy endpoints were successful implantation and acceptable capture threshold of &lt;2V at 1 year. Primary safety outcomes were vascular injury, tamponade, device dislodgement, pneumothorax, and major complications (complications resulting in intervention, prolonged hospital stay, readmission or death). Results: Successful LP implantation was found to be 99.4% (Cl [99.1%, 99.6%], (P = 0.95)) and acceptable capture threshold of &lt;2V at 1 year was 97.1% (CI [96%, 98.2%], P = 0.001). Major complications occurred in 2.5% (CI [1.3%, 3.6%], P = 0.001). Infection occurred in 0.5% (Cl [0.0%, 0.9%], P = 0.03) and the analysis was homogeneous (I2 = 45.16%, P = 0.04). Vascular injury occurred in 0.9% (CI [0.4%, 1.3%], P = 0.001), cardiac tamponade in 0.4% (CI [0.2%, 0.7%], P = 0.002)) and device dislodgement in 0.3% (CI [0.2%, 0.4%], P &lt; 0.001). Conclusion: LPs had a high rate of successful implantation and capture threshold at 99.4% and 97.1% respectively, while having low rates of major complications, infections, dislodgement, cardiac tamponade and vascular injury.

Clinical feasibility evaluation of a digital workflow of prosthetically oriented onlay bone grafting for horizontal alveolar augmentation: a prospective pilot study

BackgroundOnlay bone grafting is considered highly reliable for reconstructing severe horizontal bone defects. A critical problem is how to achieve precise position of the bone block to control alveolar ridge dimensions. This research aims to establish a digital workflow for prosthetically oriented onlay bone grafting and evaluate its accuracy and efficiency.MethodsThis prospective pilot study investigated eight patients who required implant restoration in the esthetic area with horizontal alveolar bone defects. The workflow includes preoperative virtual planning, design and manufacture of patient-specific templates, bone grafting surgery, and implant insertion. Primary outcomes were graft accuracy, defined by root mean square estimate (RMSE) values between preoperatively designed and actual implanted outer contours of bone blocks. Secondary outcomes were bone graft and implant success rates. Besides, the surgeons used the visual analog scale (VAS) to rate the intuitiveness, ease of understanding, and helpfulness of the workflow.ResultsNo bone grafts or implants failed in any of the eight patients, resulting in a 100% success rate. The RMSE values between the preoperative design and the implanted outer contour of bone blocks were 0.41 ± 0.15 mm. The digital approach showed advantages in intuitiveness (9.3 ± 0.5), understanding (9.0 ± 0.5), and helpfulness (8.4 ± 1.1) according to surgeons' VAS scores.ConclusionsA digital workflow provided encouraging results, in terms of accuracy and efficacy, for horizontal bone augmentation.Trial registrationThis study was registered in the National Clinical Trials Registry in 16/02/2023 under the identification number ChiCTR2300068361.

Comparison of vertical bone resorption following various types of autologous block bone grafts

BackgroundThis study aims to measure and compare the differences in vertical bone resorption after vertical augmentation using different types of autologous block bone.MethodsData were collected from 38 patients who had undergone vertical ridge augmentation using an autologous block bone before implant insertion. The patients were divided into three groups based on the donor sites: ramus bone (RB), chin bone (CB), and iliac crestal bone (IB).ResultsThe surgical outcome of the augmentation was evaluated at the follow-up periods up to 60 months. In 38 patients, the mean amount of vertical bone gain was 8.36 ± 1.51 mm in the IB group, followed by the RB group (4.17 ± 1.31 mm) and the CB group (3.44 ± 1.08 mm). There is a significant difference in vertical bone resorption between the groups (p < 0.001), and the RB group demonstrated significantly lower resorption than the CB and IB groups (p = 0.011 and p < 0.001, respectively). The most common postoperative complications included neurosensory disturbance in the CB graft and gait disturbance in the IB graft. Out of the 92 implants inserted after augmentation, four implants were lost during the study period, resulting in an implant success rate of 95.65%.ConclusionsThe RB graft might be the most suitable option for vertical augmentation in terms of maintaining postoperative vertical height and reducing morbidity, although the initial gain was greater with the IB graft compared to other block bones.

