Results Of Repair Research Articles

Poster 247: Comparative Outcomes of Radial and Bucket-Handle Meniscal Tear Repair at Mean 10 Years: A Propensity-Matched Analysis

Poster 247: Comparative Outcomes of Radial and Bucket-Handle Meniscal Tear Repair at Mean 10 Years: A Propensity-Matched Analysis

Paper 20: Clinical Outcomes of Ulnar Collateral Ligament Repair with Internal Brace Versus Ulnar Collateral Ligament Reconstruction in Competitive Athletes

Paper 20: Clinical Outcomes of Ulnar Collateral Ligament Repair with Internal Brace Versus Ulnar Collateral Ligament Reconstruction in Competitive Athletes

Trends in utilization, timing, and outcomes of thoracic endovascular repair for type B aortic dissection in the United States

BackgroundAortic dissection is the most common acute aortic syndrome in the United States. Type B aortic dissection (TBAD) can be managed medically, through open surgical repair, or with thoracic endovascular repair (TEVAR). The present study sought to assess contemporary trends in the use and timing of TEVAR. MethodsAdult nonelective TBAD admissions were identified in the 2010 to 2020 Nationwide Readmissions Database. Patients were categorized as medical management (Medical Management), TEVAR at initial hospitalization (Early), or TEVAR during readmission (Delayed). Multivariable models were developed to assess associations with clinical outcomes and resource utilization. ResultsOf 85,753 patients, 8.7% underwent TEVAR at index hospitalization (Early). From 2010 to 2020, the proportion undergoing TEVAR decreased significantly (from 11.3% to 9.6%; nptrend < .001), while the proportion of TEVAR at a subsequent hospitalization increased (from 13.0% to 21.6%; nptrend < .001). Compared to Medical Management, the Early group was younger (median. 63 [interquartile range (IQR), 52-74] years vs 69 [IQR, 57-81] years), and more frequently privately insured (27.7% vs 17.5%; P < .001). Following adjustment, the Early group had a reduced odds of mortality (adjusted odds ratio [aOR], 0.56; 95% confidence interval [CI], 0.48-0.66) and increased hospitalization costs (β = +$50,000; 95% CI, $48,000-$53,000). Among 4267 TEVAR patients with available procedure timing data, 15.7% were categorized as Delayed. The Early and Delayed groups did not differ in terms of demographics. The Delayed group had a decreased likelihood of major adverse events (aOR, 0.50; 95% CI, 0.39-0.64); however, this did not affect 90-day cumulative hospitalization costs (β = +$2700; 95% CI, -$5000-$11,000, ref: Early). ConclusionsThis study suggests changes to TBAD management in both treatment modality and TEVAR timing. Focused analysis on the timing and long-term costs of TEVAR are needed to optimize care delivery.

Paper 10: 5-Year Outcomes: Arthroscopic Anatomic Glenoid Augmentation is Superior to Bankart Repair

Objectives: Arthroscopic anatomic glenoid reconstruction (AAGR) is an increasingly popular treatment approach for shoulder instability. AAGR shows a promising short-term safety profile and clinicoradiological outcomes, suggesting its efficacy is comparable to Bankart repair. Recurrence rates reported in the literature are up to 30% following Bankart repair, however, there is a lack of literature comparing the long-term outcomes of AAGR versus Bankart repair. The purpose was to compare recurrence rates and patient-reported outcomes in patients who received AAGR to patients who received Bankart repair with a minimum of 5-year follow-up. Methods: This was a retrospective study comparing 73 patients who underwent AAGR and 76 patients who underwent Bankart repair consecutively between 2012 and 2018. Patients who had a minimum 5-year follow-up were included in the final analysis. Data collected included demographics, pre- and postoperative Western Ontario Shoulder Instability (WOSI) Index and Disabilities of the Arms, Shoulders, and Hands (DASH) Scores, postoperative complications and recurrence. The primary outcome measure was dislocation recurrence, with secondary outcome measures of patient-reported outcomes and postoperative complications. Results: The demographics and preoperative outcome scores were similar between groups. Patients in the AAGR group presented with significantly higher bone loss (&gt;10%, p&lt;0.05) than those in the Bankart group. There were fewer incidences of recurrence in the AAGR group (1.4%) than the Bankart group (18.4%). There was a significant difference in pre-to-post operative WOSI (p=0.02) and DASH (p=0.01) scores between groups, as well as a significant difference in the number of patients who met the WOSI (p&lt;0.001) and the DASH (p&lt;0.001) minimum clinically important difference threshold, with the AAGR group showing a greater improvement pre- to postoperatively. Conclusions: AAGR has better long-term outcomes and fewer incidences of recurrence compared to Bankart repair.

