Long-term Outcomes Of Surgical Treatment Research Articles

Comparison of Long-Term Outcomes of Surgical Treatment of Human Papillomavirus-Dependent Neoplastic Lesions in Patients With Chronic Immunosuppression After Allogenic Organ Transplantation and Patients With Primary or Acquired Immunodeficiency—A One-Center Experience

Immunodeficiency predisposes to severe manifestations of human papillomavirus (HPV) infection, including extensive, recalcitrant anogenital lesions and their progression towards carcinomas. This holds for primary and acquired immunodeficiencies, and post-transplant immunosuppressive therapy. About 50% to 90% of patients receiving chronic immunosuppression after allogenic transplantation develop HPV-associated lesions within 4 to 5 years, comprising 10% to 15% of patients presenting with (pre)cancerous HPV-dependent anogenital lesions. Immunodeficiency is one of the highest risk factors associated with severe clinical manifestations of HPV-associated cancers. The primary objective of this work is to compare the long-term therapeutic effectiveness of surgical intervention for HPV-dependent lesions in transplant recipients undergoing chronic immunosuppression and patients burdened with primary or acquired immunodeficiencies. Two groups of 30 patients (selected for most extensive presentations of HPV-dependent neoplastic anogenital lesions), who underwent surgical treatment of these lesions were followed up for 3 to 5 years. The first group comprised patients who qualified and underwent kidney or liver transplantation (10 for a rare disease indication) and are under chronic immunosuppressive regimens. The second group comprised patients burdened by primary or acquired immunodeficiency (15 each). The recurrence rate in the follow-up period was the primary compared parameter. The recurrence rate was higher in the second group, amounting to >15%. For the first group a <5% recurrence rate was observed for recipients without rare disease indications, compared to <15% for recipients with such indications. The importance of rapid surgical intervention and the need for postoperative monitoring for recurrence is highlighted. Chronic immunosuppression demonstrates high relative safety and efficacy in terms of HPV-dependent anogenital lesion recurrence.

Mid- and long-term results of surgical treatment of brachiocephalic Takayasu arteritis

Objective: To examine the mid - and long-term outcomes of surgical treatment of brachiocephalic Takayasu arteritis. Methods: This is a retrospective case series study. The clinical data of 39 patients,which had been diagnosed as brachiocephalic Takayasu arteritis (244 cases),who underwent surgical treatment,were analyzed between July 2012 to November 2022 at Department of Endoluminal Vascular Surgery, the First Affiliated Hospital of Zhengzhou University. There were 5 males and 34 females, aged (37.9±14.0)years (range:13 to 71 years). Despite medical treatment, the patients suffered severe ischemic symptoms continually and then underwent surgical interventions. Among them, 20 patients underwent endovascular procedures, 11 underwent open surgical procedures, and 8 underwent hybrid procedures. Patients were followed up through outpatient visits at 1, 3, 6 months after surgery and once every year later. Follow-up was conducted until November 2022. Operation status, postoperative complications and re-intervention of patients were recorded and the Kaplan-Meier survival curves were used to analyze postoperative vascular patency rates. Results: All 39 surgeries were successful, with no intraoperative death or serious complications. The follow-up period was (48.8±38.2) months(range:1 to 123 months). Thirty-three patients experienced symptom relief after surgery, and 6 patients required secondary surgical interventions. The patency rates for the endovascular treatment group at 1-, 3-, 5-, and 10-year were 95.0%, 75.2%, 60.2%, and 60.2%, respectively, while the patency rates for open surgery were all 90.9%. In the hybrid surgery group, the patency rates at 1-, 3-, 5-, and 8-year were all 87.5%. Conclusion: For patients with brachiocephalic Takayasu arteritis, choice of an appropriate blood flow revascularization intervention should be based on the patient's condition,and the mid-and long-term outcomes are satisfactory.

Short- and long-term outcomes of surgical treatment in patients with intestinal Behcet's disease.

