Need For Reintervention Research Articles

Midterm outcomes of minimally invasive mitral valve surgery in a heterogeneous valve pathology cohort: respect or resect?

Minimally invasive mitral valve surgery (MIV) through a right lateral thoracotomy has become the standard of care at specialized centers and might soon will be the only acceptable surgical treatment option in the future era of interventional procedures. The aim of our study was to analyze the outcomes of our MIV-specialized, single-center, mixed valve pathology cohort with regard to morbidity, mortality and midterm outcomes comparing two different repair techniques (respect versus resect). Baseline and operative variables, postoperative outcomes and follow-up information about survival, valve competence and freedom from reoperation were retrospectively collected and analyzed. The repair cohort was divided into three groups (resection, neo-chordae and both) and compared for outcomes. Between July 22nd 2013 and May 31st 2022 a total of 278 consecutive patients underwent MIV. Out of those, we identified 165 eligible patients for the three repair groups: 82 patients (29.5%) had "resection", 66 "neo-chordae" (23.7%) and 17 "both" (6.1%). All preoperative variables were comparable between the groups. The predominant valve pathology of the entire cohort was degenerative disease with 20.5% Barlow's, 20.5% bi-leaflet and 32.4% double segment pathology. Bypass time was 164±47, cross-clamp time 106±36 minutes. All valves planned for repair (85.6%) were successfully repaired except for 13 resulting in a repair rate of 94.5%. Only 1 patient (0.4%) had to be converted to clamshell and 2 (0.7%) needed rethoracotomy for bleeding. Mean intensive care unit (ICU) stay was 1.8 days and hospital stay 10.6±1.3 days. In-hospital mortality was 1.1% and the incidence of stroke (1.8%). All in-hospital outcomes were comparable between the groups. Follow up was complete in 86.2% (n=237) for a mean of 3.7±0.8, up to 9 years. Five-year survival was 92.6% (P=0.5) and freedom from re-intervention 96.5% (P=0.1). All but 10 patients had mitral regurgitation less than grade 2 (95.8%, P=0.2) and all but two had less than New York Heart Association (NYHA) II (99.2%, P=0.1). Despite a heterogeneous cohort with mixed valve pathologies, there is a high reconstruction rate, low short- and midterm morbidity, mortality and need for re-intervention with comparable outcomes of the resect and respect technique in a specialized MIV center.

Incidence, reintervention, and survival associated with type II endoleak at hospital discharge after elective endovascular aneurysm repair in the Vascular Quality Initiative

BackgroundThe longitudinal clinical significance of type II endoleaks (T2ELs) remains controversial. Specifically, the real-world incidence, need for reintervention, and associated mortality referable to T2ELs remain unknown. Moreover, current professional society clinical practice guidelines recommend differing aneurysm sac growth thresholds to prompt intervention. Therefore, the purpose of this analysis was to better quantify the prevalence of early T2ELs after infrarenal endovascular aortic aneurysm repair (EVAR) and determine its association with reintervention and survival. MethodsAll elective EVARs from the Vascular Quality Initiative (2010-2020) were examined to identify patients with isolated T2ELs vs no endoleak (NONE) at discharge. Procedures with a type I or III endoleak were excluded. A subgroup analysis was performed on patients surviving beyond the first postoperative year with follow-up data available on endoleaks. The primary outcome was overall survival. Secondary outcomes included perioperative mortality and reinterventions. Outcomes were assessed by multivariable logistic and Cox proportional hazards regression to adjust for covariates. ResultsWe identified 53,697 patients who underwent EVAR. The overall incidence of isolated T2ELs at discharge was 16%. In-hospital mortality was lower for those with isolated T2ELs vs NONE (0.8% vs 1.9%, odds ratio: 0.6, 95% confidence interval: 0.5-0.8, P < .0001). Unadjusted overall survival was marginally higher at 5 years for patients with T2ELs vs NONE (84% vs 82%); however, after risk adjustment, survival was similar (hazard ratio: 0.95, 95% confidence interval: 0.9-1.0). Among 44,345 patients with 1-year follow-up, 66% had data on endoleak status for assessment. Survival was similar regardless of endoleak status (NONE, at discharge only, at follow-up only, or at both time points). Among patients with documented T2ELs during follow-up, 6.1% and 2.5% had abdominal aortic aneurysm sac diameter growth ≥5 mm and ≥10 mm, respectively. Reinterventions occurred in 12%. Rupture (1%) and any open reintervention (4%) were rare among patients with 1-year follow-up. For patients with T2ELs, 5-year survival was similar between those with and without reintervention by 1 year (89% vs 91%, log-rank P = .06). ConclusionsT2ELs remain common after EVAR within the Vascular Quality Initiative and are not associated with long-term mortality. Reinterventions for T2ELs were not associated with improved overall survival among patients with T2ELs. Although additional data surrounding the appropriate role of reintervention for T2ELs remain necessary, it appears that the natural history of T2ELs is benign.

