Failure Of Procedure Research Articles

A Vexing Problem of Air Trapping in the Trima Accel During Plateletpheresis Procedure: Reflecting Our Experience in Troubleshooting.

Troubleshooting for any fault of apheresis equipment or kit is hardly addressed. Here, we report a unique problem of air trapping in a kit at two different positions leading to failure of the plateletpheresis procedure. Two plateletpheresis procedures were aborted due to "Access pressure low", though the needle position was absolutely perfect. In the third event, platelet yield was not increasing even after 30 minutes from the time of initiation. It was completed after stopping the centrifuge pump which could have displaced the air bubble from the collection port. The root cause for these events was analyzed in consultation with the apheresis technical expert and "air block" was found to be the cause. Air block can also result in a "low access pressure" alarm despite improper phlebotomy being the common cause. Perfect kit loading, checking of tubing defects prior to loading, and comparative analysis of troubleshooting to have adequate knowledge are essential tools for the smooth functioning of apheresis.

PO-05-010 PERMANENT PACEMAKER IMPLANTATION OUTCOMES FOLLOWING SURGICAL AORTIC VALVE REPLACEMENT: A NATIONAL READMISSIONS DATABASE ANALYSIS

High grade atrioventricular block requiring permanent pacemaker (PPM) implantation is a common complication of surgical aortic valve replacement (SAVR) and is associated with longer hospital stays and higher readmission rates. However, these outcomes have not been examined in large nationally-representative cohorts. The study examined the rates and predictors of procedural complications, mortality, and heart failure readmissions during index admission or within 90-day readmission after SAVR. We evaluated 194,058 admissions for SAVR, including 11,561 with PPM implantation, between 2016-2019 using the Nationwide Readmissions Database. Admissions between October and December were excluded to permit 90-day readmission follow-up. ICD-10-CM codes were used to identify complications occurring during index admission and readmissions with primary codes corresponding to acute decompensated heart failure. Early mortality was defined as occurring during either index or readmission. Multivariable logistic regression identified independent predictors of procedural complications and combined primary heart failure readmissions and mortality. Between 2016-2019, post-SAVR PPM implantation increased (5.5% to 6.1%; P<0.01) with a concurrent decrease in index mortality (1.0% to 0.7%; P<0.04). Compared to those without PPM, SAVR patients with PPMs had decreased rates of early mortality (4.1% vs 3.2%; P<0.01) but higher rates of non-home discharges (28.5% vs 18.4%; P<0.01), total readmissions (15.8% vs 12.7%; P<0.01), heart failure readmissions (0.8% vs 0.3%; P<0.01), and procedural complications (37.1% vs 24.0%; P<0.01). PPM implantation was independently associated with decreased early mortality (OR 0.8, P<0.01). Female gender (OR 1.3; P<0.01), diabetes (OR 1.1; P=0.02), length of stay ≥2 days (OR 5.3; P<0.01), age ≥65 years old (OR 1.3; P<0.01), mitral valve (MV) replacement (OR 1.6; P <0.01), and fascicular block (OR 1.5; P<0.01) were associated with PPM implantation. PPM implantation rates were significantly higher in patients ≥65 years old (5.1% vs. 7.3%; P<0.01), females (5.5% vs. 6.9%; P<0.01), and those undergoing MV procedures (5.3% vs. 12.5%; P<0.01). In this four-year real-world analysis, there was a significant increase in PPM use and decrease in mortality. PPMs were associated with lower rates of mortality, but higher complication and readmission rates. PPM implantation was significantly more frequent in older female patients undergoing concurrent MV procedures.

