Polytetrafluoroethylene Patch Research Articles

Management of Grade IV Renal Graft Trauma Secondary to Oncological Surgery: A Case Report

Renal graft injury is a challenging condition that can endanger function or become a life-threatening event. Although the most common cause of renal graft injury is trauma, some cases of injuries associated with surgical procedures have been described. Here, we present a case of a transplant patient who experienced a grade IV renal graft injury after an open oophorectomy. A 31-year-old woman received a renal transplant from a cadaveric donor. During her follow-up, a multilocular cyst with a solid mural nodule tumor of the left ovary was documented, with an 84% risk for malignancy as determined by the International Ovarian Tumour Analysis score. Therefore, an open unilateral (left) oophorectomy was scheduled. The patient was readmitted 2 days after surgery and was hemodynamically stable despite intense pain in the right iliac fossa, sudden creatinine elevation, and hematuria. Tomography revealed a peri-graft hematoma with a mass effect. An exploratory laparotomy was performed, and 2 lacerations with an exposed collecting system and without urinary leakage were identified. These were repaired with absorbable barbed sutures reinforced with Teflon patches on the edges, with cellulose hemostatic mesh and fibrin adhesive on top of these patches. In the postoperative period, creatinine decreased to its baseline levels, but a urinary leak was noted, which was corrected by ureteral stent placement. The management of renal graft trauma requires closer monitoring and stricter criteria for reaching a definitive therapeutic decision to prevent the deterioration of the graft and the patient.

Pericardial Closure With Expanded Polytetrafluoroethylene Patch in Left Ventricular Assist Device Surgery.

To reduce adhesions after left ventricular assist device (LVAD) implantation, pericardial closure using an expanded polytetrafluoroethylene (ePTFE) patch has been suggested. However, as foreign material, ePTFE patches could increase the risk of infectious complications. In this single-center retrospective study, we investigated outcomes of pericardial closure using an ePTFE patch in LVAD implantation. We included all patients who underwent LVAD implantation at our center between 2011 and 2020 (n = 166). Primary endpoint was development of mediastinitis at any point of time between LVAD implantation and heart transplantation (HTx) or death. Secondary endpoint was overall survival. Preoperative and postoperative clinical data were collected to ensure comparability between the groups. We included 166 patients with LVAD. A total of 116 patients (70%) underwent pericardial closure using an ePTFE patch. There were significant differences between the groups in treatment setting, previous cardiac surgery, Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level, development of driveline infection, and HTx. Patients with an ePTFE patch developed mediastinitis more frequently (16%) than patients without ePTFE patch (4%) ( p = 0.039). A significant difference in overall survival between the groups could not be confirmed ( p = 0.29). The use of PTFE patches for pericardial closure in LVAD implantation was associated with a higher incidence of mediastinitis, but not with a difference in overall survival.

Our experiences with carotid artery endarterectomy operations

Aims: In this retrospective study, we aimed to presentour experiences with patients undergoing carotid endarterectomy (CEA) operations. Methods: Between January 2011 and January 2021, a total of 88 patients (27 female, 61 male, mean age; 68.9 ± 8.7 and 41-88 years old) who underwent CEA were included in the study.Patients' files were reviewed.Bilateral CEA was performed in 2 of the patients. The complaints and demographic characteristics of the patients are shown in Table 1 and Table 2, respectively. Coronary artery bypass grafting (CABG) was also performed in 10 (8 of them simultaneously and 2 of them 1 month later)of the patients. In one of these simultaneously operated patients, aortic valve replacement was performed in addition to CEA and CABG. On the other hand, the operation was terminated due to the development of intraoperative sudden cardiac arrest in 2 patients. Results: Polytetrafluoroethylene patch, biological patch, Dacron patch, and great saphenous vein patch were used in 1, 1, 3,and 40 patients, respectively, while the CEA site was primarily closed in 43 patients.Characteristic features ofthe CEA operations are shown in Table 3. Also, complications of CEA surgery are shown in Table 4.In-hospital mortality was detected in 3 patients. Conclusion: The early results of our CEA operations are in line with the literature.

UEDA Heart Awards for 2023.

