Preliminary Single-center Experience Research Articles

Is salvage Plug-Assisted Retrograde Transvenous Obliteration (PARTO) safe and effective for bleeding gastric varices ?- A preliminary single-center experience.

Vascular plug-assisted retrograde transvenous obliteration (PARTO) obliterates the gastric varices and portosystemic shunt, thus resulting in a lower rebleeding rate than endoscopic glue/sclerotherapy. To evaluate the safety and efficacy of PARTO as salvage therapy in liver cirrhosis with gastric variceal bleed (GVB) after failed endotherapy. We assessed the clinical success rate and changes in liver function at 6- months. Patients who underwent salvage PARTO after failed endotherapy for GVB (between December 2021 and November 2022) were searched and analyzed from the hospital database. Clinical success rate and rebleed rate were obtained at six months. Child-Pugh score (CTP) and Model for end-stage liver disease (MELD) score were calculated and compared between baseline and 6-month follow-up. Fourteen patients (n = 14, Child-Pugh class A/B) underwent salvage PARTO. Nine had GOV-2, and five had IGV-1 varices. The mean shunt diameter was 11.6 ± 1.6mm. The clinical success rate of PARTO was 100% (no recurrent gastric variceal hemorrhage within six months). No significant deterioration in CTP (6.79 ± 0.98 vs. 6.21 ± 1.52; p = 0.12) and MELD scores (11.5 ± 4.05 vs. 10.21 ± 3.19; p = 0.36) was noted at 6months. All patients were alive at 6months. One patient (n = 1, 7.1%) bled from esophageal varices after three days of PARTO and was managed with variceal banding. 21.4% (3/14) patients had progression of esophageal varices at 6months requiring prophylactic band ligation. Three patients (21.4%) had new onset or worsening ascites and responded to low-dose diuretics therapy. PARTO is a safe and effective procedure for bleeding gastric varices without any deterioration in liver function even after six months. Patient selection is critical to prevent complications. Further prospective studies with larger sample size are required to validate our findings.

ECMR 1-19 - Use of a 0.55T 80cm-wide Bore Scanner for Cardiac Imaging in Bariatric and Claustrophobic Patients: A Preliminary Single Centre Experience

ECMR 1-19 - Use of a 0.55T 80cm-wide Bore Scanner for Cardiac Imaging in Bariatric and Claustrophobic Patients: A Preliminary Single Centre Experience

Could transperineal interstitial laser ablation of the prostate be the right option for highly-comorbid patients with lower urinary tract symptoms due to benign prostatic obstruction? A preliminary single-center experience focusing on functional and safety outcomes

Could transperineal interstitial laser ablation of the prostate be the right option for highly-comorbid patients with lower urinary tract symptoms due to benign prostatic obstruction? A preliminary single-center experience focusing on functional and safety outcomes

Dual docking technique for robotic repair of simultaneous inguinal and umbilical hernia: A preliminary single center experience.

This study aimed to assess clinical results in terms of intraoperative outcomes, recovery and recurrence of our robotic technique for the treatment of patients affected by simultaneous inguinal and umbilical hernia, providing technical details to facilitate multiquadrant surgery in robotic hernia repair. Data from patients affected by simultaneous primary inguinal and umbilical hernia who underwent robotic repair with our dual docking technique was retrospectively analysed. Fifteen patients were included. No intraoperative complications occurred. All patients achieved complete mobilisation within 7h. The mean length of hospital stay was 21.6h, with five patients discharged on the same day of surgery. There was no major complication and no recurrence within the median follow-up period of 673days. This surgical technique shows optimal postoperative outcomes, such as early mobilisation and short length of stay. Our study provides an aid to surgeons performing multiquadrant robotic surgery for the treatment of abdominal hernias.

Feasibility of Robotic Mitral Valve Repair Using Barbed Nonabsorbable Sutures: A Preliminary Single-Center Experience.