AB-452663-4 LEFT ATRIAL POSTERIOR WALL ABLATION USING PULSED FIELD ABLATION AS ADJUNCTIVE THERAPY DURING RE-DO PROCEDURES AFTER MULTIPLE FAILED PULMONARY VEIN ISOLATIONS USING THERMAL ENERGY

Pulmonary vein isolation (PVI) is the cornerstone for patients with atrial fibrillation (AF). Long-term efficacy is limited because of high PV reconnection rates. Ablation targets and strategies beyond PVI in re-do left atrial (LA) procedures have failed to improve outcome. Pulsed field ablation (PFA) has recently been introduced as a novel ablation technology. We report the first experience of re-do PVI with adjunctive LA posterior wall ablation (LAPWA) in patients with multiple failed LA procedures using thermal energy (RF /cryo). After high-density bipolar 3D voltage maps using a pentaspline diagnostic catheter, ablation was performed in conscious sedation using a steerable sheath and a pentaspline over-the-wire basket and flower PFA catheter. After re-do PVI (irrespective of PV status), the pentaspline catheter was visualized in the 3D mapping system. The posterior wall was ablated using the PFA catheter in the flower configuration (Figure). Projected catheter images overlapped approx. 30% between sites across the posterior wall. Per ablation site, 4 applications were administered. Post ablation, 3D voltage maps confirmed complete PVI and LAPWA. Bidirectional PVI was also documented using pacing. Procedural parameters, acute success, in-hospital safety and arrhythmia recurrence were assessed. Between Sept. 2021 and Nov. 2022, 17 patients were enrolled. Mean age was 68±8 years. Time since first AF diagnosis was 72±46 months. Mean number of previous LA procedures was 3±1. Acute PVI and LAPWA were 100% successful. Median procedural time was 160±62 min (including 47±10 min for pre and post mapping). LA dwell time of the PFA catheter was 46±19 min. Fluoroscopy time and dose area product were 24±09 min and 13±13 Gy.cm2. All patients tolerated this approach without procedural interruption. There were no acute or chronic complications. After a follow-up of 163±105 days, 12/17 (71%) patients were free of documented AF, atrial flutter or tachycardia. In patients with multiple failed LA ablations for AF, re-do PVI (irrespective of PV status) and LAPWA using PFA seems to be a safe and feasible approach with promising short-term results. Larger studies are needed to investigate long-term efficacy and safety in this patient group with otherwise very limited therapeutic options.

Outcomes and Hemodynamic Performances of Transcatheter Aortic Valve Replacement with Two Generations of Self-Expanding Transcatheter Aortic Valves.

The superiority of the new-generation self-expanding Evolut R compared with the first-generation CoreValve with regards to outcomes after transcatheter aortic valve replacement (TAVR) is unclear. The aim of this study was to investigate the hemodynamic and clinical performance of Evolut R compared with its direct predecessor, CoreValve, in a Taiwanese population. This study included all consecutive patients who underwent TAVR with either CoreValve or Evolut R between March 2013 and December 2020. Thirty-day Valve Academic Research Consortium-2 (VARC-2)-defined outcomes and hemodynamic performances were investigated. There were no significant differences in baseline demographic characteristics between the patients receiving CoreValve (n = 117) or Evolut R (n = 117). Aortic valve-in-valve procedures for failed surgical bioprosthesis and procedures under conscious sedation were performed significantly more often with Evolut R. Pre-dilatation was performed significantly more often and contrast media volume was significantly higher with CoreValve. Stroke (0% vs. 4.3%, p = 0.024) and the need for emergent conversion to open surgery (0% vs. 5.1%, p = 0.012) were significantly lower in Evolut R than in CoreValve recipients. Evolut R significantly reduced 30-day composite safety endpoint (4.3% vs. 15.4%, p = 0.004). Advancements in transcatheter valve technologies have resulted in improved outcomes for patients undergoing TAVR with self-expanding valves. With the new-generation Evolut R, device success was high and the 30-day composite safety endpoint was significantly reduced after TAVR compared with CoreValve.