We are pleased to announce that the following 3 articles have been selected for the UEDA Heart Awards for the Year 2023.FIRST PLACEAtherosclerotic Progression Is Related to Immune-Related Adverse EventsAtsumasa Kurozumi, Kayo Sakamoto, Takashi Nakagawa, Futoshi Matsunaga, Akihiko Shimomura, Chikako Shimizu, Hisao Hara, Yukio HiroiInt Heart J 2022; 63 (2): 293-298.SECOND PLACEFunctional Evaluation of Human Bioengineered Cardiac Tissue Using iPS Cells Derived from a Patient with Lamin Variant Dilated CardiomyopathyKoichiro Miura, Katsuhisa Matsuura, Yu Yamasaki Itoyama, Daisuke Sasaki, Takuma Takada, Yoshiyuki Furutani, Emiko Hayama, Masamichi Ito, Seitaro Nomura, Hiroyuki Morita, Masashi Toyoda, Akihiro Umezawa, Kenji Onoue, Yoshihiko Saito, Hiroyuki Aburatani, Toshio Nakanishi, Nobuhisa Hagiwara, Issei Komuro, Tatsuya ShimizuInt Heart J 2022; 63 (2): 338-346.THIRD PLACEA Novel Knitted Polytetrafluoroethylene Patch for Cardiovascular Surgery: Feasibility Study in a Swine ModelKatsunari Terakawa, Haruo Yamauchi, Yangsin Lee, Minoru OnoInt Heart J 2022; 63 (1): 122-130.

Use of glutaraldehyde-treated autologous pericardial patch in complete atrioventricular septal defect repair.

Synthetic patch materials, such as polytetrafluoroethylene and knitted polyester, are commonly used for the repair of complete atrioventricular septal defects using the double-patch technique. In our study, we investigated the impact of glutaraldehyde-treated autologous pericardial patch on postoperative atrioventricular valve function. In this retrospective study, patients who underwent repair of complete atrioventricular septal defects using the double-patch technique between January 1, 2018, and May 15, 2023, at our pediatric cardiac center were included in the study. Patients were divided into two groups based on the type of patch used for the repair of the ventricular component of the atrioventricular septal defect: autologous pericardial patch (group 1) and polytetrafluoroethylene patch (group 2). Postoperative data of the patients were retrospectively analyzed. Thirty-four patients (57.6%) were female, and 25 (42.4%) were male, with a median age of 7 (5-18) months. The median body weight at the time of surgery was 5.5 (4.1-10) kilograms. Down syndrome was present in 45 (76.3%) patients. The autologous pericardium was used for ventricular septal defect closure in 44 (74.6%) patients (Group 1), while polytetrafluoroethylene was used in 15 (25.4%) patients (Group 2). Permanent cardiac pacemaker placement was required in 4 (6.8%) patients due to postoperative atrioventricular block. Hospital mortality was 11.9% (n=7). Among these cases, 4 (6.8%) patients died from low cardiac output syndrome, and 3 (5.1%) patients died from sepsis. Postoperative echocardiographic evaluation revealed insignificant residual ventricular septal defects in 17 (28.8%) patients. No significant differences were observed between the groups in terms of mortality and postoperative atrioventricular valve insufficiency. The median follow-up duration for discharged patients was 5 months (7 days to 3.9 years). Throughout the follow-up period, there were no reoperations due to valve insufficiency or left ventricular outflow tract obstruction. Glutaraldehyde-treated autologous pericardium is a safe material that can be confidently used for the repair of the ventricular component of complete atrioventricular septal defects. This patch material does not adversely affect atrioventricular valve function and allows for the successful closure of ventricular septal defects.

Alternative Method of Surgical Treatment of Post-Infarction Left Ventricular Free Wall Rupture. Case Report

