Mid-term Outcomes Of Patients Research Articles

Anatomical and symptomatic mid-term outcomes of patients with isolated anterior compartment defect repair or stress urinary incontinence

BackgroundAn evaluation of preoperative and postoperative 12th month Pelvic Organ Prolapse Quantification (POP-Q) and Lower Urinary Tract Symptoms (LUTS) changes in patients operated for the diagnosis of isolated anterior compartment defect (ACD) or Stress Urinary Incontinence (SUI).MethodPatients who were diagnosed with isolated ACD or SUI were retrospectively analyzed at urogynecology unit of our tertiary referral center. All pelvic examinations were performed by the same experienced urogynecologist. Pre-operative and post-operative 12th month POP-Q scores and the responses to a detailed LUTS questionnaire in the unit were assessed.ResultsOf the 90 patients with isolated ACD or SUI, midurethral sling with mini-sling and retropubic transobturator tape methods was applied in 24, iliococcygeal fixation in 28, trapezoid repair in 9 patients, anterior bridge operation in 14, and plication of pubocervicovaginal fascia to the cervical ring in 15. We compared the POP-Q score and pre and post-operative 12th month LUTS. Between pre and post-operative 12th month, there was a statistically significant difference at Aa and Ba points (p < 0.00, 0.001). Comparative LUTS questionnaire showed statistically significant differences in stress urinary incontinence, frequency, urgency, abnormal emptying, nocturia, pelvic pain (p: <0.001, p < 0.001, p: <0.001, p:0.001, p:<0.001, p:0.003, respectively).ConclusionAnatomical and symptomatic recovery is achieved with appropriate surgical intervention in women with isolated ACD or SUI. When LUTS were evaluated in terms of symptomatic recovery, they were found to be related not only to symptoms involving the anterior compartment, but also to symptoms involving other compartments.

Mid-term outcomes of patients with subclinical hypothyroidism after coronary bypass surgery.

Subclinical hypothyroidism (SCH) is characterized by an elevated thyroid-stimulating hormone and normal free thyroxine. This study aimed to evaluate the influence of SCH on mid-term outcomes of patients after coronary artery bypass grafting (CABG). From January 2015 to December 2018, 548 SCH patients and 6718 euthyroid patients who underwent CABG were identified. Propensity score matching was used to create 2 cohorts with similar baseline characteristics (n = 544 in each group). The mid-term follow-up outcomes were compared. Adjusted hazard ratios (HRs) were calculated using Cox proportional hazards models. The mean follow-up for all patients was 39.7 ± 17.3 months. The unadjusted Kaplan-Meier estimate for mortality at 5-year follow-up was higher in patients with SCH compared with euthyroid patients (5.3% vs 1.6%, log-rank P = 0.03). After adjusting for covariates, the risk of mortality was higher in patients with SCH compared with euthyroid patients [HR, 2.40; 95% confidence interval (CI), 1.03-5.58; P = 0.04]. The adjusted risk of major adverse cardiovascular and cerebral event (HR, 2.16; 95% CI, 1.51-3.08; P < 0.001) and angina (HR, 2.44; 95% CI, 1.41-4.24; P = 0.001) was higher in patients with SCH compared with euthyroid patients. SCH is associated with an increased risk of mortality, major adverse cardiovascular and cerebral event and angina compared with euthyroidism in patients undergoing CABG.

Rectal atresia and rectal stenosis: the ARM-Net Consortium experience

PurposeTo assess the number, characteristics, and functional short-, and midterm outcomes of patients with rectal atresia (RA) and stenosis (RS) in the ARM-Net registry.MethodsPatients with RA/RS were retrieved from the ARM-Net registry. Patient characteristics, associated anomalies, surgical approach, and functional bowel outcomes at 1 and 5-year follow-up were assessed.ResultsThe ARM-Net registry included 2619 patients, of whom 36 (1.3%) had RA/RS. Median age at follow-up was 7.0 years (IQR 2.3–9.0). Twenty-three patients (63.9%, RA n = 13, RS n = 10) had additional anomalies. PSARP was the most performed reconstructive surgery for both RA (n = 9) and RS (n = 6) patients. At 1-year follow-up, 11/24 patients with known data (45.8%, RA n = 5, RS n = 6) were constipated, of whom 9 required stool softeners and/or laxatives. At 5-year follow-up, 8/9 patients with known data (88.9%, RA n = 4, RS n = 4) were constipated, all requiring laxatives and/or enema.ConclusionRA and RS are rare types of ARM, representing 1.3% of patients in the ARM-Net registry. Additional anomalies were present in majority of patients. Different surgical approaches were performed as reconstructive treatment, with constipation occurring in 46% and 89% of the patients at 1 and 5-year follow-up. However, accurate evaluation of long-term functional outcomes remains challenging.