Commentary on: 'Postoperative morbidity and weight loss after revisional bariatric surgery for primary failed restrictive procedure: a systematic review and network meta-analysis'.

aDepartment of General Surgery, Shanxi Bethune Hospital, Shanxi, China, 030032 bDepartment of General Surgery, Third Hospital of Shanxi Medical University, Shanxi, China, 030032 Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. Published online ■ ■ *Corresponding author. Address: China. E-mail address: [email protected] (J. Han). This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/

MP-453087-3 REMOVAL OF A CHRONICALLY-IMPLANTED MICRA LEADLESS VENTRICULAR – SINGLE CENTER EXPERIENCE

Leadless cardiac pacemakers (LPs) are an effective and safe alternative to transvenous pacemakers for single-chamber ventricular pacing. However, the feasibility of retrieving and replacing chronically implanted LPs is not well understood. We report an unique single center series of chronically implanted MICRA TPS™ leadless pacemakers. Since 2014 there were 227 MICRA LP devices implanted successfully to the right ventricle (RV) position. In 8 patients with average time of 685 ± 373 days retrieval procedure was indicated. The main indication for LP extraction was: a) pacemaker syndrome; b) battery depletion (in two patients together with WiSE EBR left ventricle (LV) co-implant); c) needs to upgrade VVI pacing for resynchronization therapy with LV systolic dysfunction. In all 8 patients we used MICRA delivery catheter with single loop 7 mm snare inserted into the central lumen of the original delivery catheter. Besides fluoroscopy we guided the retrieval procedure with intracardiac echocardiography (ICE). The retrieval procedure was successful in 7 out of 8 petients (87,5%). Average time of the index retrieval procedure was 118 ± 27 minutes and average fluoroscopy time was 26.6 ± 10.5 minutes. In the case with retrieval procedure failure (348 days after implant) we couldn’t snare the docking bottom of the device. In rest of the cases where we were able to snare it and connect with the delivery catheter cap, we were able to reach the insertion of the LP to the tissue and apply contratraction force with 100% success. When we analysed ICE images, the LP retrieval failure was associated with massive tissue overgrow around the device capsule. In 6 patients new MICRA TPS™ LP was implanted with excellent pacing parameters and optimal sensing and impedance during the same procedure. In one patient we implanted CRT-D transvenous system due to LV dysfunction. This series demonstrates the feasibility of retrieval of even long-term chronically-implanted MICRA LPs. The dedicated retrieval system for LPs with anchors will be of interest when we can consider needs to exchange of LPs specifically in younger patients.

Role of catheter-directed therapies in the treatment of acute pulmonary embolism. Expert opinion of the Polish PERT Initiative, Working Group on Pulmonary Circulation, Association of Cardiovascular Interventions, and Association of Intensive Cardiac Care of the Polish Cardiac Society.

Thanks to advances in interventional cardiology technologies, catheter-directed treatment has become recently a viable therapeutic option in the treatment of patients with acute pulmonary embolism at high risk of early mortality. Current transcatheter techniques allow for local fibrinolysis or embolectomy with minimal risk of complications. Therefore, these procedures can be considered in high-risk patients as an alternative to surgical pulmonary embolectomy when systemic thrombolysis is contraindicated or ineffective. They are also considered in patients with intermediate-high-risk pulmonary embolism who do not improve or deteriorate clinically despite anticoagulation. The purpose of this article is to present the role of transcatheter techniques in the treatment of patients with acute pulmonary embolism. We describe current knowledge and expert opinions in this field. Interventional treatment is described in the broader context of patient care organization and therapeutic modalities. We present the organization and responsibilities of pulmonary embolism response team, role of pre-procedural imaging, periprocedural anticoagulation, patient selection, timing of intervention, and intensive care support. Currently available catheter-directed therapies are discussed in detail including standardized protocols and definitions of procedural success and failure. This expert opinion has been developed in collaboration with experts from various Polish scientific societies, which highlights the role of teamwork in caring for patients with acute pulmonary embolism.