Long-term patient-reported outcome measures (PROMs) after primary ventral or small midline incisional hernia repair.

Ventral hernia repair is a common elective surgical procedure lacking strong evidence for specific operative approaches. This study aimed to evaluate the outcomes of primary suture repair or polypropylene sandwich mesh repair for ventral hernias. The main outcome measures were the rate of hernia recurrence, and evaluation of long-term complications and patient-reported outcomes. This retrospective cohort study evaluated patient perceived recurrence and pain in patients who had undergone a primary ventral hernia (epigastric, supraumbilical, or umbilical) repair or small (≤20 mm) midline incisional hernia repair 10 years after the procedure. Short-term follow-up occurred up to 6 weeks after the initial operation, while long-term follow-up included patients who were reviewed clinically or interviewed via telephone at or beyond 3 years after the procedure. Most (75/100, 75.0%) patients had an extra-peritoneal sandwich mesh repair. Short-term follow-up showed minimal pain and normal activities for all patients (97/97, 100%). Long-term follow-up (median 12 years [IQR 11-13]) was achieved in 95.9% (93/97) of patients with only a small number reporting a slight bulge (5/93, 5.4%) and intermittent mild discomfort (8/93, 8.6%). Nine patients (9/97, 9.3%) experienced hernia recurrence, diagnosed at a median of 26 months [interquartile range, IQR, 7-58] post-operatively. These findings suggest that an open sandwich mesh technique is a safe and effective method for repairing primary ventral hernias and small midline incisional hernias and is associated with favourable long-term patient-reported outcomes.

Early and Midterm Outcome of Surgical Repair of Total Anomalous Pulmonary Venous Connection

Early and Midterm Outcome of Surgical Repair of Total Anomalous Pulmonary Venous Connection

Outcome after Arthroscopic Meniscal Repair

Abstract Objective: The objective of this study was to evaluate the functional outcomes of all-inside meniscal repair using the Fast-Fix suturebased fixation device and its correlation with postoperative MRI findings in serving military personnel with symptomatic torn menisci. Materials and Methods: Thirty patients under 40 years of age with symptomatic meniscal tears were included in the study. Clinical evaluation, arthroscopic assessment, and meniscal repair using the Fast-Fix system were performed. Patients were followed up clinically and with postoperative MRI at one year. Functional outcomes were evaluated using the International Knee Documentation Committee (IKDC) form. Results: At one year postoperative follow-up, 10% of patients had excellent results, 66.6% had good results, 13.4% had fair results, and 10% had poor results according to the IKDC evaluation. MRI evaluation showed overall satisfactory results in 86.7% of patients. The Fast-Fix system demonstrated a success rate of 90% in this short-term follow-up study, with minimal complications. Conclusion: Arthroscopic all-inside meniscal repair using the Fast-Fix system showed promising clinical outcomes in serving military personnel with symptomatic torn menisci. The success rate was comparable to traditional suture techniques. Postoperative MRI provided valuable information for evaluating the physiological state of the repaired meniscus. Long-term followup studies are necessary to assess the structural and functional integrity of the repaired menisci over time.