Clinical course after Fontan palliation: Single center experience

BackgroundThe Fontan procedure has been the standard palliation for single-ventricle patients. We aimed to investigate the short- and midterm outcomes of patients who underwent Fontan palliation. ObjectivesTo assess and analyze the clinical course, including length of stay, complications, and mortality of single ventricle patients undergoing Fontan Palliation. MethodsRetrospective review of all patients who underwent Fontan palliation at the University of Minnesota, 2006–2020. The primary outcomes measured were length of stay, complications, and Fontan failure. ResultsOf the 55 patients the median age of Fontan was 3.9 yrs [2.63, 4.19] and the most common diagnoses were hypoplastic left heart syndrome (n = 20, 36 %), double inlet left ventricle (n = 11, 20 %) and double outlet right ventricle (n = 8, 15 %). Twenty-Seven were right ventricle dominant, 23 were left ventricle dominant, and 5 had biventricular morphology. The median hospital stay was 11 days [8, 17.5], an ICU stay of 6.5 days [4,9]. Fourteen late complications occurred in 10 patients. Three, all with HLHS, had Fontan failure leading to heart transplant. Four died: two prior to hospital discharge, one 6.7 yrs post-Fontan, and one 27 days after transplantation. Right ventricle morphology was associated with prolonged ICU (P 0.05), prolonged hospital stay (P < 0.01), and complications resulting in Fontan failure (P < 0.01). ConclusionThe survival following Fontan completion in the current era is excellent, with an overall and transplant-free survival at 5 and 10 years were at 96 % and 93 %. However, it is clear that univentricular physiology continues to present challenges, and patients remain at risk for morbidity, especially for patients with right ventricle morphology.

Mid-Term Results of Aortic Valve Sparing Root Surgery Operations

Introduction: In this study, we retrospectively analyzed the mid-term outcomes of patients who underwent aortic valve-sparing root replacement (VSARR). Patients and Methods: Ninety-six patients operated on due to annuloaortic ectasia in our clinic between 2012 and 2016 were examined. Twenty-four patients who underwent VSARR were included in the study. They were evaluated using echocardiography and computed tomography in terms of mortality and reoperation according to their preoperative demographic characteristics, aortic regurgitation (AR), and annular dilatation levels. Results: The early mortality rate was 12.5% (n= 3) and was associated with emergency operation and total arch replacement. The mean follow-up was 33.00 ± 9.53 months. The early mortality rate was 12.5% (n= 3) and was associated with emergency surgery and total arch replacement (p= 0.035, p&lt; 0.05). The mean followup was 33.00 ± 9.53 months. None of the patients required reoperation. While postoperative AR was seen in one patient with Takayasu’s arteritis (n= 1, 4.16%), it was not observed in the patients with Marfan syndrome or bicuspid aortic valve disease. Postoperative AR and preoperative AR were related (p= 0.012, p&lt; 0.05), but preoperative annulus diameter was not (p= 0.296, p&gt; 0.05). There was no difference in valve durability between the use of Dacron and Valsalva grafts (p= 0.724, p&gt; 0.05). Conclusion: For patients with aortic root aneurysms, elective VSARR is a good surgical option. However, the presence of comorbidities is related to high mortality because it necessitates urgent and complicated surgery for patients with aortic dissection.

Revision and Primary Meniscal Allograft Transplantations Provide Clinical Benefit at Mid-Term Follow-Up: A Matched-Cohort Analysis of Patient-Reported Outcomes, Reoperations, and Failures

To report the mid-term outcomes of patients who underwent revision meniscal allograft transplantation (RMAT) and compare survivorship free from reoperation and failure with a matched cohort of patients who underwent primary meniscal allograft transplantation (PMAT). A retrospective review of prospectively collected data identified patients who underwent RMAT and PMAT between 1999 and 2017. A cohort of PMAT patients matched at a ratio of 2:1 with respect to age, body mass index, sex, and concomitant procedures served as the control group. Patient-reported outcome measures (PROMs) at baseline and at a minimum of 5 years postoperatively were collected. PROMs and the achievement of clinically significant outcomes were analyzed within groups. Graft survivorship free from meniscal reoperation and failure (arthroplasty or subsequent RMAT) was compared between cohorts using log-rank testing. During the study period, 22 RMATs were performed in 22 patients. Of these RMAT patients, 16 met the inclusion criteria (73% follow-up rate). The mean age of RMAT patients was 29.7 ± 9.3 years, and the mean follow-up period was 9.9 ± 4.2 years (range, 5.4-16.8 years). There were no differences between the RMAT cohort and the 32 matched PMAT patients with respect to age (P= .292), body mass index (P= .623), sex (P= .537), concomitant procedures (P ≥ .286), or baseline PROMs (P ≥ .066). The patient acceptable symptomatic state was achieved by the RMAT cohort for the subjective International Knee Documentation Committee score (70%), Lysholm score (38%), and Knee Injury and Osteoarthritis Outcome Score subscales (Pain [73%], Symptoms [64%], Sport [45%], Activities of Daily Living [55%], and Quality of Life [36%]). In the RMAT cohort, 5 patients (31%) underwent subsequent reoperation at a mean of 4.7 ± 2.1 years (range, 1.7-6.7 years) and 5 patients met the criteria for failure at a mean of 4.9 ± 2.9 years (range, 1.2-8.4 years). There were no significant differences in survivorship free from reoperation (P= .735) or failure (P= .170) between the RMAT and PMAT cohorts. At mid-term follow-up, most patients who underwent RMAT achieved the patient acceptable symptomatic state for the subjective International Knee Documentation Committee score and the Knee Injury and Osteoarthritis Outcome Score subscales of Pain, Symptoms, and Activities of Daily Living. Additionally, there were no differences in survival free from meniscal reoperation or failure between the PMAT and RMAT cohorts. Level III, retrospective comparative cohort.