Control center team in interdisciplinary multimodal pain therapy

The topic of this article is the team in interdisciplinary multimodal pain therapy (IMPT) in the context of the development of the team concept. The starting points are historical developments, both social and scientific. After World WarII numerous war victims continued to suffer from persistent pain. On the part of medicine, the consequences were the failure of the usual procedures for acute pain and the resulting helplessness. Both the concept of pain as asymptom of physical injury and also the previous treatment options were no longer adequate. Very early on an interdisciplinary approach to pain management was organized. This involved the communication of experts from various disciplines with very different competencies and opinions. Various medical disciplines and psychotherapy were the core subjects. Crucial for functioning teams is an effective cooperation and interaction. Related organizational issues, conflicts, peculiarities, and possibilities for solutions are presented. In the meantime, IMPT as aprocedure has become aregular service provided in health care.

Management of Shoulder Instability in Patients with Seizure Disorders

Patients with seizure disorders commonly suffer shoulder dislocations and subsequent instability. Due to high rates of recurrence and bone loss, management of this instability and associated pathology has proven to be more complex than that of patients without seizure disorders. The ultimate goal of this review is to outline the various treatment modalities and their respective outcomes in this complex patient population. Optimization of medical management of seizure disorders is imperative. However, despite these efforts, the incidence of post-operative seizure activity continues to be a concern. These subsequent episodes increase the risk of further instability and failure of surgical procedures. Overall, the use of soft tissue procedures has proven to result in increased recurrence of instability compared to bone-block augmenting and grafting procedures. There are a variety of bone-block procedures that have been described for anterior and posterior instability. Despite their success in decreasing further instability, they are associated with several complications that patients should be informed of. There is no consensus regarding the optimal surgical management of shoulder instability in patients with seizure activity. A multidisciplinary approach to the management of the seizure activity is paramount to the success of their treatment. Further studies are required to evaluate the optimal timing and type of surgical intervention for individualized cases.

Psychological Aspects of Infertility - Results from an Actor-Partner Interdependence Analysis.

Introduction For some patients, undergoing medical treatment for infertility is a cause of major emotional stress which the couple needs to deal with together; it can be said that infertility is a shared stressor. From the literature it is known that a subjectively perceived sense of self-efficacy supports the patient's ability to cope adaptively with an illness. As the basis for this study, we assumed that high levels of self-efficacy are associated with low psychological risk scores (e.g., for anxiety or depressiveness), both in the patient themselves and in their partner. Accordingly, in infertility patients, targeted support to promote helpful self-efficacy expectations could represent a new counselling strategy that could enable psychologically vulnerable patients to better cope with the treatment procedure and treatment failures of medically assisted reproduction, making these patients less at risk with regard to psychosocial factors. Methods 721 women and men attending five fertility centers in Germany (Heidelberg, Berlin), Austria (Innsbruck), and Switzerland (St. Gallen, Basel) completed the SCREENIVF-R questionnaire to identify psychological risk factors for amplified emotional problems, as well as the ISE scale to measure self-efficacy. Using paired t-tests and the actor-partner interdependence model, we analyzed the data of 320 couples. Results Considering the study participants as couples, women had a higher risk score than men for four out of five risk factors (depressiveness, anxiety, lack of acceptance, helplessness). In all of the risk areas, it was possible to identify a protective effect from self-efficacy on the patient's own risk factors (actor effect). There was a negative correlation between the men's self-efficacy level and the women's feelings of depressiveness and helplessness (partner effect, man → woman). The women's self-efficacy levels had a positive correlation with acceptance and access to social support in the men (partner effect, woman → man). Conclusion Because infertility is generally something that a couple has to deal with together, future studies should focus on couples as the unit of analysis instead of just analyzing the men and women separately. In addition, couples therapy should be the gold standard in psychotherapy for infertility patients.

Principles and concepts of occlusion in restorative dentistry

The importance of occlusion to practicing dentists is immense as it plays a key role in the success or failure of restorative procedures. This article attempts to demystify and present an overview of the complex topic of occlusion and its principles which are important for the success of restorative procedures. The article discusses the principles of occlusion as these apply to restorative dentistry. It provides a guide as to what is required to optimize the occlusion for restorative treatment outcomes, including conformative and reorganized approaches. Occlusion and its effect on the temporomandibular joint are also presented. The topic is clinically relevant as it will help the practitioners to understand the key concepts of occlusion and help improve the outcome of their restorative dental procedures.