Behcet's disease (BD), a chronic vasculitic disorder affecting multiple organs, is characterized by recurrent oral and genital ulcers, arthritis, vasculitis, and intestinal ulcers. Although intestinal involvement of BD is common in East Asia, the efficacy and long-term outcomes of surgical treatment of intestinal BD still remain to be established. To evaluate the postoperative clinical course of intestinal BD and determine factors associated with its recurrence. Data from patients who underwent surgical treatment for intestinal BD between January 2010 and August 2021 were retrospectively reviewed. Patients' demographics, clinical features, postoperative course, complications, and follow-up data were evaluated. We analyzed 39 surgeries in 31 patients. The mean patient age was 45.1 years, and the mean interval between the diagnosis of intestinal BD and surgical treatment was 4.9 years (range 1.0-8.0 years). The most common indication for surgery was medical intractability (n = 16, 41.0%), followed by fistula or abscess (n = 11, 28.2%). Laparoscopic approaches were used in 19 patients (48.7%), and 5 patients (12.8%) underwent emergency surgeries. The most common surgical procedure was ileocecal resection (n = 18, 46.2%), followed by right colectomy (n = 11, 28.2%). A diverting stoma was created in only one patient (2.6%). During a mean follow-up period of 45 (range 8-72) months, eight cases (20.5%) of recurrence in five patients required reoperation. The interval between operations was 12.1 months (range 6.3-17.8 mo). Four patients (10.3%) experienced recurrence within 1 year postoperatively, and all eight recurrences occurred within 2 years of the initial surgery. The reoperation rates at 1 and 3 years were 10.3% and 20.5%, respectively. A redo ileocolic anastomosis was performed in all recurrent cases. In multivariate Cox regression analysis, emergency surgery [hazard ratio (HR) 9.357, 95% confidence interval (CI): 1.608-54.453, P = 0.013] and elevated C-reactive protein (CRP) levels (HR 1.154, 95%CI: 1.002-1.328, P = 0.047), but not medication use, were predictors of recurrence. Surgical resection is a feasible treatment option for complicated BD. Reoperation is associated with severe inflammatory conditions, reflected by increased CRP levels and the requirement for emergency surgery.

The Association of Tobacco Smoking and Level of Apoptosis in the Long Head of the Biceps Chronic Tendinopathy—An Immunohistochemical Study

Background: The substances present in cigarette smoke have a negative impact on cellular integrity and metabolism, can reduce blood flow to tissues, and can disrupt collagen synthesis. Ultimately this can lead to cell death, which clinically may result in impaired tendon healing and the onset of chronic tendinopathy. Within the shoulder, the exact association between the extent of apoptosis in the long head of the biceps (LHB) tendon and harmful factors like cigarette smoke remains unclear. Objectives: The purpose of this study was to investigate the connection between smoking, the degree of apoptosis in LHB tendinopathy, and the long-term outcomes of surgical treatment. Design: Observational, retrospective study. Methods: This study included 22 consecutive patients who had undergone arthroscopic biceps tenodesis or tenotomy for symptomatic LHB tendinopathy with or without concomitant rotator cuff tears (RCT). The intra-articular LHB tendon remnants were histologically examined by measuring the level of expression of apoptotic cell markers such as BCL2, cleaved caspase 3, and p53. Pre- and postoperative clinical outcomes were analyzed by collecting patient report outcome measures such as the American Shoulder and Elbow Surgeons (ASES) score and the Visual Analogue Scale (VAS) for pain. Results: The smokers group had a mean pack-year history of 13.12 (SD = 9.94), mean number of cigarettes per day of 14.77 (SD = 4.64), and a mean smoking duration of 16.38 (SD = 10.1) years. Among the smoking indexes, the number of cigarettes per day showed a positive correlation with Snyder classification (p = 0.0459, rho = 0.3682). Non-smokers and smokers did not show a statistically significant difference in the expression indexes of BCL2, cleaved caspase 3, or p53 (p = 0.4216, p = 0.5449, p = 0.5613, respectively). However, the cleaved caspase 3 expression index showed a negative correlation with the severity of rotator cuff lesions in the total population (p = 0.0193, rho = −0.4651). Conclusions: While apoptotic processes in the LHB tendon were observed, no significant association was found between tobacco smoking, the extent of apoptosis, and clinical outcomes. However, the expression of the apoptotic marker cleaved caspase 3 correlated with the severity of rotator cuff pathology. Furthermore, active smoker status was associated with worse clinical outcomes in terms of pain following LHB tenodesis or tenotomy.

Long-term outcomes of surgical treatment for cataract and asteroid hyalosis

Aim – to assess long-term surgical treatment outcomes and subjective level of satisfaction in patients with cataract and asteroid hyalosis.&#x0D; Material and methods. The study involved 120 patients (120 eyes) diagnosed with cataract and asteroid hyalosis. During the study, the patients were randomly assigned into 3 equivalent groups of 40 people each, depending on the surgical treatment method. Group I was formed of patients after phacovitrectomy through posterior capsulorhexis, group II included patients after total three-port phacovitrectomy, group III - patients after cataract phacoemulsification. Before the surgery, on the day of discharge, 1, 3 and 6 months after the operation, all patients received standard ophthalmological check-up and answered validated visual function questionnaire "The Visual Function test" (VF-14) assessing their subjective perception of life quality.&#x0D; Results. Visual acuity was comparable in all groups up to 1-3 months after surgery. The subjective level of satisfaction was significantly higher in patients after phacovitrectomy (groups I and II), regardless of the time passed after the operation. Some patients of group III applied for surgical treatment again due to unsatisfactory results of the previous operation.&#x0D; Conclusion. In patients with cataract with underlying vitreous destruction in the form of asteroid hyalosis, it is recommended to perform phacovitrectomy in order to achieve high functional result, as well as to improve the patient's subjective feeling of the life quality.

