Major Complication Rate Research Articles

The Belgian Registry on Coronary Function Testing (BELmicro Registry): Study Population, Prevalence of Coronary Vascular Dysfunction, and Procedural Safety

Coronary function testing (CFT) plays a pivotal role in the diagnosis of coronary vascular dysfunction and providing patients with tailored therapy. The Belgian registry on CFT (BELmicro registry) is a prospective, observational, multicenter registry including 14 centers in Belgium. All patients who underwent clinically indicated CFT were included in the registry. Baseline characteristics, CFT data, and clinical outcomes were collected. This analysis aimed to describe the baseline characteristics of a real-world population of patients who underwent CFT, evaluate the prevalence of coronary vascular dysfunction, and assess the safety of CFT in daily clinical practice. Between October 2021 and September 2023, 449 patients were enrolled. The mean age was 65 ± 10 years, and 47.4% of patients were men. A total of 59% of patients had hypertension, 18.7% had diabetes, 69.5% had hypercholesterolemia, and 40.1% had a smoking habit. Angina and nonobstructive coronary arteries (ANOCAs) were identified in 85.1% of the patients. Microvascular physiology assessment was performed in 95.5% of patients, vasoreactivity test in 28.5%, and both in 24.0%. coronary microvascular dysfunction was diagnosed in 23.4% of patients with ANOCA, epicardial vasospasm in 26.3%, and microvascular spasm in 14.9%. Rates of major complications were 0.7% for microvascular physiology assessment and 0% for vasoreactivity test. In conclusion, participants in the BELmicro registry represented a real-world population of patients, characterized by a high burden of cardiovascular risk factors. Coronary microvascular dysfunction and coronary vasospasm were frequent in patients with ANOCA. Performing CFT in daily clinical practice was feasible, with a low rate of complications.

Catheter ablation alone versus catheter ablation with combined percutaneous left atrial appendage closure for atrial fibrillation: a systematic review and meta-analysis.

Combined catheter ablation (CA) with percutaneous left atrial appendage closure (LAAC) may produce comprehensive treatment for atrial fibrillation (AF) whereby rhythm control is achieved and stroke risk is reduced without the need for chronic oral anticoagulation. However, the efficacy and safety of this strategy is still controversial. This meta-analysis was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Medline, Scopus, and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. The risk of bias was assessed using the Modified Newcastle-Ottawa scale and Cochrane risk of bias tool. Eligible studies reported outcomes in patients with AF who underwent combined CA and LAAC vs CA alone. Studies performing CA without pulmonary vein isolation were excluded. Eight studies comprising 1878 patients were included (2 RCT, 6 observational). When comparing combined CA and LAAC vs CA alone, pooled results showed no difference in arrhythmia recurrence (risk ratio (RR) 1.04; 95% confidence interval (CI) 0.82-1.33), stroke or systemic embolism (RR 0.78; 95% CI 0.27-2.22), or major periprocedural complications (RR 1.28; 95% CI 0.28-5.89). Total procedure time was shorter with CA alone (mean difference 48.45 min; 95% CI 23.06-74.62). Combined CA with LAAC for AF is associated with similar rates of arrhythmia-free survival, stroke, and major periprocedural complications when compared to CA alone. A combined strategy may be as safe and efficacious for patients at moderate to high risk for bleeding events to negate the need for chronic oral anticoagulation.

Impact of three-dimensional imaging and printing on septal myectomy results-single centre's experience.

To assess changes in the results of septal myectomy (SM) following introduction of three-dimensional (3D) imaging and 3D printing in surgical interventions planning and performing in the single-centre settings. Between January 2007 and March 2022, 268 consecutive symptomatic patients with hypertrophic obstructive cardiomyopathy and peak pressure gradient at obstruction area ≥50 mmHg underwent conventional SM (n = 112) or SM with heart 3D modelling (n = 156). For comparative analysis, we used propensity score matching (PSM) by 14 variables and there were formed group 1PSM (conventional SM, n = 77) and group 2PSM (3D-modelled SM, n = 77). It was noted for group 2PSM: larger mean resected myocardium mass [10.0 (standard deviation 4.3) vs 5.2 (standard deviation 2.7) g], P < 0.001, no mitral valve replacement cases [0 vs 28 (36.4%), P < 0.001], no iatrogenic ventricular septal defects cases [0 vs 6 (7.8%), P = 0.028], lower rate of major complications [6 (7.8%) vs 17 (22.1%), P = 0.011], smaller residual peak systolic gradient at the obstruction level [7.0 (5.0-9.0) vs 11.0 (7.0-16.0) mmHg, P < 0.001]. During the long-term follow-up, it was noted for group 2PSM as compared to group 1PSM: lower 5-year cumulative incidence of major adverse cardiovascular events [3.8% (95% confidence interval 0.7-11.7%) vs 16.9% (9.5-26.1%), P = 0.007] and cardiac-related death [3.8% (95% confidence interval 0.7-11.7%) vs 13% (95% confidence interval 6.6-21.6%), P = 0.05]. SM based on 3D virtual and printed heart models is more effective than conventional SM.