Effects of Quality of Integrity on Clinical and Structural Outcomes of Rotator Cuff Repair: A Retrospective Cohort Study of 504 Cases

Background: The clinical implications of structural integrity have been a subject of long debate. The oversimplified binary categorization of structural integrity into either healing or retear, along with faulty preoperative baselines for comparison, may contribute to the controversy. Purpose: To determine how the quality of structural integrity in a repaired cuff tendon affects both clinical and structural outcomes by dividing the patients into groups based on integrity and using the immediate postoperative baseline (time zero). Study design: Cohort study; Level of evidence, 3. Methods: A total of 504 patients with a full-thickness rotator cuff tear who underwent arthroscopic rotator cuff repair and were followed up for at least a year with magnetic resonance imaging (MRI) were included. The quality of structural integrity was graded using the Sugaya classification. To evaluate clinical outcomes, pain, range of motion, strength, functional scores, and overall satisfaction and function were used for within- and between-group analyses at the last follow-up. For the assessment of structural outcomes, the Goutallier classification for fatty infiltration (FI) and the tangent sign, occupation ratio, and normalized cross-sectional area for muscle atrophy (MA) were used. The baselines for these structural measurements were both the preoperative and the time-zero MRI scans. Results: The mean clinical follow-up period was 31.8 ± 27.5 months, and the MRI follow-up period was 10.9 ± 5.3 months. There were 178 (35.3%), 228 (45.2%), 58 (11.5%), 14 (2.8%), and 26 (5.2%) shoulders with Sugaya grades 1, 2, 3, 4, and 5, respectively. Regardless of structural integrity, all clinical outcomes at a mean follow-up of 31.8 months after repair significantly improved compared with those before repair. Only in shoulders with Sugaya grade 1 did the FI of the supraspinatus muscle improve significantly from baseline. FI of the infraspinatus muscle did not change significantly in those with grades 1 and 2 but worsened in those with grades 3 and 5. MA measured using the occupation ratio improved significantly in shoulders with Sugaya grades 1 and 2 but declined in those with grade 5. Conclusion: This study established a correlation between improved structural integrity of the repaired cuff tendon and enhanced structural outcomes in rotator cuff muscles. Furthermore, the findings revealed that both FI and MA could be reversed in patients exhibiting high-quality structural integrity. However, these structural improvements were not mirrored in the clinical outcomes.

Paper 26: Role of Age on Survival of Anterior Cruciate Ligament Primary Repair at minimum 5-year follow-up

Objectives: Short-term follow-up of anterior cruciate ligament (ACL) primary repair (ACLPR) presented increased failure risk (37%) in patients ≤21 years of age (y/o), however low rates in patients &gt;21 y/o (3.5%). Mid- and long-term clinical evidence for contemporary anterior cruciate ligament primary repair (ACLPR) is lacking, whereas outcomes of historical ACL repair were shown to deteriorate at midterm follow-up after initial good short-term outcomes. This study evaluates age-differentiated survival rates of ACLPR at 5-year FU to assess whether the previously presented rates at 2-year FU can be maintained at 5-year FU. Methods: The first 113 consecutive patients with proximal ACL tears undergoing ACLPR by a single surgeon, from 04/2008 to 09/2017, were prospectively followed up. Indication for ACLPR was determined if a proximal type I or II tear and good to excellent tissue quality was present. Failure and re-operation rates, patient reported outcome measurements (PROMs) (IKDC score, Lysholm score, Forgotten Joint score, ACL-RSI score, and Tegner Activity Scale Difference) and instrumented anterior-tibial translation side-to-side difference (ATT-SSD) were recorded at minimum 5-year FU. Results: A total of 96 patients (85%) with a mean final FU of 7.2 ±2.3 (5.0 – 12.8) years were evaluated. Ipsilateral reinjury rates for patients ≤21 y/o, from 2- to 5-year FU, remained stable (40.0%) with no additional failure recorded. Six additional re-injuries were detected in patients &gt;21 y/o, leading to a failure rate of 9.8% at 5-year FU. Mean time to failure following surgery was 17 ±11 months in patients ≤21 y/o versus 26 ±16 months in patients &gt;21 y/o. Re-operation rates for patients ≤21- and &gt;21 y/o were 0.0% and 4.0% respectively. PROMs showed no significant differences as compared to outcomes at 2-year FU (p &lt;.001) and 5-year ATT-SSD was 0.75 ±1.2 mm. Conclusions: ACLPR is correlated with a high risk of early failure (40.0% at 17 ±11 months) in patients &lt; 21 y/o, however no additional subsequent re-injuries were reported at minimum final 5-year FU. In contrast, patients &gt;21 y/o demonstrate low failure rates at 2- (3.5%) and 5-year FU (9.8%).