Barbed nonabsorbable sutures have been widely adopted for tissue closure in noncardiac robotic surgery to improve intraoperative efficiency. Here, we examine the profile in robotic mitral valve repair (rMVR), which utilized barbed nonabsorbable sutures. To our knowledge, this is the first report to describe clinical outcomes for rMVR with barbed nonabsorbable sutures. A retrospective review identified 90 patients who underwent rMVR using barbed nonabsorbable sutures at our center between 2019 and 2021. The primary outcome measure was dehiscence, while other relevant outcomes included 30-day readmission and 30-day mortality. In addition to fixation of the mitral annuloplasty band, barbed nonabsorbable sutures were employed commonly in concomitant pericardiectomy closure (100.0%, 90 of 90), atriotomy closure (100.0%, 90 of 90), and left atrial appendage closure (if eligible; 98.8%, 83 of 84). One patient who underwent mitral valve annuloplasty using only barbed nonabsorbable suture required reoperation for annuloplasty ring dehiscence. Immediate postoperative ring dehiscence was not observed in any patients after the routine reinforcement of barbed nonabsorbable sutures with everting pledgeted polyester sutures, and no additional patients required reoperation for suture-related complications. Clinical signs of dehiscence were not observed after pericardiectomy, atriotomy, or left atrial appendage closure with barbed nonabsorbable sutures. The 30-day readmission rate was 3.3% (3 of 90), and 30-day mortality was 0% (0 of 90). These data suggest the initial feasibility of barbed nonabsorbable sutures in robotic cardiac surgery, specifically within rMVR. Further research is necessary to explore the long-term safety and efficacy profile of such approach.

Early Results of the Newly-Designed Flowdynamics Dense Mesh Stent for Residual Dissection After Proximal Repair of Stanford Type A or Type B Aortic Dissection: A Preliminary Single-Center Report From a Multicenter, Prospective, and Randomized Study.

Negative remodeling of the distal aorta due to residual dissection significantly impacts the long-term outcomes of dissection patients after proximal repair of acute aortic dissection. Branched/fenestrated aortic stents are technically demanding, and studies of the first generation of multilayer flow modulators for tackling this clinical scenario are few and limited. The single-center results from a multicenter, prospective, and randomized controlled study aimed to verify the safety and effectiveness of a newly-designed flowdynamics dense mesh stent for treating residual dissection after proximal repair. Patients with nonchronic residual dissection involving visceral branches were prospectively enrolled in 3 centers (ChiCTR1900023638). Eligible patients were randomly assigned to the flowdynamics dense mesh stent (FDMS) group and control group. Follow-up visits were arranged at 1, 3, 6, and 12 months after recruitment. The primary endpoints were all-cause and aortic-related mortality. The secondary endpoints included visceral branch occlusion, reintervention, and severe adverse events. Morphological changes were analyzed to exhibit the therapeutic effect. Our center participated in the multicenter prospective randomized controlled trial, and the preliminary single-center experience was reported. Thirty-six patients were enrolled in our center, and the baseline characteristics of the 2 groups were comparable. Thirty-four patients completed the 12 month follow-up. Freedom from all-cause and aortic-related death were 94.4% and 100%. All visceral branches remained patent in the FDMS group. Increased area of the true lumen (1.03±0.38 vs 0.48±0.63 cm2 at the plane below renal arteries, p=0.006; 1.27±0.80 vs 0.32±0.50 cm2 at the plane 5 cm below renal arteries, p<0.001) and decreased area of the false lumen at the plane below renal arteries (-1.03±0.84 vs -0.15±1.21 cm2, p=0.023) were observed in the FDMS group compared with those parameters in the control group. The FDMS group showed a significant increase in true lumen volume (p<0.001) and a significant decrease in false lumen volume (p=0.018). This newly-designed FDMS for endovascular repair of residual dissection after the proximal repair is safe and effective at 12 months. One-year results of the randomized controlled clinical trial indicated the short-term safety and promising effect of FDMS on treating non-chronic residual dissection after proximal repair. At the 12th-month follow-up, the true lumen expanded, the false lumen shrunk and all visceral arteries kept patent. As far as I'm concerned, this is the first randomized controlled study concerning utilizing multilayer flow mesh stent treating aortic dissection. Despite a preliminary single-center report, our results are supposed to provide high-quality evidence to guide clinical practice and fill the gap in the application of FDMS.

Percutaneous large-bore aspiration embolectomy with veno-arterial extracorporal membrane oxygenation support or standby in patients with high-risk pulmonary embolism and contraindications to thrombolysis: a preliminary single centre experience.