Predictors of Length of Stay after Transcatheter Aortic Valve Implantation: Impact of Prognostic Nutritional Index.

Pre-transcatheter aortic valve replacement (TAVR) nutritional status can potentially affect the length of hospital stay (LoS) after TAVR. The Prognostic Nutritional Index (PNI) is a widely recognised nutritional index. We aimed to determine the effect of PNI on LoS in patients undergoing TAVR. The study population (158 patients) was divided into two groups: early discharge (LoS ≤ 3 days) and late discharge (LoS > 3 days). PNI was calculated before TAVR. In the LoS > 3 days group, the median age, creatinine level, rate of surgical access site closure and rate of major complications were higher, whereas estimated glomerular filtration rate, albumin, haemoglobin, lymphocyte count and PNI were significantly lower. Receiver operating characteristic curve analysis revealed a PNI cutoff of 39 (area under the curve = 0.778, p < 0.001) with 86.8% sensitivity and 55.2% specificity for predicting extended LoS. The 30-day endpoint analysis revealed significantly higher rates of death and hospitalisation with LoS > 3 days and PNI ≤ 39. Multivariate binary logistic regression analysis identified several independent predictors of extended LoS: severe renal insufficiency [odds ratio: 3.951 (95% confidence interval: 1.281-12.191); p = 0.017], surgical access site closure [4.353 (1.701-11.141); p = 0.002), complications [7.448 (1.305-42.518); p = 0.024] and PNI < 39 [5.906 (2.375-14.684); p < 0.005]. Decreased PNI may be associated with LoS > 3 days after TAVR. Nutritional status assessed using PNI may be a useful independent predictor of LoS after TAVR.

803. 2-YEAR RESULTS IN ESOPHAGOGASTRIC JUNCTION CANCER TREATMENT

Abstract Background Esophagogastric junction (EGJ), also known as cardia, tumors have unique characteristics with a widespread of lymph node (LN) metastatic patterns influenced by the extent of esophageal involvement. Besides, there is no worldwide consensus about its classification and the optimal lymphadenectomy and surgical resection extend. Recently, mapping the distribution of LN metastasis in these patients could provide some insights about the extent that should be the target. Furthermore, the balance between resection extension and the procedure safety is also difficult to achieve. This work aims to review the last 2 years of EGJ tumor treatment in a single oncological center. Methods We present a retrospective, single center study that included all the patients with EGJ cancer undergone surgical resection between 2022 and 2023. These tumors were classified using our modified Siewert (mSiewert) classification based on mapping endoscopy with measures of the full extension and not only the tumor’s epicenter. Patient demographics, tumor characterization, neoadjuvant treatment, surgical procedure and postoperative results were assessed, alongside with pathological and oncological metrics as recurrence, disease-free survival (DFS) and overall survival (OS). Results We included 64 cardia cancer patients who underwent a curative treatment strategy, with a median age of 68 years, mostly men (87.5%), with a median BMI of 25 kg/m2. 68.2% were classified as ECOG-PS 0 however 62.5% were classified as ASA III-IV. Most tumors were moderately (39.2%) or poorly (31.4%) differentiated adenocarcinomas. Majority were locally advanced (cT3, 78.1%) and in stage III (85.9%). Regarding tumor location, 49.2% were classified as mSiewert I-II (49.2%), followed by I-II-III (18%) and II-III (18%). 36.1% had esophageal involvement ≥4cm, 87.5% received neoadjuvant treatment split between the CROSS and FLOT protocols. Our resection rate was 85.9%. We mostly performed Mckeown esophagectomy (49.1%) and transhiatal esophagectomy (18.2%). We had a 12.7% admission rate to the intensive care unit and a 27.3% major complication rate (Clavien-Dindo ≥ 3b). Anastomotic dehiscence occurred in 16.4% of cases, with hospital mortality rate of 3.6%. The median hospital stay was 6 days, with a 16.4% readmission rate. Pathological staging revealed that 47.3% were stage III, with a median lymph node yield of 28 and a 98.2% R0 resection rate. Most patients received adjuvant treatment, primarily FLOT protocol or Nivolumab, in 38.2% and 29.1%, respectively. The recurrence rate was 28%, with a median time to recurrence of 26 weeks, mainly occurring as distant metastasis pattern (64.3%). One-year overall survival (OS) was 88.7%, and one-year disease-free survival (DFS) was 66.4%, with a median follow-up time of 48 weeks and only a 3.6% loss to follow-up rate. Conclusion This study highlights the unit’s adaptation of EGJ tumor treatment to new insights, emphasizing the importance of comprehensive classification and multimodal and multidisciplinary approach to enhance patient outcomes.