At the crossroads between adoption and in vitro fertilisation, the destination of parenthood

New ways of avoiding infertility are being discovered through technological developments in the medical field, but even so the risks and associated implications (scientific and ethical) exist. Birth defects, medical problems, procedure failure, obscure long-term effects (unstudied and not yet discovered) and legal issues are just some of them. An alternative that offers opportunities to couples who want children is adoption. Although this process is not without risks either, and in some cases the road to success can be quite arduous, it involves placing the adopted child in the new family as a real offspring, rather than as a family seeking to compensate for infertility with a child who becomes a kind of 'family implant'. Looking at the bigger picture, there are solutions for children who don't have a family as well as those who want to be parents. However, great care must be taken when making decisions, especially when a human life is at stake. There are no guarantees.

PD35-03 ROBOTIC POSTERIOR URETHROPLASTY: 105 CASES FROM A SINGLE CENTER

You have accessJournal of UrologyCME1 Apr 2023PD35-03 ROBOTIC POSTERIOR URETHROPLASTY: 105 CASES FROM A SINGLE CENTER Alex Wang, Ashley Alford, and Lee Zhao Alex WangAlex Wang More articles by this author , Ashley AlfordAshley Alford More articles by this author , and Lee ZhaoLee Zhao More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003333.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic posterior urethroplasty (RPU) has been described in small case series to be a viable option for men requiring posterior urethral reconstruction. Outcomes of RPU in larger scale cohorts are lacking. Herein we present our experience with RPU to date. METHODS: We performed a retrospective review of men who underwent RPU from October 2014 to August 2022. Our cohort included men who required RPU secondary to conditions including prostate cancer treatment, pelvic trauma, and rectourethral fistulas. All RPUs were performed by a single reconstructive urologist at a single institution. We collected pre-operative, intra-operative, and post-operative characteristics. Post-operative complications were graded using the Clavien-Dindo classification system. RESULTS: Cohort characteristics and outcomes are represented in Table 1. A total of 105 patients were included, with median age of 69 and median BMI of 27. 72 (68.6%) patients had a history of prostate cancer treated with surgery and/or radiation. 60 (57%) patients had a history of abdominal or pelvic radiation. Mean follow-up time was 18 months. 63 (60%) patients underwent a previous urethral procedure, 84.1% (53/63) of which was an endoscopic dilation. Intra-operatively, a combined abdominal/perineal approach was used in 41 (27%) patients. Various methods of reconstruction were implemented, the most common of which were excision and primary anastomosis (EPA), Y-V plasty of bladder neck, and re-siting of bladder neck. 7 patients had Clavien-Dindo grade 3a or higher complications within 30 days. 28% (30/105) subsequently required an artificial urinary sphincter (AUS) with average time from surgery to AUS placement of 9 months. One-quarter of patients required at least one subsequent urethral surgery for recurrent stricture, with 4 patients ultimately undergoing cystectomy and urinary diversion. All cystectomy patients had a history of radiation. CONCLUSIONS: We present one of the largest cohorts to date of patients who underwent RPU, demonstrating success of a variety of techniques for urethral reconstruction even in patients with history of failed urethral procedures. Immediate post-operative complications were rare, however 28% of patients did ultimately require AUS placement and 25% patients underwent a subsequent urethral procedure, most commonly via endoscopic approach. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e975 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Wang More articles by this author Ashley Alford More articles by this author Lee Zhao More articles by this author Expand All Advertisement PDF downloadLoading ...