Clinical outcome of endoscopic treatment of symptomatic Hepaticojejunal anastomotic strictures after pancreatoduodenectomy

BackgroundHepaticojejunostomy anastomotic stricture (HJAS) is an adverse event after pancreatoduodenectomy (PD) which can result in jaundice and/or cholangitis. With endoscopy, HJAS can be managed. However, few studies report the specific success and adverse event rates of endoscopic therapy after PD. MethodsPatients with symptomatic HJAS, who underwent an endoscopic retrograde cholangiopancreatography at the Erasmus MC between 2004-2020, were retrospectively included. Primary outcomes were short-term clinical success defined as no need for re-intervention <3 months and long-term <12 months. Secondary outcome measures were cannulation success and adverse events. Recurrence was defined as symptoms with radiological/endoscopic confirmation. ResultsA total of 62 patients were included. The hepaticojejunostomy was reached in 49/62 (79%) of the patients, subsequently cannulated in 42/49 (86%) and in 35/42 patients (83%) an intervention was performed. Recurrence of symptomatic HJAS after technically successful intervention occurred in 20 (57%) patients after median time to recurrence of 7.5 months [95%CI, 7.2–NA]. Adverse events were reported in 4% of the procedures (8% of patients), mostly concerning cholangitis. DiscussionEndoscopic treatment for symptomatic HJAS after PD has a moderate technical success rate and a high recurrence rate. Future studies should optimize endoscopic treatment protocols and compare percutaneous versus endoscopic treatment.

Outcomes of Stent Angioplasty Based on Postoperative Antiplatelet Regimen for Isolated Iliac Occlusive Disease

Antiplatelet therapy following stent angioplasty for lower extremity peripheral arterial disease is recommended. To date, however, the ideal number of agents and length of treatment for iliac artery intervention are yet to be determined. The goal of this study is to determine whether single antiplatelet therapy (SAPT) or dual antiplatelet therapy (DAPT) is superior and how long this regimen should be administered in the postoperative period. Patients with arterial occlusive disease receiving isolated iliac artery stent angioplasty (including both common iliac artery and/or external iliac artery) registered in the Society for Vascular Surgery Vascular Quality Initiative Peripheral Vascular Intervention module between 2010 and 2021 were included. Patients were stratified into two groups: (1) DAPT (aspirin and P2Y12 inhibitor) and (2) SAPT, to include aspirin or P2Y12 inhibitor. Outcomes were evaluated based on antiplatelet therapy at discharge and at 1-year follow-up. Primary outcome measures of mortality, major adverse limb events, major adverse cardiac events, and need for reintervention were assessed using univariate analysis. A P value of <.05 was set as significance criterion. A total of 5615 patients meeting inclusion criterion were analyzed with 3859 (68.7%) in group 1 (DAPT) and 1756 (31.3%) in group 2 (SAPT). Average age of the population was 65.4 ± 10.7 years with 3200 males (57%) and 2413 females (43%). Patients in the DAPT group were found to have lower mortality at 1 year (3.1% vs SAPT = 11.7%; P < .001) with more patients undergoing minor amputations (DAPT 46.2% vs SAPT 31%; P < .001), but with no significant difference between those requiring major amputations (P = .097). The DAPT group was also found to require more reinterventions (5.5% vs SAPT = 4%, P = .01). There was no significant difference in major adverse cardiac events (P = .217) or in major adverse limb events (P = .10) between the two groups. At the 1-year follow-up, patients receiving isolated iliac artery stent angioplasty for occlusive disease treated with DAPT therapy were found to have lower mortality with an increase in reinterventions. There was no significant difference in major adverse cardiac events or in major adverse limb events between DAPT and SAPT regimens.

Open Bypass Is Superior to Endovascular Revascularization in Patients Undergoing Reintervention for Chronic Limb-threatening Ischemia Using a Medicare-linked Database