Large-bore catheter aspiration embolectomy reduces thrombus burden and right ventricle strain and improves haemodynamics after pulmonary embolism (PE). Sparse data are available for patients with high-risk PE and contraindications to thrombolysis or thrombolysis failure, particularly if veno-arterial extracorporal membrane oxygenation (VA-ECMO) is required. All patients with acute high-risk PE and contraindications to thrombolysis undergoing FlowTriever® percutaneous embolectomy and VA-ECMO circulatory support (or standby) at the University Hospital Zurich between April 2021 and August 2022 were retrospectively analysed. The primary outcome was the combination of recurrent PE, heart failure hospitalization, and all-cause death at 30 days. The analysis included 15 patients: mean age was 63.1 years and 14 (93%) were men. Overall, four (27%) patients presented with cardiac arrest, eight (53%) with ongoing obstructive shock, and three (20%) with persistent arterial hypotension. Veno-arterial extracorporal membrane oxygenation was implanted prior to aspiration embolectomy in eight (53%) patients. Three of seven patients without initial VA-ECMO support experienced periprocedural cardiac arrest, of whom two received ECMO support before completion of embolectomy. Veno-arterial extracorporal membrane oxygenation weaning was successful in all patients after a mean of 5.4 days. There was one periprocedural death in a patient who did not receive VA-ECMO support following a periprocedural cardiac arrest. The primary outcome at 30 days occurred in five (33.3%; 95% confidence interval 13.0-61.3%) patients. This study provides preliminary evidence for the feasibility of percutaneous large-bore aspiration embolectomy in combination with VA-ECMO support (or standby) in patients with high-risk PE and contraindications to thrombolysis.

Echocardiographic features in infants with dilated cardiomyopathy treated with reversible pulmonary banding: a preliminary single-centre experience

Echocardiographic features in infants with dilated cardiomyopathy treated with reversible pulmonary banding: a preliminary single-centre experience

Is Ultrasound-guided Bedside Percutaneous Transhepatic Biliary Drainage Safe and Feasible in Critically Ill Patients with Severe Cholangitis? A Preliminary Single-center Experience.

Severe cholangitis secondary to biliary obstruction carries high mortality unless biliary drainage is performed urgently. Owing to various patient-related and logistical issues, bedside biliary drainage is considered a salvage therapeutic option. This study aims to evaluate the safety and efficacy of ultrasonography (USG)-guided biliary drainage at the bedside in patients with severe cholangitis admitted to the intensive care unit (ICU). A total of 20 patients with severe cholangitis admitted to ICU who underwent bedside percutaneous transhepatic biliary drainage (PTBD) under USG guidance were retrospectively evaluated. Clinical outcomes, details about the PTBD procedure, and complications were recorded and analyzed. Among 20 patients, 13 were male and 7 were female with a mean age of 50.5 years. The most common cause of biliary obstruction was gall bladder malignancy (45%, n = 9) followed by cholangiocarcinoma (25%, n = 5). Left- and right-sided PTBD was performed in 40% (n = 8) and 35% (n = 7) patients, respectively, while 25% (n = 5) of patients underwent bilateral PTBD. The technical success rate was 100%. A total of 65% (n = 13) of patients were discharged from ICU upon improvement while the remaining 35% (n = 7) died despite bedside PTBD. None of the patients had any major procedure-related complications. Ultrsound-guided bedside PTBD seems to be a safe and effective option in critically ill patients with severe cholangitis when shifting of patients is not feasible. Singh J, Tripathy TP, Patel R, Chandel K. Is Ultrasound-guided Bedside Percutaneous Transhepatic Biliary Drainage Safe and Feasible in Critically Ill Patients with Severe Cholangitis? A Preliminary Single-center Experience. Indian J Crit Care Med 2023;27(1):16-21.

