Mid-term Clinical Outcomes Research Articles

Midterm Survivorship and Clinical Outcomes in Fresh Osteochondral Allograft Transplantation for the Treatment of Large Bipolar Lesions of the Knee.

Fresh osteochondral allograft (OCA) transplantation is an established treatment option for patients with chondral or osteochondral lesions of the knee. Predictably positive outcomes are seen in situations of focal or isolated cartilage defects. However, OCA transplantation may also be performed in more complex joint salvage situations in young patients. To evaluate survivorship and outcomes in patients who underwent OCA transplantation for large bipolar lesions of the knee. Case series; Level of evidence, 4. Fresh OCAs were implanted for bipolar chondral lesions in 86 patients (89 knees) between 1983 and 2020. A total of 37 male and 52 female knees with a mean patient age of 37.9 years (range, 14.5-66.0 years) were treated. Surgical indications included degenerative chondral lesions, osteoarthritis, osteochondritis dissecans, traumatic chondral injuries, and previous failed OCAs. The clinical evaluation included the modified Merle d'Aubigné-Postel score, International Knee Documentation Committee (IKDC) score, and Knee Injury and Osteoarthritis Outcome Score (KOOS). Outcomes were collected during outpatient clinic visits or via mail. The minimum follow-up was 2 years. Additional procedures after OCA transplantation were documented. OCA failure was defined as a reoperation that involved removal of the allograft. There were 81 knees (91.0%) that had undergone previous surgery, with a mean of 3.2 previous procedures (range, 1-11). The mean treated defect surface area was 16.7 cm2. Graft failure occurred in 31 knees (34.8%). Reoperations (including failures) occurred in 46 knees (51.7%). The mean time to failure was 4.8 years. Survivorship of the bipolar OCA was 73.8% at 5 years, 66.6% at 10 years, and 58.9% at 15 years. Among the 58 knees (65.2%) in which the OCA was still in situ, the mean follow-up was 11.3 years (range, 2.1-27.6 years). The mean modified Merle d'Aubigné-Postel score improved from 12.4 to 14.8 points; 64.3% of knees (36/56 with available data) were considered successful with a score ≥15. The mean IKDC pain score improved from 6.3 to 4.0, and the mean IKDC function score improved from 2.9 to 6.2. The KOOS symptoms, pain, activities of daily living, sports/recreation, and quality of life subscores all increased postoperatively by a mean of 19.7, 25.9, 27.1, 35.4, and 36.4, respectively. OCA transplantation is a salvage treatment option for large bipolar cartilage lesions of the knee with acceptable survivorship and significant clinical improvement in a challenging patient population.

Pathology-Independent Expansion of Indications for Rapid-Deployment Aortic Valve Replacement: Midterm Outcomes.

This study evaluated the midterm outcomes of rapid deployment aortic valve replacement (RDAVR) performed regardless of pathology for various aortic valve diseases at a single center. Of the 344 patients who underwent RDAVR using Edwards INTUITY during the study period at our institution, 176 had bicuspid valve diseases (51.2%), 20 had pure aortic regurgitation (5.8%), and 4 had infective endocarditis (1.2%). Median follow-up duration was 28.6 months (maximum: 86.4 months). Midterm clinical outcomes were evaluated, and the changes of valve hemodynamics from early postoperative period to 5 years after surgery were also investigated. Mean age was 68.9 ± 9.8 years, and 46.2% of the patients were female. Isolated RDAVR was performed in 90 patients (26.2%), and concomitant procedures, including aortic surgery (48.8%), mitral valve surgery (20.3%), arrhythmia surgery (9.0%), tricuspid valve surgery (7.0%), and coronary artery bypass grafting (5.5%), were performed in 254 patients (73.8%). Operative mortality occurred in 11 patients (3.2%), and permanent pacemaker implantation was required in 5 patients (1.5%) in early postoperative period. Overall survival rate was 86.9% at 5 years, and cumulative incidence of cardiac death was 6.3% at 5 years. No deterioration of valve hemodynamics was observed at midterm echocardiographic evaluation in either the overall population or for each size of valve. Isolated or concomitant aortic valve replacement using rapid-deployment valves was performed for various aortic valve diseases regardless of the underlying pathology at our institution, and the clinical and hemodynamic outcomes were excellent for up to 5 years.

Medial Patellofemoral Ligament Repair with Suture Tape Augmentation Can Yield Good Midterm Clinical Outcomes Regardless of Skeletal Maturity and Joint Laxity.