The need for reinterventions following lower extremity revascularization (LER) is common, ranging from 13% to 85% depending on different follow-up periods. Prior literature has detailed the outcomes of bypass therapy (BT) and endovascular therapy (ET) for initial LER for chronic limb-threatening ischemia. Nonetheless, there is a paucity of data regarding the best revascularization technique for patients undergoing reintervention following prior revascularization. This study aims to describe the outcomes of BT vs ET in patients with prior open or endovascular LER. We identified all patients with a history of prior ipsilateral LER who had undergone redo LER for chronic limb-threatening ischemia from 2010 to 2019 in the Vascular Quality Initiative VISION database. Patients who had undergone suprainguinal procedures were excluded. Study groups included BT vs ET in patients with prior ET and BT vs ET in patients with prior BT. A total of 17,145 patients had undergone prior ET with 69.7% undergoing redo ET and 30.3% undergoing BT, and 15,905 patients had undergone prior BT with 83.7% undergoing ET and 16.3% undergoing redo BT. Among patients with prior ET, patients undergoing BT were more likely to be smokers (79% vs 67.1%; P < .001), present with rest pain (38.8% vs 27%; P < .001), and lower ankle-brachial index (ABI) (0.6 ± 0.6 vs 0.8 ± 0.6; P < .001). BT was associated with a lower risk of 1-year major amputation/death (adjusted hazard ratio [aHR], 0.75; 95% confidence interval [CI], 0.7-0.8; P < .001), ACM (aHR, 0.8; 95% CI, 0.7-0.9; P < .001), major amputation (aHR, 0.7; 95% CI, 0.6-0.8; P < .001), and revascularization (aHR, 0.76; 95% CI, 0.7-0.9; P < .001). Among patients with prior BT, redo BT patients were more likely to be smokers (86.2% vs 67.7%; P < .001), present with rest pain (46.7% vs 27.8%; P < .001), and have a lower ABI (0.5 ± 0.5 vs 0.8 ± 0.6; P < .001). Redo BT was associated with improved 1-year major amputation/death (aHR, 0.8; 95% CI, 0.7-0.9; P < .001), ACM (aHR, 0.7; 95% CI, 0.67-0.8; P < .001), major amputation (aHR, 0.8; 95% CI, 0.7-0.9; P = .008), and revascularization (aHR, 0.76; 95% CI, 0.7-0.8; P < .001). These results persisted at 5 years (Table, Figure). The present study shows that revascularization with ET is performed more frequently in patients with prior BT or ET. Despite a higher percentage of smoking, rest pain, and lower ABI in patients undergoing redo BT, BT had better outcomes with improved limb salvage, durability, AFS and ACM (all-cause mortality) compared with redo ET. Future prospective studies are needed to confirm our findings.TableLog-rank test and multivariable Cox regression analysis of 5-year outcomesETBTLog-rankBT vs ETP valueSurvival function (%)Survival function (%)HR (95% CI)Prior PVI Amputation or deatha74.361.5<0.0010.77 (0.7-0.8)<.001 Mortalityb66.451.4<0.0010.78 (0.7-0.8)<.001 Major amputationc25.219.2<0.0010.7 (0.6-0.8)<.001 Revascularizationd6351<0.0010.7 (0.7-0.8)<.001Prior bypass Amputation or deathe74.262.9<0.0010.8 (0.78-0.9)<.001 Mortalityf65.951.2<0.0010.79 (0.7-0.9)<.001 Major amputationg25.223.40.0010.87 (0.78-0.97).013 Revascularizationh63.250.5<0.0010.7 (0.7-0.8)<.001BT, Bypass therapy; CI, confidence interval; ET, endovascular therapy; PVI, peripheral vascular intervention.a Adjusting for age, gender, history of congestive heart failure (CHF), coronary artery disease (CAD), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), preoperative aspirin, preoperative P2Y12 antagonist, preoperative statins, preoperative angiotensin-converting enzyme inhibitors (ACEIs), presenting with rest pain, and below knee intervention.b Adjusting for age, gender, history of CHF, CAD, CKD, COPD, preoperative aspirin, preoperative P2Y12 antagonist, preoperative statins, preoperative ACEIs, and presenting with rest pain.c Adjusting for age, race, history of CHF, CKD, diabetes, preoperative ACEIs, presenting with rest pain, and below-knee intervention.d Adjusting for age, gender, smoking, CKD, preoperative P2Y12 antagonist, presenting with rest pain, and below-knee intervention.e Adjusting for age, gender, race, history of CHF, CAD, CKD, preoperative aspirin, preoperative P2Y12 antagonist, preoperative statins, presenting with rest pain, and below-knee intervention.f Adjusting for age, gender, history of CHF, CAD, CKD, COPD, preoperative aspirin, preoperative P2Y12 antagonist, preoperative statins, preoperative ACEIs, and presenting with rest pain.g Adjusting for age, race, history of CHF, CKD, CAD, preoperative ACEIs, presenting with rest pain, and below-knee intervention.hAdjusting for age, gender, smoking, CKD, preoperative P2Y12 antagonist, presenting with rest pain, preoperative aspirin, preoperative ACEI, preoperative P2Y12 antagonists, and below-knee intervention. Open table in a new tab

No difference in outcomes with 15 mm vs. 20 mm lumen-apposing metal stents for endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction: a meta-analysis.

We compared outcomes between use of 15 vs. 20 mm lumen-apposing metal stents (LAMSs) in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for gastric outlet obstruction. Databases were queried for studies that used LAMS for EUS-GE to relieve gastric outlet obstruction, and a proportional meta-analysis was performed. Thirteen studies were included. The 15 mm and 20 mm LAMS had pooled technical success rates of 93.2% (95% confidence interval [CI], 90.5%-95.2%) and 92.1% (95% CI, 68.4%-98.4%), clinical success rates of 88.6% (95% CI, 85.4%-91.1%) and 89.6% (95% CI, 79.0%-95.1%), adverse event rates of 11.4% (95% CI, 8.1%-15.9%) and 14.7% (95% CI, 4.4%-39.1%), and reintervention rates of 10.3% (95% CI, 6.7%-15.4%) and 3.5% (95% CI, 1.6%-7.6%), respectively. Subgroup analysis revealed no significant differences in technical success, clinical success, or adverse event rates. An increased need for reintervention was noted in the 15 mm stent group (pooled odds ratio, 3.59; 95% CI, 1.40-9.18; p=0.008). No differences were observed in the technical, clinical, or adverse event rates between 15 and 20 mm LAMS use in EUS-GE. An increased need for reintervention is possible when using a 15 mm stent compared to when using a 20 mm stent.