SC172 - Focal therapy cryoablation in low-intermediate risk prostate cancer: preliminary single-center experience with oncologic and functional outcomes with a short-term follow-up

SC172 - Focal therapy cryoablation in low-intermediate risk prostate cancer: preliminary single-center experience with oncologic and functional outcomes with a short-term follow-up

Hyper accuracy three-dimensional (HA3D™) technology for planning complex liver resections: a preliminary single center experience

Three-dimensional visualization technology (3DVT) has been recently introduced to achieve a precise preoperative planning of liver surgery. The aim of this observational study was to assess the accuracy of 3DVT for complex liver resections. 3DVT with hyper accuracy three-dimensional (HA3D™) technology was introduced at our institution on February 2020. Anatomical characteristics were collected from two-dimensional imaging (2DI) and 3DVT, while intraoperative and postoperative outcomes were recorded prospectively. A total of 62 patients were enrolled into the study. 3DVT was able to study tumor extension and liver anatomy, identifying at least one vascular variation in 37 patients (59.7%). Future remnant liver volume (FRLV) was measured using 2DI and 3DVT. The paired samples t test assessed positive correlation between the two methods (p < 0.001). At least one vessel was suspected to be invaded by the tumor in 8 (15.7%) 2DI cases vs 16 (31.4%) 3DVT cases, respectively. During surgery, vascular invasion was detected in 17 patients (33.3%). A total of 73 surgical procedures were proposed basing on 2DI, including 2 alternatives for 16 patients. After 3DVT, the previously planned procedure was changed in 15 cases (29.4%), due to the clearer information provided. A total of 51 patients (82%) underwent surgery. The most frequent procedure was right hepatectomy (33.3%), followed by left hepatectomy (23.5%) and left trisectionectomy (13.7%). Vascular resection and reconstruction were performed in 10 patients (19.6%) and portal vein was resected in more than half of these cases (66.7%). 3DVT leads to a more detailed and tailored approach to complex liver surgery, improving surgeons’ knowledge of liver anatomy and accuracy of liver resection.Graphical abstract

Preliminary Single-Center Experience of Bromelain-Based Eschar Removal in Children with Mixed Deep Dermal and Full Thickness Burns.

Introduction: Early eschar removal is the standard management of burns. The goal is to remove all of the necrotic tissue and render the wound suitable for healing or skin grafting. The enzymatic debridement of burn wounds allows for minimally invasive removal of burn eschar. The aim of the study was to describe and compare the demographic characteristics, surgical treatment and outcomes of patients treated with Nexobrid® with patients who had standard surgical excision. Material and Methods: A retrospective review was conducted on children who underwent enzymatic debridement. The study group was compared with children treated with the standard of care (SoC). Results: Twelve children (mean age 8 years, range 3 to 15 years) with mixed deep dermal and full thickness burn wounds were treated with Nexobrid®. The mean size of the burns was 29% TBSA. The median percentage TBSA debrided using Nexobrid® was 15% (range 2–27%). In a clinical assessment, enzymatic debridement was effective in removing dead tissue in a single application. No adverse reaction to Nexobrid® and serious complications after enzymatic procedure were recorded in the study group. The estimated relative risk of the need for reconstructive procedures decreases 3.5 times for the study group (RR 3.5, 95%CI 0.9–13.5, p = 0.089). Conclusion: The bromelain-based enzymatic method offers a good and safe debridement option to improve the treatment and life quality of children with severe burns. The main outcome of interest was the number of reconstructive procedures due to scar contractures, which was reduced in the group treated enzymatically compared to the SoC-treated children.

Intermittent Levosimendan for Late Right Ventricular Failure in Patients with Left Ventricular Assist Devices