Acute myocardial infarction (AMI) is one of the causes of death in developed countries, despite the latest medical technologies. AMI is usually accompanied by numerous fatal complications. One of these complications is left ventricular free wall rupture (LVFWR). Myocardial rupture after AMI can occur from 1 day to 3 weeks after the infarction. Most ruptures occur 3-5 days after a heart attack. Left ventricular free wall rupture requires only emergency surgical intervention, which in most cases consists in applying U-shaped sutures or wrapping sutures using Teflon patch.
 The aim. To demonstrate an example of alternative surgical tactics and intraoperative management of a patient with myocardial infarction complicated by rupture of the free wall of the heart with the transition to cardiogenic shock.
 Case report. We presented the clinical case of patient V., 72 years old, who was delivered by ambulance on January 10, 2023 to the intensive care department of the National Amosov Institute of Cardiovascular Surgery (Kyiv, Ukraine). Main diagnosis: ischemic heart disease, acute coronary syndrome with ST-elevation myocardial infarction, cardiogenic shock.
 Conclusion. The only effective method of treatment of rupture of the free wall of the heart is surgical intervention. Using a sandwich patch with resection of necrotic areas of the myocardium and U-shaped sutures with Teflon patch passed from the side of the left ventricular cavity through the myocardium in the peri-infarct zone and through a patch from a vascular prosthesis allows hermetically sew up the LVFWR.

Synthetic polytetrafluoroethylene patches for irreparable rotator cuff tears-how are they doing at 5 years?

Treating massive and irreparable rotator cuff tears are problematic. Several studies have reported that polytetrafluoroethylene (PTFE) patches demonstrated excellent construct integrity and positive clinical and patient outcomes. However, these studies either had small sample sizes or short follow-up periods. To determine the survivorship, efficacy, and medium-term (2-19 years) outcomes of PTFE patch repairs. This retrospective study used prospectively collected data to establish the medium-term outcomes of PTFE interposition patch repairs for massive rotator cuff tears that could not be repaired by the standard technique. Patients included those who met the ≥2-year follow-up criteria post repair. Standardized assessments of patient-ranked shoulder pain and function and shoulder strength and passive range of motion (ROM) were performed preoperatively and at follow-up visits. Radiographs and ultrasonography were used to evaluate repair integrity, measure proximal humeral head migration, and determine glenohumeral arthritis scores. Forty-one shoulders formed the study cohort at a mean follow-up period of 5 years (range: 2-19 years). The mean age of this group was 72 (standard deviation: 10; range: 50-88) and had 14 cm2 tears at surgery. Twenty-five of 41 (61%) PTFE interposition patch repairs remained intact at an average of 5 years postrepair. Thirteen patches failed at the patch-tendon junction, 1 was removed, and 2 patients underwent reverse total shoulder replacement. Patient-ranked shoulder stiffness (P<.05), frequency of pain during activity and sleep (P<.001), pain levels during overhead activity and rest (P<.001), and overall shoulder function significantly improved from bad preoperatively to fair at the mean 5-year postoperative visit (P<.001). No significant improvements were demonstrated in dynamometer-measured shoulder strength maneuvers and passive ROM. All patients demonstrated proximal humeral head migration on shoulder radiographs regardless of repair integrity (mean Upper Migration Index=1.2). Failed repairs were associated with higher mean preoperative glenohumeral arthritis grades compared with intact repairs (grade 2 in failed repairs compared with grade 1 in intact repairs) (P<.01). PTFE interposition patch repairs for massive and irreparable tears had good construct integrity and clinical outcomes at 2 years. These outcomes were not maintained. PTFE patch repairs often failed at the patch-tendon junction at 4 years and beyond and were ineffective in (1) preventing proximal humeral head migration, (2) stopping progression of glenohumeral arthritis, and (3) improving shoulder strength and ROM.

Anuloplastia de De Vega. Cincuenta años desde el comienzo de la reparación valvular selectiva, regulable y permanente

De Vega annuloplasty consists of a double suture supported by Teflon patches at its ends and tied in such a way as to correct regurgitation in the tricuspid valve. After 50 years since its publication, its historical background, the original technique and the successive modifications that have emerged under the same pathophysiological concept are reviewed. De Vega annuloplasty has been used extensively throughout the world to correct tricuspid insufficiency, especially secondary functional regurgitation concomitantly with mitral valve surgery. It has also been used in traumatic injuries, heart transplantation or the child population. Compared with annuloplasty with a rigid or semirigid ring, it seems to confer less stability over time, without this having translated into an increase in morbidity and mortality or in the rate of reinterventions. It is a fast, simple, reproducible, economical, safe technique that offers excellent clinical results in selected patients, and that after 50 years is still valid, especially as a treatment for non-severe functional tricuspid regurgitation in the context of left valve surgery without significant dilatation of the right ventricle.