(482) Patients Receiving Urologic Implants Taking Sodium-Glucose Co-Transporter 2 Inhibitors, a Global, Propensity-Score Matched Analysis

Abstract Introduction Sodium-glucose co-transporter 2 inhibitors (SGLT2i) prevent the reabsorption of glucose and facilitate its excretion in urine. These medications are a newer treatment for Type 2 Diabetes Mellitus patients and have also been associated with positive cardiorenal effects. Patients taking these medications are at a hypothetical increased risk of urinary tract infections given the mechanism of action. Objective We questioned whether patients taking SGLT2i would be at an increased risk of genitourinary device infection or failure. As these medications are newer and without widespread use, we sought to utilize the power of a multinational database to generate a sufficient sample size to generate our answer. Methods TriNetX is a collaborative research enterprise which collects real-time data from almost 89 million patients located in 58 healthcare organizations across the globe and analyzes patient data from 20 years back to present (2002-2022). We queried TriNetX for all adult male patients undergoing Artificial Urinary Sphincter (AUS) or Inflatable Penile Prosthesis (IPP). For each implant, we separated patients into two cohorts defined by those taking an SGLT2i within 1 year before and/or after surgery and those not taking this class of medications. Cohorts and outcomes were defined using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-10) codes. We used the impact of Age, Race, Ethnicity, Body Mass Index, diabetes (DM) smoking history, history of radiation, and history of prostatectomy to generate propensity score matching (PSM). Our primary outcome was need for re-intervention (revision, removal, or replacement surgery) at any point after implantation based on CPT codes. Secondary outcomes included infection rate and overall device complication rate, including infections based on ICD-10 codes. Analytics were performed via TriNetX on demographic data which calculated Risk Ratios and were run on June 14th, 2022 Results In total, there were 8864 patients who underwent IPP and 4272 who underwent AUS (Table 1). After PSM, there were 292 patients in each IPP cohort and 74 patients in each AUS cohort. After matching for IPP and AUS, patients were similar ages (60.6 vs 60.6 years and 67.9 vs 67.8 years) with similar comorbidity profiles. The average Hemoglobin A1c level was 8.0 vs 7.4% (p&amp;lt;0.01) for IPP and 7.9% vs 7.3% (p=0.13) for AUS. Patients with an IPP on an SGLT2i were at a lower risk of overall complication (RR 0.60, p=0.02). There was no difference for AUS and risk of complication. There was no difference for either implant on risk of infection or need for second procedures for both AUS and IPP. Conclusions Patients taking SGLT2is may be safely offered urologic implants. To our knowledge, this is the first study to evaluate this class of medications in this patient population. There may be a difference in overall risk of complication for patients on SGLT2is getting an IPP, however there are similar rates of infection and re-intervention. These newer medications remain incompletely studied but the data supports their use in patients interested in implants. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast.

(108) Risk Factors for Reinterventions, Complications, and Infections after Inflatable Penile Prosthesis: A Propensity-Matched Study

Abstract Introduction Erectile dysfunction affects at least 40 million men in the United States, with inflatable penile prosthesis (IPP) used as a successful intervention in more than 25,000 men per year. Although common medical comorbidities are hypothesized to be risk factors for infections or complications, this too remains incompletely understood. Large scale, multi-institutional research may help urologists better understand the risks and rates of complications following IPP. Objective To characterize risk for reintervention, complications, and infections in patients with common suspected risk factors undergoing IPP placement in a multicenter global research network. Methods TriNetX is a research network of real-time data from 58 Healthcare Organizations globally. We queried the network for adult men with IPP implant from 2002-2022. We examined select outcomes for the general populations. We also assessed select outcomes for cohorts based on medical comorbidities that were diagnosed prior to IPP. These comorbidities included diabetes mellitus, hypertension, nicotine use, radiation, prostatectomy, urethral surgery, and organ transplant history. Propensity score matching was performed using these variables and excluding the comorbidity of interest for each cohort. International Classification of Disease Tenth Edition (ICD-10) and Current Procedural Terminology (CPT) codes were used to define cohorts and outcomes. Our primary outcome was the need for reintervention, defined here as revision, removal, or replacement at any point after implantation. Secondary outcomes included overall rates of device complication and infection. Analytics were performed using TriNetX software to calculate demographic information, odds ratios (OR), and z-test. The analysis was run on June 13, 2022. Results The study included 10,094 patients with an IPP from 2002 to 2022. The average index age was 62 +/− 11 and the racial demographics were 22% black and 58% white. The general population had a reintervention rate of 9.9%. The rate of complication was 18.8% with a 4.9% rate of infection. Full results are included in Table 1. No comorbidity diagnosed at the time of IPP had a significant association with higher rates of reintervention, complications, or infections. Conclusions Patients had higher rates of IPP complications than previously reported, but this may come from different reporting parameters used in this study. Notably, none of hypothesized comorbidities diagnosed at the time of IPP led to higher rates of reintervention, complications, or infections. Based on this data, the assessed comorbidities are not a contraindication for IPP. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast.

Clinical Outcomes of Micropulse Transscleral Cyclophotocoagulation: 2 Years of Experience in Portuguese Eyes.