Long-term outcome of surgical treatment for idiopathic spinal arachnoid web: A case series

ObjectiveSpinal arachnoid web (SAW) is a rare condition of the spine with limited long-term follow-up data in the literature. The longest reported follow-up period was an average 3.2 years. The objective of this study is to report our long-term results of patients who underwent surgical treatment for symptomatic idiopathic SAW. MethodsWe conducted a retrospective review of cases of idiopathic SAW that were operated between 2005–2020. We collected preoperative and last follow-up (LFU) data on motor force, sensory loss, pain, upper motor neuron (UMN) sign, gait disorder, sphincter dysfunction, syringomyelia, hyperintensity on T2-MRI, appearance of newer symptoms and number of reoperations. ResultsOur study included 9 patients with a mean follow-up period of 3.6years (range 2–9.1years). The surgical intervention involved a standard centered laminectomy, durotomy and arachnoid lysis. At presentation, motor weakness was present in 77.8% of patients, sensory loss in 66.7%, pain in 88.9%, sphincter dysfunction in 33.3%, UMN sign in 22%, gait disorder 55.6%, syringomyelia in 55.6% and MRI T2 hyperintensity in 55.6% of patients. At LFU, there was an improvement in all symptoms and signs to varying degrees. No new neurological symptoms appeared postoperatively, and there was no recurrence during the follow-up period. ConclusionOur results demonstrate that the reported immediate and short-term favorable outcomes following arachnoid lysis for symptomatic SAW persist over a long-term period and the risk of readhesion-correlated neurological deterioration following conventional surgical intervention is low.

Meta-analysis of Randomized Clinical Trials on Long-term Outcomes of Surgical Treatment of Perforated Diverticulitis.

To assess long-term outcomes of patients with perforated diverticulitis treated with resection or laparoscopic lavage (LL). Surgical treatment of perforated diverticulitis has changed in the last few decades. LL and increasing evidence that primary anastomosis (PRA) is feasible in certain patients have broadened surgical options. However, debate about the optimal surgical strategy lingers. PubMed, Scopus, and Web of Science were searched for randomized clinical trials (RCT) on surgical treatment of perforated diverticulitis from inception to October 2022. Long-term reports of RCT comparing surgical interventions for the treatment of perforated diverticulitis were selected. The main outcome measures were long-term ostomy, long-term complications, recurrence, and reintervention rates. After screening 2431 studies, 5 long-term follow-up studies of RCT comprising 499 patients were included. Three studies, excluding patients with fecal peritonitis, compared LL and colonic resection, and 2 compared PRA and Hartmann procedures. LL had lower odds of long-term ostomy [odds ratio (OR) = 0.133, 95% CI: 0.278-0.579; P < 0.001] and reoperation (OR = 0.585, 95% CI: 0.365-0.937; P = 0.02) compared with colonic resection but higher odds of diverticular disease recurrence (OR = 5.8, 95% CI: 2.33-14.42; P < 0.001). Colonic resection with PRA had lower odds of long-term ostomy (OR = 0.02, 95% CI: 0.003-0.195; P < 0.001), long-term complications (OR = 0.195, 95% CI: 0.113-0.335; P < 0.001), reoperation (OR = 0.2, 95% CI: 0.108-0.384; P < 0.001), and incisional hernia (OR = 0.184, 95% CI: 0.102-0.333; P < 0.001). There was no significant difference in odds of mortality among the procedures. Long-term follow-up of patients who underwent emergency surgery for perforated diverticulitis showed that LL had lower odds of long-term ostomy and reoperation, but more risk for disease recurrence when compared with resection in purulent peritonitis. Colonic resection with PRA had better long-term outcomes than the Hartmann procedure for fecal peritonitis.