Fibronectin enhances attachment of human adipose-derived mesenchymal stem cells into polytetrafluoroethylene patch during surgical closure of the atrial and ventricular septal defect.

Polytetrafluoroethylene (PTFE) patch is commonly used during surgical closure for atrial septal defect (ASD) and ventricular septal defect (VSD). However, this patch has several limitations such as its inability to grow or remodel, especially in children and young adults. To tackle these limitations, we have tried to use fibronectin and human adipose-derived mesenchymal stem cells (hAMSCs) in the PTFE patch. To understand the impact of fibronectin to enhance hAMSCs cell-to-cell adherence and cell-to-patch surface attachment into PTFE patches used in the surgical closure of ASD or VSD. The hAMSCs were plated and fixated with 15 mL methanol and cluster of differentiation (CD) 90+, CD105+, and CD45 - antibodies were labeled with fluorescein isothiocyanate, rinsed with phosphate-buffered saline, and analyzed under a fluorescence microscope. Fibronectin solution (0.1%) was used to soak patch scaffolds for approximately 2-h duration and then dried for 20 min in the treatment group. The samples were examined with a scanning electron microscope (SEM). SEM examination showed incomplete attachment of the cells even after 10 days in the control group at 1.14 ± 1.13. In contrast, the treatment group showed more cells attached to the patch surface at 31.25 ± 13.28 (P ≤ 0.0001). The observation at 5 days was 17.67 ± 20.21, at 7 days was 12.11 ± 10.94, and at 10 days was 18.83 ± 23.25. There was no significant statistical difference in mean cell per view among each treatment group (P = 0.802). Our work demonstrates that fibronectin has a positive impact on hAMSC attachment seeded onto the PTFE patch. These properties, in combination with their developmental plasticity, have generated tremendous interest in regenerative medicine.

Orthotopic Heart Transplant with Concurrent Supracoronary Ascending Aortic Replacement

We report a case of successful orthotopic heart transplant with concurrent supracoronary ascending aortic replacement (SCAAR) using a vascular conduit. An orthotopic heart transplant was performed on a 29-year-old White man with idiopathic dilated cardiomyopathy and reduced ejection fraction (20%). During the revision of the donor heart, a wall defect was detected in the ascending part of the donor aorta that could not be corrected. It was decided to perform a SCAAR using a 22-mm polytetrafluoroethylene vascular conduit and double-patch sandwich technique with Teflon patches. Two months later postoperative computed topography scan demonstrated sufficient patency of the vascular conduit and aorta with an improvement in the general somatic and functional state of the patient, and normal systolic and diastolic function of the transplanted heart. Our clinical case is unique in the complexity of the procedure with potential high intraoperative and early postoperative risks as well as the fact that SCAAR was performed immediately after heart transplant. In this clinical case, reconstruction of the ascending aorta with a vascular conduit is a strategically correct solution in the event of aortic defects that cannot be corrected with a suture technique.

Repair of pseudoaneurysm in extra-anatomic aortic arch bypass graft.

Repair of pseudoaneurysm in extra-anatomic aortic arch bypass graft.

A Novel Knitted Polytetrafluoroethylene Patch for Cardiovascular Surgery.

Polytetrafluoroethylene (PTFE) is widely used in cardiovascular surgeries; however, postoperative complications such as thrombosis, calcification, and neointimal hyperplasia are yet to be resolved in patients. We developed two types of novel knitted PTFE patches and evaluated them using a swine model. Both patches were composed of knitted PTFE impregnated with micro-PTFE particles, and one of them was pressed after PTFE impregnation. Twenty micromini pigs were used in this study. After left lateral thoracotomy, the new patches (n = 8 for each type of patch) were implanted into the descending aorta and left atrium for the high- and low-pressure models, respectively. Clinically used expanded PTFE (ePTFE) patches were used as the control material (n = 4). The patches were explanted and histopathologically examined at 4, 12, and 24 weeks after implantation. A tensile test was also applied to the high-pressure model at 12 and 24 weeks. As a result, there was no significant difference noted in the tensile test, intimal hyperplasia thickness, or endothelialization among the three patches. In contrast, the degree of macrophage infiltration into the patches and the degree of macrophage, lymphocyte, and granulocyte infiltration outside the patches were lower in the new patches than in the control ePTFE. The degree of cellular infiltration outside new patches decreased over time. There were no significant differences between the two new patch types in these results. In conclusion, our novel knitted PTFE patch showed noninferiority in durability and intensity and less inflammatory responses than a clinically used ePTFE patch.