While several studies have reported short-term clinical outcomes after medial patellofemoral ligament (MPFL) repair with suture tape augmentation, there is still a dearth of knowledge regarding midterm clinical outcomes. This study aimed to evaluate the midterm clinical outcomes of MPFL repair with suture tape augmentation in patients with patellar dislocation. We retrospectively reviewed the clinical records of patients who underwent MPFL repair with suture tape augmentation for at least one episode of patellar dislocation between 2015 and 2020. Patient-reported clinical outcomes (PROs) were evaluated via the International Knee Documentation Committee (IKDC) score and the knee injury osteoarthritis outcome score (KOOS). In total, 17 knees (4 males and 13 females) who underwent MPFL repair with suture tape augmentation with a mean follow-up of 54.6 ± 19.5 months were included in this study. PROs significantly improved from preoperatively to the final follow-up (IKDC score: 50.7 ± 26.6 vs. 88.8 ± 13.0, p < 0.001; KOOS: 68.8 ± 23.3 vs. 91.2 ± 8.4, p = 0.011) without reducing the patient's activity level at the final follow-up (UCLA AS score: 7.9 ± 2.4 at preinjury vs. 7.9 ± 2.2 at the final follow-up, p = 0.655). Subgroup analysis revealed good postoperative outcomes, regardless of the patient's skeletal maturity or the presence or absence of generalized laxity. In conclusion, MPFL repair with suture tape augmentation is a safe and effective treatment for midterm follow-up.

Mid-term Clinical and Radiographic Outcomes of the Actis Total Hip System: A Retrospective Study.

Introduction Implant technology for total hip arthroplasty (THA) was developed to improve hip function and patient satisfaction. Actis (DePuy Synthes, Warsaw, IN, USA) is a short fit-and-fill titanium stem, with a medial-collared and triple-taper (MCTT) geometry, that is fully coated with hydroxyapatite (HA). We evaluated the radiographic and clinical outcomes of the Actis Total Hip System during a mean follow-up of five years. Patients and methods We retrospectively analyzed data from 80 patients (14 male and 66 female, mean age: 65 ± 8.4 years) who underwent primary THA using Actis stems (anterolateral approach, 60 hips; posterior approach, 20 hips). Radiographs were obtained postoperatively and at the time of the final examination. Radiographic assessments included the alignment of the femoral stem, spot welds, stress shielding, cortical hypertrophy, subsidence (>2 mm), radiolucent line, pedestal formation, Dorr type, canal fill ratio (CFR), and stem fixation. Clinical evaluation included the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ) and Harris Hip Score (HHS). Results The mean follow-up period was 64.0 ± 6.0 months. No significant differences were observed in the alignment of the femoral components between approaches. Of the 80 hips, 53 (66.3%) showed radiographic signs of stem osseointegration, predominantly in the mid-distal region of the stem at the final follow-up. Multiple logistic regression analysis revealed that younger age and a higher CFR (20 mm proximal to the lesser trochanter) were associated with the presence of spot welds. Mild stress shielding occurred in 25 hips (31.3%), and no patient experienced severe stress shielding. All stems were fixed by bone on growth. The JHEQ and HHS significantly improved at the final assessment. Conclusion At the five-year follow-up, patients who received the Actis Total Hip System during THA had good radiographic and clinical outcomes.

Predictive value of NT-pro BNP on outcomes of children with ventricular septal defect surgery

BackgroundLimited study has shown whether NT-proBNP is related to the prognosis of children wth ventricular septal defect (VSD) surgery. The study was conducted to determine the predictive value of NT-proBNP on outcomes of children with VSD surgery.MethodsA total of 798 children with VSD surgery were enrolled, with NT-proBNP measured at preoperatively and 24-h postoperatively. The short- and mid-term clinical outcomes were recorded. Propensity scores (PS) was performed to acquire pre-op and post NT-proBNP 24-h PS-matched cohorts for comparisons between groups.ResultsIn the pre NT-proBNP PS-matched cohort, the higher NT pro-BNP group had longer hospitalization time and lower post-op 1-month EF value compared with low NT pro-BNP group (all P &amp;lt; 0.05), and there wasn't significant difference of mechanical ventilation time, cardiopulmonary bypass (CPB) time, intensive care unit (CCU) stay, and ejection fraction (EF) values of 3 month to 12 months after surgery (all P &amp;gt; 0.05). In the post NT-proBNP PS-matched cohort, there wasn't significant difference of mechanical ventilation time, CPB time, CCU stay, hospitalization time, and EF values of 1 month to 12 months after surgery between two groups (all P &amp;gt; 0.05).ConclusionsVSD children with higher pre NT-proBNP level had longer hospital stays after surgery than those with lower level. Pre NT-proBNP level had no effect on mechanical ventilation time, CPB time, ACC time and CCU stay and cardiac function after 3 months postoperatively. Post-op 24-h NT pro-BNP level wasn't associated with clinical outcomes.