MP60-16 DORSAL/ DORSO-LATERAL ONLAY BUCCAL MUCOSAL GRAFT VERSUS VENTRAL ONLAY LOCAL PENILE SKIN FLAP IN COMPLEX ANTERIOR URETHRAL STRICTURES; A PROSPECTIVE RANDOMIZED STUDY

You have accessJournal of UrologyCME1 Apr 2023MP60-16 DORSAL/ DORSO-LATERAL ONLAY BUCCAL MUCOSAL GRAFT VERSUS VENTRAL ONLAY LOCAL PENILE SKIN FLAP IN COMPLEX ANTERIOR URETHRAL STRICTURES; A PROSPECTIVE RANDOMIZED STUDY Ahmed Tawakol, Mohammed Abdel-Rassoul, Mohamed Abdelwahab, Mohamed Elghoneimy, Ahmed Y. Abdelaziz, Ahmed Rammah, Mohamed Elgammal, and Amr Elkady Ahmed TawakolAhmed Tawakol More articles by this author , Mohammed Abdel-RassoulMohammed Abdel-Rassoul More articles by this author , Mohamed AbdelwahabMohamed Abdelwahab More articles by this author , Mohamed ElghoneimyMohamed Elghoneimy More articles by this author , Ahmed Y. AbdelazizAhmed Y. Abdelaziz More articles by this author , Ahmed RammahAhmed Rammah More articles by this author , Mohamed ElgammalMohamed Elgammal More articles by this author , and Amr ElkadyAmr Elkady More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003318.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Anterior urethral stricture is a challenging disease. Multiplicity of surgical techniques denotes that none is ideal. Our aim is to compare the use of buccal mucosal grafts (BG) versus local penile skin flaps (PF) in patients with complex anterior urethral strictures regarding success rates and complications. METHODS: A total of 34 adult patients with complex anterior urethral stricture were included. A complex anterior urethral stricture was defined as a stricture length of>2 cm and/or previous failed procedures, including urethral dilatation, internal optical urethrotomy and urethroplasty. We randomized patients to undergo either buccal mucosa dorsal/ dorso-lateral onlay graft or ventral onlay local penile skin flap urethroplasty. We compared operative time, estimated blood loss, complications, and succcess rates in both groups. Successful treatment outcome was defined as no further treatment of the urethral stricture required after urethroplasty and peak flow rate>15 ml/s. RESULTS: Mean follow up was 22.3 months in BG group vs 18.9 months in PF group. The site of the stricture, the median stricture length (40 mm in BG group Vs. 50 mm in PF group) and mean operative time were not statistically different between the two groups. Estimated blood loss was higher in PF group (median 400 ml and 300 ml in PF and BG group respectively, p=0.003); statistically significant but clinically insignificant.Two patients (11.8%) in each group developed wound infection. In PF group, one patient (5.9%) had urinary fistula, and one patient (5.9%) presented by mild ventral chordee post operatively. The success rates in the buccal mucosal and penile flap groups were similar (88.2%). CONCLUSIONS: Dorsal/ dorso-lateral onlay buccal mucosal graft and ventral onlay penile skin flap urethroplasty provided similar success rates. Complications were higher in the penile skin flap group. Both techniques can be used for the treatment of complex anterior urethral strictures with good outcome based on the surgeon's expertise. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e849 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Tawakol More articles by this author Mohammed Abdel-Rassoul More articles by this author Mohamed Abdelwahab More articles by this author Mohamed Elghoneimy More articles by this author Ahmed Y. Abdelaziz More articles by this author Ahmed Rammah More articles by this author Mohamed Elgammal More articles by this author Amr Elkady More articles by this author Expand All Advertisement PDF downloadLoading ...

Morphological Study of the Thebesian Valve in Fresh Autopsied Adult Human Hearts.