Is bicortical femoral pin insertion safe for Image-based Robotic Knee Arthroplasty Surgery ? A comparative complications analysis in 970 Consecutive Cases

ObjectivesLimited data exists on complications associated with robotic image-based system in knee arthroplasty. This study aims to document complications in robotic arm-assisted knee arthroplasties, and evaluate the system’s safety by comparing two femoral pin insertion methods: bicortical diaphyseal with additional stab wounds, and unicortical metaphyseal placement through the main incision. MethodsAll patients undergoing primary knee arthroplasty with the image-based robotic system (Mako, Stryker, Mako Surgical Corp., Fort Lauderdale, FL, USA) from 1st March 2021 to 31st January 2024 with a minimum follow-up of 2 months were included. Demographics, system and non-system-related complications, as well as outcomes were recorded. Complications were categorized as either major (requiring a second surgical intervention) or minor. ResultsA total of 970 consecutive cases (median age 69.3 years) were analyzed. The unicortical group comprised 651 cases, while the bicortical group 319. The incidence of non-system-related complications was 2.37%, with the most common being joint stiffness (10 cases; 1.03%), followed by lateral femoral condyle fracture (4;0.41%). The overall incidence of system-specific complications was 1.03%. Pin-related femoral fractures occurred in 0.2% of cases, all postoperatively and in the unicortical group. There was no statistically significant difference between the femoral pin insertion-related complication rates among the two groups (0.3% in the unicortical, compared to 0% in the bicortical group; p-value= 0.3). Complications included tibia fracture (0.1%), delayed wound healing (0.2%), superficial wound infection (0.1%), tibia osteomyelitis (0.1%), and “exostosis” (0.2%). The major complications rate was 0.3% and minor 0.7%. ConclusionsMinimal system-specific overall complications indicate that robotic arm-assisted surgery is safe. The bicortical diaphyseal femoral pin insertion method does not increase the complication rates compared to the unicortical metaphyseal method. Level of evidenceIII

Resective surgery for mesial temporal lobe epilepsy associated with hippocampal sclerosis in patients over 50 years: a case-control study.

Mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE/HS) is the most common cause of drug-resistant focal seizures and surgical resection is the primary treatment option, with seizure-free rates ranging from 60 to 80%. However, data on postsurgical seizure outcomes in patients ≥ 50years of age are limited. This study aimed to assess the efficacy and safety of surgery in this age group compared to younger patients. We performed a retrospective analysis of data from resective surgeries conducted in patients with MTLE/HS between 1990 and 2022. We focused on patients aged ≥ 50years and compared the surgical safety and efficacy variables between this group and a control group of patients aged < 50years through a case-control study. Among the 450 MTLE/HS patients who underwent surgery during the inclusion period, 61 (13.6%) were aged ≥ 50years and matched with 183 younger patients, totaling 244 study participants. The two groups had similar characteristics. At the last follow-up (median 5.7years), Engel I outcomes were achieved in 80.3% of the older patients and 81.4% of the younger patients, with no significant difference (p = 0.85). Postoperative cognitive and psychiatric outcomes did not differ between the groups. Major complication rates were also comparable, at 3.3% in the older group and 2.7% in the younger group (p = 0.83). The extratemporal ictal abnormalities observed on video-EEG were the only variable that demonstrated a significant association with an unfavorable seizure outcome in the older group (OR 9.3, 95% CI [1.8-47.6], p = 0.005). This study provides grade 3 evidence that resective surgery for MTLE/HS patients aged ≥ 50years is as effective and safe as it is for younger patients, and thus should be considered as the primary treatment option for drug-resistant cases.

