Mid-term Outcomes Of Patients Research Articles

Acetabuloplasty with bone grafting in uncemented hip replacement for protrusion.

This retrospective study investigated midterm outcomes of uncemented total hip replacement with acetabuloplasty using impacted bone grafts in acetabular protrusion or primary hip arthritis with an inadequate thickness of the medial acetabular wall. The medial acetabular wall was augmented by impaction bone grafting, and an uncemented cup was implanted in all cases. Hip centre of rotation, medial acetabular wall thickness and cup positioning were evaluated radiologically, with the Harris Hip Score determined at each follow-up. A total of 32 patients (39 hips) were followed for a mean of 4.5 years, with significant improvement of the Harris Hip Score at the last follow-up. Hip centre of rotation was restored close to the optimal position. Medial acetabular wall thickness and cup position obtained immediately postoperatively were maintained up to the last follow-up, without statistically significant differences. Bone graft integration was observed in all cases by one or two years postoperatively, with no signs of loosening or cup migration at the last follow-up. Heterotopic ossification was identified in 15.4% of cases, without clinical evidence of hip mobility impairment or pain. Impaction bone grafting for acetabuloplasty, associated with the implantation of an uncemented cup, yields good midterm results in patients with acetabular protrusion and with primary hip arthrosis with a thinned medial acetabular wall. The restored bone stock and medial acetabular wall thickness enable the placement of the hip centre of rotation close to the optimal location, which could offer further long-term benefits.

Mid-Term Results of Congenital Supravalvar Mitral Ring Resection.

Supravalvar mitral ring is a rare congenital anomaly leading to left ventricle inflow obstruction. We present our surgical experience and mid-term results in patients operated for supravalvar mitral ring and associated congenital heart defects. A retrospective analysis was performed in order to evaluate the cases surgically treated with the diagnosis of supravalvar mitral ring between 2001 and 2014. Ten patients were identified, seven of whom had accompanying congenital heart defects. Median age at the operation was 4.5 years. Ventricular septal defects were encountered in half of the cases. Two of the patients had mitral annular hypoplasia, another two had the components of Shone's complex. The mean preoperative gradient across the supravalvar mitral ring decreased from 14.1 ± 4.2 mmHg to 4.6 ± 2.2 mmHg. All patients are alive and remain in a good clinical condition after a mean follow-up of five years. Supravalvar mitral ring is a surgically treatable cause of left ventricular inflow obstruction. Although residual gradients may be encountered in patients with mitral annular hypoplasia, surgical resection of the ring is encouraged.