Comparisons between the Outcome of Mitral Repair versus Replacement in Patients with Ischemic Heart Disease with Severe Ischemic Mitral Regurgitation and Undergoing Coronary Artery Bypass Grafting (CABG) Surgery: Review Article

Comparisons between the Outcome of Mitral Repair versus Replacement in Patients with Ischemic Heart Disease with Severe Ischemic Mitral Regurgitation and Undergoing Coronary Artery Bypass Grafting (CABG) Surgery: Review Article

Poster 303: Outcomes Following Repair of Radial Meniscus Tears Compared to Bucket Handle Meniscus Tears

Objectives: Preserving the meniscus has become a priority in managing meniscal tears with advancement of meniscus repair techniques. Meniscal repair, as opposed to partial meniscectomy, reduces risk of development and progression of knee osteoarthritis. Radial meniscus tears have traditionally been associated with a poor prognosis because they occur perpendicular to circumferential meniscal fibers, compromising hoop tension. Advances in surgical technique and biologic augmentation have facilitated repair of these complex injuries. The purpose of this study was to compare post-operative complication and surgical revision rates in patients who underwent repair of a radial meniscus tear versus bucket-handle meniscus tear. We hypothesized the outcomes of repair of radial meniscus tear would be similar to a matched group of patients who underwent repair of a bucket handle meniscus tear. Methods: A retrospective study was performed to identify patients who underwent repair of radial meniscus tear. Chart review was performed for 1506 patients who underwent meniscus repair from 2012 to 2019, and demographic information, type of meniscus tear, concomitant ACL reconstruction, post-operative complications, repeat surgeries, and failure at the repair site were detailed in a database. Patients who underwent repair of a radial tear were matched with patients who underwent repair of a bucket-handle tear based on sex, age (within 5 years), BMI (within 5 kg/m2), meniscus laterality, and concomitant ACL reconstruction. Isolated meniscus repairs were augmented with platelet rich plasma (PRP). Results: Fifty patients (age, 31.8 ± 15.2 years; BMI, 30.2 ± 6.4 kg/m2) were identified who underwent a radial meniscus tear repair. Of these patients, 16 (32.0%) were female and 23 (46.0%) underwent concomitant ACL reconstruction. Complications including recurrent swelling, stiffness, persistent pain, and repeat injury were reported in 15 patients (30.0%). Six patients underwent repeat surgery (12.0%). Four repeat surgical patients, who had previously undergone meniscus repair and concomitant ACL reconstruction, were found to have an intact radial repair at the time of second surgery, and underwent repeat surgery for a reason unrelated to the radial tear repair (e.g. cyclops lesion, synovectomy, new meniscus tear). Two patients had a radial tear repair failure that required surgical revision (4.0%). Radial tear repair patients who underwent concomitant ACL reconstruction differed significantly from those who did not only in age (ACL group, 26.0 ± 10.9 y; non-ACL group, 36.6 ± 16.7 y; p = 0.03). There were no significant differences in post-operative complications, repeat surgeries, or failures between the radial and bucket-handle tear repair patients. Conclusions: Repair of radial meniscus tears with contemporary techniques and biological enhancement with either ACL reconstruction or PRP can be expected to have similar outcomes to repairs of bucket handle meniscus tears.