Three-Year Outcomes of a US Pivotal Trial Substudy for Conformable Endoprosthesis in >=10 mm Non-Angulated Neck Anatomy

To report the midterm clinical outcomes from the GORE® EXCLUDER® Conformable AAA Endoprosthesis system (EXCC) pivotal regulatory trial in the United States (U.S.). This is a prospective, multicenter, investigational device exemption clinical trial at 31 US. sites with Core Laboratory assessment of imaging and independent adjudication of safety. The study enrolled patients with abdominal aortic aneurysms (AAA) with a minimum proximal landing zone ≥10mm and proximal neck angulation of ≤60 degrees between December 2017 and February 2019 as part of a larger study to gain indications of the EXCC device. Endpoints included patient survival, freedom from secondary interventions, and stent-graft related outcomes. There were 80 patients enrolled (88.8% male, mean 73.5± 8.14 years-old). Mean maximum aortic diameter was 57.7±8.0mm (range, 42.5-82.7). There was 100% freedom from type I and III endoleak and aneurysm-related mortality at 36-months. Freedom from secondary intervention was 91.9± (0.83, 0.96, 95% C.I.) at 36-months. There were no device fractures, migrations (≥10mm), or aneurysm ruptures. At 36months, thirteen patients (26.5%) had type 2 endoleak, 32 patients (58.2%) had AAA sac regression, 17 (30.9%) had no change in diameter, and 6 (10.9%) had sac enlargement. Seven patients (8.8%) through 36months underwent reintervention. The 3-year outcomes have continued to show an adequate safety and efficacy profile of the EXCC device with no aneurysm related mortality or Type I/III endoleak. These results demonstrate durability for an EVAR device in US regulatory trials.

Mini-crush or Nano-crush Stenting Technique for Complex Coronary Bifurcation Lesions: The Multicenter MINANO Registry.

This multicenter study aimed to retrospectively evaluate the mid-term clinical outcomes of mini-crush (MCT) and nano-crush (NCT) techniques in patients with complex bifurcation lesions (CBLs). The study comprised 431 patients [male: 318 (73.8%), mean age: 60.96 ± 10.34 years] who underwent bifurcation PCI between January 2018 and December 2023 were included in the study from six tertiary centers. The primary endpoint was defined as the major cardiovascular events (MACE), which include cardiac death, target vessel myocardial infarction (TVMI), or clinically driven target lesion revascularization (TLR). This is the first study to compare the clinical outcomes of MCT and NCT in patients with CBL. The initial revascularization strategy was MCT in 302 (70%) cases and NCT in 129 (30%) patients. SYNTAX scores [24.33±6.54 vs 24.43±5.45, p=0.707] were comparable in both groups. The incidence of MACE (18.6 vs. 10.9%, p=0.031), TVMI (11.6 vs 5.6%, p=0.030), and clinically driven TLR (14 vs. 6%, p=0.006) were significantly higher in the NCT group compared to the MCT group. Being in the MCT group (HR: 0.549, p=0.035), high SYNTAX score (HR: 1.105, p<0.001), non-fatal intra-procedural complications (HR: 3.269, p<0.001), proximal side-branch optimization (HR: 0.451, p=0.013), diabetes mellitus (HR: 2.263, p=0.009), and chronic kidney disease (HR: 1.948, p=0.024) were found to be independent predictors of MACE. This non-randomized study suggests that MCT was associated with better mid-term MACE, TVMI, and clinically driven TLR rates compared with NCT in patients with CBLs.

Mid-term radiographic evaluation of a monoblock trabecular metal tibia following total knee arthroplasty in obese and morbidly obese patients.

Indications for primary total knee arthroplasty (TKA) have become more inclusive of morbidly obese patients, however, higher rates of complications and lower implant survival have also been reported in this population. The purpose of this study was to investigate the mid-term survival, clinical, and radiographic outcomes of a cementless trabecular metal monoblock tibial component in severely obese patients. This was a retrospective study of class II and III obese (BMI > 35) patients who received a cementless primary TKA. Standing radiographs were assessed for the presence of progressive tibial radiolucent lines (RLL), and clinical measures were assessed at least 2 years post-operative via the Oxford Knee Score (OKS), UCLA Activity and Satisfaction Score, and the Euro-QoL 5-dimension (EQ-5D-5L) index and visual analogue scale (EQ-VAS) health status. Patients (n = 176) were 61.2 ± 8.3 years of age, BMI 44.9 ± 6.5 kg/m2, and were predominantly female (n = 118, 66.7%). Mean follow-up was 59.2 ± 17.1 months. There were two total revisions at 6- and 57-months post-operative, respectively, and the 5-year survival estimate was 98.3% (95% confidence interval: 93.0%, 99.6%). Patient satisfaction was 93.9% and the post-operative OKS, EQ-5D-5L index, and EQ-VAS were 40.2 ± 7.9, 0.856 ± 0.205, and 73.6 ± 14.7, respectively. No cases of radiolucent lines were detected. At 6years this cementless monoblock tibial component demonstrated excellent survival without radiographic indications of aseptic loosening in a population of severely obese patients.