Background The coronary sinus (CS) and its tributaries have been used to perform various electrophysiological and cardiac interventional procedures which require cannulation.The Thebesian valve (TV) guarding the coronary sinus orifice (CSO) exhibits morphological variations which might make cannulation unsuccessful leading to the failure of invasive cardiac procedures.This study aimed to analyze in detail themorphological features of the TV infreshautopsiedhuman hearts which were representative of the adult population of this region owing to its practical implications in invasive cardiac procedures. Methodology This was a cross-sectional, descriptive study conducted in the Department of Anatomy in collaboration with the Department of Forensic Medicine and Toxicology at Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry. A total of 104 fresh adult heart specimens were collected during the autopsy. The CSO was located, and the characteristic shape, composition, position, and extent of coverage of the CSO by the TV were observed and analyzed. Results The TV was present in 65% of heart specimens.The most common shape was remnant (33%), and the most common site of origin was inferior (63%).The valve composition was thin and membranous in 63% of heart specimens.In 7% of heart specimens, the TV covered more than 75% of the CSO diameter, of which in 4% of heart specimens, the CSO was completely closed and found to be obstructive. Conclusions This study highlights the variability in the morphological structure of the TV in adult human hearts and its potential implications in unsuccessful CS cannulation and failure of invasive cardiac procedures.Thus, prior imaging of the TV should be an integral part of CS cannulation procedures to avoid unsuccessful cannulation and complications related to repeated forceful cannulation.

Accuracy of the Sentence-BERT Semantic Search System for a Japanese Database of Closed Medical Malpractice Claims

In this study, we developed a similar text retrieval system using Sentence-BERT (SBERT) for our database of closed medical malpractice claims and investigated its retrieval accuracy. We assigned each case in the database a short Japanese summary of the accident as well as two labels: the category was classified as a hospital department mainly, and the process indicated a failed medical procedure. We evaluated the accuracies of a similar text retrieval system with the two labels using three different multilabel evaluation metrics. For the encoders of SBERT, we employed two pretrained BERT models, UTH-BERT and NICT-BERT, that were trained on huge Japanese corpora, and we performed iterative optimization to train the SBERTs. The accuracies of the similar text retrieval systems using the trained SBERTs were more than 15 points higher than those of the Okapi BM25 system and the pretrained SBERT system.

Medial-Pivot Design Improved Knee Symptoms From Anteroposterior Instability in Early-Range Flexion and Resolved Anterior Knee Pain in Revision Total Knee Arthroplasty

BackgroundInstability can lead to poor functional results after tricompartmental total knee arthroplasty (TKA). We identified a group of patients who appeared to have anteroposterior (AP) instability in early-range flexion (ie, 20 to 30° range) associated with anterior knee pain and feelings of instability. The purpose of this study was to assess the clinical results in terms of stability and anterior knee pain after revision TKA with a medial-pivot implant and to assess the effect of the implant positioning used in the revision technique. MethodsThere were 45 patients (45 knees) evaluated retrospectively to assess standing lower extremity alignment and functional results by generating a knee stability score after revision TKA with medial pivot implant design. ResultsRevision TKA using the medial-pivot TKA lowered the joint line by 3.6 millimeters (mm) (P < .001) and positioned the tibia anteriorly by 3.5 mm (P < .001) on radiographic measurements as compared with results after primary TKA. Moreover, medial pivot revision TKA improved AP stability by a 56-point change in score (P < .001). ConclusionRevision TKA using a medial pivot design improved AP stability and anterior knee pain after failed primary procedures.

Vertebral body tethering: An alternative to posterior spinal fusion in idiopathic scoliosis?

Skeletally immature patient with adolescent idiopathic scoliosis (AIS) whose curves continue to progress despite bracing should be treated surgically. Vertebral body tethering (VBT) is a non-fusion, compression-based, growth preserving alternative to posterior spinal fusion (PSF) based on the concept of 'growth modulation' to prevent possible functional complications secondary to fusion while correcting scoliotic deformity. This review aims to shed light on the indications of VBT, short- and medium-term outcomes, describe the surgical technique and associated complications, and to compare its efficacy to that of PSF. A review of peer-reviewed literature on VBT as a surgical technique, its indications, outcomes, complications, and comparison with other surgical interventions to correct AIS was conducted in December 2022. Indications remain controversial and mainly include stage of skeletal maturity based on radiographic markers, curve location, magnitude and flexibility, and presence of secondary curve. Assessment of VBT clinical success should not be restricted to improvement in radiographic parameters but should include functional results and patient-centered outcomes, improved body image and pain, and durability of outcomes. In contrast to fusion, VBT seems to be associated with preserved spinal growth, shorter recovery, potentially better functional outcomes, less motion loss but possibly less curve correction. Yet still, with VBT there exists a risk of overcorrection, construct breakage or failure of procedure which require revision and at times conversion to PSF. Patient and family preferences must be accounted for acknowledging gaps in knowledge, attributes and drawbacks of each intervention.