Long-term outcomes of treating rhegmatogenous retinal detachment with macular hole using platelet-rich blood plasma

The study analyzed the long-term outcomes of surgical treatment of rhegmatogenous retinal detachment (RRD) complicated by macular hole (MH) using platelet-rich plasma (PRP) and local staining of the internal limiting membrane (ILM). This prospective open-label study included 27 patients (15 females and 12 males) aged 57 to 65 (59.2±7.2) years. In all studied cases, RRD complicated by MH was determined. The best corrected visual acuity (BCVA) before surgery was 0.05±0.01 (from 0.02 to 0.08). The average MH diameter measured with OCT was 576.3±150.4 μm (409 μm to 944 μm). After vitrectomy, a perfluororganic compound (PFOC) was injected into the MH area in amount of 2-3 optic nerve head diameters to prevent the ingress of dye under the retina, then the internal limiting membrane (ILM) was stained and removed. After sequential PFOC/air replacement, PRP was injected into the macular hole site. An increase in BCVA from 0.05±0.01 to 0.09±0.03 was observed in the preoperative period one month after surgery, with a further increase to 0.35±0.11 at the maximum follow-up time (two years). The MH was blocked and a glial scar was present in all cases according to OCT data. 1-2 years after the operation, all patients showed a favorable anatomical effect according to OCT data. According to computer microperimetry data, mean macular photosensitivity was 23.8±1.3 dB two years after the surgery. This study shows a favorable anatomical and functional effect in patients with RRD and MH within a 2-year follow-up. A comparative study involving a larger cohort of patients is required to clarify the indications and contraindications for the use of the studied technique.

Prospects for the use of autofluorescence endoscopy in rhinosurgery

To assess the possibility of using autofluorescence endoscopy to control the condition of flaps of the nasal mucous membrane after surgical interventions. The assessment of the processes of biological destruction of 15 fragments of the mucous membrane of the inferior nasal concha, obtained during intranasal interventions with endoscopic technique in autofluorescence mode, followed by histological examination at different periods of observation, has been conducted. The results of the proposed method were tested in 84 patients with chronic and intraoperative defects of the nasal septum after the surgical intervention. It has been shown that autofluorescence endoscopy can be used to assess the viability of flaps of the nasal cavity's mucous membrane. A change of the autofluorescence signal to a whitish and orange shades indicates the presence of ischemia and necrosis. Method sensitivity was 92.3%, specificity was 95.8% and total accuracy was 95.4%. This method is promising for predicting the long-term outcomes of surgical treatment of the nasal septum's perforation in relation to the risk of reperforation forming, as well as for assessment of the functional viability of local flaps in plastic reconstruction of defects of the anterior skull base.

Predictors of Total Hip Arthroplasty Following Pediatric Surgical Treatment of Developmental Hip Dysplasia at 20-Year Follow-Up.

Long-term outcomes of surgical treatment for pediatric developmental dysplasia of the hip (DDH) are not well defined. The purpose of this study was to report long-term radiographic and clinical outcomes, survivorship free of total hip arthroplasty (THA), and predictors of subsequent THA following childhood treatment of DDH. This study was a single-institution retrospective review of hips treated for DDH with closed or open reduction at a minimum 10-year follow-up. 107 patients (119 hips) were included with a mean patient age of 3.3 years at childhood treatment. At mean 30.5 years follow-up, 24 hips had undergone THA (20%). Mean patient age at time of THA was 33.5 years. None of the hips treated with closed reduction alone required THA, whereas 8 hips treated with open reduction (25%) underwent THA. Hips with patient age > 4 years at the time of treatment had lower survivorship at 35 years follow-up (50% vs. 85%; p < 0.001). Additionally, femoral osteotomy (OR 2.0, p < 0.001), and previous treatment elsewhere (27% vs. 16%; p < 0.01) were associated with subsequent THA. Early referral and appropriate intervention may prove important, as age and prior treatment were predictive of subsequent THA.

Parasagittal meningiomas: surgical treatment outcomes

Purpose: to improve the outcomes of surgical treatment of parasagittal meningioma patients by implementing a differentiated approach to the choice of surgical intervention, given the preoperative assessment of patency of the superior sagittal sinus (SSS) and collateral venous circulation. Materials and methods. Analysis of short-term and long-term outcomes of surgical treatment of 199 patients in the Department of Neurosurgery № 2, Mechnikov Dnipropetrovsk Regional Clinical Hospital was carried out. In the first follow-up period (2000 to 2012), the data were obtained retrospectively (95 cases). In the second follow-up period (2013 to 2021), the data were obtained prospectively (104 cases). The patients were assigned to the groups according to a differentiated approach (implemented in 2013) to the choice of surgical treatment tactics based on preoperative angiographic data (selective cerebral angiography and CT angiography). Results. In the first follow-up period, the completeness of surgical resection according to Simpson Grading Scale was: type I, 23 (24.2%) cases; type II, 37 (38.9%) cases; type III, 13 (13.7%) cases; type IV, 22 23.2%) cases. 53.7% of patients had intraoperative or postoperative complications. Among patients with tumors of the middle third of the SSS, 21 (41.2%) had their neurological status improved postoperatively. Mortality rate was 4.2%. 14 (14.7%) patients had further parasagittal meningioma growth after its removal grade II–IV according to Simpson Scale. In the second follow-up period, the completeness of surgical intervention according to Simpson Scale was: type I, 74 (71.2%) cases; type II, 26 (25%) cases; type III, 2 (1.9%) cases; type IV, 2 (1.9%) cases. 19.2% of patients had intraoperative or postoperative complications. Among the patients with tumors of the middle third of the SSS, 46 (79.3%) patients had postoperative improvement of neurological status. No lethal outcome was reported. 3 (2.9%) patients had further parasagittal meningioma growth after radical surgical removal according to Simpson grade II. Conclusions. Adequate analysis of instrumental methods of brain study using cerebral vasculature study, application of neuronavigation station (with brain MRI and/or CT angiography data available) and new microsurgical techniques contributed to the completeness of surgery and minimally invasive removal of parasagittal meningioma with reduced intraoperative and postoperative complications, which affected the immediate and long-term treatment outcomes.