The multi-center mid-term clinical outcomes of combined complete preservation of chordal structure mitral valve replacement with total anatomic complete arterial myocardial revascularization for coronary patients with moderate-to-severe or severe ischemic mitral regurgitation

Objective: To evaluate the clinical outcomes of combined complete preservation of chordal structure mitral valve replacement (C-MVR) with total anatomical arterial myocardial revascularization (TACR) in coronary patients with moderate-to-severe or severe ischemic mitral regurgitation (IMR). Methods: This is a retrospective multi-center case series study. Data were retrospectively collected from 127 patients with coronary artery disease with moderate to severe or severe IMR who received TACR with C-MVR from July 2015 to April 2024 in 13 hospitals in China. There were 90 males and 37 females, aged (56.5±10.7) years (range: 33 to 74 years). Perioperative data and follow-up data including left ventricular ejection fraction, left ventricular end-diastolic diameter, and patency rate of arterial grafts of patients were collected. Comparisons were made using paired sample t-test or χ2 test. Results: In this cohort of 127 patients, 67 underwent concurrent tricuspid valve repair. During surgery, 113 grafts of the left internal mammary artery (LIMA), 127 grafts of the left radial artery, 80 grafts of the right radial artery, and 110 grafts of the right internal mammary artery (RIMA) were harvested. The number of the distal anastomosis was 4.2±0.4 (range: 3 to 5). The aortic cross-clamp time and cardiopulmonary bypass time were (97.5±23.4) minutes (range: 90 to 161 minutes) and (145.4±19.2) minutes (range: 101 to 210 minutes), respectively. There was one operative death. Intraoperative placement of an intra-aortic balloon pump was performed in 21 patients to improve the left ventricular ejection. No sternal ischemic occurred. All patients completed follow-up, with a mean follow-up period of (64.3±7.5) months (range: 4 to 110 months). No major cerebrovascular events occurred during the follow-up period, and all patients survived. Left ventricular ejection fraction improved postoperatively (55.0%±5.3% vs. 41.0%±15.3%, t=17.23, P<0.01). The proportion of patients with New York Heart Association functional class ≤2 increased postoperatively (23.6% (30/127) vs. 87.3% (110/126), χ²=103.77, P<0.01). The proportion of patients with Canadian Cardiovascular Society Angina Classification ≤3 decreased postoperatively (4.8% (6/126) vs. 78.7% (100/127), χ²=142.19, P<0.01). The left ventricular end-diastolic diameter decreased postoperatively ((5.70±4.50) cm vs. (6.10±0.23) cm, t=12.15, P<0.01). Coronary multi-detector computed tomography angiography (MDCTA) follow-up was conducted for (60.5±11.7) months (range: 6 to 109 months) postoperatively. MDCTA confirmed the patency rates of the grafts: 96.4% (108/112) for the LIMA grafts, 88.9% (112/126) for the left radial artery grafts, 93.7% (74/79) for the right radial artery grafts, and 90.9% (100/110) for the free RIMA grafts. No significant differences in graft patency rates were observed between the arterial grafts (χ²=5.24, P=0.155). Conclusion: The results of this multi-centre study demonstrate satisfactory mid-term results of C-MVR with TACR for the treatment of coronary artery disease with moderate to severe or severe IMR.

Mid-Term outcomes of osgood-schlatter patients undergoing arthroscopic excision

Aim:If surgical intervention is necessary for Os-Good-Schlatter patients ,a number of surgical techniques including open surgical,arthroscopic and bursoscopic procedures are available.The aim of this study was to evaluate the mid-term clinical results of patients who underwent arthroscopic excision with the diagnosis of OSD. Materials and Methods:This study was modeled with a retrospective design.16 patients who underwent arthroscopic ossicle excision were included in this study.The Visual Analog Scale (VAS) Score,Tegner Activity Scale and Lysholm Knee Score forms were administered to the patients in order to compare their pre-operative and post-operative condition.In addition,complications such as infection,residual bone fragments,re-hospitalization or recurrence were evaluated and recorded. Results:A total of 16 patients were included in the study, and of these patients, 11 (68.75%) were male and 5 (31.25%) were female. The mean age of the patients is 28.8 (20–41 ± 7) years. The mean follow-up period was 82.9 (61–108 ± 15) months. The mean time for return to sports-related training activities for all of the patients was 9.2 (8–11) weeks. The mean VAS decreased from 6.8 ± 1.1 points preoperatively, to 5.7 ± 1.3 at the final follow-up (P &amp;lt; 0.001). In addition, the mean Tegner Activity Level score improved from 5.7 ± 0.6 preoperatively to 7.8 ± 0.9 at the final follow-up (P &amp;lt; 0.001). The mean Lysholm Knee Scale score was 77.4 ± 4.6 points in the preoperative period, increasing to 97.7 ± 5.8 points at the final follow-up (P &amp;lt; 0.001). In one patient, recurrence occurred at the 105th postoperative month and revision surgery was performed. Conclusion:Arthroscopic ossicle excision for OSD can be considered an adequate technique when the mid-term results are evaluated.Although rare, recurrence may occur after arthroscopic surgery.In order to demonstrate the superiority of the arthroscopic method over open surgical procedures, comparative studies containing long-term results are required.

Mid-term outcomes of elbow hemiarthroplasty using the triceps-on approach for comminuted distal humerus fractures.