Poster 230: Improved Mid-Term Outcomes in Patients with Slipped Capital Femoral Epiphysis Related Femoroacetabular Impingement

Objectives: Slipped Capital Femoral Epiphysis (SCFE) of the hip is a potentially devastating injury that can occur in the developing hip. In-situ pinning is considered the current standard of care; however, even with prompt surgical fixation, there remains a risk of post-operative disability as a result of metaphyseal CAM deformity. This deformity can lead to subsequent femoroacetabular impingement resulting in labral and articular cartilage damage. Hip arthroscopy with labral repair and femoral osteochondroplasty has increasingly been utilized in these patients to correct the underlying deformity and improve hip mechanics. Short-term follow-up has demonstrated excellent outcomes in patients treated for SCFE with subsequent hip arthroscopy. Mid-term follow-up of these patients is sparse and limited to studies with small sample sizes. These studies primarily evaluate radiographic and physical examination findings rather than patient reported outcomes (PROs). The purpose of this study is to evaluate the mid-term clinical and functional patient reported outcomes of a large population of patients undergoing hip arthroscopy after SCFE in-situ fixation. Methods: SCFE patients that underwent subsequent hip arthroscopy for FAI were recruited for this prospective study. Patients were recruited from a single surgeon practice. Patients were sent a survey which included a single assessment numeric evaluation (SANE) prompt, subjective Likert-style questions assessing disability and satisfaction, and PROMIS Physical Function and iHOT-12 questionnaires. Patient charts were retrospectively reviewed for patient demographics, visual analogue scale (VAS) pain scores, and a modified Harris Hip Score (mHHS) from the post-pinning and pre-arthroscopy period. Descriptive statistics were utilized to assess overall patient outcomes. Results: In total, forty patients met inclusion criteria and thirty-three completed the mid-term follow up survey for an 82.5% response rate. Mean age at the time of arthroscopy was 18.5 years and mean duration of follow up was 5.85 years (Table 1). Patient subjective outcomes are reported in Table 2; notably, 33 of 33 patients (100%) were neutral, satisfied, or very satisfied with surgery. No patients reported that if given the choice again, they would choose to not have surgery. mHHS pre-operatively was 67.43, which was interpreted as poor functional status. Mean mid-term follow-up PROMIS-PF t- score was 51.19, indicating that the functional status of the included patients was at or above the average functional status of the overall population. Mean VAS pain score at rest was 4.78 pre- operatively and 1.94 at mid-term follow up. The average post-operative iHOT-12 score was 65.64 (Table 3) Conclusions: The results of the first mid-term, large-sample sized comprehensive follow-up of patients undergoing hip arthroscopy following surgical pinning of SCFE demonstrate that these patients have excellent functional and clinical outcomes. Subjectively, these patients report improved satisfaction with the operation and overall improvement in functional status. Objectively, the studied patients are performing at the level of the average non-surgical population as measured by PRO scoring systems. These findings suggest that the excellent outcomes reported at short-term follow-up persist at mid-term follow-up. This study demonstrates that hip arthroscopy for FAI in the setting of a prior in-situ pinning of a SCFE is a viable surgical treatment and reliably improves patient’s pain and physical function at mid- term follow up. [Table: see text][Table: see text][Table: see text]

Early and Mid-Term Outcomes After Surgery for Bicuspid and Tricuspid Aortic Valve Disease: The Tasmanian Experience

This study aimed to compare the early and mid-term outcomes of patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) disease who underwent aortic valve replacement (AVR) and/or aortic surgery at a tertiary, regional cardiothoracic unit.

Impact of Preoperative Quantitative Flow Ratio of the Left Anterior Descending Artery on Internal Mammary Artery Graft Patency and Midterm Patient Outcomes After Coronary Artery Bypass Grafting.