Leadless Pacemaker Implantation, Focusing on Patients With Conduction System Disorders Post–Transcatheter Aortic Valve Replacement: A Retrospective Analysis

BackgroundImpairment of the conduction system is a common complication of transcatheter aortic valve replacement (TAVR), which is typically performed in elderly patients. A leadless pacemaker (LP) may be a suitable option in this frail population, but the available scientific data concerning the efficacy and safety of leadless pacing after TAVR are sparse. The purpose of this analysis was to evaluate the efficacy and safety of LP implantation in patients with relevant bradycardias after TAVR, compared to other indications. MethodsConsecutive patients were retrospectively enrolled. Demographics, background heart diseases, interventional parameters, and follow-up data were collected. ResultsA total of 257 consecutive patients who underwent LP implantation were included. In 26 patients, the device was implanted due to bradycardias after TAVR (TAVR group), whereas the remaining 231 patients were in the population without previous TAVR (non-TAVR group). The mean implantation duration (56 ± 22 minutes in the TAVR group vs 48 ± 20 minutes in the non-TAVR group; P = not significant [NS]) and the implantation success rate (100% in the TAVR group vs 98.7% in the non-TAVR group; P = NS) were similar in the 2 cohorts. No significant differences occurred in pacing parameters (sensing, impedance, and threshold, respectively) between the 2 groups, either at implantation or during follow-up. A total of 8 major periprocedural complications (3.1% of patients in total; 3.8% in the TAVR group vs 3.0% in the non-TAVR group; P = NS) occurred within 30 days, without significant difference between the 2 groups. ConclusionsLP implantation appears to be safe and effective in patients after TAVR, and therefore, this procedure is a suitable option for this often old and frail population.

Orthodontic tooth extrusion to regenerate missing papilla adjacent to maxillary anterior single implants: A 2- to 7-year retrospective study.

Regeneration of the missing papilla adjacent to single implants in the esthetic zone has always been challenging, despite advances in vertical hard and soft tissue regeneration. Orthodontic tooth extrusion has been shown to effectively gain alveolar bone and gingival tissue. This retrospective study evaluated the effectiveness of orthodontic tooth extrusion on regenerating missing papilla between existing maxillary anterior single implant and its adjacent tooth. Patients who underwent orthodontic tooth extrusion to regenerate missing papilla adjacent to a single implant in the esthetic zone were included in this study. The gingival phenotype, orthodontic extrusion movement, proximal bone level, dento-implant papilla level, facial gingival level, mucogingival junction level, and keratinized tissue width, of the extruded tooth were recorded at pre-orthodontic extrusion (T0 ), post-orthodontic extrusion and retention (T1 ), and latest follow-up (T2 ). A total of 17 maxillary single tooth had orthodontic tooth extrusion to regenerate missing papilla adjacent to 14 maxillary anterior single implants in 14 patients. After a mean follow-up time of 48.4 months, implant success rate was 100% (14/14), with none of the orthodontically extruded teeth being extracted. After a mean extrusion and retention period of 14.3 months, a mean orthodontic extrusion movement of 4.62 ± 0.78 mm was noted with a mean proximal bone level gain of 3.54 ± 0.61 mm (77.0% efficacy), dento-implant papilla level gain of 3.98 ± 0.81 mm (86.8% efficacy), and facial gingival tissue gain of 4.27 mm ± 0.55 mm (93.4% efficacy). A mean keratinized tissue width gain of 4.17 ± 0.49 mm with minimal mean mucogingival junction level change of 0.10 ± 0.30 mm were observed. The efficacy of orthodontic eruption movement on dento-implant papilla gain was less in the thin (80.5%) phenotype group when compared with that in the thick (91.5%) phenotype group. Within the confines of this study, orthodontic extrusion is an effective, noninvasive method in regenerating mid-term stable proximal bone and papilla adjacent to maxillary anterior single implants. This retrospective study presents a mid-term result on orthodontic extrusion as a mean to regenerate dento-implant papilla defect. The extended retention period following orthodontic extrusion showed stable and efficacious proximal bone and papilla gain.

Intracardiac vs Transesophageal Echocardiography for Left Atrial Appendage Occlusion With Watchman FLX in the U.S.