There has been an increasing interest in elbow hemiarthroplasty to circumvent the problems with total elbow arthroplasty for comminuted distal humerus fractures in the elderly. The primary aim of the study is to assess the mid-term clinical and radiological outcomes of patients undergoing TEA and hemiarthroplasty for distal humerus fractures. Retrospective analysis of data for patients undergoing hemiarthroplasty for distal humerus fractures (OTA- C3 Comminuted total articular fractures) was done. This is a non-randomized consecutive series from a single centre. A minimum follow-up of 3 years was required for inclusion. Patients with delayed/neglected presentation (>3 weeks), those needing total elbow arthroplasty and conservatively managed fractures needing delayed arthroplasty were excluded. A total of 12 patients were operated in the period between 2016 and 2021(mean follow-up-59.4 months). The mean age of the patients undergoing hemiarthroplasty was 68.4 years. The mean arc of flexion extension was 21-115°. The mean range of supination was 75° while pronation was 86° (p>0.05). The mean QuickDASH score was 8.7. There were no cases of infection, dislocations, intra-operative fractures or revision surgery. Two patients had transient weakness in the ulnar nerve distribution that recovered on follow-up.Evidence of heterotrophic ossification was seen in 8 patients. None of the patients showed radiological evidence of loosening but trochlear cartilage wear was seen in 2 patients. None of the radiographs showed migration of the condyles. There were 5 cases where the medial condyle though approximated had not healed. Elbow hemiarthroplasty provides predictably good clinical and radiological outcomes on mid-term follow-up. Longer follow-up is necessary to determine the survival of these prostheses in the long term.

Suture Button Fixation in Shoulder Instability Surgery to Achieve Bone Healing: A Critical Analysis Review.

» Suture button fixation has emerged as an effective surgical construct in arthroscopic and open Latarjet and anterior glenoid reconstruction with free autograft bone with high rates of bone block healing.» Biomechanical data suggest that screw and suture button mechanical fixation constructs provide similar load to failure and stability for the Latarjet procedure.» Preliminary bone healing models have identified that flexible fixation may exhibit a higher degree of bone callus maturation, whereas rigid fixation results in excessive callus hyperplasia» Mechanical tensioner use provides consistent tensioning of suture button constructs and improves bone-to-bone healing rates when used for anterior glenoid reconstruction surgery.» Evidence is lacking regarding the reliability of bone-to-bone healing of allografts to native bone with use of suture button constructs.» Suture button fixation provides good short- and mid-term clinical outcomes for the arthroscopic Latarjet and anterior glenoid reconstruction with free autograft bone.

Midterm Survival, Clinical, and Hemodynamic Outcomes of a Novel Mechanical Mitral Valve Prosthesis

ObjectivesTo evaluate the midterm survival, clinical, and hemodynamic outcomes of the On-X mechanical mitral valve, based on the 5-year results of the Prospective Randomized On-X Anticoagulation Clinical Trial (PROACT). MethodsPROACT Mitral was a multicenter study evaluating 401 patients who underwent mitral valve replacement (MVR) with either Standard or Conform-X On-X mitral valves, comparing low-dose and standard-dose warfarin. Here, we report pre-specified, secondary outcomes of survival, New York Heart Association (NYHA) Functional Classification, and valve hemodynamics as assessed by core-lab-adjudicated echocardiography at 1, 3, and 5 years within the pooled population. ResultsActuarial survival was 99.7%, 95.1%, and 92.4% at 1, 3, and 5 years, with no significant difference between Standard and Conform-X cuffs. Hemodynamic analysis revealed mean transvalvular gradients of 4.6 ± 2.0 mmHg at 1 year with no interaction between valve size and patient body surface area (BSA). MGs were consistent over time. Quality of life improved with 96.6% of patients in NYHA class I or II at the latest available follow-up of 3 or 5 years. There were no significant differences in survival, clinical, or hemodynamic outcomes between valve sizes. ConclusionsThe On-X mechanical mitral valve demonstrated favorable survival, stable hemodynamics, and enhanced quality of life up to five years post-implantation. Derived from high-quality, rigorous randomized trial data, these findings can guide decision-making in young patients requiring MVR.

Ultrasound-guided high-intensity focused ultrasound for symptomatic uterine fibroids: clinical outcome of two European centers.