Background In coronary artery bypass grafting, grafting a target vessel with nonsignificant stenosis increases the risk of graft failure. The present study aims to investigate the impact of preoperative quantitative flow ratio (QFR), a novel functional assessment of the coronary artery, on internal mammary artery graft failure rate and midterm patient outcomes. Methods and Results Between January 2016 and January 2020, we retrospectively included 419 patients who underwent coronary artery bypass grafting who had received preoperative angiography and postoperative coronary computed tomographic angiography in our center. QFR of the left anterior descending (LAD) artery was computed based on preoperative angiograms. The primary end point was the failure of the graft on the LAD artery assessed by coronary computed tomographic angiography at 1 year, and the secondary end point was major adverse cardiac and cerebrovascular events including death from any cause, myocardial infarction, stroke, or repeat revascularization. Grafts on functionally nonsignificant LAD arteries (QFR >0.80) had a significantly higher failure rate than those on functionally significant LAD arteries (31.4% versus 7.2%, P<0.001). QFR outperforms degree of stenosis in discriminating graft failure (C statistic, 0.76 versus 0.58). Clinical follow-up (3.6 years, interquartile range [3.3-4.1]) was accomplished in 405 patients, and the rate of major adverse cardiac and cerebrovascular events was significantly higher among patients with functionally nonsignificant LAD arteries (10.1% versus 4.2%; adjusted hazard ratio, 3.08 [95% CI, 1.18-8.06]; P=0.022). Conclusions In patients receiving internal mammary artery to LAD artery coronary artery bypass grafting, preoperative QFR of the LAD artery of >0.80 was associated with a higher graft failure rate at 1 year and worse patient outcomes at the 3.6-year follow-up.

Midterm Outcomes in Patients With Aortic Stenosis Treated With Contemporary Balloon-Expandable and Self-Expanding Valves: Does Valve Size Have an Impact on Outcome?

Background No data currently exist comparing the contemporary iterations of balloon-expandable (BE) Edwards SAPIEN 3/Ultra and the self-expanding (SE) Medtronic Evolut PRO/R34 valves. The aim of the study was the comparison of these transcatheter heart valves with emphasis on patients with small aortic annulus. Methods and Results In this retrospective registry, periprocedural outcomes and midterm all-cause mortality were analyzed. A total of 1673 patients (917 SE versus 756 BE) were followed up for a median of 15 months. A total of 194 patients died (11.6%) during follow-up. SE and BE groups showed similar survival at 1 (92.6% versus 90.6%) and 3 (80.3% versus 85.2%) years (Plog-rank=0.136). Compared with the BE group, patients treated with the SE device had lower peak (16.3±8 mm Hg SE versus 21.9±8 mm Hg BE) and mean (8.8±5 mm Hg SE versus 11.5±5 mm Hg BE) gradients at discharge. Conversely, the BE group demonstrated lower rates of at least moderate paravalvular regurgitation postoperatively (5.6% versus 0.7% for SE and BE valves, respectively; P<0.001). In patients treated with small transcatheter heart valves (≤26 mm for SE and ≤23 mm for BE; N=284 for SE and N=260 for BE), survival was higher among patients treated with SE valves at both 1 (96.7% SE versus 92.1% BE) and 3 (91.8% SE versus 82.2% BE) years (Plog-rank=0.042). In propensity-matched patients treated with small transcatheter heart valve, there remained a trend for higher survival among the SE group at both 1 (97% SE versus 92.3% BE) and 3 years (91.8% SE versus 78.7% BE), Plog-rank=0.096). Conclusions Real-world comparison of the latest-generation SE and BE devices demonstrated similar survival up to 3 years' follow-up. In patients with small transcatheter heart valves, there may be a trend for improved survival among those treated with SE valves.

Mid-term outcomes following the Hemi-Commando procedure for complex infective endocarditis involving the aortomitral junction.

Perivalvular abscesses with destruction of the aortomitral junction (AMJ) are a severe complication of infective endocarditis (IE) and are associated with high mortality and complex management. The Hemi-Commando procedure is a mitral valve-sparing alternative to the Commando procedure in suitable patients with complex IE and paravalvular destruction. This study reviews the mid-term outcomes in patients undergoing the Hemi-Commando procedure for treating IE with destruction of the AMJ. The clinical outcomes of patients with IE and AMJ involvement who underwent the Hemi-Commando procedure between 2015 and 2021 at the Leipzig Heart Center were retrospectively analysed. Primary outcomes were 30-day mortality and 1-year survival. Secondary outcome was 1-year freedom from reoperation. A total of 22 patients underwent the Hemi-Commando procedure during the study period. The patients' mean age was 59.8 ± 18.3 years. The study population was predominantly male (86.4%). Preoperative sepsis was present in 6 (27.3%) patients, and the median EuroSCORE II was 28.5%. Almost two-thirds (N = 14; 63.6%) of the patients presented with native IE. Streptococci were the most common pathogens (N = 8; 36.4%). Paravalvular abscess was found intraoperatively in 16 (72.7%) patients. The 30-day mortality was 13.6%. The estimated 1- and 3-year survival rates were 77.5% and 66.4%, respectively. The estimated freedom from reoperation at 1 and 3 years was 92.3%. The Hemi-Commando procedure offers an acceptable mid-term survival chance with low reoperation rates and is, therefore, a reasonable mitral valve-sparing alternative to the Commando procedure in suitable patients with extensive IE and perivalvular involvement.