Safety and efficacy of outpatient versus inpatient adult brachial plexus surgery

PurposeOutpatient orthopedic surgery is becoming more common as a method of providing safe and cost-effective medical care. The purpose of this study was to compare outcomes between adult patients undergoing outpatient versus inpatient brachial plexus surgery. MethodsA single institution database was queried for patients with brachial plexus injuries undergoing brachial plexus exploration with or without concomitant reconstructive procedures from 2010 to 2022. Outcome measures included 90-day major and minor complications, as well as longer term pain scores and reoperation rates. Multivariate analysis was performed to compare outcomes between the cohorts. ResultsIn a group of 51 adult patients, 36 (70.6 %) were admitted for at least one night following surgery and 15 (29.4 %) underwent outpatient surgery. The cohorts were similar with respect to demographics. When compared to brachial plexus procedures performed between 2010 and 2016, those performed between 2017 and 2022 were 67 % more likely to be outpatient (OR 0.33; p = 0.11). The overall major complication rate during the 90-day episode of care was 11.8 % (n = 6), all of which occurred in the inpatient cohort. There was no significant difference in minor complication rate. 90-day reoperation rate due to complications was 2.8 % in the inpatient cohort and 0.0 % in the outpatient cohort. ConclusionNo prior study has assessed the safety of brachial plexus exploration and reconstruction in an outpatient setting. This study demonstrates that outpatient brachial plexus surgery is a safe option for properly selected patients. Procedures were more often performed outpatient in recent years, reflecting a continuing evolution of our practice.

767. INFLUENCE OF NEOADJUVANT IMMUNOTHERAPY-CHEMOTHERAPY ON PERIOPERATIVE OUTCOMES IN LOCALLY ADVANCED ESOPHAGEAL ADENOCARCINOMA

Abstract Background This study evaluates the perioperative outcomes of patients with locally advanced esophageal adenocarcinoma (EAC) who were treated with neoadjuvant immunotherapy (IO) and chemotherapy versus a matched cohort of patients that received neoadjuvant chemotherapy (NAC) alone. Methods A single center non-randomized phase II trial was undertaken in locally advanced (cT3-4 and/or N+) EAC and 49 patients completed neoadjuvant Avelumab + DCF (Docetaxel, Cisplatin, 5FU) and esophagectomy between 2/2018 and 2/2020. These patients were matched to contemporary patients (1/2018-6/2020) who met inclusion criteria but received neoadjuvant chemotherapy alone (NAC) with a comparable Docetaxel based. The postoperative outcomes were then compared between the two groups. Results Ninety-nine patients with locally advanced EAC underwent esophagectomy and meet enrolment criteria for this study. Of these patients, 50 received NAC alone 49 received IO+NAC. Baseline characteristics such as age, gender and clinical stage were comparable between groups. Operative approach and rate of MIE (~60%) was similar in both groups. Overall and major complication rate were similar between groups (50 vs. 51%, p=0.91; 20 vs. 26%, p=0.44 respectively) with concordant rates of anastomotic leak (6 [12%] vs. 6 [12%], p=0.86) and respiratory complications (13 [26%] vs. 11 [22%], p=0.68) in NAC alone and IO+NAC group respectively. There were no significant differences in the LOS and 30- and 90-days mortality rates between the two groups. Conclusion The addition of immunotherapy to neoadjuvant chemotherapy for locally advanced esophageal adenocarcinoma does not appear to significantly alter perioperative short-term outcomes after esophagectomy

Radiologic myosteatosis predicts major complication risk following esophagectomy for cancer: a multicenter experience

BackgroundMyosteatosis is a measure of skeletal muscle quality that is readily identifiable on computed tomography (CT). The effect of preoperative myosteatosis on outcomes after radical esophagectomy remains unclear. This study aimed to correlate the presence of myosteatosis on CT scan with perioperative morbidity, mortality, and survival outcomes after esophagectomy in an Australian population across 3 esophageal cancer centers. MethodsA retrospective analysis was performed for all patients undergoing radical esophagectomy for cancer across 3 centers. Radiologic assessment of preoperative CT images was performed to determine the presence of myosteatosis. The outcomes measured included perioperative complication rate, overall survival (OS), and disease-free survival (DFS). ResultsA total of 462 patients were included in the analysis (male patients, 78.4%; median age, 67 years). Moreover, 353 patients (76.4%) had myosteatosis on CT. Compared to patients with normal skeletal muscle attenuation, patients with myosteatosis had a higher rate of major (Clavien-Dindo grade ≥ IIIb) complication (14.7% vs 24.9%, respectively; P = .026) and a higher rate of 30-day mortality (0.0% vs 4.0%, respectively; P = .048). Myosteatosis was associated with a major complication on multivariate analysis (hazard ratio, 1.906; 95% CI, 1.057–3.437; P = .032). There was no difference in OS and DFS between patients with and without myosteatosis (OS: 59 vs 56 months, respectively [P = .465]; DFS: 39 vs 42 months, respectively; P = .172). ConclusionThe presence of myosteatosis on radiologic imaging was associated with an increased risk of major complications and 30-day mortality. Identifying myosteatosis can be an adjunct to preoperative nutritional assessment and prognostication, facilitating early recognition of patients at risk of complications.