Mid-Long-Term Outcomes of Surgical Treatment of Legg-Calvè-Perthes Disease: A Systematic Review.

Background: Legg–Calvè–Perthes disease (LCPD) is a common childhood disease that usually occurs in 4- to 12-year-old children. Surgical treatment consists of femoral, pelvic, or combined osteotomies. This comprehensive review aimed to investigate the mid- and long-term outcome of the surgical treatment. Methods: A systematic review of PubMed, Science Direct, and MEDLINE databases was performed by two independent authors, using the keywords “outcome”, “surgical treatment”, “pelvic osteotomy”, “femoral osteotomy”, and “Legg–Calvè–Perthes disease” to evaluate studies of any level of evidence that reported the surgical outcome of LCPD. The result of every stage was reviewed and approved by two senior investigators. Results: A total of 2153 articles were found. At the end of the screening, we selected 23 articles eligible for full-text reading according to the inclusion and exclusion criteria. Our analysis showed that the main prognostic factors for surgical outcome in patients with LCPD are the age at onset and the degree of initial disease severity. Conclusions: Surgical treatment in patients older than 6 years has excellent results in Herring B and B/C hips and poor results in Herring C hips, with a slight advantage for patients between 6 and 8 years old.

Septal Thickness Does Not Impact Outcome After Hypertrophic Obstructive Cardiomyopathy Surgery (Septal Myectomy and Subvalvular Mitral Apparatus Remodeling): A 15-Years of Experience.

BackgroundThe aim of this study was to assess the impact of septal thickness on long-term outcomes of surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM) and correction of mitral subvalvular anomalies.MethodsSixty-six consecutive patients (58 ± 12 years, 56% female) undergoing extended septal myectomy and subvalvular mitral apparatus remodeling from 2007 to 2021 were retrospectively reviewed. Patients were divided into 2 groups according to septal thickness: moderate [< 18 mm, 29 patients (44%)] and severe [≥ 18 mm, 37 patients (56%)]. End points included survival, symptom improvement, reduction of left ventricle outflow tract (LVOT) gradient, resolution of mitral regurgitation (MR), and reoperation.ResultsThe mean interventricular septal thickness was 19 ± 3 mm, 15.8 ± 0.8 mm in patients with moderate and 21.4 ± 3.2 mm in those with severe hypertrophy. Preoperative data, intraoperative variables, postoperative complication rates, pre-discharge echocardiographic and clinical parameters did not differ between the two study groups [except for procedures involving the posterior mitral leaflet (p = 0.033) and septal thickness after myectomy (p = 0.0001)]. Subvalvular apparatus remodeling (secondary chordae of mitral valve resection and papillary muscle and muscularis trabecula procedures including resection, splitting, and elongation) was invariably added to septal myectomy (100%). Four (6%) procedures involved the posterior mitral leaflets. Mitral valve replacement was carried out in two patients (3%, p = 0.4). Reoperation for persistent MR was necessary in one patient (1%, p = 0.4). Neither iatrogenic ventricular septal defect nor in-hospital mortality occurred. During follow-up (mean 4.8 ± 3.8 years), two deaths occurred. NYHA class was reduced from 2.9 ± 0.7 to 1.6 ± 0.6 (p < 0.0001), the LVOT gradient from 89.7 ± 34.5 to 16.3 ± 8.8 mmHg (p < 0.0001), mitral valve regurgitation grade from 2.5 ± 1 to 1.2 ± 0.5 (p < 0.0001), and septal thickness from 18.9 ± 3.7 to 13.9 ± 2.7 mm (p < 0.0001).ConclusionsRegardless of septal thickness, subvalvular apparatus remodeling with concomitant septal myectomy can provide satisfactory long-term outcomes in terms of symptom improvement, LVOT obstruction relief, and MR resolution (without mitral valve replacement in most cases) in patients with HOCM.