Medium-Term Outcomes in Pediatric Patients Undergoing Cardiac Catheterization Early After Congenital Cardiac Surgery.

Safety and acute outcomes for patients who need catheterization shortly after congenital cardiac surgery has been established; literature on mid-term outcomes is lacking. We sought to evaluate the mid-term outcomes of patients who undergo early postoperative cardiac catheterization. This is a retrospective cohort study of patients who underwent cardiac catheterization within 6weeks of congenital cardiac surgery with longitudinal follow-up and assessment of mid-term outcomes. Multivariable analysis was utilized to relate variables of interest to outcomes. 99 patients underwent cardiac catheterizations within 6weeks of cardiac surgery between January 2008 and September 2016. Forty-six (45.5%) interventional procedures were performed at a median age of 41days (IQR 21-192) and a median weight of 3.9kg (3.3-6.6). During a median follow-up duration of 4.24years (1.6-5.6) in study survivors, 61% of patients remained free from the primary endpoint (death and/or transplant). Sixty-nine patients (69.7%) underwent an unplanned surgical or catheter procedure. Renal failure at catheterization (OR 280.5, p 0.0199), inotropic medication at catheterization (OR 14.8, p 0.002), and younger age were all significantly associated with meeting the primary endpoint. Patients requiring surgical intervention as an initial additional intervention underwent more unplanned re-interventions, while patients who survived to hospital discharge demonstrated favorable mortality, though with frequent need for re-intervention. In patients requiring early postoperative cardiac catheterization, renal failure, younger age, and need for inotropic support at catheterization are significantly associated with meeting the primary endpoint.

Anatomic shoulder arthroplasty with high side reaming versus reverse shoulder arthroplasty for eccentric glenoid wear patterns with an intact rotator cuff: comparing early versus midterm outcomes with minimum 7 years of follow-up.

Eccentric glenoid bone loss patterns (B- and C-type glenoid) pose a difficult challenge when performing shoulder arthroplasty. Anatomic total shoulder arthroplasty with preferential high-side reaming (ATSA+HSR) has been an accepted method to treat this problem. Reverse shoulder arthroplasty (RSA) has become an alternative method to manage these cases with eccentric glenoid wear. The purpose of this study was to compare the early 2-year outcomes with the midterm outcomes for patients who underwent ATSA+HSR vs. RSA for eccentric glenoid wear patterns with an intact rotator cuff. From 2008 to 2014 there were 242 shoulder arthroplasties performed in the setting of eccentric glenoid wear patterns. Of that initial cohort 101 ATSA+HSR and 93 RSA had both 2-year and final follow-up with a minimum of 7 years from surgery. American Shoulder and Elbow Surgeons (ASES) scores, Simple Shoulder Test (SST), range of motion, patient satisfaction, and radiographs were evaluated for each cohort and contrasted at the 2-year follow-up point and last follow-up time point. The average follow-up in the ATSA+HSR cohort was 8.3 years compared with 7.8 years in the RSA cohort. At the 2-year follow-up point, the ATSA+HSR group had better average ASES scores (85 vs. 80 [P<.001]), SST scores (10 vs. 9.6 [P<.001]), forward elevation (162° vs. 151° [P<.001]), external rotation (47° vs. 42° [P<.001]), and internal rotation (IR) (80% full IR vs. 55% full IR [P<.001]). At the 2-year follow-up, 95% of the ATSA+HSR cohort were satisfied compared with 93% in the RSA cohort. At the final follow-up, the RSA group had better average ASES scores (80 vs. 77 [P<.001]) and SST scores (9.4 vs. 8 [P<.001]) and a similar forward elevation (152° vs. 149° [P=.025]). The ATSA+HSR had better external rotation (45° vs. 41° [P<.001]) and IR (74% full IR vs. 54% full IR [P=.005]). Patient satisfaction at the final follow-up had decreased to 82% in the ATSA+HSR group, compared with 95% satisfied in the RSA group. Of the initial ATSA+HSR cohort, 8% of patients had undergone revision compared with 2% in the RSA cohort. ATSA with HSR had better outcome scores and range of motion with a similar patient satisfaction rating to RSA at the 2-year point. Over time, the ATSA+HSR results deteriorated, and at the final midterm follow-up, the RSA group had more durable results with better outcome scores, a higher patient satisfaction rating, and a lower revision rate.