Clinical characteristics and short-term outcomes in patients with cardiogenic shock undergoing mechanical circulatory support escalation from intra-aortic balloon pump to impella: From the J-PVAD registry.

An escalation strategy from intra-aortic balloon pump (IABP) to Impella (AbioMed, Danvers, MA, USA) is proposed in patients with cardiogenic shock (CS) refractory to IABP therapy, but its clinical data are lacking. This study aimed to elucidate the clinical characteristics and short-term outcomes in patients undergoing IABP-Impella escalation. From the Japanese nationwide registry of Impella (J-PVAD), a total of 2578 patients with CS receiving Impella support were classified into the IABP-Impella group (n = 189) or the Primary Impella group (n = 2389). We applied 1:3 propensity score (PS) matching, selecting 185 patients and 555 patients, respectively. Before matching, the IABP-Impella group presented longer shock-to-Impella time, worse laboratory data, and more frequent inotropes and pulmonary artery catheter use than the Primary Impella group. After matching, the baseline characteristics were well-balanced. Regarding the 30-day clinical outcomes in the PS-matched cohort, there were no significant differences in the rates of mortality and major complications (a composite of bleeding, hemolysis, infection, stroke, myocardial infarction, limb ischemia, and vascular injury) between the groups. However, The IABP-Impella group showed a significantly higher rate of infection (10.3 % vs. 5.6 %, p = 0.042) and additional mechanical circulatory support use (34.1 % vs. 23.8 %, p = 0.008) than the Primary Impella group. Compared to patients with primary Impella support, those undergoing IABP-Impella escalation showed similar 30-day mortality and major complications despite poorer clinical conditions before Impella support and a more complicated clinical course after Impella insertion.

Intra-operative and post-operative complications of endometriosis excision using the SOSURE approach - A single- surgeon retrospective series of 1116 procedures over 8 years.

Endometriosis surgery outcomes have been widely studied, yet heterogeneity in terminology and techniques persist. This study focuses on the perioperative outcomes of a single surgeon using the same structured approach (SOSURE: Survey & Sigmoid mobilisation, Ovarian mobilisation, Suspension of uterus and ovaries, Ureterolysis, Rectovaginal and pararectal space development, Excision of all visible disease) and adheres to the recent standardised terminology proposed by international gynaecological and endometriosis societies. A quality improvement study was conducted retrospectively from January 2015 to January 2023. Data collection involved two databases: the National British Society for Gynaecological Endoscopy (BSGE) database and a more comprehensive locally kept database. The methodology also integrated four endometriosis staging systems. Intra-operative and post-operative complication rates. Between 2015 and 2023, 1047 women underwent 1116 endometriosis procedures in various UK hospitals with S.K. as primary surgeon. Exclusions totalled 20 due to missing records and specific surgical criteria. The rate of major post-operative complications (Clavien-Dindo grade 3a and 3b) was 1.5% and minor post-operative complications (Clavien-Dindo grade 1 and 2) were seen in 13.8%. No Clavien-Dindo grade 4 or 5 complications were noted. Our study has shown a low complication rate in endometriosis surgery, despite increasing complexity of surgical cases. This is likely attributed to the surgeon's learning curve, high surgical volume and adherence to a structured approach. Our study demonstrates the learning curve of a surgeon over the course of 8 years. This series involved more than 1000 patients and to our knowledge, is the first to report the complexity of the casemix using four different endometriosis staging systems.