The aim of this study is to assess the clinical outcome and mid-term efficacy of ultrasound-guided high-intensity focused ultrasound (USgHIFU) as a treatment for symptomatic uterine fibroids at two major European HIFU centers. This bi-center longitudinal clinical study involved the treatment of 100 patients with symptomatic uterine fibroids using USgHIFU (n = 59 in Germany, n = 41 in Bulgaria). Clinical outcomes were evaluated at 6 weeks, 6 months, and 1 year follow-up utilizing the uterine fibroid symptoms-quality of life questionnaire for fibroid-related symptoms and health-related quality of life as well as MRI imaging for determining the fibroid volume. The mean fibroid volume reduction rate was 33.2 ± 22.9%, 51.3 ± 24.2%, and 59.1 ± 28.0% at 6 weeks, 6 months, and 1 year, respectively (each p < 0.001). The mean symptom severity score decreased from 43.9 ± 18.8 at baseline to 35.4 ± 18.2 at 6 weeks, 31.1 ± 20.0 at 6 months, and 23.1 ± 14.0 at 1 year (each p < 0.001). The mean QOL score improved from 56.5 ± 23.4 at baseline to 65.4 ± 22.2 at 6 weeks, 72.5 ± 19.5 at 6 months, and 79.4 ± 15.3 at 1 year (each p < 0.001). No major complications were observed, though two patients experienced temporary sciatic nerve irritation following the procedure. Four patients had pregnancies and deliveries without any complications after USgHIFU therapy. To our knowledge, this is the first longitudinal study conducted in two major European HIFU centers that reveals the clinical efficacy of USgHIFU ablation on symptomatic uterine fibroids. Our results confirm that USgHIFU is a non-invasive approach with a low risk of complications, offering an innovative treatment option for affected women. Question To evaluate mid-term clinical efficacy and safety of US-guided high-intensity focused ultrasound (HIFU) for treating symptomatic uterine fibroids and patient outcomes across two European centers. Findings US-guided HIFU treatment resulted in significant fibroid volume reduction (up to 59.1% after 1 year) improving symptoms and quality of life with no major complications. Clinical relevance This prospective longitudinal study provides preliminary data assessing mid-term efficacy and clinical outcomes of ultrasound-guided HIFU. It is shown to be a low-risk, non-invasive treatment option for symptomatic uterine fibroids that reduces fibroid size and improves patients' quality of life.

Prosthesis selection for reconstruction of superior vena cava: comparison of midterm patency rates.

This study compared the mid-term patency of expanded polytetrafluoroethylene grafts without rings versus that of bovine pericardial conduits used for superior vena cava reconstruction for various thoracic diseases. Among 80 patients who underwent superior vena cava resection and reconstruction between 2009 and 2023 at our institution, 31 patients who received polytetrafluoroethylene grafts without rings (Polytetrafluoroethylene group) and 28 patients who received bovine pericardial conduits (Bovine group) were enrolled. Median follow-up durations were 19.5 and 64.6 months in the Polytetrafluoroethylene and Bovine groups, respectively. Primary outcome was midterm graft patency rate, and secondary outcomes were early and midterm clinical outcomes, including all-cause mortality and superior vena cava reintervention. Operative mortality was 1.7%. Cumulative incidence of all-cause mortality was not significantly different between the groups. Graft occlusion was detected in 22 patients. Cumulative incidence of graft occlusion was 24.2%, 36.4%, 42.4%, 48.5% and 60.6% at 1 month, 3 months, 6 months, 1 year and 2 years, respectively, in the Bovine group, whereas no graft occlusion was observed in the Polytetrafluoroethylene group (P = 0.007). Although the incidence of graft occlusion was higher in the Bovine group, cumulative incidence of reintervention was not significantly different between the groups (0.0% vs 3.0% in Polytetrafluoroethylene vs Bovine groups at 1 year, P = 0.406). Multivariate analysis demonstrated that bovine pericardial conduit (polytetrafluoroethylene graft as reference) and left brachiocephalic vein reconstruction (right brachiocephalic vein reconstruction as reference) were significant risk factors for graft occlusion. In superior vena cava reconstruction, polytetrafluoroethylene grafts without rings were superior to bovine pericardial conduits in terms of midterm graft patency.

Transfibular Total Ankle Arthroplasty: Clinical, Functional, and Radiographic Outcomes and Complications at a Minimum of 5-Year Follow-up.

The Trabecular Metal Total Ankle Implant differs from other newer-generation implants in the transfibular approach, multiplanar external frame for alignment, tantalum trabecular metal interfaces, curved geometry, and shallow resection depths. The primary aim of this study was to report midterm clinical and radiographic results, as well as survivorship and adverse events at a minimum of 5-year follow-up. A total of 83 ankles (81 patients, average age 60.6 years old, 50.6% females) with average 6.3 years' (range, 5.0-10.1) follow-up were included. Postoperative patient-reported outcome measures (PROMs) included SF-12 physical (PCS) and mental component summary (MCS) scores, Ankle Osteoarthritis Scale (AOS), pain visual analog scale (VAS). Radiographic outcomes included postoperative range of motion (ROM) and coronal/sagittal alignment. Adverse events were reported using the Canadian Orthopaedic Foot and Ankle Society Reoperation Coding System (CROCS). Preoperative tibiotalar coronal deformity included 27 valgus (10 degrees, range 2-20 degrees) and 25 varus ankles (-9 degrees, range -2 to -25 degrees), corrected to neutral postoperatively. Postoperative tibiopedal ROM was 17.8 degrees dorsiflexion and 21.8 degrees plantarflexion. Adverse events occurred at average 28.7 months, most commonly gutter debridement (n = 17, 16.7%) and subsequent operative treatment unrelated to metal components (n = 10, 12.0%). There were 2 cases (2.4%) of acute deep infection treated with irrigation and debridement, polyethylene exchange, and retention of metal components without recurrence of infection. There were no cases of fibular nonunion, septic or aseptic loosening, or implant subsidence. Postoperative PROMS included SF-12 PCS: 40.4; SF-12 MCS: 56.0; VAS: 2.3; AOS Pain: 17.0; and AOS Disability: 24.9. Overall implant survival, defined by retention of the metal components, was 100% at final follow-up. At a minimum of 5 years, patients who underwent TM TAA reported minimal ankle pain and regained neutral ankle alignment and mobility, without septic or aseptic implant loosening. Although having certain limitations, this study suggests that TM TAA is a viable option for the treatment of end-stage ankle arthritis.