Stenting performs better than drug-coated balloon angioplasty in popliteal lesions

BackgroundPeripheral arterial disease (PAD) is a common and highly morbid disease. Although there have been recent advancements in the endovascular modalities to treat PAD, comparisons of these strategies, especially in the popliteal region, remain underinvestigated. The objective of this study was to compare midterm outcomes in patients with PAD undergoing treatment with both novel and SS compared with drug-coated balloon (DCB) angioplasty. MethodsAll patients at a multi-institution health system treated for PAD in the popliteal region from 2011 to 2019 were identified. Presenting features, operative details, and outcomes were included in the analysis. Patients who underwent popliteal revascularization with stents were compared with DCB. SS were compared separately with novel dedicated stents. Two-year primary patency was the primary outcome. ResultsWe included 408 patients (72.7 ± 11.8 years old; 57.1% men) in the analysis. There were 221 (54.7%) patients who underwent popliteal stenting and 187 (45.3%) who underwent popliteal DCB. There were high rates of tissue loss in both groups (57.9% vs 50.8%; P = .14). Stented patients had longer lesions (112.4 ± 3.2 vs 100.2 ± 5.8 mm; P = .03) and higher rates of concomitant superficial femoral artery treatment (88.2% vs 39.6%; P < .01). Chronic total occlusions accounted for the majority of lesions treated (stent 62.4%, DCB 64.2%). Perioperative complications were similar between groups. Primary patency for the stented group was higher at two years than the DCB group (61.0% vs 46.1%; P = .03). When evaluating stented patients only, SS had higher 2-year patency than novel stents in the popliteal segment (69.6% vs 51.4%; P = .04). On multivariable analysis, stenosis, as opposed to chronic total occlusion, was associated with improved patency (hazard ratio, 0.49; 95% confidence interval, 0.25-0.96; P = .04), whereas novel stents were associated with worse primary patency (hazard ratio, 2.01; 95% confidence interval, 1.09-3.73; P = .03). ConclusionsIn a population of patients with severe vascular disease, stents do not have inferior patency and limb salvage rates compared with DCB angioplasty when treating the popliteal region. For patients with advanced vascular disease, and especially tissue loss, stents and DCB are both beneficial when treating popliteal lesions.

MP59-19 FACTORS ASSOCIATED WITH THE USE OF LOWER ENERGY DENSITY IN GREEN LASER PROSTATE PHOTO-VAPORIZATION

You have accessJournal of UrologyCME1 Apr 2023MP59-19 FACTORS ASSOCIATED WITH THE USE OF LOWER ENERGY DENSITY IN GREEN LASER PROSTATE PHOTO-VAPORIZATION Laura Zuluaga, Mauricio Plata, Carlos Gustavo Trujillo, Jessica Santander, Maria Paula Mogollon, Juan Ignacio Caicedo, Julian Azuero, Cesar Diaz Ritter, Claudia Colmenares, and Martin Rondón Laura ZuluagaLaura Zuluaga More articles by this author , Mauricio PlataMauricio Plata More articles by this author , Carlos Gustavo TrujilloCarlos Gustavo Trujillo More articles by this author , Jessica SantanderJessica Santander More articles by this author , Maria Paula MogollonMaria Paula Mogollon More articles by this author , Juan Ignacio CaicedoJuan Ignacio Caicedo More articles by this author , Julian AzueroJulian Azuero More articles by this author , Cesar Diaz RitterCesar Diaz Ritter More articles by this author , Claudia ColmenaresClaudia Colmenares More articles by this author , and Martin RondónMartin Rondón More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Energy density (ED) (kJ/mL) measures the amount of Joules used in relation to prostate volume (PV). ED appears to be related to adequate tissue removal and probably improved mid-term outcomes in patients treated with photo-vaporization (PVP) of the prostate with GreenLight laser. We aim to assess associated factors with a lesser ED delivery in prostate photo-vaporization. METHODS: Data was retrospectively collected from a single center database with 748 patients who underwent surgery between 2012 and 2019. Groups were divided according to intra-operative energy delivered to the prostate. Group 1: < 4.0 and group 2: ≥4.0 kJ/mL. Peri and postoperative outcomes were assessed. Bivariate and multivariate analyses were performed to determine the statistically significant variables associated with the use of low ED. RESULTS: General characteristics are shown in Table 1. Group 1 had a total of 36% (n=268), and Group 2 had 64% (n=480) patients. Bivariate analysis was performed, and statistically significant association was observed for higher PV (OR=1.02 [1.02-1.01] IC 95% p-value <0.01), history of combination therapy (OR=1.5 [2-1.1] IC95% p-value=0.01) and postoperative longer bladder catheterization time. After controlling by confounding variables, the multivariate analysis showed that for patients with lower ED delivered acute urinary retention (AUR) appeared to be a protective factor (OR=0.6 [0.9-0.4] IC95% p-value=0.01), and a larger prostate volume (OR=1.02 [1.3-1.02] IC95% p-value <0.01) was associated with lesser ED. CONCLUSIONS: After analyzing factors like surgeons' expertise and comorbidity, we found that PV is shown to be associated with lower energy density delivery and potentially associated with worse functional outcomes. Source of Funding: No funding was received © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e816 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laura Zuluaga More articles by this author Mauricio Plata More articles by this author Carlos Gustavo Trujillo More articles by this author Jessica Santander More articles by this author Maria Paula Mogollon More articles by this author Juan Ignacio Caicedo More articles by this author Julian Azuero More articles by this author Cesar Diaz Ritter More articles by this author Claudia Colmenares More articles by this author Martin Rondón More articles by this author Expand All Advertisement PDF downloadLoading ...