BackgroundIntraprocedural imaging is critical for device delivery in transcatheter left atrial appendage occlusion (LAAO). Although pivotal trials of LAAO devices were conducted using transesophageal echocardiography (TEE), intracardiac echocardiography (ICE) is an emerging imaging modality. ObjectivesThis study compared outcomes after ICE- and TEE-guided Watchman FLX implantation in the SURPASS (SURveillance Post Approval AnalySiS Plan) nationwide LAAO registry. MethodsBaseline characteristics were compared using chi-square and t-tests. Outcomes were reported in unadjusted and adjusted comparisons via propensity weighting. ResultsBetween August 2020 and September 2021, LAAO was attempted in 39,759 patients at 698 sites, including 2,272 cases (5.7%) with ICE and 31,835 (80.0%) with TEE. ICE and TEE patients had similar baseline characteristics and mean procedural times (ICE 82 minutes vs TEE 78 minutes). ICE patients were less likely to receive general anesthesia (54% vs 98%, P < 0.01). Successful device implantation (98.3% vs 97.6%) and complete seal rates at 45 days were similar (n = 25,280; 83% vs 82%). Most adverse event rates were similar; unadjusted mortality rates at 45 days were 1.1% for ICE vs 0.8% for TEE (P = 0.14), and 1.0% vs 0.7% (P = 0.27) in adjusted analyses. Even after adjustment, pericardial effusion rates requiring intervention were significantly higher with ICE at 45 days (1.0% vs 0.5%; P = 0.02). This rate decreased as operators performed more ICE-guided procedures, although 82% of operators had performed <10 ICE-guided procedures overall. ConclusionsIn the largest comparison to date, ICE use was infrequent. ICE and TEE both achieved high rates of complete LAAO. ICE was associated with significantly higher rates of pericardial effusion requiring intervention.

Outcomes of left bundle branch area pacing compared to His bundle pacing as a primary pacing strategy: Systematic review and meta-analysis.

Novel pacing technologies, such as His bundle pacing (HBP) and left bundle branch area pacing (LBBaP), have emerged to maintain physiological ventricular activation. We investigated the outcomes of LBBP with HBP for patients requiring a de novo permanent pacing. Systematic review of randomized clinical trials and observational studies comparing LBBaP with HBP until March 01, 2023 was performed. Random and fixed effects meta-analyses of the effect of pacing technology on outcomes were performed. Study outcomes included pacing metrics, QRS duration, lead revision, procedure parameters, all-cause mortality and heart failure hospitalization (HFH). Overall, 10 studies with 1596 patients were included. Implant success rate was higher in LBBaP compared with HBP (RR 1.24, 95% CI: 1.08 to 1.42, p=.002). LBBaP was associated with lower capture threshold at implantation (mean difference (MD) -0.62V, 95% CI: -0.74 to -0.51V, p<.0001) and at follow-up (MD -0.74V, 95% CI: -0.96 to -0.53, p<.0001), shorter procedure duration (MD -14.66min, 95% CI: -23.54 to -5.78, p=.001) and shorter fluoroscopy time (MD -4.2min, 95% CI: -8.4 to -0.0, p=.05). Compared with HBP, LBBaP was associated with a decreased risk of all-cause mortality (RR: 0.50, 95% CI: 0.33 to 0.77, p=.002) and HFH (RR: 0.57, 95% CI: 0.33 to 1.00, p=.05). No statistical differences were found in lead revisions and QRS duration before and after pacing. This meta-analysis found that LBBaP was superior to HBP regarding pacing metrics and implant success rate as an initial pacing strategy, although absence of head-to-head randomized comparison warrants caution in interpretation of the results.