The Importance of Re-interventions After Ruptured EVAR

Peri-operative survival is the most important and relevant outcome measure for treatment of an acutely life threatening disease, such as ruptured abdominal aortic aneurysm (rAAA). In this respect, endovascular and open repair of rAAAs have equal results in randomised trials. However, approximately 70% of patients with rAAAs survive the peri-operative period, and for these patients the long-term prognosis of the disease is of utmost importance. In the paper by van Beek et al.,1van Beek S.C. Vahl A. Wisselink W. Reekers J. Legemate D. Balm R. Midterm re-interventions and survival after endovascular versus open repair for a ruptured abdominal aortic aneurysm.Eur J Vasc Endovasc Surg. 2015; 49: 661-668Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar the midterm survival and re-intervention rate after rAAA repair is assessed in a cohort of patients treated in the period 2004–11. The study, which was performed in conjunction with the AJAX trial,2Reimerink J.J. Hoornweg L.L. Vahl A.C. Wisselink W. van den Broek T.A. Legemate D.A. et al.Endovascular repair versus open repair of ruptured abdominal aortic aneurysms: a multicenter randomized controlled trial.Ann Surg. 2013; 258: 248-256Crossref PubMed Scopus (267) Google Scholar included 476 patients with rAAAs in the Amsterdam ambulance region of whom 73 were treated by endovascular aneurysm repair (EVAR). While 116 of the patients (including 57 who received EVAR) were treated within the randomised trial, most of the patients were treated with open surgery outside randomisation. Overall, both the 5 year survival and re-intervention rates were equal in patients treated with open repair and those treated with EVAR. When focusing on the patients who survived the peri-operative period, re-interventions were more common in the EVAR group (33% at 5 years) than in the open repair group (10%). The study adds important data to the current debate regarding the role of EVAR in the treatment of ruptures. There are, however, possible confounders and biases that may affect the generalisability of the results. Owing to the management protocol for rAAA in the study, where stable patients were transferred to three major centres for assessment for EVAR, case selection is an important issue. In the AJAX trial, EVAR was performed with an aorto-uni-iliac device, which is not routine at most centres today. The follow up protocol varied for open repair and EVAR patients, and the study disregards complications that were not surgically corrected, for example hospitalisation for bowel obstruction or incisional hernias that were not operated on. The higher re-intervention rate among survivors of ruptured EVAR compared with open repair is in line with the experience from elective repair. Still, this finding raises several important questions regarding the management of ruptures with EVAR. The midterm re-intervention rate of 33% is worrying, especially when considering the lack of evidence for early survival benefit for endovascular repair in ruptures. The re-intervention rate after ruptured EVAR in the current series is higher than the experience reported from the elective setting, despite highly selective use of EVAR with strict anatomical criteria in this study. These findings could affect the need for tailored follow up after ruptured EVAR. Further studies of midterm outcome of patients treated with EVAR for ruptured AAA is required to further assess the possible long-term risks. Midterm Re-interventions and Survival After Endovascular Versus Open Repair for Ruptured Abdominal Aortic AneurysmEuropean Journal of Vascular and Endovascular SurgeryVol. 49Issue 6PreviewTo compare the midterm re-intervention and survival rates after EVAR and OR for ruptured abdominal aortic aneurysms (RAAA). Full-Text PDF Open Archive

Valve-in-valve transcatheter aortic valve implantation for failing surgical aortic stentless bioprosthetic valves: A single-center experience

BackgroundValve-in-valve (ViV) transcatheter aortic implantation (TAVI) is an alternative to redo surgery for patients with a failing aortic bioprosthesis. A lack of anatomic markers may complicate the procedure. This study reports procedural and midterm outcomes of patients undergoing ViV-TAVI for failing stentless bioprostheses, at a single institution. MethodsA total of 22 consecutive patients with failing homograft (n = 17), stented porcine valve (n = 3), aortic root bioprosthesis (n = 1), or native resuspended aortic valve (n = 1) (aged 74 ± 12 years; Society of Thoracic Surgeons 30-day predicted risk of mortality score: 14% ± 8%) were treated with ViV-TAVI, between 2007 and 2014. All had severe aortic regurgitation and were highly symptomatic before TAVI: 41% had chronic kidney disease; 32% had undergone previous coronary bypass grafts; 27% had previous percutaneous coronary intervention; 14% had severe pulmonary disease; 14% had had a stroke. All underwent TAVI with a self-expanding device. ResultsThe 30-day mortality was 0%. No cases occurred of myocardial infarction, tamponade, stroke, severe bleeding, acute kidney injury, or major vascular complications. Three instances of device migration, and 1 of device embolization, occurred. Permanent pacing was required in 14%. Paravalvular aortic regurgitation was absent or mild in 19, and mild to moderate in 3. Average hospital stay was 8 ± 3 days; all patients were discharged home. Six-month and 1-year mortality was 4.8% and 14.3%, respectively. Aortic valve area and paravalvular aortic regurgitation were unchanged at 1 year. ConclusionsThe ViV-TAVI procedure may be performed in high-risk patients with a degenerate stentless bioprosthesis with low 30-day mortality, and 1-year mortality of 14.3%. Although technically challenging, owing to a lack of anatomic markers, satisfactory positioning is possible in most cases, with excellent clinical and echocardiographic outcomes.