Use of hydrocolloid dressing in infants requiring open chest management after cardiac surgery

PurposeSternal splintage is known as an effective maneuver to stabilize hemodynamics during the immediate postoperative period, particularly in very sick infants. On the other hand, its wound management is not always straightforward. We employed dressing using a product made of a hydrocolloid material in such circumstances. This report describes our experience in utilizing the dressing in term of its potential advantages.Materials and methodsSix infants needed open chest management following complicated procedures for congenital heart disease. A polytetrafluoroethylene patch was fixed to augment the skin defect at the time of sternal splintage, and a hydrocolloid dressing was applied to entirely cover the wound including the suture line.ResultAll patients survived their difficult circumstances. None of them suffered wound complications such as infection or healing problem during sternal splintage or subsequent to eventual chest closure. The dressing product was easy to handle with no adverse events associated with its material.ConclusionsIt is reconfirmed that a dressing made of hydrocolloid material was of practical use for sealing the wound in infants requiring open chest management after cardiac surgery.

InfraRed image correlation for non-destructive testing and evaluation of delaminations in glass fibre reinforced polymer materials

InfraRed Thermography (IRT) is one of the widely used Non-destructive Testing and Evaluation (NDT&E) method for characterization of fiber reinforced polymers. Among verity of testing methodologies and associated post processing schemes recently proposed pulse compression favorable thermal wave imaging methodologies gain importance due to their merits. This present paper highlights a highly depth resolved Frequency Modulated Thermal Wave Imaging (FMTWI) and its digitized version named as Digitized Frequency Modulated Thermal Wave Imaging (DFMTWI) for identification of subsurface Teflon patches introduced as defects to simulate the delaminations at various layers of GFRP test specimen of various sizes and depths.

Biological versus synthetic patch for the repair of congenital diaphragmatic hernia: 8-year experience at a tertiary center

PurposeThe aim of this study is to compare outcome between small intestinal submucosal (SIS) and polytetrafluoroethylene (PTFE) patches in patients with congenital diaphragmatic hernia (CDH) with large muscular defects. Material and methodsWe performed a retrospective review of prospectively collected data of patients who underwent CDH repair from January 2011 to June 2019, with a minimum follow-up of 1 year. Data were collected regarding length of stay (LOS), mortality and recurrence. Kaplan-Meier analyses was used. ResultsIn the study period, 195 patients with CDH were admitted, 176 underwent surgical repair and 19 died before surgery. Sixty-two (35%) required a patch. Over the last 5 years, our institution transitioned from the use of all SIS to all PTFE. SIS was used in 18 cases and PTFE in 25. Overall survival rate was 89% (174/195). There was no significant difference regarding LOS and mortality. Nine patients (50%) of SIS and 1 (4%) of PTFE repairs recurred (P < 0.01; log-rank test P < 0.01), with a time course of recurrence of 18 (SD = 13) and 8 months, respectively. Median follow-up was 60 months (SD: 23) for the SIS group and 26 (SD: 10) for the PTFE group. ConclusionA significant lower recurrence was found using PTFE patches instead of SIS for the repair of large CDH. Level of evidenceLevel 3. Retrospective comparative study.

Patches of different types for carotid patch angioplasty.

Patches of different types for carotid patch angioplasty.