A 10-year survival rate of tapered self-tapping bone-level implants from medically compromised Korean patients at a maxillofacial surgical unit

BackgroundThe 10-year survival rate of dental implants in healthy subjects is 90–95%. While in healthy individuals, dental implants have become commonplace to solve problems of edentulism, whether dental implant treatment is optimal in patients with systemic disease remains unclear. The purpose of this study is to investigate the clinical outcomes of tapered, sand-blasted, and acid-etched internal submerged dental implants installed in medically compromised patients in our maxillofacial surgical unit.MethodsA total of 1019 Luna® dental implants were placed in 333 patients at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. Kaplan–Meier survival estimates after 10 years of follow-up were computed for healthy vs. medically compromised patients.ResultsThe 10-year follow-up survival rate of 1019 Luna® dental implants in the Korean maxillofacial surgical unit was 97.0% with a mean follow-up of 41.13 ± 35.13 months (0–120 months). The survival rate was 97.0%, in which 31 implants were failed during the follow-up. Cumulative 10-year implant survival rates were 99.4% in healthy individuals without systemic disease and 95.9% in patients with systemic disease.ConclusionsComparable success and survival rates were achieved with those of implants in healthy patients. Preoperative general health assessments including laboratory test results and checking the previous medication records are essential in diagnosing any unrecognized conditions for improved implant success rates in medically compromised patients.

Long-Term Efficacy of Chlorhexidine Gel in Single-Crown Implant Rehabilitation: A Five-Year Follow-Up Study.

Chlorhexidine digluconate (CHX) has shown the ability to significantly reduce inflammation and marginal bone loss (MBL) at the 1-year follow-up but limited data exist regarding its long-term efficacy in peri-implant stability. The objective was to compare the long-term effects (5 years of follow-up) of a placebo gel (16 patients in Group A) or a 0.20% CHX gel (15 patients in Group B) used at each previous surgical and prosthetic stage. Control visits were conducted in 2022, investigating the long-term effects by biological, radiological, and clinical evaluation. The data were statistically analyzed. The research achieved a 96.7% implant success rate over five years, but 41.9% of patients did not attend annual oral hygiene check-ups. The average MBL was 1.04 ± 0.39 mm, with no significant differences between the two groups. Notably, patients who attended regular periodontal check-ups experienced significantly less MBL than those who did not (p < 0.05). At five years, direct effects of CHX were absent, with both groups showing moderate bone loss. However, the results suggest that early disinfection could enhance both short- and long-term outcomes. In fact, patients with initial minor MBL due to use of CHX, preserve this advantage also after 5 years of follow-up. Additionally, the data underscore the importance of annual check-ups in early detection and management of biological complications.

Changing trends in implant designs: A review

Implantology is an ever-evolving scientific field that undergoes continuous refinement and innovation. Dedicated research and development efforts are focused on consistently improving the success rates of implants through innovative redesign and advancements. The introduction of advanced technologies has revolutionized the evaluation of patients in three dimensions, enabling clinicians to utilize precise and predictable approaches for diagnosis, planning, and treatment. This multidisciplinary patient-centric framework has opened new avenues for providing tailored and effective healthcare solutions. Therefore, it is of utmost importance for clinicians to conduct a comprehensive analysis of each patient's condition, ensuring meticulous selection of the suitable implant design and material, and making informed decisions regarding the most appropriate technique to be employed.

Instantaneous dental implant loading technique by fixed dentures: A retrospective cohort study.

In the context of dental prostheses, splinting multiple implants together may improve their stability. The approach may be especially favorable when performing immediate loading procedures, increasing the implant osseointegration rate, and reducing the risk of implant and prosthetic failure. The instantaneous loading technique (ILT) involves creating a metal framework to splint the implants by intraorally welding them pair-by-pair, using purposefully created abutments. The aim of the study was to investigate the prosthetic success when using ILT to rehabilitate partially edentulous patients through immediately loaded prostheses. Clinical records of patients treated with ILT were retrospectively assessed, and the prosthetic success rate was analyzed in terms of fractures, chipping, unscrewing, screw fracture rate, and mucositis. Furthermore, the implant success rates were evaluated by measuring marginal bone loss (MBL). A total of 55 patients (20 males and 35 females with a mean age of 59.8 ±9.4 years), corresponding to 66 prostheses, were included. A total of 160 implants were placed. At the last follow-up (39.6 ±28.4 months), 1 patient (1.8%; 1 prosthesis (1.5%)) showed the fracture of the prosthesis material. Peri-implantitis affected 4 implants (2.5%), and 4 more implants (2.5%) showed radiolucency, affecting 5 patients (9.1%). Two other patients (3.6%) suffered from mucositis. The implant success rate, according to the Albrektsson and Zarb criteria, was 94.4%. No implants were lost. The mean MBL values at the implant level, the prosthesis level and the patient level were 0.28 ±0.56 mm, 0.30 ±0.51 mm and 0.33 ±0.54 mm, respectively. The instantaneous loading technique appears to be a viable approach to rehabilitating partially edentulous patients through immediate loading.