This study evaluates the safety and efficacy of micropulse transscleral cyclophotocoagulation (MPTSCPC) in glaucoma patients, with standard parameters, over a 24-month period. Retrospective analysis of 61 eyes undergoing MPTSCPC from January 2018 to December 2020 was carried out. Patients received 160 seconds of laser, with settings of 2000 mW/cm2 and a duty cycle of 31.3%. A total of 61 eyes were included, arranged in an age distribution of 73.9 ± 10.8 years. The most frequent diagnosis was primary open-angle glaucoma (POAG), with a mean best-corrected visual acuity (BCVA) of 5/10 in the Snellen Visual chart. Around 37.7% of the eyes had undergone at least one glaucoma filtration surgery prior to MPTSCPC. The mean pretreatment intraocular pressure (IOP) was 24.9 ± 8.6 mm Hg. Except for the contrast at 24 months, at every other follow-up visit, there was a significant reduction (p ≤ 0.001) in IOP and in the number of topical drugs required to control IOP, from four (baseline) to three, with oral acetazolamide suspension in most cases. The total success rate (absolute and clinical successes combined) was 81.9% after 1 year of the treatment. There was no drop in visual acuity or cases of serious complications. There is a positive and significant correlation between prior glaucoma surgery and the need for reinterventions (p = 0.028). Micropulse transscleral cyclophotocoagulation (MPTSCPC) is an effective and safe procedure for reducing IOP within a broad spectrum of glaucoma patients. Additional studies are needed to confirm the current indications, widen their scope, and determine the optimal treatment settings on an individual basis. Basto RC, Almeida J, Roque JN, et al. Clinical Outcomes of Micropulse Transscleral Cyclophotocoagulation: 2 Years of Experience in Portuguese Eyes. J Curr Glaucoma Pract 2023;17(1):30-36.

O012 Elevated sGP130 characterises dysregulated chronic inflammation in diabetic peripheral vascular disease

Abstract Introduction Chronic systemic inflammation is integral to the pathophysiology of cardiovascular disease and diabetes mellitus. Interleukin 6 (IL-6) is a cytokine which may stimulate either pro- or anti-inflammatory activity depending cell population. Classical IL-6 signalling only occurs in cells expressing membrane-bound IL-6 receptor, and results in anti-inflammatory JAK/STAT3 pathway activation. Trans-signalling, by contrast, involves soluble IL-6 receptor α and soluble glycoprotein 130 (sGP130), and therefore may affect any cell regardless of membrane receptor expression. We designed a study to characterise Interleukin-6 (IL-6) trans-signalling in a diabetic cohort receiving treatment for symptomatic peripheral vascular disease and identify whether IL-6 signalling is correlated to outcomes in this patient group. Methods A single-centre, prospective cohort study of patients with DM undergoing infra-inguinal revascularization was conducted. Pre-operative serum was obtained from patients, who were then followed and observed for major amputation, death, and need for re-intervention as primary outcomes. Quantitative serum assays for IL-6, sIL-6rα, and sGP130 were performed. Results 40 patients (20 controls) were included in the study. Diabetic peripheral vascular disease patients had significantly higher serum IL-6 (p=0.0038), as well as higher serum sGP130 (p=0.0119) at baseline. Significant correlation was found between serum IL-6 and C-reactive Protein (p= 0.02), and serum IL-6 and sGP130 (p=0.02) in the disease group, but not in controls. sGP130 was higher in patients who reached primary outcomes (p=0.0196). Conclusion Systemic IL-6 trans-signalling is dysregulated in diabetic peripheral vascular disease and may be a future therapeutic target or adjunct to surgical management. Elevated sGP130 may be a prognostically-relevant biomarker in this population.

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.

Valve-sparing root replacement versus composite valve graft root replacement: Analysis of more than 1500 patients from 2 aortic centers

ObjectivesThe long-term outcomes comparing valve-sparing root replacement, composite valve graft with bioprosthesis, and mechanical prosthesis have yet to be explored. We investigated the long-term survival and reintervention rates after 1 of 3 major aortic root replacements in patients with tricuspid aortic valves and patients with bicuspid aortic valves. MethodsA total of 1507 patients underwent valve-sparing root replacement (n = 700), composite valve graft with bioprosthesis (n = 703), or composite valve graft with mechanical prosthesis (n = 104) between 2004 and 2021 in 2 aortic centers, excluding those with dissection, endocarditis, stenosis, or prior aortic valve surgery. End points included mortality over time and cumulative incidence of aortic valve/proximal aorta reintervention. Multivariable Cox regression compared adjusted 12-year survival. Fine and Gray competing risk regression compared the risk and cumulative incidence of reintervention. Propensity score–matched subgroup analysis balanced the 2 major groups (composite valve graft with bioprosthesis and valve-sparing root replacement), and landmark analysis isolated outcomes beginning 4 years postoperatively. ResultsOn multivariable analysis, both composite valve graft with bioprosthesis (hazard ratio, 1.91, P = .001) and composite valve graft with mechanical prosthesis (hazard ratio, 2.62, P = .005) showed increased 12-year mortality risk versus valve-sparing root replacement. After propensity score matching, valve-sparing root replacement displayed improved 12-year survival versus composite valve graft with bioprosthesis (87.9% vs 78.8%, P = .033). Adjusted 12-year reintervention risk in patients receiving composite valve graft with bioprosthesis or composite valve graft with mechanical prosthesis versus valve-sparing root replacement was similar (composite valve graft with bioprosthesis subdistribution hazard ratio, 1.49, P = .170) (composite valve graft with mechanical prosthesis subdistribution hazard ratio, 0.28, P = .110), with a cumulative incidence of 7% in valve-sparing root replacement, 17% in composite valve graft with bioprosthesis, and 2% in composite valve graft with mechanical prosthesis (P = .420). Landmark analysis at 4 years showed an increased incidence of late reintervention in composite valve graft with bioprosthesis versus valve-sparing root replacement (P = .008). ConclusionsValve-sparing root replacement, composite valve graft with mechanical prosthesis, and composite valve graft with bioprosthesis demonstrated excellent 12-year survival, with valve-sparing root replacement associated with better survival. All 3 groups have low incidence of reintervention, with valve-sparing root replacement showing decreased late postoperative need for reintervention compared with composite valve graft with bioprosthesis.