Direct-to-implant and tissue expander-based immediate breast reconstruction in Chinese women: A comparison of surgical complications and patient-reported outcomes

BackgroundDirect-to-implant (DTI) breast reconstruction restores the patient's body image immediately after the mastectomy but may increase postoperative complications compared to tissue expander (TE)-based breast reconstruction. There are very few studies that compared the surgical complications and patient-reported outcomes of DTI and TE breast reconstructions in Asian women. MethodThe study compares postoperative complications and patient-reported outcomes (PROs) between DTI and TE breast reconstruction in Chinese women and explores the risk factors of postoperative complications and influencing factors of PROs. Retrospective chart review of patients undergoing immediate breast reconstruction between 2008 and 2022 was conducted and BREAST-Q questionnaires of the breast reconstruction module were distributed to eligible patients. Multivariate regression models were used to explore risk factors for postoperative complications and factors that influence BREAST-Q scores. ResultsDTI was associated with lower rates of major complication and implant loss but has no significant influence on patients’ satisfaction or quality of life. Age and axillary lymph node dissection are important complication risk factors for both DTI and TE. The application of ADM significantly increased the risk of seroma or hematoma. In the DTI group, capsular contracture significantly reduced patients’ satisfaction with breast scores. ConclusionDTI dual-plane breast reconstruction does not increase complication rates in appropriately selected Chinese patients. In DTI patients, the management of capsular contracture is crucial for improving patient satisfaction.

Continuation vs Discontinuation of Renin-Angiotensin System Inhibitors Before Major Noncardiac Surgery

Before surgery, the best strategy for managing patients who are taking renin-angiotensin system inhibitors (RASIs) (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) is unknown. The lack of evidence leads to conflicting guidelines. To evaluate whether a continuation strategy vs a discontinuation strategy of RASIs before major noncardiac surgery results in decreased complications at 28 days after surgery. Randomized clinical trial that included patients who were being treated with a RASI for at least 3 months and were scheduled to undergo a major noncardiac surgery between January 2018 and April 2023 at 40 hospitals in France. Patients were randomized to continue use of RASIs (n = 1107) until the day of surgery or to discontinue use of RASIs 48 hours prior to surgery (ie, they would take the last dose 3 days before surgery) (n = 1115). The primary outcome was a composite of all-cause mortality and major postoperative complications within 28 days after surgery. The key secondary outcomes were episodes of hypotension during surgery, acute kidney injury, postoperative organ failure, and length of stay in the hospital and intensive care unit during the 28 days after surgery. Of the 2222 patients (mean age, 67 years [SD, 10 years]; 65% were male), 46% were being treated with angiotensin-converting enzyme inhibitors at baseline and 54% were being treated with angiotensin receptor blockers. The rate of all-cause mortality and major postoperative complications was 22% (245 of 1115 patients) in the RASI discontinuation group and 22% (247 of 1107 patients) in the RASI continuation group (risk ratio, 1.02 [95% CI, 0.87-1.19]; P = .85). Episodes of hypotension during surgery occurred in 41% of the patients in the RASI discontinuation group and in 54% of the patients in the RASI continuation group (risk ratio, 1.31 [95% CI, 1.19-1.44]). There were no other differences in the trial outcomes. Among patients who underwent major noncardiac surgery, a continuation strategy of RASIs before surgery was not associated with a higher rate of postoperative complications than a discontinuation strategy. ClinicalTrials.gov Identifier: NCT03374449.

Major Complications of Deep Venous Stenting.

Deep venous stent placement has developed into a primary treatment modality for venous obstruction in recent decades. Reported rates of complications are low in the literature and are based mainly on case reports and single-centre cohorts. Interventionalists performing these procedures must be aware of the occurrence of complications associated with stent placement to counsel patients adequately and promote avoidance through optimal procedural approach. This study aims to determine the incidence of serious complications associated with iliocaval and iliofemoral stent placement in a cohort of patients from 3 major tertiary deep venous referral centres. Data were collated from January 2014 to September 2023. The following major complications were included in the analysis: death, major bleeding requiring transfusion, massive pulmonary embolism, any complication which required endovascular or open surgical intervention, vessel rupture, acute kidney injury requiring dialysis, stent crushing, fracture, migration, involution or erosion. One thousand eight hundred fourteen (1814) patients were treated for acute or chronic deep venous pathology during the 9-year study period. Sixty-one patients (3.3%) experienced a major stent-related complication. The most frequently reported complication was stent crushing (n = 18, 29.5%), followed by stent fracture (n = 10, 16.4%) and erosion of the stent through the vessel wall (n = 8, 13.1%). Death was a rare event (0.2%). Deep venous stent placement is a safe procedure with low rates of major complications. It is incumbent upon operators to be aware of the risks associated with these procedures, however, rare, so that they may obtain fully informed consent from patients.