Safety and efficacy of His-Purkinje system pacing in the treatment of patients with atrial fibrillation and heart failure: a systematic review and meta-analysis.

To evaluate the safety and efficacy of the His-Purkinje system pacing (HPCSP) in the treatment of individuals with atrial fibrillation (AF) complicated by heart failure (HF). The PubMed, Cochrane Library, Web of Science, and Embase databases were searched through September 1, 2022. The literature was initially screened based on the inclusion and exclusion criteria. The baseline characteristics of the subjects, implantation success rate, New York Heart Association (NYHA) classification, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), QRS duration, pacing threshold, and impedance were extracted and summarized; statistical analysis was performed using RevMan 5.3 software. In all, 22 articles were included, involving 1,445 patients. Compared to biventricular pacing (BiVP), HPCSP resulted in improved cardiac function, including increased ejection fraction (MD = 5.69, 95% CI: 0.78-10.60, P = 0.02) and decreased LVEDd (MD = -3.50, 95% CI: -7.05-0.05, P = 0.05). It was also correlated with shorter QRS duration (MD = -38.30, 95% CI: -60.71--15.88, P < 0.01) and reduced all-cause mortality and rehospitalization events (RR = 0.72, 95% CI: 0.57-0.91, P < 0.01) in patients. Left bundle branch pacing (LBBP) lowered the pacing threshold (MD = 0.47; 95% CI: 0.25-0.69; P < 0.01), and there was no statistical difference in the rate of endpoint events when comparing these two physiologic pacing modalities (RR = 1.56, 95% CI: 0.87-2.80, P = 0.14). The safety and efficacy of HPCSP in patients with AF and HF were verified in this meta-analysis. HPCSP can reverse cardiac remodeling and has great clinical application value. Relatively speaking, His-bundle pacing (HBP) can maintain better ventricular electro-mechanical synchronization, and the pacing parameters of LBBP are more stable. PROSPERO (CRD42022336109).

Evaluation of UV photofunctionalization effect on ultrastructural properties of SLA titanium disks: An in vitro study.

The success rate of dental implants diminishes over time; the lack of osseointegration and infection are the major causes of most implant failures. One of the effective methods to improve the surface properties is to irradiate ultraviolet (UV) light. This study investigated the effect of UV photofunctionalization on the ultrasuperficial properties of sandblasted, large-grit, acid-etched (SLA) titanium discs. In this in vitro study, 24 sandblasted and acid-etched titanium discs, with a lifespan of more than four weeks, were categorized into three groups (n=8): control, ultraviolet C (UVC), and ultraviolet B (UVB). Then, they were exposed to a UV light source for 48 hours at a 1-cm distance. In addition to measuring the contact angle between the liquid and the disc surface in each of the three groups, the atomic concentrations of carbon, oxygen, and nitrogen atoms were measured at three different sites on each disc. One-way ANOVA and post hoc Tukey tests were used to analyze data. The mean concentration of carbon atoms significantly differed in the control, UVC, and UVB groups (P<0.001). The mean concentrations of nitrogen atoms differed significantly between the three groups (P<0.001). However, the mean concentrations of oxygen atoms were not significantly different between the three groups. In examining the contact angle, wettability was higher in the UVC group than in the UVB group and higher in the UBV group than in the control group. Photofunctionalization with UV light significantly decreased carbon and nitrogen concentrations on the surface of titanium implants, indicating that the implant's superficial hydrocarbons were eliminated. It was observed that UVC photofunctionalization was more effective than UVB photofunctionalization in reducing superficial contamination and improving wettability.

A preliminary study of minimal left atrial appendage occlusion using Watchman under the guidance of fluoroscopy.