Progressive changes in residual gradient after aortic coarctation repair and its role in the prediction of reintervention: A longitudinal data analysis.

Repair of aortic coarctation through left thoracotomy is the standard treatment when anatomically feasible. Long-term outcomes are well studied, including the need for reintervention. However, the timely variation in residual gradients across the repaired segment is ill-defined. The aim of this work was to study the progressive changes of estimated peak gradient (ePG) acquired by transthoracic continuous-wave Doppler echocardiography across the aortic arch after repair and to assess the role of timing of assessment and values of ePG in prediction of reintervention. All eligible patients for this study who underwent aortic coarctation repair through left thoracotomy from 2001 to 2017 were reviewed. Details of the aortic arch dimensions and associated lesions were obtained by transthoracic echocardiography (TTE). The primary outcome was the ePG across the aortic arch after repair. Longitudinal data analyses with mixed effect modeling were used to determine independent predictors for ePGs. A total of 312 patients were included. Median age and weight were 30 days and 4 kg, respectively. Associated lesions included ventricular septal defect (VSD) (53%), bicuspid aortic valve (53%) and mitral stenosis (25%). Over 15-years follow-up the freedom from reintervention was 92.3%, while 24 out of the 312 patients underwent reintervention (7.7%). Longitudinal data analyses of serial 2566 TTE studies were done. The graphical display showed that the ePG across coarctation area in the first postoperative TTE was the most notable difference between those who underwent reintervention and those who did not. Further testing with proportional hazard and logistic regression modeling confirmed this finding. The area under receiver operating curve statistics showed that an ePG of 25 mmHg is an optimal cutoff value for the prediction of the reintervention. The ePG acquired in the first postoperative TTE is the most important predictor for reinterventions. The presence of VSD is associated with decreased ePGs. We propose that an ePG in the first postoperative TTE of 25 mmHg or more is a strong predictor for the need of reintervention.

Abstract 530: Explantation Vs Graft Preserving Strategy Following Primary Endovascular Aneurysm Repair

Background: Continuous sac expansion could result in rupture, requiring aggressive management with re-intervention to abolish the risk of rupture. Re-intervention could be achieved through salvage of the primary endograft through graft preserving strategy or explantation as necessary. We aim to scrutinise our 20 years of EVAR practice, strategies indications for management and re-interventions following primary endovascular aneurysm repair (EVAR). Methods: We performed 1555 aortic interventions over study period, including 910 EVARs. Using conventional and innovative diagnostic modalities with Prone contrASt enHanced computed tomography Angiography (PASHA), 136 endoleaks (ELs) were identified (15 type I, 98 type II; 18 type III; 5 type IV). Results: In total, 4.84% (44/910) patients underwent re-intervention post-primary EVAR; 18 EVAR GORE SalvAge Fabric Technique (ARAFAT), 12 double breastings, and 14 explantations (Figure 1) . Mean EL detection duration following primary EVAR was 53.3 ± 6.82 months, while re-intervention time was 70.2 ± 6.98 months. Mean sac size before the primary EVAR and re-intervention were 6.00 and 7.51 cm. Polyester (61.40%, 12/18) was the most commonly employed stent-graft material. Factors associated with the need for reintervention and likelihood of chronic fabric fatigue failure (CFFF) included the use of more than three modular stent-graft components (3.42 ± 1.31); with the proximal stent-graft diameter of 31.6 ± 3.80 cm and the use of iliac limbs more than 18 mm. We had one peri-operative mortality following explantation due to sepsis-induced multiorgan failure. Conclusions: Increasing complications post-EVAR necessitates developing and studying re-intervention strategies to salvage existing endograft and/or address graft-related complications. Re-intervention could be achieved through salvage of the primary endograft through graft preserving strategy or explantation as necessary.

A comparison of two immobilization methods in the conservative treatment of pediatric distal forearm fractures: Long arm cast versus single sugar-tong splint.

The aim of this study was to compare the results of single sugar-tong splint (SSTS) and long arm cast (LAC) as an immobilization method in pediatric distal forearm fractures. Between January 2016 and December 2019, a total of 186 pediatric patients (143 males, 43 females; mean age: 10.3±3 years; range, 4 to 15 years) with distal forearm fractures were retrospectively analyzed. The patients were divided into two groups according to the immobilization method: SSTS group (n=74) and LAC group (n=112). All patients were evaluated at the time of admission, immediately after the reduction, and at one, two, and four weeks. Sagittal and coronal plane angulations and translation percentages of the radius at each visit were calculated. Alterations in coronal angle, sagittal angle, sagittal translation and coronal translation were calculated by subtracting the measurements after reduction from the measurements at four weeks. Both groups were comparable in terms of demographic characteristics, fracture localization, and side of injured extremity. There was a statistically significant difference only in the sagittal angulations in the first (LAC: 4.7; SSTS: 6.5; p=0.009) and second week (LAC: 5.3; SSTS: 6.8; p=0.024). The rest of radiological measurements were comparable. In the LAC group, seven patients had re-intervention (three manipulations, four surgeries) and in the SSTS group, three patients had re-intervention (two manipulations, one surgery) (p=0.657). Our study results suggest that SSTS and LAC are comparable in terms of radiological results and need for re-intervention as an immobilization method of pediatric distal forearm fractures.