<h3>Purpose</h3> Implantable continuous flow left ventricular assist devices (LVADs) are increasingly used in end-stage heart failure as a bridge-to-transplant (BTT) or destination therapy (DT). One of its most common pitfalls is the development of right ventricular (RV) failure. Despite the fact that right heart failure remains an independent risk factor for mortality, evidence-based therapies are still lacking. The aim of the study is to describe our preliminary single center experience using intermittent infusion of levosimendan in patients with late right heart failure post LVAD implantation. <h3>Methods</h3> We retrospectively revised the data of all patients who received an LVAD in our center and evaluated the patient characteristics and outcomes of those treated with levosimendan for late RV failure. <h3>Results</h3> In the past 10 years (from 2011 until 2020), a total of 130 patients received an LVAD and 8 of them were treated with intermittent levosimendan for RV failure (3 females and 5 males). Two patients had a HeartMate 2 (HM2) and six a HeartMate 3 (HM3). The mean age at LVAD implantation was 59 years and the etiology of their heart failure was coronary artery disease (4/8), myocarditis (2/8) or a non-ischemic dilated cardiomyopathy (2/8). All patients received a monthly dose between 0.1 and 0.3 mcg/kg/min. The average duration of levosimendan therapy during our follow-up was 12 months (ranged from 4 to 26 months). Two patients died because of multi-organ failure due to progression of RV failure, while one of them also suffered hemolysis and several gastrointestinal bleedings. One patient was successfully bridged to a heart transplant (after 13 months of levosimendan therapy), but unfortunately died directly after surgery due to acute graft failure. In one other patient, levosimendan was stopped at the request of the patient based on a subjective lack of efficacy and one episode of ventricular tachycardia. The four remaining patients continue their intermittently therapy and are still alive (2 waiting for the availability of a heart transplant, while the other two have LVAD as destination therapy). <h3>Conclusion</h3> In this first case series, the intermittent use of levosimendan looks promising for the treatment of late RV failure after LVAD.

3D Hyper Accuracy 3DTM Surgical Simulation for Planning Complex Liver Resections: A Preliminary Single Center Experience

Introduction: In the field of hepato-biliary surgery the three-dimensional (3D) reconstruction systems are proposed to achieve a precise preoperative planning of liver surgery. The aim of this study was to assess the feasibility and the accuracy of preoperative 3D simulations before complex liver resections in a single western center.

Preoperative Iron Supplementation in Pediatric Cardiac Surgical Patients: A Preliminary Single-Center Experience

To assess preoperative hemoglobin and perioperative red blood cell transfusion in children undergoing cardiac surgery after the implementation of a preoperative patient blood management (PBM) clinic with oral iron supplementation. A retrospective analysis. A single tertiary hospital. Patients who underwent cardiac surgery with cardiopulmonary bypass at the Hospital for Sick Children (Toronto, Canada) during a 12-month period before and following the implementation of a preoperative PBM clinic. Patients younger than 3 months of age, or who were admitted to the cardiac intensive care unit preoperatively, were excluded because they were not systematically assessed by the PBM clinic. None. A total of 296 patients were included in the authors' analysis. After adjustment for confounding factors (age at surgery, preoperative oxygen saturation, type of congenital heart disease, surgery type), they found that preoperative hemoglobin levels were significantly higher in children treated with iron supplementation (n=201) compared to historic controls (n=95) (13.9 [12.8-15.1] g/dL v 12.9 [11.7-15.0] g/dL, adjusted p=0.001). The exposure rate to red blood cell transfusion (50% v 61%, adjusted p=0.930) was not significantly different between groups. However, the volumes of allogeneic red blood cells (1.4 (0.0-14.0) mL/kg v 12.5 (0.0-23.0) mL/kg, adjusted p=0.004) and autologous blood (11.0 (6.8-17.0) v 17.0 (11.0-31.0), adjusted p < 0.001) transfused were significantly reduced in children treated with iron supplementation. Preoperative iron supplementation led to an increase in preoperative hemoglobin levels. The exact prevalence of iron deficiency and the effect of iron supplementation on perioperative allogeneic blood transfusion and long-term outcomes should be studied in a prospective randomized study.

Abdominal Computed Tomography Findings among COVID-19 Patients with Index Gastrointestinal Manifestations: A Preliminary Single-center Experience.