Integrated Single-Cell Analysis Reveals Spatially and Temporally Dynamic Heterogeneity in Fibroblast States during Wound Healing

Wound healing is a dynamic process over temporal and spatial scales. Key to repair outcomes are fibroblasts, yet how they modulate healing across time and in different wound regions remains incompletely understood. By integrating single-cell RNA-sequencing datasets of mouse skin and wounds, we infer that fibroblasts are the most transcriptionally dynamic skin-resident cells, evolving during postnatal skin maturation, and rapidly after injury towards distinct late scar states. We show that transcriptional dynamics in fibroblasts are largely driven by genes encoding extracellular matrix and signaling factors. Lineage trajectory inference and spatial gene mapping reveal that Prg4-expressing fibroblasts transiently emerge along early wound edges. Within days, they become replaced by long-lasting and likely non-interconverting fibroblast populations, including Col25a1-expressing and Pamr1-expressing fibroblasts that occupy subepidermal and deep scar regions, respectively, where they engage in reciprocal signaling with immune cells. Signaling inference shows that fibroblast-immune crosstalk repeatedly uses some signaling pathways across wound healing time, while use of other signaling pathways is time- and space-limited. Collectively, we uncovered high transcriptional plasticity by wound fibroblasts, with early states transiently forming distinct micro-niches along wound edges and in the fascia, followed by stable states, that stratify scar tissue into molecularly dissimilar upper and lower layers.

A Classic and Effective Approach for Managing Totally Implantable Venous-Access Port Site Dehiscence in Patients with Cancer: The Limberg Flap

Background: Totally implantable venous-access ports (TIVAPs) are essential for long-term intravenous treatment in cancer patients, but TIVAP site dehiscence remains a significant issue. This study aims to investigate how Limberg flap transposition compares to primary repair and other local flap techniques in managing TIVAP site dehiscence.Methods: A retrospective study was conducted on patients who underwent repair operations, without TIVAP removal, for right subclavicular area TIVAP site dehiscence between May 2016 and March 2023. Outcomes of primary repair, Limberg flap transposition and other local flap surgeries were analyzed, focusing on incisional integrity and dehiscence recurrence rate.Results: Nine patients and 3,204 catheter days were included in the study, with a total of 15 surgical repair procedures performed for dehiscence, including cases of recurrence. Among them, Limberg flap transposition demonstrated the longest period of incisional integrity, with a mean of 231.4 days, surpassing primary repair (74.25 days) and other local flap techniques (29.5 days). Additionally, the Limberg flap exhibited the lowest recurrence rate, with 0.86 events per 1,000 catheter days, compared to primary repair (10.10 events per 1,000 catheter days) and other local flap approaches (16.95 events per 1,000 catheter days).Conclusion: Limberg flap transposition is considered as an effective solution for TIVAP site dehiscence, showing reduced complications and recurrence rates compared to primary repair and other local flap techniques. This study suggests Limberg flap transposition should be considered the preferred option for managing TIVAP dehiscence in cancer patients, thereby improving patient care and outcomes.

High-Porosity Sieve-Type Neural Electrodes for Motor Function Recovery and Nerve Signal Acquisition.

In this study, the effects of electrode porosity on nerve regeneration and functional recovery after sciatic nerve transection in rats was investigated. A sieve-type neural electrode with 70% porosity was designed and compared with an electrode with 30% porosity. Electrodes were fabricated from photosensitive polyimide and implanted into the transected sciatic nerves. Motor function recovery was evaluated using the Sciatic Function Index. The number of active channels and their signal quality were recorded and analyzed to assess the sensory neural signal acquisition. Electrical impedance spectroscopy was used to evaluate the electrode performance. The group implanted with the 70% porosity electrode demonstrated significantly enhanced nerve regeneration and motor function recovery, approaching control group levels by the fifth week. In contrast, the group with the 30% porosity electrode exhibited limited improvement. Immunohistochemical analysis confirmed extensive nerve fiber growth within the 70% porous structure. Moreover, the 70% porosity electrode consistently acquired neural signals from more channels compared to the 30% porosity electrode, demonstrating its superior performance in sensory signal detection. These findings emphasize the importance of optimizing electrode porosity in the development of advanced neural interfaces, with the potential to enhance clinical outcomes in peripheral nerve repair and neuroprosthetic applications.