Early Experience of Inner Branch Retrograde Cannulation With E-nside Branch Stent Graft for Thoracoabdominal Aortic Aneurysms.

The aim of our study is to investigate the feasibility of retrograde cannulation using devices with inner branches (IB) for the endovascular treatment of thoracoabdominal aortic aneurysms (TAAAs). A retrospective analysis using IB configuration with retrograde cannulation was carried out on TAAAs patients undergoing endovascular treatment. Seven patients underwent IB endovascular treatment with retrograde cannulation between September 2020 and November 2021. The mean age was 80.4 years and 4 patients were male. A total of 26 of 28 target vessels were cannulated by retrograde access with a technical success of 93% (2 of 26 target vessels). Two intra-procedural complications were observed (1 renal artery dissection and 1 collateral renal artery rupture). In total, 26 of 28 treated vessels were retrograde cannulated with a technical success of 93%. A total of 39 stent bridges were used (all Viabahn VBX devices). The mean duration of the procedure was 321±102 minutes, and the mean scan time was 134±62 minutes. Mortality at 30 days was observed in 1 case. During the follow-up, 1 stent bridge occlusion was observed without the need for reintervention. Retrograde cannulation can also be successfully performed in the case of inner branches. In inner branched cases, retrograde cannulation should be taken into consideration in particular cases or it could become the option of choice. Dedicated endovascular material available such as steerable catheters and latest generation covered stents is fundamental for the success of the treatment.

MP71-07 THE RISK OF COMPLICATIONS, INFECTIONS, AND RE-INTERVENTIONS IN MEN RECEIVING ARTIFICIAL URINARY SPHINCTERS, A GLOBAL, PROPENSITY SCORE MATCHED ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP71-07 THE RISK OF COMPLICATIONS, INFECTIONS, AND RE-INTERVENTIONS IN MEN RECEIVING ARTIFICIAL URINARY SPHINCTERS, A GLOBAL, PROPENSITY SCORE MATCHED ANALYSIS Zachary Prebay, Halle Foss, David Ebbott, Michael Li, and Paul Chung Zachary PrebayZachary Prebay More articles by this author , Halle FossHalle Foss More articles by this author , David EbbottDavid Ebbott More articles by this author , Michael LiMichael Li More articles by this author , and Paul ChungPaul Chung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Artificial urinary sphincters (AUS) are treatments for patients with stress urinary incontinence. However, risk factors for implant infection, complication, or re-intervention (removal, repair, replacement) are incompletely understood. METHODS: We queried the TriNetX database for all adult male patients undergoing AUS utilizing CPT codes. We evaluated the impact of age, body mass index, race, ethnicity, diabetes (DM), smoking history, history of radiation therapy (RT), history of radical prostatectomy (RP) and history of urethroplasty on select clinical outcomes utilizing ICD-10 codes. Our primary outcome was the need for re-intervention defined by CPT codes. Secondary outcomes included overall device complication rate and infection rate defined by ICD codes. Analytics were performed on TriNetX which calculated risk ratios (RR). We evaluated our outcomes first on the entire population and then repeated analyses for each individual comparison cohort using the remaining demographic variables to perform propensity score matching (PSM). RESULTS: Analyses were run on September 22nd, 2022. The overall rates of AUS re-intervention, complication and infection were 23.4%, 24.1% and 6.4%, respectively (Table 1). Kaplan Meier analysis showed median AUS survival (no need for re-intervention) at 10.6 years and projected 20-year survival probability at 31.3%. Patients with a history of smoking or urethroplasty were at higher risk of AUS complication (31.0% vs 25.6%, RR 1.21, p<0.01; 37.6% vs 23.3%, RR 1.62, p<0.01) and re-intervention (27.6% vs 22.1%, RR 1.25, p<0.01; 35.1% vs 24.2%, RR 1.45, p=0.03). Patients with DM (8.5% vs 5.7%, RR 1.48, p=0.02) or a history of RT (8.3% vs 4.3%, RR 1.92, p<0.01) were at higher risk of AUS infection. Patients with a history of RP were at a lower risk of AUS infection (4.4% vs 7.8%, RR 0.56, p<0.01). Patients with a history of RT were at higher risk of AUS complication (26.6% vs 21.2%, RR 1.25, p=0.02). All risk factors besides race showed a difference in device removal itself (p<0.05). CONCLUSIONS: Multiple characteristics are associated with risk of re-intervention, infection, or complication. These results can help guide patient selection and counseling with the goal of reducing complications. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1016 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary Prebay More articles by this author Halle Foss More articles by this author David Ebbott More articles by this author Michael Li More articles by this author Paul Chung More articles by this author Expand All Advertisement PDF downloadLoading ...

Outcomes of Laparoscopic Liver Resection for Hepatocellular Carcinoma: A Single-Center Experience

Hepatocellular carcinoma (HCC) is the sixth most common cancer in the world. Surgery is the treatment of choice in stages 0 and A in the Barcelona Clinic Liver Cancer classification. A minimally invasive technique in this scenario has the advantage of reducing postoperative pain, blood loss, and hospital stay. We present our experience and outcomes in laparoscopic liver resection in HCC. Retrospective descriptive analysis from all patients who underwent laparoscopic liver resection for HCC in our center between August 2006 and December 2020. Laparoscopic liver resection for HCC was performed in 20 patients. The median age was 70 years, and the male gender was 75%. Sixteen patients had chronic liver disease, and 87.5% were Child A. The most common liver resection was the non-anatomical (45%). 30-day morbidity was 15%, without the need for reintervention. We had no 30-day mortality and postoperative liver failure. Negative margins were achieved in 90% of patients. Median disease-free survival and overall survival were 25 and 40.5 months, respectively. Laparoscopic liver resection for the treatment of HCC in our series is safe, with no 30-day mortality, low incidence of complications, no postoperative liver failure, and suitable medium- and long-term oncological results.