Outcomes after stent graft therapy for dissection-related aneurysmal degeneration in the descending thoracic aorta

Stent graft therapy has emerged as an alternative to open surgery in the management of chronic dissection-related aneurysmal degeneration (DRAD) in the descending thoracic aorta (DTA). The incidence of perioperative complications, need for secondary aortic intervention (SAI), and rate of aneurysmal false-lumen thrombosis have not been thoroughly described. Perioperative and midterm outcomes in patients who underwent stent graft therapy for chronic DRAD DTA at a single institution between January 2006 and September 2013 were retrospectively analyzed. Preoperative anatomic factors, including the number of visceral and renal side branches off the false lumen, and false lumen volume, were analyzed for their ability to predict treatment failure. Treatment failure was defined as death, need for a SAI, and failure to achieve thrombosis of the DRAD DTA. Treatment success was defined as thrombosis of the false lumen in the area of the DRAD DTA with stability or a decrease in the maximum diameter of the DRAD DTA. During the study period, 47 patients underwent stent graft therapy for chronic DRAD DTA. Patients were a mean age of 58.3 ± 11.7 years, 74.5% (n = 35) were male, and 14.9% (n = 7) had a history of connective tissue disease. The left subclavian artery was covered in 48.9% (n = 23), and revascularization was performed in 87.0% (n = 20). Spinal drains were used in 74.5% (n = 35). Spinal cord ischemia developed in 6.4% (n = 3), which resolved in two and improved in one. No retrograde aortic dissections occurred. The 30-day mortality was 4.3% (n = 2); one death was in a patient with rupture. Mean clinical follow-up was 35.1 ± 20.9 months. The 5-year Kaplan-Meier survival was 89% ± 5%. Treatment failure occurred in 18 patients (38.3%): 9 required SAIs, 6 did not have thrombosis of the false lumen in the area of the DRAD DTA, and 4 died, with 1 patient dying during a SAI. No preoperative anatomic factor predicted treatment failure. The 5-year freedom from treatment failure was 54% ± 9%. Including the nine patients who underwent SAI, treatment success was achieved in 85.2% of patients. In this single-center experience of stent graft therapy for chronic DRAD DTA, treatment success was achieved in 85% of patients after a SAI rate of 20%. No preoperative anatomic factor predicted treatment failure, which occurred in almost 40% of the patients. Identifying predictors of treatment failure may improve future outcomes.

Early and mid-term outcomes of the aortic arch surgery: experience from the low-volume centre.

AimThe aim of this retrospective study was to examine the early and mid-term outcomes for patients undergoing elective aortic arch surgery over a 13-years period in the single low-volume centre. Results of aortic arch surgery published in the literature are usually results of high-volume centers, but the majority of institutions have much lower caseload.MethodsFrom January 1999 to March 2013 total of 353 surgeries on thoracic aorta were performed in our institution. Only 30 procedures (8.5%) were elective aortic arch surgeries. This group of patients was analyzed.ResultsDeep hypothermia alone and hypothermia with ortograde cerebral perfusion was used in 7 (23%) and 23 (77%) patients respectively. Mean core temperature was 22°C (17 – 26°C). Cannulation sites was axillary artery or brachiocephalic trunk in 17 (57%), femoral artery in 8 (27%) and ascending aorta or aortic arch in 5 (16%). Mean hypothermic circulatory arrest time was 39 min (15 – 74 min). There was one death due to multiorgan failure; all-cause mortality at 30 days was 3.3%. The frequency of other complications was permanent neurological deficit in 2 (6.7%), temporary neurological deficit in 2 (6.7%) and renal failure requiring hemodialysis in 2 (6.7%) patients. In the follow-up 13 patients died, remaining 16 are still alive.ConclusionDespite the lower caseload and technical problems manifested by a higher number of re-operations for bleeding, the all-cause mortality at 30 days as well as mid-term results are comparable with results reported by the high-volume centres.