Outcomes of pulmonary valve leaflet augmentation for transannular repair of tetralogy of Fallot

ObjectiveTo evaluate the midterm results of pulmonary valve leaflet augmentation in transannular repair of tetralogy of Fallot (TOF). MethodsFrom 2007 to 2019, 131 patients underwent a transannular repair with pulmonary leaflet augmentation for TOF (n = 120) and double outlet right ventricle with pulmonary stenosis (n = 11). Patch material was expanded polytetrafluoroethylene (n = 76), glutaraldehyde-treated autologous pericardium (n = 47) and bovine pericardium (n = 8). ResultsMedian age at repair was 8.9 months (interquartile range, 5.4-14.8). There was no operative mortality. Median follow-up was 6.25 years (interquartile range, 2.77-7.75). Freedom from severe pulmonary regurgitation (PR) was 85% (95% confidence interval [CI], 77%-90%) and 76% (95% CI, 66%-83%) at 1 and 5 years, respectively. Freedom from moderate or greater PR was 69% (95% CI, 60%-76%) and 30% (95% CI, 21%-39%) at 5 and 10 years, respectively. Three patients required pulmonary valve replacement for PR. Nine patients required pulmonary balloon valvuloplasty. Freedom from intervention for pulmonary valve stenosis was 98% (95% CI, 93%-99%) and 94% (95% CI, 87%-97%) at 1 and 5 years, respectively. One patient with severe PR had an indexed right ventricular volume >160 mL/m2. Use of expanded polytetrafluoroethylene resulted in a greater freedom from moderate or greater PR (log-rank test P < .001; Cox regression hazard ratio, 0.40; 95% CI, 0.25-0.63; P < .001). ConclusionsAt midterm follow-up of transannular repair with pulmonary valve leaflet augmentation, severe PR occurs in less than 50% of patients. The expanded polytetrafluoroethylene patch performs better than pericardium.

A combined sternotomy/laparotomy approach in central tendon diaphragmatic hernia repair

Abstract We describe a combined sternotomy/laparotomy approach as a novel technique in central tendon diaphragmatic hernia repair. During a routine second trimester prenatal ultrasound, a 19-year-old woman was found to have a fetus with a diaphragmatic hernia. Subsequent fetal MRI at 28 weeks demonstrated a large central tendon defect through which the majority of the liver was herniated. The fetus was closely followed until her delivery at 38 weeks. The patient was intubated shortly after delivery and treated for pulmonary hypertension. A thoraco-abdominal CT scan revealed a large, mushroom-shaped herniation of the liver. By day of life 7, the patient demonstrated physiological stability. Following a multidisciplinary meeting, the decision was made to proceed to surgery. A sternotomy with an upper midline laparotomy revealed the liver herniating through a central tendon defect without any hernia sac. The liver was reduced into the abdomen without kinks in the hepatic veins. The defect was then closed using a polytetrafluoroethylene patch. She did not develop any compartment syndrome despite pre-operative concerns. Post-operatively, she was weaned to conventional mechanical ventilation after brief requirement of high-frequency oscillatory ventilation, and subsequently extubated. A combined sternotomy/laparotomy provided an excellent operative exposure and may be effective in a large congenital central tendon diaphragmatic hernia repair.

Closure Techniques in Carotid Endarterectomy: Tracing the “Invisible” - Indirect Evidence from Randomised Controlled Trials with a Network Meta-analysis