BackgroundAbout 20% of COVID-19 patients can have digestive symptoms, apart from the typical chest-related symptoms, and 10% of patients may have only gastrointestinal (GI) symptoms during their entire disease course.Aim and objectiveThe purpose of this study was to describe the spectrum of abdominal computed tomographic (CT) findings in a cohort of 15 COVID-19 patients (confirmed on reverse transcription polymerase chain reaction (RT-PCR)) who presented with various GI presentations without preceding respiratory symptoms.Materials and methodsA total of 93 patients with COVID-19 (confirmed on RT-PCR) who underwent CT imaging (between September 28, 2020 and March 20, 2021) in our center were retrospectively searched from the existing database. Among those, 15 patients having index presentation with abdominal symptoms and underwent CT abdomen were further evaluated.ResultsBiliary stasis in the form of distended gallbladder and wall thickening was the most common finding, seen in 66.7% (n = 10) patients, followed by bowel wall thickening. Small bowel and large bowel thickenings were seen in 26.7% (n = 4) and 20% (n = 3) patients, respectively. Other findings include fluid-filled colon (n = 1), mesenteric venous thrombosis (MVT) (n = 2), paper-thin bowel wall and pneumatosis (n = 1), acute pancreatitis (n = 1), and ascites (n = 2). One patient who presented with abdominal pain did not show any obvious imaging findings on CT.ConclusionPatients with COVID-19 can present with initial GI symptoms preceding typical respiratory symptoms. CT imaging helps in identifying the GI involvement, to rule out alternate etiologies, and also aids in appropriate management planning.How to cite this articlePatel RK, Chandel K, Mittal S, et al. Abdominal Computed Tomography Findings among COVID-19 Patients with Index Gastrointestinal Manifestations: A Preliminary Single-center Experience. Euroasian J Hepato-Gastroenterol 2021;11(2):76–80.

The role of telemedicine in the postoperative home monitoring after robotic colo-rectal cancer surgery: a preliminary single center experience.

The telemedicine studies, takes care and prevents diseases at distance basing on the interaction among physicians and patients remotely. Few data are available on its application to early postoperative after surgery. The endpoints of our preliminary experience were the detection, as primary, of feasibility and safety of home telemonitoring after robotic colo-rectal resection and, as secondary, perception and satisfaction of the patients. From December 2019 to March 2020, at the Division of Robotic Surgery of San Giovanni Hospital of Rome, 20 of 29 colorectal cancer patients, submitted to Robotic resection, were prospectively included in a program of postoperative home telemonitoring. Telemonitoring was considered feasible if at least 75% of data were available and safe if morbidity ≤ II by Clavien-Dindo classification. Perception and patients' satisfaction were evaluated through a dedicated questionnaire. Out of 20 patients, the median age was 68 years, overall postoperative morbidity was 30%, all events classified Clavien-Dindo Grade I or II. Only 2 patients were corresponded to surgical consult without readmission during home telemonitoring. Compliance of patients was > 80%, overall grade of satisfaction was very high: 4.2 as median (range 0-5). In this preliminary study, the procedures of postoperative home telemonitoring were feasible and safe and high rate of patients' satisfaction was observed. The telemedicine could enhance the role of robotic technique in decrease the hospital stay and improving postoperative recovery after surgery. Further structured prospective trial are needed to validate the routine application of telemedicine in healthcare.

Abstract No. 414 Transradial embolization: a preliminary single-center experience

To report a single-center experience using transradial approach to perform embolization procedures. In this IRB-approved, HIPPA compliant study, the informed consent was waived. Consecutive patients underwent transradial embolization were retrospectively reviewed from January 2017 to September 2019. Procedure details, medications, and complications were reported. Thirty-two patients underwent transradial embolization. All (100%) underwent US-guided access, and received intraarterial nitroglycerin (200-1000 μg (416.6)), as well as heparin (3000-6000 IU (3458)). None required crossover to transfemoral access. There were 14 (44%) fibroid embolization, 7 (22%) radioembolization, 5 (16%) hepatic mapping, and 3 (9%) chemoembolization. The remaining three were embolization of angiomyolipoma, renal cell carcinoma, and splenic artery aneurysm. There was one (3%) minor hematoma, and one (3%) asymptomatic, nonocclusive radial artery thrombus. None required further management. Transradial embolization is safe and feasible in our preliminary experience.

FRI-021 - Outcome of liver grafts procured from hepatitis C-positive donors in the era of direct-acting antiviral drugs: a preliminary single centre experience

FRI-021 - Outcome of liver grafts procured from hepatitis C-positive donors in the era of direct-acting antiviral drugs: a preliminary single centre experience

Preliminary Single-Center Experience with the Use of ICG in Endoscopic Skull Base Surgery: New Findings and Proposed Indications

Preliminary Single-Center Experience with the Use of ICG in Endoscopic Skull Base Surgery: New Findings and Proposed Indications