Hybrid strategy for unstable patients with severe carotid and cardiac disease requiring surgery

Concurrent severe carotid and cardiac disease is a challenging situation where staged surgery is probably the most common strategy. However, in patients with an unstable clinical presentation, the best approach is still a matter of debate. The aim of the study was to report in-hospital and midterm outcome in patients who received carotid artery stenting and synchronous cardiac surgery. From June 1998 to July 2012, 54 consecutive patients who were treated at a high-volume university medical center with this hybrid approach were included in the study. All of the patients received carotid angioplasty while being administered aspirin and regular unfractionated heparin. Then, all of the patients were immediately transferred to the operating room for coronary and/or cardiac valve surgery. All of the patients were administered aspirin and clopidogrel once bleeding was ruled out, after surgery. There were 5 in-hospital surgical related deaths, and no patient suffered a stroke or required carotid urgent re-intervention. At follow-up (55 ± 28 months; range 1-144 months), there were no new neurological deficits, while one additional death occurred. In this series, synchronous carotid stenting and cardiac surgery were feasible with an acceptable complication rate in a high-surgical-risk population, which could not undergo staged procedures.

Effect of preoperatively continued aspirin use on early and mid-term outcomes in off-pump coronary bypass surgery: a propensity score-matched study of 1418 patients.

BackgroundTo date, effect of preoperatively continued aspirin administration in off-pump coronary artery bypass grafting (CABG) is less known. We aimed to assess the effect of preoperatively continued aspirin use on early and mid-term outcomes in patients receiving off-pump CABG.MethodsFrom October 2009 to September 2013 at the Fuwai Hospital, 709 preoperative aspirin users were matched with unique 709 nonaspirin users using propensity score matching to obtain risk-adjusted outcome comparisons between the two groups. Early outcomes were in-hospital death, stroke, intra- and post-operative blood loss, reoperation for bleeding and blood product transfusion. Major adverse cardiac events (death, myocardial infarction or repeat revascularization), angina recurrence and cardiogenic readmission were considered as mid-term endpoints.ResultsThere were no significant differences among the groups in baseline characteristics after propensity score matching. The median intraoperative blood loss (600 ml versus 450 ml, P = 0.56), median postoperative blood loss (800 ml versus 790 ml, P = 0.60), blood transfusion requirements (25.1% versus 24.4%, P = 0.76) and composite outcome of in-hospital death, stroke and reoperation for bleeding (2.8% versus 1.6%, P = 0.10) were similar in aspirin and nonaspirin use group. At about 4 years follow-up, no significant difference was observed among the aspirin and nonaspirin use group in major adverse cardiac events free survival estimates (95.7% versus 91.5%, P = 0.23) and freedom from cardiogenic readmission (88.5% versus 85.3%, P = 0.77) whereas the angina recurrence free survival rates was 83.7% and 73.9% in the aspirin and nonaspirin use group respectively (P = 0.02), with odd ratio for preoperative aspirin estimated at 0.71 (95% confidence interval, 0.49-1.04, P = 0.08).ConclusionsPreoperatively continued aspirin use was not associated with increased risk of intra- and post-operative blood loss, blood transfusion requirements and composite outcome of in-hospital death, stroke and reoperation for bleeding in off-pump CABG. Preoperative aspirin use tended to decrease the hazard of mid-term angina recurrence.

Splenic flexure colon cancers: minimally invasive treatment.

Optimal treatment of splenic flexure (SF) colon cancer-less than 10% of all colorectal cancers is a matter of debate, in particular with regard to the optimal extent of radical surgery, according to the oncological principles of curative resection. Aims of this study were to assess the clinicopathological characteristics and report operative data and survival of patients with SF colon cancers. Short- and mid-term outcome of patients undergoing laparoscopic curative resection for SF colon cancer between June 2005 and September 2011 was assessed. The analysis considered 16 patients: 10 underwent segmental resection, 4 left hemicolectomy and 2 subtotal colectomy. There were no intraoperative deaths or major morbidity. The median operative time was 185 min. The median number of lymph nodes harvested was 17. Disease-free survival rate at 30-month follow-up was 75%. Laparoscopic resection of SF cancer is feasible and safe. Oncological principles of disease-free margins and minimum node harvest can be respected even with segmental resection.