Evaluation of the Early-Mid-Term Results of Isolated Tibial Insert Exchange After Total Knee Arthroplasty.

This study aimed to assess the early and mid-term results of patients who had undergone total knee arthroplasty (TKA) and then underwent an isolated tibial insert exchange due to tibial insert fracture and/or melting. A retrospective study was conducted at the Orthopedics and Traumatology Clinic in a secondary-care public hospital in Türkiye on seven knees of six patientsaged 65 years and abovewho underwent an isolated tibial insert exchange and were followed up for at least six months. Pain and functional assessments of the patients were made with the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) performed at the last control before the treatment and at the final follow-up visit after the treatment. The median age of the patients was 70.5 years. The median length of time between the primary TKA and the isolated tibial insert exchange was 5.96 years. After isolated tibial insert exchange, the patients were followed for a median of 268 days and a mean of 414 days. The WOMAC pain, stiffness, function, and total indexes were median 15, 2, 52, and 68, respectively, before the treatment. In contrast, the final follow-up WOMAC pain, stiffness, function, and total indexes were median 3 (p = 0.01), 1 (p = 0.023), 12 (p = 0.018), and 15 (p = 0.018), respectively. It was observed that the median VAS, which was "9" preoperatively, showed a statistically significantimprovement to become "2" in the postoperative period. A strong negative correlation was found between age and the amount of decline in the total score of the WOMAC pain scale (r = -0.780; p = 0.039). There was a powerful negative correlation between the body mass index (BMI) and the amount of decline in WOMAC pain scores (r = -0.889; p = 0.007). A strong negative correlation was found between the length of time passing between two surgical procedures and the amount of decline in the WOMAC pain score (r = -0.796; p = 0.032). Individual patient factors and prosthetic conditions should be considered undoubtedly when determining the best revision strategy in TKA patients. In cases where the components are well-aligned and well-fixed, isolated tibial insert exchange is an alternative to revision TKA since it is less invasive and more cost-effective.

Prognostic impact of branch vessel involvement on organ malperfusion and mid-term survival in patients with acute type A aortic dissection

BackgroundThis study aimed to investigate the impact of branch vessel involvement on organ malperfusion and mid-term survival in patients with acute type A aortic dissection (ATAAD). MethodsBetween January 2019 and December 2020, 493 consecutive patients with angiographically confirmed ATAAD were retrospectively analysed. Preoperative computed tomography angiography parameters (branch artery involvement, longitudinal extent of dissection) were reviewed. The incidence of organ malperfusion, in-hospital mortality, and mid-term outcomes of patients with and without branch vessel involvement were compared. ResultsBranch vessel involvement was detected in 407 patients (82.6%), and organ malperfusion was observed in 234 patients (47.5%). The incidence of organ malperfusion was significantly higher in patients with branch vessel involvement compared with patients without it (52.6% vs. 23.3%, p < 0.001). Patients with coronary artery involvement (32.5%) were more likely to manifest as clinical malperfusion, whereas it occurred only 19.4% in patients with renal artery involvement. In-hospital mortality was higher in patients with branch vessel involvement (19.9% vs. 8.1%, p = 0.010). Median follow-up time was 16.1 months. Two-year survival rate was lower in patients with branch vessel involvement (76.3% vs. 84.5%, p = 0.085) or organ malperfusion (68.3% vs. 86.0%, p < 0.001). Multivariable analysis identified cardiac, cerebral, visceral and renal malperfusion as independent predictors for in-hospital mortality. ConclusionsOnly a small proportion of branch vessel involvement was associated with corresponding organ malperfusion in patients with ATAAD. Branch vessel involvement had a greater effect on short-term outcomes than mid-term survival, and organ malperfusion was related to a worse prognosis beyond it.