Long-term outcomes of TEVAR for thoracic aortic diseases: a retrospective single-center study

BackgroundThe outcomes of Thoracic Endovascular Aortic Repair (TEVAR) vary depending on thoracic aortic pathologies, comorbidities. This study presents our comprehensive endovascular experience, focusing on exploring the outcome in long term follow-up.MethodsFrom 2006 to 2018, we conducted TEVAR on 97 patients presenting with various aortic pathologies. This retrospective cohort study was designed primarily to assess graft durability and secondarily to evaluate mortality causes, complications, reinterventions, and the impact of comorbidities on survival using Kaplan-Meier and Cox regression analyses.ResultsThe most common indication was thoracic aortic aneurysm (n = 52). Ten patients had aortic arch variations and anomalies, and the bovine arch was observed in eight patients. Endoleaks were the main complications encountered, and 10 of 15 endoleaks were type I endoleaks. There were 18 reinterventions; the most of which was TEVAR (n = 5). The overall mortality was 20 patients, with TEVAR-related causes accounting for 12 of these deaths, including intracranial bleeding in three patients. Multivariant Cox regression revealed chronic renal diseases (OR = 11.73; 95% CI: 2.04–67.2; p = 0.006), previous cardiac operation (OR = 14.26; 95% CI: 1.59-127.36; p = 0.01), and chronic obstructive pulmonary diseases (OR = 7.82; 95% CI: 1.43–42.78; p = 0.001) to be independent risk factors for 10-year survival. There was no significant difference in the survival curves of the various aortic pathologies. In the follow-up period, two non-symptomatic intragraft thromboses and one graft infection were found.ConclusionComorbidities can increase the risk of TEVAR-related mortality without significantly impacting endoleak rates. TEVAR is effective for severe aortic pathologies, though long-term graft durability may be compromised by its thrombosis and infection.

Comparison of postoperative outcome of laparoscopic and open inguinal hernia mesh repair

Comparison of postoperative outcome of laparoscopic and open inguinal hernia mesh repair

The Fate of Mitral Valve Surgery in the Pediatric Age: A 25-Year Single-Center Experience.

Background: The aim of this study was to evaluate the natural history of patients after mitral valve intervention in the pediatric age. Methods: This is a retrospective study including all patients who underwent mitral valve surgery from 1998 to 2022. The patients' surgical reports, postoperative records, and ambulatory visits were reviewed. The endpoints of the study were survival and freedom from mitral valve reoperation. Results: Of the 70 patients included in the cohort, 61 patients (86.7%) had congenital mitral valve disease, of whom 46 patients (75.4%) had a predominantly mitral regurgitation lesion, and 15 patients (24.6%) had a predominantly mitral stenosis. In the mitral regurgitation group, all of the patients underwent valve repair with an operative mortality of one patient (2.1%), and with median follow-up of 4 years (range, 0.5-13 years), there was 4.3% mortality (n = 2) and 71.2% freedom from reoperation. In the mitral stenosis group, 11 patients underwent mitral valve repair, and 4 patients underwent valve replacement. There was an operative mortality of two patients (13.3%). With a 2-year median follow-up (range: 0.1-23 years), there were no additional mortality cases in the mitral stenosis group. All three patients who survived primary mitral valve replacement (100%) and four patients who survived a primary repair (40.0%) underwent reoperation. Conclusions: This study demonstrates encouraging outcomes for mitral valve repair. The mortality of patients with congenital mitral valve disease may also be related to a difficult postoperative course, rather than the MV lesion itself.

Comparing clinical and echocardiographic outcomes following valve-sparing versus transannular patch repair of tetralogy of Fallot: a systematic review and meta-analysis.