Endovascular Repair of Aortic Arch Zones 0 to 2 Using Physician-Modified Endografts: A Systematic Review and Meta-Analysis.

The purpose of this study was to collect all the available evidence concerning technical success and early and mid-term clinical outcomes of physician-modified endografts (PMEGs) for the treatment of aortic arch pathologies in zones 0 to 2. We performed a systematic review to identify all the eligible studies that reported outcomes to the PMEGs for aortic arch pathologies in zones 0 to 2 and then conducted a qualitative synthesis and meta-analysis of the results. The main outcomes were technical success, mortality, stroke rate, bridging stents' complications, and reintervention rate. We estimated pooled proportions and 95% confidence intervals (CIs). A total of 134 study titles were identified by the initial search strategy, of which 14 (zone 0 n=6; zone 1 n=1; zones 1 t o2: n=7) were considered eligible for inclusion in the meta-analysis. A total of 777 patients (80% male; 62±6 years) were identified among the eligible studies. The pooled technical success for the PMEG in zone 0 was 96.6% (95% CI=93.9%-98.2%), whereas in zones 1 to 2 was 95.9% (95% CI=92.9%-97.6%). The pooled 30-day mortality was 4.6% (95% CI=2.0%-10%) and 4.3% (95% CI=2.2%-8.2%) for zones 0 and 1 to 2, respectively, whereas the prevalence of late mortality was 8.2% (95% CI=4.7%-14%) and 3.4% (95% CI=1.9%-6%). The pooled stoke rate was 3.7% (95% CI=2.1%-6.4%) in zone 0 and 2.7% (95% CI=1.4%-5%) in zones 1 to 2. The early reintervention rate was 3.5% (95% CI=1.5%-8.0%) and 4.2% (95% CI=2.4%-7.2%) for zones 0 and 1 to 2, respectively, whereas during the mean follow-up of 26 months was 8.5% (95% CI=3.0%-21%) and 1.9% (95% CI=0.8%-4.3%). The pooled bridging's stent instability was 3.9% (95% CI=1.1%-12.9%) in zone 0 and 3.2% (95% CI=1.8%-5.8%) in zones 1 to 2. Endovascular repair of aortic arch pathologies using PMEGs seems to present a satisfactory level of technical success and a low mortality rate. To attain clearer conclusions, further research employing randomized controlled trials, longer-term follow-up, and consistent reporting of results is warranted. This systematic review and meta-analysis of observational studies analyzed the short- and mid-term outcomes of aortic arch aneurysm and/or dissection using physician-modified endografts. It separately examined the outcomes from zones 0 and 1-2 of the aortic arch. Fourteen studies (n=777 patients) were included. Overall technical success rates were 96.6% for zone 0 and 95.9% for zone 1-2. Regarding early mortality and stroke rates, no significant differences were observed, while late mortality was higher in patients in zone 0. The late reintervention rate favored patients treated with PMEGs in zone 1-2. The physician-modified technique appears to be an excellent and rapidly available alternative for the treatment of aortic arch diseases.

Comparison of Sutureless Aortic Valve Replacement and Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis of Propensity Score Matching.

To evaluate the clinical outcomes of sutureless aortic valve replacement (SUAVR) and transcatheter aortic valve implantation (TAVI). We systematically searched the electronic database and the Clinical Trials Registry up to 31 February 2023. Random effects model risk ratio (RR) and mean differences (MD) with corresponding 95% confidence intervals (CIs) were pooled for the clinical outcomes. The included 16 studies using propensity-matched analysis consisted of 6516 patients, including 3258 patients in the SUAVR group and 3258 patients in the TAVI group. The SUAVR group had lower mortality than the TAVI group at 1-year [RR = 0.53, 95% CI (0.32, 0.87), I 2 = 49%, p = 0.01], 2-year [RR = 0.56, 95% CI (0.37, 0.82), I 2 = 51%, p = 0.03] and 5-year [RR = 0.56, 95% CI (0.46, 0.70), I 2 = 0%, p < 0.01]. The SUAVR group had a significantly lower rate of new permanent pacemaker implantation (PPI) [RR = 0.74, 95% CI (0.55, 0.99), I 2 = 48%, p = 0.04], moderate-to-severe paravalvular leak (PVL) [RR = 0.18, 95% CI (0.11, 0.30), I 2 = 0%, p < 0.01], more-than-mild residual aortic regurgitation (AR) [RR = 0.27, 95% CI (0.14, 0.54), I 2 = 0%, p < 0.01]. In addition, the SUAVR group had a higher rate of new-onset atrial fibrillation (AF) [RR = 3.66, 95% CI (1.95, 6.89), I 2 = 84%, p < 0.01], major or life-threatening bleeding event [RR = 3.63, 95% CI (1.81, 7.28), I 2 = 83%, p < 0.01], and higher postoperative mean aortic gradient [MD = 1.91, 95% CI (0.73, 3.10), I 2 = 91%, p < 0.01] than the TAVI group. The early and mid-term clinical outcomes of SUAVR were superior compared to TAVI. Further studies should be conducted to highlight the specific subgroups of patients. that will benefit from each technique. INPLASY 2022110058 (https://inplasy.com/inplasy-2022-11-0058/).