The effect of femoral component valgus/varus angle on the mid-term efficacy of unicondylar knee arthroplasty

ABSTRACT Objective: To investigate the effect of femoral component valgus/varus angle (FCVA) on the mid-term outcome after unicondylar knee arthroplasty. Methods: Patients who underwent unicompartmental knee replacement in the Department of Bone and Joint Surgery, were retrospectively analyzed. According to the postoperative femoral prosthesis internal and external rotation angle, patients were divided into six groups the postoperative femoral prosthesis internal and external rotation angle: standard group, mildly abnormal group. The patients were followed up for 12 months, and complications were recorded during the follow-up period. The Range of motion (ROM), visual analog scale (VAS), and Knee society score (KSS) were compared between the six groups. Results: One hundred twenty-four patients with 124 knees were included in this study. There were no statistical differences in age, gender, body mass index, preoperative ROM, or preoperative VAS, KSS-C, and KSS-F scores among the six groups. Comparison of postoperative outcomes and efficacy grades showed that: (1) the differences in ROM grades, as well as VAS, KSS-C, and KSS-F efficacy at 12 months postoperatively were statistically significant in all six groups by rank sum test; and patients in the normal group had better ROM grades and KSS-F grades than those in the mild and severe abnormality groups; (2) During the follow-up, no patient records had other serious complications such as periprosthetic infection, prosthetic loosening, periprosthetic fracture, and spacer dislocation. Conclusion: Controlling the femoral prosthetic internal rotation angle between 6° and 0° in unicompartmental knee replacements can lead to better mid-term outcomes for patients.

Mid-Term Survivorship, Radiographic and Functional Outcomes of Robotic-Assisted Unicompartmental Knee Arthroplasty.

The use of robotic-arm assistance for medial unicompartmental knee arthroplasty (RAUKA) has become an area of interest to overcome technical challenges, improve accuracy, and optimize patient outcomes. Due to the rise in osteoarthritis (OA) and robotic assistance, well-powered long-term studies are warranted. The aim of this study was to analyze midterm survivorship, radiographic changes, range of motion (ROM), and patient-reported outcome measurements (PROMs) of RAUKA. Patients who underwent RAUKA for medial compartmental OA were identified from April 2009 to May 2014. The query yielded 162 knees with a mean follow up of 6.5 years. Primary endpoints were to compare survivorship, final mechanical axis alignment, radiographic changes, mean ROM, and changes to the following PROMs: Knee Society Score (KSS), International Knee Documentation Committee (IKDC), and Oxford Knee Score (OKS). Statistical analyses were primarily descriptive. A p-value less than 0.05 was considered statistically significant. There were no revisions of the primary implant, one case required exchange of polyethylene bearing and debridement for deep infection, and five cases required additional surgical intervention with implant retention. Overall survivorship was 100%. Radiographic assessment demonstrated no mechanical loosening or osteolysis surrounding the implant. Mean ROM was 3 to 121.9º. Patients demonstrated a mean functional KSS of 78.55, IKDC of 78.22, and OKS of 43.94. The study supports excellent mid-term outcomes in patients undergoing RAUKA for medial compartment OA. Longer term follow-up studies are necessary to determine the efficacy of this technology for patients undergoing RAUKA for medial compartment OA.

Comparing Outcomes Between Surgical and Transcatheter Aortic Valve Replacement in Classical Low-Flow Low-Gradient Aortic Stenosis

Patients with classic low-flow low-gradient (cLFLG) aortic stenosis (AS) have a poor prognosis but still benefit from aortic valve replacement. There is a paucity of evidence to guide the choice between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). This study compared procedural and midterm outcomes in patients with cLFLG AS between TAVR and SAVR. Patients with cLFLG AS, defined as an aortic valve area ≤1 cm2, mean gradient <40 mm Hg, and left ventricular ejection fraction <50%, were selected from a single center between 2015 and 2020. Inverse probability weighting and regression were used to adjust for differences in baseline characteristics, the nonrandom assignment of treatment modalities, and procedural differences. The primary end point was all-cause mortality. A total of 322 patients (220 TAVR and 102 SAVR) were included. At a follow-up of 4.4 ± 1.5years, the adjusted hazard ratio (HR) for mortality after inverse probability weighting with SAVR was 0.66, 95% confidence interval (CI) 0.31 to 1.35; p=0.24. Worse renal function at baseline (per 10ml/min/m2 increase HR 0.92, 95% CI 0.84 to 1.00, p=0.04) and multiple valve interventions (HR 5.39, 95% CI 2.62 to 11.12, p <0.001) independently predicted mortality. There was no difference in stroke and permanent pacemaker implantation, but the rates of renal replacement therapy were higher among the SAVR cohort: 13.7% versus 0%; p <0.001. In conclusion, among patients with cLFLG AS, there was no difference in midterm mortality between TAVR and SAVR, supporting the use of either treatment. However, in patients with poor renal function or at risk of renal failure, TAVR may be the preferred option.