Current Definitions of Failure in Lateral Ankle Instability Surgery: A Systematic Review.

"Failure" is a term that is frequently used to describe an unfavorable outcome for patients who undergo surgical treatment for lateral ankle instability (LAI). A standard definition of failure for the surgical treatment of ankle instability has not been established by clinicians and researchers. To identify the definitions of ankle instability treatment failure that are currently in the literature and to work toward the standardization of the definition. Systematic review; Level of evidence, 4. A systematic search of MEDLINE, SPORTDiscus, CINAHL, Embase, and Web of Science was conducted to identify clinical studies that included patients who underwent surgical treatment for LAI and included information about surgical failure. Studies with level of evidence 1 to 4 were included in this review. Animal studies, biomechanical studies, cadaveric studies, review articles, and expert opinions were excluded. The included studies were then reviewed for definitions of failure of any surgical procedure that was performed to correct LAI. Of the 1200 studies found, 3.5% (42/1200) published between 1984 and 2021 met the inclusion criteria and were analyzed. After reviewing the data, we found numerous definitions were reported in the literature for LAI surgical failure. The most common was recurrent instability (40% [17/42]), followed by rerupture (19% [8/42]). For the original surgical procedure, the anatomic Broström-Gould technique was used most frequently (57% [24/42]). The failure rate of the Broström-Gould technique ranged from 1.1% to 45.2% depending on the definition of failure. There were multiple definitions of failure for the surgical treatment of LAI, which is one of the reasons why the rate of failure can vary greatly. The literature would benefit greatly from the standardization of the definition of ankle instability treatment failure. This definition should include specific, objective physical examination findings that eliminate the ambiguity surrounding failure.

The Association Between Low Body-Mass Index and Serious Post-endoscopic Adverse Events.

Low body mass index (LBMI) was associated with longer colonoscopy procedure time and procedural failure, and commonly considered to be a risk factor for post-endoscopic adverse events, but evidence is lacking. We aimed to assess the association between serious adverse events (SAE) and LBMI. A single center retrospective cohort of patients with LBMI (BMI ≤ 18.5) undergoing an endoscopic procedure was matched (1:2 ratio) to a comparator group (19 ≤ BMI ≤ 30). Matching was performed according to age, gender, inflammatory bowel disease or malignancy diagnoses, previous abdomino-pelvic surgery, anticoagulation therapy and type of endoscopic procedure. The primary outcome was SAE, defined as bleeding, perforation, aspiration or infection, following the procedure. The attribution between each SAE and the endoscopic procedure was determined. Secondary outcomes included each complication alone and endoscopy-attributed SAEs. Univariate and multivariate analyses were applied. 1986 patients were included (662 in the LBMI group). Baseline characteristics were mostly similar between the groups. The primary outcome occurred in 31/662 (4.7%) patients in the LBMI group and in 41/1324 (3.1%) patients in the comparator group (p = 0.098). Among the secondary outcomes, infections (2.1% vs. 0.8%, p = 0.016) occurred more frequently in the LBMI group. Multivariate analysis revealed an association between SAE and LBMI (OR 1.76, 95% CI 1.07-2.87), male gender, diagnosis of malignancy, high-risk endoscopic procedure, age > 40years, and ambulatory setting. Low BMI was associated with higher post-endoscopic serious adverse events. Special attention is required when performing endoscopy in this fragile patient population.