Is surgery in acute aortic dissection type A still contraindicated in the presence of preoperative neurological symptoms?

Severe neurological deficit (ND) due to acute aortic dissection type A (AADA) was considered a contraindication for surgery because of poor prognosis. Recently, more aggressive indication for surgery despite neurological symptoms has shown acceptable postoperative clinical results. The aim of this study was to evaluate early and mid-term outcomes of patients with AADA presenting with acute ND. Data from 53 patients with new-onset ND who received surgical repair for AADA between 2005 and 2012 at our institution were retrospectively reviewed. ND was defined as focal motor or sensory deficit, hemiplegia, paraplegia, convulsions or coma. Neurological symptoms were evaluated preoperatively using the Glasgow Coma Scale (GCS) and modified Rankin Scale (mRS), and at discharge as well as 3-6 months postoperatively using the mRS and National Institutes of Health Stroke Scale. Involvement of carotid arteries was assessed in the pre- and postoperative computed tomography. Logistic regression analysis was performed to detect predictive factors for recovery of ND. Of the 53 patients, 29 (54.7%) showed complete recovery from focal ND at follow-up. Neurological symptoms persisted in 24 (45.3%) patients, of which 8 (33%) died without neurological assessment at follow-up. Between the two groups (patients with recovery and those with persisting ND), there was no significant difference regarding the duration of hypothermic circulatory arrest (28 ± 14 vs 36 ± 20 min) or severely reduced consciousness (GCS <8). Multivariate analysis showed significant differences for the preoperative mRS between the two groups (P < 0.007). A high preoperative mRS was associated with persistence of neurological symptoms (P < 0.02). Cardiovascular risk factors, age or involvement of supra-aortic branches were not predictive for persistence of ND. More than half of our patients recovered completely from ND due to AADA after surgery. Severity of clinical symptoms had a predictive value. Patients suffering from AADA and presenting with ND before surgery should not be excluded from emergency surgery.

Mitral Valve Surgery in Patients with Isolated Mitral Valve Endocarditis - Analyzation of Perioperative Parameters and Long-Term Outcomes

Background: Aim of this study was to investigate the perioperative conditions as well as short- and mid-term outcome of patients with isolated mitral valve (MV) endocarditis undergoing MV surgery.

Early to mid-term outcomes of patients with complex elbow dislocations following internal fixation

Objective: To report our experience of treating complex elbow fracture/dislocations and to discuss the incidence of elbow dislocations. Methods: A total of 19 (15 male, 4 female) patients with an average age of 34 years (range, 23 - 62 years) surgically treated for elbow dislocations between August 2008 and October 2013 were evaluated clinically using the Roberts criteria after an average follow-up of 21 months (range, 4 - 42 months). There were associated injuries of 4 olecranon fractures, 7 radial head fractures, 6 radial head and coronoid fractures and 2 lateral condyle fractures. Results: In 19 of 29 patients evaluated in the emergency department, related fractures were detected. According to the Roberts criteria, the results were excellent in 6 patients (31.5%), good in 7 patients (36.8%), fair in 5 patients (26%), and poor in 1 patient (5%). Younger age and lack of ligament lesions were associated with good results. Ligament and cartilage lesions, older age and a longer period of immobilization were associated with worse results. Conclusions: The primary goal of surgery is to restore stability to initiate early range of motion, which is the key factor for a successful outcome. The patient’s age and the presence of ligament and cartilage injury have prognostic value. Pure dislocation is uncommon, so it is recommended that radiographs are evaluated carefully for associated fractures around the elbow, especially on first presentation in the emergency department.