Left atrial appendage occlusion (LAAO) has been considered an alternative treatment to prevent embolic stroke in patients with nonvalvular atrial fibrillation (NVAF). However, it carries a risk of general anesthesia or esophageal injury if guided by transesophageal echocardiography (TEE). We aimed to investigate the feasibility and safety of minimal LAAO (MLAAO) using Watchman under fluoroscopy guidance alone in patients with NVAF. A total of 249 consecutive patients with NVAF who underwent LAAO using the WATCHMAN device were divided into two groups: the Standard LAAO (SLAAO) group and the MLAAO group. Procedural characteristics and follow-up results were compared between the two groups. There was no statistically significant difference in the rate of successful device implantation (p > 0.05). Fluoroscopy time, radiation exposure dose, and contrast medium usage in the MLAAO group were higher than those in the SLAAO group (p < 0.001). The procedure time and hospitalization duration were significantly lower in the MLAAO group than those in the SLAAO group (p < 0.001). The occluder compression ratio, measured with fluoroscopy, was lower than that measured with TEE (17.63 ± 3.75% vs. 21.69 ± 4.26%, p < 0.001). Significant differences were observed between the SLAAO group and the MLAAO group (p < 0.05) in terms of oropharyngeal/esophageal injury, hypotension, and dysphagia. At 3 months after LAAO, the MLAAO group had a higher incidence of residual flow within 1-5 mm compared to the SLAAO group, although the difference was not statistically significant. MLAAO guided by fluoroscopy, instead of TEE, without general anesthesia simplifies the operational process and may be considered safe, effective, and feasible, especially for individuals who are unable to tolerate or unwilling to undergo TEE or general anesthesia.

Intrauterine instillation of human chorionic gonadotropin at the time of blastocyst transfer: Systematic review and meta-analysis

Intrauterine instillation (IU) of Human Chorionic Gonadotropin (hCG) before embryo transfer (ET) has been proposed to enhance implantation success rates. This is the first meta-analysis to evaluate the effect at the blastocyst-stage. A systematic literature search was performed using Medline, Embase, Cochrane Library and Google. Randomized clinical trials (RCTs) were included. The primary outcome combined live birth rate (LBR) and ongoing pregnancy rate (OPR). The secondary outcomes were clinical pregnancy rate (CPR), implantation rate (IR) and miscarriage rate (MR). 93 citations were identified, of which there were seven eligible RCTs. 2499 participants were included in the meta-analysis; 1331 were assigned to an experimental group and 1168 were assigned to the control group. The overall effect of IU hCG instillation on LBR and OPR was not significant: risk ratio (RR) 1.00 (95% CI, 0.90–1.12). Analysis of secondary outcomes found the effect of IU hCG instillation was not significant. Analysis of the data suggests that the studies conducted have too much heterogeneity to identify whether a specific cohort may have a significant benefit. The findings of this meta-analysis demonstrate that there is insufficient evidence at present to support the use of IU hCG instillation prior to blastocyst-stage ET.

Success rate of immediately loaded implants in the posterior zone.

Dental implants are considered an ideal treatment for a missing single tooth. Immediate loading of implants can hasten the procedure, providing comfort to the patients. Recently, immediate loading of implants has gained much importance as it helps hasten the procedure and provides more comfort to patients. A previous systematic review published 5 years ago compared the success rates between immediate and conventional loading. There are several factors that influence the success rate of implants that were not discussed in detail in the previous review. Hence, the present systematic review is done to report differences in the outcomes from single implant restorations of missing teeth in the posterior region in patients who were subjected to immediate loading and conventional loading. A follow up for 1 year was done. Electronic databases of Medline, Scopus, and Web of Science were searched for publications in the English Language during May 2021. The search results yielded 306 articles, out of which 225 were excluded based on title and abstract screening. Screening of the remaining 81 full text articles yielded 14 original research articles that satisfied the predefined inclusion criteria. Meta analysis was not possible due to the heterogeneity of the data. The overall success rate of the immediate loading of a single implant is 94.31%. Implants in the maxillary region had a higher survival rate than those in the mandibular region. The age range between 18 and 80 years showed good prognosis and outcomes in older individuals. Good oral hygiene was emphasized for all patients to prevent any secondary conditions or delays in healing.