Surgical Outcomes of Total Anomalous Pulmonary Venous Connection Repair

Background and Objectives: Over the years, surgical repair of total anomalous pulmonary venous connection (TAPVC) outcomes have improved, however, morbidity and mortality still remain significant. This study aims to assess the early and long-term outcomes of surgical treatment of TAPVC children, operated on between 2006 and 2016, in one pediatric center in Poland. Materials and Methods: Diagnostics, surgical treatment, and follow-up data from 83 patients were collected. In addition, survival and risk factor analyses, control echocardiographic, and electrocardiographic examinations were performed. Results: In the analyzed group (n = 83), there were seven hospital deaths (within 30 days after the operation) (8.4%) and nine late deaths (10.8%). The mean follow-up time was 5.5 years, and, for patients who survived, it was 7.1 years. The mean survival time in patients with completed follow-up (n = 70) was 10.3 years; the overall five-year survival rate was 78.4%. Independent mortality risk factors were type I TAPVC, single ventricle physiology, time from admission to operation, intensive care unit stay, postoperative hospital stay, and temporary kidney insufficiency requiring dialysis. Conclusions: The presence of single ventricle physiology and the supracardiac subtype of TAPVC might be negative prognostic factors, while normal heart physiology presents with good post-repair results. This study indicates that cardiac arrhythmias may occur. Morbidity and mortality, related to surgical TAPVC correction, still remain significant.

Surgical treatment of hypertrophic obstructive cardiomyopathy in relatively elderly patients: Short- and long-term outcomes.

Our goal was to assess the short- and long-term outcomes of surgical treatment for hypertrophic obstructive cardiomyopathy in patients ≥65 years of age compared to patients &lt; 65 years of age. Sixty-four patients aged ≥65 years, surgically treated for symptomatic hypertrophic obstructive cardiomyopathy, were compared to a control group of 125 patients &lt;65 years. Patients aged ≥65 years were less frequently male (36% vs 68%, P &lt; 0.001) and had higher EuroSCORE II scores [1.4 (1.1-2.2) vs 0.8 (0.7-1.2), P &lt; 0.001], lower risk of sudden death, higher pulmonary artery pressure [40 (30-50) vs 30 (30-43), P = 0.04) and more mitral annulus calcifications (44% vs 14%, P &lt; 0.001) compared to younger patients.Hospital death was 1%, with no difference between the 2 groups (1.5% vs 0.8%, P = 0.9).Patients aged ≥65 years had more concomitant coronary bypass grafting (12% vs 5%, P = 0.05) and a higher incidence of blood transfusions (50% vs 17%, P &lt; 0.001) and postoperative atrial fibrillation (19% vs 8%, P = 0.02).Follow-up was 98% complete [median 8.3 (5.3-12.8) years]. The 13-year survival in the group aged ≥65 was 54 (SD: 9) % vs 83 (SD: 5) % in the control group (P &lt; 0.001), but it was comparable to that expected in the age-sex matched general national population.At 13 years, the cumulative incidence function of cardiac death in the elderly group was 19 (SD: 7)%, mostly unrelated to hypertrophic cardiomyopathy causes.At the last follow-up, 90% of patients were in New York Heart Association functional class I-II and 68% were in sinus rhythm. Selected elderly symptomatic patients with hypertrophic obstructive cardiomyopathy can benefit from surgery, with low hospital mortality and morbidity, relief of symptoms and late survival comparable to that expected in the age-sex matched general population.

Early and long-term outcomes of surgical treatment of patients with drug-resistant epilepsy