Mid-term Outcomes in Patients Following Transcatheter Aortic Valve Implantation in the CoreValve Australia and New Zealand Study

Although numerous studies have reported the safety and effectiveness of transcatheter aortic valve implantation (TAVI), integration of this therapy into standard of care varies widely by region. We evaluated mid-term follow-up in 540 patients with severe symptomatic AS at high risk of surgical AV replacement, enrolled in the ongoing Medtronic CoreValve Australia-New Zealand Study. Between August 2008 and July 2013, 10 centres in Australia/New Zealand enrolled 540 patients, which includes initial use of the CoreValve System for all investigators. Patients were deemed suitable for TAVI based on consensus of a multidisciplinary Heart Team. Primary endpoints were cardiovascular death and major adverse cardiovascular and cerebrovascular events (MACCE) at 30 days. Data were fully monitored, and an independent Clinical Events Committee employed. Baseline characteristics include; 45% female, mean age 84 years, EuroSCORE 17.3±10.7%, and 74.9% had New York Heart Association III/IV symptoms. At 30 days, all deaths were cardiovascular (4.1%); MACCE was 11.5%. At one and two years, all-cause mortality was 11.9% and 21.2%; cardiovascular mortality, 9.9% and 15.2%; and stroke, 8.2% and 10.1%, respectively. Early experience with the CoreValve System in a large cohort of fully-monitored patients was associated with good early- and mid-term safety outcomes.

Mid-term results of patients with transposition of great arteries who underwent Senning procedure

Mid-term results of patients with transposition of great arteries who underwent Senning procedure

The impact of the metabolic syndrome on the outcome after aortic valve replacement.

The aim of this study was to examine the influence of the metabolic syndrome on the left ventricular geometry as well as on the early and mid-time outcome in patients with aortic stenosis who underwent aortic valve replacement. The study included 182 patients who underwent aortic valve replacement due to aortic stenosis. The metabolic syndrome was defined by the presence of at least three AHA-NHLB (American Heart Association/National Heart, Lung and Blood Institute) criteria. All the patients were followed for at least 2 years after the surgery. The metabolic syndrome did not influence the severity of aortic stenosis (mean gradient and aortic valve area). However, the metabolic syndrome was associated with the reduced prevalence of the normal left ventricular geometry and the increased risk of concentric left ventricular hypertrophy in patients with aortic stenosis. Among the metabolic syndrome criteria, only increased blood pressure was simultaneously associated with the short-term and mid-term outcome, independently of other risk factors. Increased fasting glucose level was an independent predictor of the only 30-day outcome after the valve replacement. The metabolic syndrome and left ventricular hypertrophy were, independently of hypertension and diabetes, associated with the 30-day outcome, as well as incidence of major cerebrovascular and cardiovascular events in the 2-year postoperative period. The metabolic syndrome does not change severity of the aortic stenosis, but significantly impacts the left ventricular remodeling in these patients. The metabolic syndrome and left ventricular hypertrophy, irrespective of hypertension and diabetes, are predictors of the short-term and mid-term outcome of patients with aortic stenosis who underwent aortic valve replacement.

Transcatheter Aortic Valve Replacement Has Improved Short-Term but Similar Midterm Outcomes in Isolated Aortic Valve Replacement After Prior Coronary Artery Bypass Grafting

An increasing number of patients with prior coronary artery bypass grafting (CABG) now present with severe aortic stenosis. The proposed benefit of surgical (SAVR) vs transcatheter aortic valve replacement (TAVR) is unknown. The objective of this study was to compare short-term and midterm outcomes of patients undergoing isolated SAVR vs TAVR in those with prior CABG. A retrospective analysis was performed of 255 patients who underwent isolated SAVR after prior CABG from January 2002 to February 2013 at Emory University. Outcomes of 148 patients undergoing SAVR (2002 to 2013) and 107 undergoing TAVR (2007 to 2013) were compared using multivariable logistic regression and analysis of variance techniques, adjusting for The Society of Thoracic Surgeons (STS) risk score. Kaplan-Meier plots were used to determine survival rates, and midterm survival between groups was compared using the Cox proportional hazards model. TAVR patients were older (79.8 ± 7.9 years vs 72.5 ± 8.8 years, p < 0.001) but were gender equivalent (female: 24% vs 22%, p= 0.61). The preoperativeejection fraction was similar between groups (TAVR: 0.433 ± 0.131 vs SAVR: 0.469 ± 0.148%, p= 0.60). The TAVR group had a significantly higher the STS risk scores (11.8% vs 7.1%, p < 0.001). All-cause 30-day mortality was 1.9% for TAVR and 4.1% for SAVR (p= 0.32), a result that marginally favors TAVR after risk adjustment (adjusted odds ratio, 0.19; p= 0.07). Postoperative morbidity and resource utilization was significantly higher in the SAVR patients.Midterm survival was similar between the two groups after adjustment (adjusted hazard ratio, 0.78, p= 0.46). Excellent outcomes can be achieved in SAVR or TAVR after prior CABG. Although TAVR improves short-term outcomes and resource utilization compared with SAVR, midterm mortality outcomes are similar.