Feasibility and safety study of ultrasound-guided percutaneous microwave ablation for sub-cardiac liver cancers without artificial ascites assistance.

To investigate the efficacy and safety of ultrasound (US)-guided microwave ablation (MWA) without artificial ascites (AA) inpatients with sub-cardiac (SC) liver cancers. This retrospective study included patients with the left lobe and caudate lobe of the liver cancer who underwent US-guided MWA in our institute from January 2020 to December 2022. According to whether the target lesion was located ≤5 mm from the pericardium, patients were divided into the SC group and the non-sub-cardiac (NSC) group. In the SC group, AA was not employed during the ablation procedure. The results of technical success, technical efficiency, local tumour progression (LTP), and major complications were recorded. A total of 79 patients with 87 lesions were enrolled. There were 38 patients with 38 lesions in the SC group and 41 patients with 49 lesions in the NSC group. The median follow-up of all patients was 15 (range, 3-44) months. There was no significant difference in technical success rates (100% vs 100%), technique efficiency rates (100% vs 95.7%), LTP rates (2.63% vs 0%,), and major complication rates (2.63% vs 7.32%) between the SC group and the NSC group (P > .05). No cardiac-related complications occurred. US-guided MWA without AA for SC liver cancers was safe and effective. The clinical prognosis of thermal ablation without AA in the treatment of SC liver cancers is still unclear. The finding of this study provided evidence supporting the efficacy and safety of US-guided MWA without AA for treating this tricky location.

Corner Osteotomy as the more Advanced Approach to Deformity Correction in Adult Spinal Deformity: A Retrospective Comparative Study Between Two Osteotomy Techniques.

A retrospective study. To investigate the usefulness of corner osteotomy (CO) in patients with adult spinal deformity (ASD) by comparing with pedicle subtraction osteotomy (PSO) for lordosis correction. PSO remains a valuable procedure for patients with ASD, but it has a limit to obtaining correction angles exceeding 45° in patients with a large pelvic incidence or with previous spinal fusion surgeries. Theoretically, CO can exceed the limitation of PSO and can achieve a wide range of correction angles. However, no study has analyzed the clinical data and usefulness of CO. This study included 115 patients (mean age 71.1y, mean follow-up period 78.9mo) with ASD who underwent deformity correction using PSO or CO. Comparative analysis was performed on spinopelvic parameters including segmental angle (SA) around the osteotomy site, and clinical and surgical assessment between the PSO and corner groups. In the corner group, the postoperative SA (35° vs. -39.3°, P=0.004) and the degree of SA correction (34.8° vs. 39.7°, P=0.004) were greater, and a broader range of SA correction was also possible (18-51° vs. 18-61°). Although the operative time was longer in the corner group (316.8min vs. 342.3min, P=0.014), the estimated blood loss (EBL) was lower (2841.3mL vs. 2465.4mL, P=0.032). There was no difference in major complication rates, but the frequency of rod fracture (RF) was lower in the corner group (36/27 vs. 1/51, P<0.05). CO showed a greater SA correction and achieved a broader range of SA correction angles than PSO with no difference in the incidence of major complications. In addition, the EBL and the frequency of RF were lower. Based on these results, we expect that CO can serve as a promising surgical alternative to PSO for spinal deformity correction among patients with ASD.

Partial pancreatoduodenectomy versus total pancreatectomy in patients with preoperative diabetes mellitus: Comparison of surgical outcomes and quality of life.

To reduce perioperative risks among patients with a preoperative diabetes mellitus (DM) a total pancreatectomy (TP) might be a alternative to pancreatoduodenectomy (PD). This study aimed to compare the postoperative quality of life (QoL) of patients with preoperative DM undergoing PD or TP. A single-centre retrospective study was conducted, all consecutive patients with preoperative DM undergoing PD or TP between 2011 and 2023 were identified in a prospective database. The primary endpoint was QoL, prospectively assessed using EORTC QLQ-C30 questionnaires at 3, 6, and 12months after surgery and then annually until death. Secondary endpoints were morbidity and mortality. Seventy-one patients were included, 17 after TP and 54 after PD. Insulin-dependent DM occurred in 21 (39%) of the PD patients. QoL was worse after TP, especially in terms of physical functioning (-31.7 points; 95% CI: -50.0 to -13.3; P < 0.001), role functioning (-41.3 points; 95% CI: -61.3 to -21.3; P < 0.001), emotional functioning (-27.5 points; 95% CI: -50.4 to -4.6; P = 0.019), fatigue symptoms (20 points; 95% CI: 2.7 to 37.4; P = 0.024) and pain symptoms (30.2 points; 95% CI: 4.1 to 56.3; P = 0.024). The rates of postoperative major complications (29% vs. 35%; P = 0.853) and mortality (11% vs. 7%; P = 0.857) were similar between TP and PD. Postoperative morbidity and mortality were comparable between PD and TP, however QoL is significantly lower after TP. Importantly, patients with preoperative DM have a 60% chance of remaining noninsulin-dependent after PD.