Transannular patch (TAP) repair of tetralogy of Fallot (ToF)relieves right ventricular tract obstruction but may lead to pulmonary regurgitation. Valve-sparing (VS) procedures can avoid this situation, but there is a potential for residual pulmonary stenosis. Our goal was to evaluate clinical and echocardiographic outcomes of TAP and VS repair for ToF. A systematic search of the PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials and Web of Science databases was carried out to identify articles comparing conventional TAP repair and VS repair for ToF. Random-effects models were used to perform meta-analyses of the clinical and echocardiographic outcomes. Forty studies were included in this meta-analysis with data on 11723 participants (TAP: 6171; VS: 5045). Participants who underwent a VS procedure experienced a significantly lower cardiopulmonary bypass time [mean difference (MD): -14.97; 95% confidence interval (CI): -22.54, -7.41], shorter ventilation duration (MD: -15.33; 95% CI: -30.20, -0.46) and shorter lengths of both intensive care unit (ICU) (MD: -0.67; 95% CI: -1.29, -0.06) and hospital stays (MD: -2.30; 95% CI: [-4.08, -0.52). There was also a lower risk of mortality [risk ratio: 0.40; 95% CI: (0.27, 0.60) and pulmonary regurgitation [risk ratio: 0.35; 95% CI: (0.26, 0.46)] associated with the VS group. Most other clinical and echocardiographic outcomes were comparable in the 2 groups. This meta-analysis confirms the well-established increased risk of pulmonary insufficiency following TAP repair while also demonstrating that VS repairs are associated with several improved clinical outcomes. Continued research can identify the criteria for adopting a VS approach as opposed to a traditional TAP repair.

Clinical outcomes of aortic root repair using pericardial autograft for acute type a aortic dissection

BackgroundFor acute type A aortic dissection involving the aortic root with root diameter no more than 45 mm, there are various aortic root repair techniques. In this study, a novel surgical technique using a pericardial autograft for aortic root repair was introduced. We described its surgical steps in detail and compare its clinical outcomes with direct suture technique.MethodsBetween July 2017 and August 2022, 95 patients with acute type A aortic dissection who underwent aortic root repair were enrolled, including aortic root repair using pericardial autograft (group A, n = 49) or direct suture (group B, n = 46). The patient’s clinical data were retrospectively analyzed, and a 5-year follow-up was conducted.ResultsThe 30-day mortality, re-exploration for bleeding, postoperative new-onset renal failure requiring continuous renal replacement therapy, stroke, and paraplegia occurred in 3%, 4%, 11%, 5%, and 2% of the overall patients, respectively. There was no significant difference in the 30-day mortality and complication rate between the two groups. The 30-day mortality and re-exploration for bleeding marked the primary endpoint events. Logistic regression analysis indicated that there was a significant correlation between the primary endpoint events and surgical technique (odds ratio, 0.002; 95% confidence interval, 0-0.159; P = 0.026). The aortic valve insufficiency of the two groups were significantly improved after operation (group A, P < 0.001; group B, P < 0.001). During follow-up, there was no significant difference in short-term survival between the two groups after surgery (log-rank P = 0.75), and all patients were free from reoperation for aortic disease.ConclusionsPatients who underwent aortic root repair using pericardial autograft tended to have reduced 30-day mortality and a lower risk of re-exploration for bleeding. Using pericardial autograft for aortic root repair is a safe and useful approach for patients with acute type A aortic dissection involving the aortic root.

Neuronal DNA repair reveals strategies to influence CRISPR editing outcomes.

Genome editing is poised to revolutionize treatment of genetic diseases, but poor understanding and control of DNA repair outcomes hinders its therapeutic potential. DNA repair is especially understudied in nondividing cells like neurons, which must withstand decades of DNA damage without replicating. This lack of knowledge limits the efficiency and precision of genome editing in clinically relevant cells. To address this, we used induced pluripotent stem cells (iPSCs) and iPSC-derived neurons to examine how postmitotic human neurons repair Cas9-induced DNA damage. We discovered that neurons can take weeks to fully resolve this damage, compared to just days in isogenic iPSCs. Furthermore, Cas9-treated neurons upregulated unexpected DNA repair genes, including factors canonically associated with replication. Manipulating this response with chemical or genetic perturbations allowed us to direct neuronal repair toward desired editing outcomes. By studying DNA repair in postmitotic human cells, we uncovered unforeseen challenges and opportunities for precise therapeutic editing.