Midterm results of Oxford shoulder hemiarthroplasty.

Background:Hemiarthroplasty of the shoulder is known to provide satisfactory long term results provided concentric reduction can be obtained in a high percentage of patients. Careful soft tissue balancing with appropriate adaptation of version of the component appears to allow good results permitting centering of the arthroplasty without replacement of a glenoid component.Materials and Methods:29 consecutive patients (30 shoulders) who underwent Oxford cementless shoulder hemiarthroplasty between 2004 and 2006 were analyzed. Mean age was 71 years (range 34-91 years, 95% of the confidence interval [CI] of standard deviation [SD] was 10.32-17.58). Mean duration of preoperative symptoms was 42.8 months (range 9-84 months, 95% CI of SD was 17.83-30.11). Patients’ self reported Oxford shoulder score (OSS) was collected prospectively and was used as an assessment tool to measure final outcome.Results:The mean initial OSS was 17.9 (range 7-43, 95% CI of the SD was 7.19-12.13). The score improved by an average of 16.9 points at a mean followup of 5.9 years (range 4.3-7.6 years) to reach mean final OSS of 34.8 (range 13-48, 95% CI of the SD was 9.31-15.73). The improvement of OSS was highly significant with a two tailed P < 0.0001 and 95% CI of this difference was 11.47-22.20.Conclusion:This study demonstrates shoulder hemiarthroplasty as reliable procedure for improvement of shoulder function as shown by the patients’ self reported outcome score (OSS) in end stage glenohumeral arthritis with intact or reparable rotator cuff at midterm followup. Our results suggest successful outcome of the Oxford shoulder hemiarthroplasty (Corin, UK) away from its originating center and in hospitals where fewer shoulder replacements are performed.

Midterm outcome of implantable left ventricular assist devices as a bridge to transplantation: Single-center experience in Japan

BackgroundTwo implantable continuous-flow left ventricular assist devices (LVADs), DuraHeart (Terumo Heart, Ann Arbor, MI, USA) and EVAHEART (Sun Medical, Nagano, Japan), were approved in Japan in April 2011. We analyzed the midterm outcome of patients implanted with these implantable LVADs at the University of Tokyo Hospital. Methods and resultsA total of 31 patients who underwent implantation of LVADs (10 DuraHeart, 21 EVAHEART) as a bridge to transplantation at our institution between April 2011 and August 2013 were retrospectively reviewed. All patients were followed up through December 2013. Seven patients underwent conversions from NIPRO paracorporeal LVAD (Nipro, Osaka, Japan) to an implantable LVAD. The mean observation period was 483±239 days (41.0 patient years). Eight patients were transplanted and one patient showed functional recovery with subsequent LVAD explantation. Four patients died due to cerebrovascular accident, empyema, or device malfunction due to pump thrombosis after cerebral bleeding. Kaplan–Meier analysis revealed 6-, 12-, and 24-month survival rates of 93%, 86%, and 86%, respectively. The rates of freedom from cerebrovascular accidents and device-related infections at 1 year after LVAD implantation were 65% and 36%, respectively. Twenty-nine patients were discharged home after LVAD implantation. During the period of this study, there were 59 readmissions (53 urgent, 6 elective) among 22 patients (76%). The overall and urgent readmission rates were 1.66 and 1.49 per patient year, respectively. The common reason for readmission was device-related infection (31%), followed by cerebrovascular accidents (17%). The total out-of-hospital time after the primary discharge was 90%. ConclusionsOur midterm survival rate after LVAD implantation is satisfactory. However, patients undergoing LVAD support were often readmitted with adverse events.