MP62-10 CAN PATIENTS ON SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITORS SAFELY RECEIVE A UROLOGIC IMPLANT?

You have accessJournal of UrologyCME1 Apr 2023MP62-10 CAN PATIENTS ON SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITORS SAFELY RECEIVE A UROLOGIC IMPLANT? Zachary Prebay, Halle Foss, David Ebbott, Jason Hyman, Michael Li, and Paul Chung Zachary PrebayZachary Prebay More articles by this author , Halle FossHalle Foss More articles by this author , David EbbottDavid Ebbott More articles by this author , Jason HymanJason Hyman More articles by this author , Michael LiMichael Li More articles by this author , and Paul ChungPaul Chung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003320.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) prevent the reabsorption of glucose and facilitate its excretion in urine. Patients taking these medications are at a hypothetical increased risk of urinary tract and genital infections given the mechanism of action. We questioned whether patients taking SGLT2i would be at an increased risk of genitourinary device infection or failure. METHODS: We queried the TriNetX database for all adult male patients undergoing Artificial Urinary Sphincter (AUS) or Inflatable Penile Prosthesis (IPP). For each implant, we separated patients into cohorts defined by those taking an SGLT2i within 1 year before and/or after surgery and those not taking an SGLT2i. Cohorts and outcomes were defined using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-10) codes. We used Age, Race, Ethnicity, Body Mass Index (BMI), Diabetes, smoking history, history of radiation, and history of prostatectomy to generate propensity score matching (PSM). Our primary outcome was need for re-intervention (revision, removal, or replacement surgery) at any point after implantation based on CPT codes. Secondary outcomes included infection rate and overall complication rate based on ICD-10 codes. Analytics were performed via TriNetX which calculated Risk Ratios. RESULTS: Analyses were run on October 14th, 2022. There were 9783 patients who underwent IPP and 4655 who underwent AUS (Table 1). After PSM, there were 340 and 82 patients in each IPP and AUS cohort with similar ages (60.9 vs 60.7 years; 68.6 vs 68.7 years) and similar comorbidity profiles except patients with an IPP on an SGLT2i had higher average BMI (31.9 vs 30.6 kg/m2, p=0.01). The average Hemoglobin A1c level was higher for patients taking an SGLT2i; 8.0% vs 7.1% (p<0.01) for IPP and 7.9% vs 6.9% (p=0.01) for AUS. Patients with an IPP on an SGLT2i were at a lower risk of overall complication (10.6% vs 19.9%, RR 0.53, p<0.01). There was no difference for AUS and risk of complication and no difference for either implant on risk of infection or re-intervention. CONCLUSIONS: Patients taking SGLT2is may be safely offered urologic implants. Patients taking an SGLT2 had a lower risk of complication for IPP, and there were similar rates of infection and re-intervention for both IPP and AUS. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e865 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary Prebay More articles by this author Halle Foss More articles by this author David Ebbott More articles by this author Jason Hyman More articles by this author Michael Li More articles by this author Paul Chung More articles by this author Expand All Advertisement PDF downloadLoading ...

His bundle pacing and left bundle branch area pacing: Feasibility and safety

Introduction and objectivesThere has been increasing interest in pacing methods that provide physiological stimulation, such as His bundle pacing (HBP) or left bundle branch area pacing (LBBAP). Our goal was to assess the feasibility and safety of these techniques. MethodsProspective observational single-center study evaluating 46 patients with indication for a pacemaker that attempted HBP or LBBAP from July 2020 to November 2021. Procedural endpoints and pacing parameters were assessed and compared at implantation and three-month follow-up. ResultsOverall acute procedural success was achieved in 96% of the cases. Successful HBP was achieved in 91% of the patients and all patients for LBBAP. During implantation, HBP patients presented a higher capture threshold (0.80 [0.55–1.53] V vs. 0.70 [0.40–0.90] V, p=0.08) and lower R-wave amplitude (4.0 [2.9–6.2] mV vs. 7.8 [5.5–10.5] mV, p=0.001) compared to LBBAP patients. There was no difference between groups, either acutely or at 3-months, regarding paced QRS duration (125±22 ms vs. 133±16 ms, p=0.08; 118±16 ms vs. 124±14 ms, p=0.19). Although procedural time was similar with both techniques (95 [75–139] min vs. 95 [74–116] min, p=0.79), fluoroscopy time was significantly reduced during LBBAP (8.1 [5.3–13.4] min vs. 4.1 [3.1–11.3] min, p=0.05). At 3 months of follow-up, the pacing threshold remained with a stable profile in HBP as in LBBAP (1.25 [0.75–2.00] V, p=0.09 and 0.60 [0.50–0.80] V, p=0.78), respectively. The need for re-intervention occurred in 3 (6.5%) HBP cases during follow-up. ConclusionThis first national study demonstrates the feasibility and safety of the HBP and LBBAP in patients with pacemaker indication.