Epilepsy surgery is effective in 30–85% of patients with drug-resistant epilepsy. However, risk factors associated with favorable and unfavorable outcomes of epilepsy surgery need to be further evaluated. We present the outcome of the large epilepsy surgery cohort in Russian Federation.Purpose: evaluation of risk factors of favorable and unfavorable long-term outcomes in the Russian cohort of drugresistant patients with epilepsy.Material and methods. Three hundred and eight patients with structural drug-resistant epilepsy were operated by the neurosurgery team of Moscow State University of Medicine and Dentistry. Presurgical investigations and surgeries were performed by this team between 01.01.2014 and 31.12.2020. All patients underwent neurological and neuropsychological evaluation, seizure semiology assessment, neuroimaging and neurophysiological examination. Histological analysis of resected tissues was performed. Results of surgery were assessed according to J. Engel (1993) at 6, 12, 24, 48 and 60 months after surgery. Risk factors, associated with favorable (Engel I–II) and unfavorable (Engel III–IV) outcomes were evaluated.Results. Underwent 308 primary resection procedures, placement of a vagus nerve stimulator were in 41 patients, 9 patients have been repeated by resection procedures and 8 — underwent radiosurgical treatment. 256 (83%) patients were MR-positive, 53 (17%) — MR-negative. Temporal lesions were revealed in 186 (60%) patients, extratemporal — in 8 (3%), bilateral temporal — in 15 (5%), combination of temporal and extra-temporal — in 81 (26%), multifocal — in 16 (5%), generalized form in 2 (1%). In 12 months after surgery there were favorable outcomes (Engel I + II) in 85% of patients (n = 148), in 24 months — 70% (n = 127). In patients with MRI positive and negative lesions the result of surgery after 12 months was comparable. Postoperative complications were diagnosed in 6 (1.9%) patients, there were no mortality. Temporal plus epilepsy (p = 0.009), multifocal (p = 0.008) and bilateral lesions (p = 0.006) were the most significant risk factors of unfavorable surgery outcomes.Conclusion. The presented results confirm the efficiency of surgical treatment of drug-resistant epilepsy. Temporal plus form epilepsy, multifocal and bilateral lesions were the most significant risk factors of unfavorable surgery outcomes.

Long-term outcomes of bandage therapeutic-optical keratoplasty in the treatment of keratoconus

Evaluation of the long-term outcomes of surgical treatment of stages II and III progressive KC with BTOK technique. The study included 107 patients (126 eyes): group 1 with stage II KC - 78 eyes, 100% of these patients were observed for 1 year, 52 eyes (66%) for 3 years, and 18 eyes (23%) for 5 years; group 2 - 48 eyes with stage III KC, with 100% of them observed for 1 year, 39 eyes (81%) for 3 years, and 12 eyes (25%) - 5 years. All patients received a customized allograft in the form of an intrastromal corneal ring segment (ICRS). During the first year after BTOK surgery, the uncorrected and corrected visual acuity (UCVA and CVA) in the first group increased by 0.5±0.04 (p<0.05) and 0.2±0.02 (p<0.05), respectively, in the second group - by 0.46±0.05 (p<0.05) and 0.47±0.05 (p<0.05) due to a decrease in refractive indices in the central 3.0 mm zone. In the first group, mean refraction in the central 3.0 mm zone (Km) was within 45±3.75 (p<0.05), in the second - 48.63±.2 diopters (p<0.05), while maximum refraction in the central 3.0 mm zone (Kmax) decreased from 50.02±2.20 (p<0.05) to 44.61±1.03 diopters (p<0.05) in the first group, from 58.21±3.43 (p<0.05) to 50.45±3.46 diopters (p<0.05) in the second group. The values of UCVA, CVA and refractive indices of the central corneal zone in the first and second groups did not change statistically significantly after three and five years. Minimum corneal thickness in the first group increased from 476.23±13.35 to 485.08±15.80 µm (p<0.05), in the second - from 412.73±38.63 to 422.00±42.25 µm (p<0.05). BTOK surgery can be used in patients with stages II and III KC to improve the visual functions, strengthen the ectatic cornea and stop the progression of the disease.

Risk factors for recurrence of uterine fibroids

The objective: a study of the risk factors and the frequency of recurrence of uterine fibroids (UF) after conservative myomectomy. Materials and methods. A clinical and statistical retrospective analysis of the long-term outcomes of surgical treatment of 40 patients in reproductive age (from 19 to 42 years) with UF was carried out based on the data of case histories, outpatient cards and data from a questionnaire/telephone survey. All women had a complicated gynecological and reproductive history. In the postoperative period, the patients received hormonal therapy with progestogens (in cyclic regime) and oral contraceptives for 6–12 months. For the diagnosis of UF recurrence, clinical examination, bimanual examination, transvaginal echography were performed every 3 months during the first 3 years, then every six months. The fact of UF recurrence was ascertained of the appearance at least of one myomatous node more than 1 cm in diameter. Results. The long-term results were studied in 36 out of 40 patients after conservative myomectomy. At the time of assessment, the average age of patients after surgery was 39.7±6.17 years, 4 (11 %) women of them were in active reproductive age, 11 (33.3 %) – late reproductive age, and 10 (27.7 %) – premenopausal period. The mean period of observations was 6.22±1.71 years. Recurrence of UF was diagnosed in 22 (55 %) patients, 3 (7.5 %) of them required repeated surgery (2 women after supravaginal amputation of the uterus, 1 – transcervical resection of the submucous node).The cumulative (accumulated) percentage of UF recurrence within 7 years after surgery was 67.4±8 % with the maximum increase of recurrence frequency in the 2nd and 3rd years after surgery (up to 31.7 6 % and 51.2±7 %, respectively). After conservative myomectomy, pregnancy occurred in 11 (27.5 %) women, including 2 out of 5 persons with infertility before surgery, and 4 out of 9 patients who had miscarriage in anamnesis. The maximum number of pregnancies (5) occurred in the interval from 1 to 1.5 years after surgery. Pregnancy ended in timely delivery in 7 patients, spontaneous abortion – 3 (7.5 %), induced abortion – 1 (2.5 %). All 7 pregnant women were delivered by caesarean section.Conclusions. A retrospective analysis of long-term outcomes of organ-preserving surgical treatment of patients of reproductive age with uterine fibroids determined a high frequency of myoma recurrence after conservative myomectomy, reaching 67.4±8 % in7 years after the operation. The greatest increase in recurrence was observed in the 2nd and 3rd years after surgery. The statistically significant risk factors for the development of recurrence of the disease were the number of myomatous nodes and the patient’s age (30–40 years). The use of hormonal therapy (norethisterone or oral contraceptives) after surgery did not lead to a decrease in the rate of recurrence of uterine fibroids. And although conservative myomectomy made it possible to increase the frequency of pregnancy in operated patients, the level of reproductive losses after surgery remained high (36.3 %).