Midterm follow up in patients with reduction ascending aortoplasty.

BackgroundThe reduction ascending aortoplasty in patients with an aortic ectasia/dilatation is a common procedure during concomitant cardiac operations. Aim of the follow up study was the evaluation of possible re-dilatation and complications.MethodsFrom 1998 to 2010 124 patients (69% male; mean age 66.6 ± 12 ys) with ectasia of the ascending aortic who had no further indication for an aortic replacement, were included. The mean preoperative diameter of the ascending aorta was 4.2 ± 0.6 cm. The patients risk profile was moderate (mean EF 51% ± 11%, Euroscore 4.2 ± 2.1). To treat the dilatation of the ascending aorta, a longitudinal incision was performed and a strip of the aortic wall was resected. A reduction aortoplasty was carried out with a double-layered suture line using a 4/0 Prolene mattress suture with an additional 4/0 Prolene running suture. A follow up (rate 95%) was performed by echocardiography- and clinical examination.ResultsAll patients underwent reduction aortoplasty associated with a primary cardiac surgical procedure (AVR 63%, CABG 13%, other or combination 24%). The intrahospital mortality rate was 4%. Four aortic bleeding complications occurred. After a mean postoperative period of 57 ± 39 months, the ascending aortic diameter (3.6 ± 0.6 cm) was still significantly (P < 0.01) reduced. No postoperative aortic-related complications including aortic rupture, dissection and reoperation were observed. In 4 patients, the ascending aorta had re-dilated to the preoperative diameter.ConclusionReduction ascending aortoplasty without external wrapping is a safe procedure with acceptable midterm results in patients with asymptomatic dilatations and concomitant cardiac surgical procedures.

Early donor-specific antibodies in lung transplantation: Risk factors and impact on survival

The impact of early donor-specific anti-HLA antibodies (DSA) on patient and graft survival after lung transplantation remains controversial. In this study we analyzed risk factors for DSA that developed before initial hospital discharge after lung transplantation (early DSA) and compared mid-term outcomes in patients with or without DSA. Between January 2009 and August 2013, 546 patients underwent lung transplantation at our institution. One hundred (18%) patients developed early DSA (Group A) and 446 (82%) patients (Group B) did not. Patient records were retrospectively reviewed. Retransplantation (odds ratio [OR] = 2.7, 95% confidence interval [CI] 1.1 to 6.5, p = 0.03), pre-operative HLA antibodies (OR = 2.1, 95% CI 1.2 to 3.4, p = 0.003) and primary graft dysfunction (PGD) score Grade 2 or 3 at 48 hours (OR = 2.6, 95% CI 1.5 to 4.6, p = 0.001) were associated with early DSA development. Overall, 1- and 3-year survival in Group A and B patients was 79 ± 4% vs 88 ± 2% and 57 ± 8% vs 74 ± 3%, respectively (p = 0.019). Eleven Group A (11%) and 32 Group B (7%) patients died before hospital discharge (p = 0.34). Among patients surviving beyond discharge, 1- and 3-year survival in Group A and B patients was 89 ± 4% vs 95 ± 1% and 65 ± 8% vs 80 ± 3% in Group A and B patients, respectively (p = 0.04). Multivariate analysis identified early anti-HLA Class II DSA (OR = 1.9, 95% CI 1.0 to 3.4, p = 0.04) as an independent risk factor for post-discharge mortality but not for in-hospital mortality. Pre-operative HLA antibodies, retransplantation or post-operative PGD increase the risk of developing early DSA, which were independently associated with an increased risk for mortality.