Sutureless Aortic Valve Replacement with Perceval Bioprosthesis Superior to Transcatheter Aortic Valve Implantation: A Promising Option for the Gray-Zone of Aortic Valve Replacement Procedures-A State-of-the-Art Systematic Review, Meta-Analysis, and Future Directions.

Background: The management of patients with aortic valve pathologies can sometimes fall into a "gray zone", where the optimal treatment approach is not straightforward. The comparative benefits of sutureless aortic valve replacement (SUAVR) using the Perceval bioprosthesis versus transcatheter aortic valve implantation (TAVI) for the "gray zone" of aortic valve replacement procedures remain a topic of debate. To further explore this issue, we conducted a study with pairwise, single-arm, and Kaplan-Meier-based meta-analyses to compare the outcomes of SUAVR with the Perceval bioprosthesis versus TAVI, as well as to evaluate the efficacy, safety, and durability of SUAVR with the Perceval bioprosthesis over mid-term and long-term follow-up periods. Methods: The PubMed, PubMed Central, OVID Medline, Cochrane Library, Embase, and Web of Science databases were systematically searched. All study types were included, except study protocols and animal studies, without time restrictions. The final search was carried out in May 2024. Results: No statistically significant differences were observed in permanent pacemaker implantation (PPI) rates between the two groups. SUAVR showed a lower incidence of new-onset myocardial infarction but was associated with higher rates of new-onset atrial fibrillation and major bleeding. TAVI had higher rates of left bundle branch block and major vascular complications. Conclusions: Our findings show that SUAVR has a lower incidence of complications and a favorable mid-term overall survival compared to TAVI. SUAVR has more advantages compared to TAVI and can be considered a valuable and promising option for the "grey zone" of aortic valve pathologies.

Is Ablation Suitable For Small Renal Masses (SRMs)? A Meta-Analysis

ObjectiveTo compare perioperative and oncology outcomes of ablation and partial nephrectomy in small renal masses (SRMs). MethodsWe conduct this meta-analysis strictly according to the PRISMA standard, and the quality evaluation follows the AMSTAR standard. Four databases, Embase, PubMed, Cochrane Library, and Web of Science, were systematically searched. The search time range is from database creation to November 2023. Stata16 statistical software was used for statistical analysis. Weighted mean difference (WMD) represented continuity variables, odds ratio or relative risk (OR/RR) represented dichotomies variables, and 95% confidence intervals (95%CI) were calculated. ResultsA total of 27 studies, including 6030 patients. Results showed that patients undergoing partial nephrectomy were younger (WMD = -5.45 years, 95%CI [-7.44, -3.46], P < 0.05), had longer operation time (WMD = 64.91 min, 95%CI [44.47, 85.34], P < 0.05), had longer length of stay (WMD = 2.91 days, 95%CI [2.04, 3.78], P < 0.05), and had more estimated blood loss (WMD = 97.76 ml, 95%CI [69.48, 126.04]. P < 0.05), the overall complication rate was higher (OR = 1.84, 95%CI [1.48, 2.29], P < 0.05), the major complication rate was higher (OR = 1.98, 95%CI [1.36, 2.88], P < 0.05), and the recurrence rate was lower (OR = 0.32, 95%Cl [0.20, 0.50], P < 0.05). However, there were no differences between ablation and partial nephrectomy in cancer-specific survival (CSS) (HR = 2.07, 95%CI [0.61, 7.04], P > 0.05), overall survival (OS) (HR = 1.24, 95%CI [0.58, 2.65], P > 0.05), and recurrence-free survival (RFS) (HR = 2.68, 95%CI [0.91, 7.88], P > 0.05). ConclusionPatients undergoing partial nephrectomy are younger, have longer operation time and length of stay, and have higher complication rate. However, there was no significant difference in CSS, OS, and RFS between partial nephrectomy and ablation, but more well-designed, high-quality studies are needed to confirm this.