Failed radial head arthroplasty treated by removal of the implant.

In patients with a failed radial head arthroplasty (RHA), simple removal of the implant is an option. However, there is little information in the literature about the outcome of this procedure. The aim of this study was to review the mid-term clinical and radiological results, and the rate of complications and removal of the implant, in patients whose initial RHA was undertaken acutely for trauma involving the elbow. A total of 11 patients in whom removal of a RHA without reimplantation was undertaken as a revision procedure were reviewed at a mean follow-up of 8.4 years (6 to 11). The range of motion (ROM) and stability of the elbow were recorded. Pain was assessed using a visual analogue scale (VAS). The functional outcome was assessed using the Mayo Elbow Performance Score (MEPS), the Oxford Elbow Score (OES), and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Radiological examination included the assessment of heterotopic ossification (HO), implant loosening, capitellar erosion, overlengthening, and osteoarthritis. Complications and the rate of further surgery were also recorded. The indications for removal of the implant were stiffness in five patients, aseptic loosening in five, and pain attributed to the RHA in three. The mean time interval between RHA for trauma to removal was ten months (7 to 21). Preoperatively, three patients had overlengthening of the implant, three had capitellar erosion, six had HO, and four had radiological evidence of loosening. At the final follow-up, the mean the flexion-extension arc improved significantly by 38.2° (95% CI 20 to 59; p = 0.002) and the mean arc of prono-supination improved significantly by 20° (95% CI 0 to 72.5; p = 0.035). The mean pain VAS score improved significantly by 3.5 (95% CI 2 to 5.5; p = 0.004). The mean MEPS improved significantly by 27.5 (95% CI 17.5 to 42.5; p = 0.002). The mean OES improved significantly by 9 (95% CI 2.5 to 14; p = 0.012), and the mean DASH score improved significantly by 23.5 (95% CI 7.5 to 31.6; p = 0.012). Ten patients (91%) had HO and osteoarthritis. Two patients underwent further surgery due to stiffness and pain, respectively. Simple removal of the implant at revision surgery following a failed RHA introduced following trauma provides satisfactory mid-term results with an acceptable risk of complications. Osteoarthritis, instability, and radioulnar impingement were not problems in this series.

OSDOKINA crush technique for the management of side branch ostial lesion ISTANBOL study

Abstract Background Isolated ostial bifurcation lesions (Medina type 0.0.1) represent &amp;lt;20% of coronary bifurcation lesions. Percutaneous coronary intervention (PCI) of this subset of lesions is challenging for the interventional cardiologist because of the technical difficulty and potential risk of serious complications. Purposes Recently, we devised a new technique, called the OSDOKINA crush technique, for the treatment of Medina type 0.0.1 coronary bifurcation lesions. The aim of this study was to evaluate the technical feasibility, safety and short-term and midterm procedural and clinical results achieved with OSDOKINA crush technique for Medina type 0.0.1 coronary bifurcation lesions. Materials and Methods Between September 2020 and January 2024, we included 49 patients who had Medina type 0,0,1 coronary bifurcation lesions. The vessel size had to be ≥2.5 mm by visual estimation on coronary angiography. Demographic, clinical and lesion characteristics of the cases were recorded. Quantitative coronary angiography analyses were performed using dedicated bifurcation angiographic software. Procedural success was defined as successful implantation of the stent into the target lesion, causing a final residual stenosis ≤30%. Major adverse cardiac events(MACE) were defined as cardiac death, myocard infarction and target lesion revascularisation. All patients were followed up to twelve months after the intervention. Results The lesion localisations were the ostium of diagonal branch in 19 (38.7%), ostium of the obtuse marginalis branch in 17 (34.6%), ostium of right posterior descending or right posterolateral branch in 13 (26.7%). SB RVD, SB lesion length and SB diameter stenosis by QCA were 2.65±0.35 mm, 9.4±3.9 mm, and 79.8±12.6, respectively. SB predilatation was applied in all cases. In 1 patient (2.1%), a stent had to be placed in the main branch using the double-kissing mini crush technique due to flow-limiting dissection that developed after the second kissing balloon inflation. Considering all cases, the angiographic success rate was 97.9% (n: 48). All patients had 12-month follow-up results. Acute myocardial infarction occurred in 1 patient (2.1%) due to side branch stent thrombosis. No patient had main branch revascularization. Cardiac or non-cardiac death was not observed. Cumulative MACE was 2.1%(n:1). Conclusion The OSDOKINA crush technique has excellent acute results and midterm clinical outcomes in the management of Medina type 0.0.1 coronary bifurcation lesions. Multicenter studies with large patient groups are needed.