Long-term Outcome of Surgical Treatment with Various Reinforcement Material Grafts on Scleromalacia

Purpose: To investigate the long-term efficacy and stability of the use of various reinforcement material grafts on scleromalacia.Methods: This retrospective study was conducted on scleromalacia patients who underwent surgical treatment with reinforcement material grafts from January 2012 to March 2019. The choice of amniotic membrane, Tenon’s capsule, acellular sclera, or collagen matrix implanted in the area of scleromalacia was made based on disease severity. Amniotic membrane transplantation with a pedicular rotatory inferior conjunctival flap was performed to prevent having a bare sclera. The patient demographics, cause of scleromalacia, best-corrected visual acuity (BCVA), recurrence rate, postoperative complications, and restoration appearance were evaluated.Results: A total of 58 patients (58 eyes) were enrolled in this study. The mean age of patients was 65.7 ± 9.6 years, and 32 patients (55.2%) were women. The mean follow-up period was 28.1 ± 17.3 months. The most common cause of scleromalacia was pterygium operation (53 patients, 91.4%). The reinforcement materials were mainly amniotic membrane (31 patients, 53.4%) and acellular sclera (15 patients, 25.7%). There was no recurrence of scleromalacia or structural instability during the follow-up period. The preoperative and postoperative mean BCVA values were 0.24 ± 0.24 and 0.21 ± 0.23 logMAR, respectively. Wound dehiscence (three patients, 5.2%) and conjunctival cyst (three patients, 5.2%) occurred with the highest frequency.Conclusions: The use of the appropriate reinforcement material graft according to the severity of scleromalacia and amniotic membrane transplantation using a pedicular rotatory inferior conjunctival flap to prevent a bare sclera can be effective for treating scleromalacia, without long-term recurrence.

Long-Term Outcomes of Surgical Treatment for Acute Type-A Aortic Dissection with Coronary Artery Involvement.

The surgical strategies for acute type-A aortic dissection (aTAAD) with coronary artery involvement have been controversial, and its prognosis remains unclear. Thus, in this study, we aim to determine the characteristics, surgical strategies, and prognosis of patients with coronary artery involvement due to aTAAD.Retrospective analysis of 65 consecutive aTAAD patients with coronary artery involvement between September 2005 and January 2012 was performed. The patients were divided into two groups: those treated with aTAAD repair and coronary ostia reimplantation (Neri type-A, group A, n = 37) and those with aTAAD repair and coronary artery bypass grafting (Neri type B and C, group B, n = 28).Overall in-hospital mortality was determined to be 8.1% for group A and 21.4% for group B (P = 0.124). No significant difference was determined between groups A and B in cardiopulmonary bypass time, cross-clamp time, cerebral perfusion time, and hospitalization time. Intensive care unit (ICU) stay was 5.8 ± 7.4 days for group A, whereas it was 12.4 ± 10.6 days for group B (P = 0.009). The morbidity of postoperative temporary and permanent neurological dysfunction was similar between the two groups, while renal and respiratory dysfunction were 8.1% versus 25.0% and 16.2% versus 39.3%, respectively (P = 0.062, P = 0.036). Average follow-up time was 112.0 ± 44.8 months, and survival curves have not shown statistical significance between two groups (P = 0.386).Coronary artery dissection with Neri type B and C in acute TAAD has been associated with higher early death, but comparable long-term survival after discharge. However, combined immediate coronary artery bypass grafting and aortic repair remains a safe, effective, and acceptable approach to these challenging group of patients.