According to the 2017 clinical practice guidelines of the European Society for Vascular Surgery on the management of atherosclerotic carotid and vertebral artery disease, “Eversion endarterectomy is recommended over routine primary arteriotomy closure”, whereas “The choice between eversion or patched endarterectomy should be left to the discretion of the operating surgeon”.1Naylor A.R. Ricco J.B. de Borst G.J. Debus S. de Haro J. Halliday A. et al.Editor's Choice – management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the European Society for Vascular Surgery (ESVS).Eur J Vasc Endovasc Surg. 2018; 55: 3-81Abstract Full Text Full Text PDF PubMed Scopus (491) Google Scholar The guidelines also conclude that “There is no evidence that patch type influences outcome”.1Naylor A.R. Ricco J.B. de Borst G.J. Debus S. de Haro J. Halliday A. et al.Editor's Choice – management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the European Society for Vascular Surgery (ESVS).Eur J Vasc Endovasc Surg. 2018; 55: 3-81Abstract Full Text Full Text PDF PubMed Scopus (491) Google Scholar The study by Lazarides et al. represents a step forward, discriminating between the various patch types and concluding that eversion endarterectomy and patching with bovine pericardium or polytetrafluoroethylene (PTFE) are associated with a similarly low 30 day stroke and death rate, while primary closure and Dacron, vein, or polyurethane patches perform statistically significantly worse.2Lazarides M.K. Christaina E. Argyriou C. Georgakarakos E. Tripsianis G. Georgiadis G. Network meta-analysis of carotid endarterectomy closure techniques.Eur J Vasc Endovasc Surg. 2021; 61: 181-190Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar Eversion endarterectomy was also found to be associated with the lowest rate of restenosis compared with all other methods of arterial closure after carotid endarterectomy (CEA). Lazarides et al. have reached these conclusions using a novel and sophisticated methodological approach, called network meta-analysis, and should be commended for this high quality and resource demanding work. This method allows the combination of direct evidence from head to head studies, but additionally extends the analysis to incorporate indirect comparisons across trials based on a common comparator, using the effect estimates of the direct comparisons.3Salanti G. Indirect and mixed-treatment comparison, network, or multiple-treatments meta-analysis: many names, many benefits, many concerns for the next generation evidence synthesis tool.Res Synth Methods. 2012; 3: 80-97Crossref PubMed Google Scholar In this way not only does it give the full picture instead of making pairwise comparisons, but it also ranks the various treatment modalities using summary outputs. In the study by Lazarides et al., eversion endarterectomy ranked first with respect to both 30 day stroke/death and late restenosis rates, followed by PTFE and bovine pericardium patch, although readers should be aware that a high probability of being the best does not necessarily mean a large difference in clinical outcomes.2Lazarides M.K. Christaina E. Argyriou C. Georgakarakos E. Tripsianis G. Georgiadis G. Network meta-analysis of carotid endarterectomy closure techniques.Eur J Vasc Endovasc Surg. 2021; 61: 181-190Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar The evidence provided by Lazarides et al. looks robust enough, as the authors have reported evaluation of the transitivity assumption, implying that it was equally likely that any patient could have been given any of the treatments in the randomised controlled trials network. Moreover, the comparison adjusted funnel plots did not reveal any evidence of asymmetry, with no significant publication bias, thus increasing the validity of the results. However, heterogeneity in definitions among the included studies did not allow the authors to evaluate other than 30 day stroke/death and late restenosis outcomes, while the effect of other covariates could not be assessed in a meta-regression analysis. By updating and promoting the use of universal reporting standards in future studies, we might be able to further focus on modelling multiple outcomes, account for the effect of confounding factors, and draw more conclusions about the optimal closure technique during carotid endarterectomy. Editor's Choice – Network Meta-Analysis of Carotid Endarterectomy Closure TechniquesEuropean Journal of Vascular and Endovascular SurgeryVol. 61Issue 2PreviewThere is discordance between reviews comparing eversion endarterectomy (EvE) with conventional carotid endarterectomy (CEA) mostly because under this term various “closure” techniques are included, from direct closure to a wide spectrum of patches with different materials. Full-Text PDF

Mid-term durability of polytetrafluoroethylene patches in unicuspid aortic valve repair.

Unicuspid aortic valve (UAV) morphology is a cause for aortic valve dysfunction in childhood or adolescence. Repair requires the use of patch material, and polytetrafluoroethylene (PTFE) has been proposed for this purpose because of lack of calcification. We reviewed our mid-term experience with PTFE for the repair of UAV to analyse the durability of this technique. Out of 21 patients with an UAV undergoing aortic valve repair for severe aortic regurgitation between 2014 and 2016, 11 patients (52%) were treated using PTFE patch material. Aortic regurgitation was present in all patients, the primary indication for surgery was regurgitation in 8, stenosis in 2 and aneurysm in 1. Symmetric bicuspidization of the UAV was performed in all. One patient required additional root remodelling for root dilatation, and another 3 tubular ascending aortic replacement. No patient died in hospital or during follow-up. Seven patients (63.6%) required reoperation for progressive AR. Freedom from reoperation was 58% at 1 and 35% at 5 years postoperatively. At reoperation the PTFE patches were found dehisced from aortic wall and/or native cusp tissue. In 3 patients re-repair was performed; a stable result was achieved in 1. Two patients underwent valve replacement 3 months and 1 year postoperatively. The other 4 patients underwent valve replacement. The repair of UAVs using PTFE patch is associated with poor durability, a more durable patch with better healing characteristics material is needed.