Replacement Procedures Research Articles

Surgical Approaches for Aortic Root Aneurysm: A Comparative Analysis of the David and Yacoub Techniques

Introduction: This paper compares the David and Yacoub procedures for valve-sparing aortic root replacement, two leading techniques for treating aortic root aneurysms while preserving the native aortic valve. Both methods aim to avoid prosthetic valve replacement and the need for lifelong anticoagulation. Material and Methods: We reviewed the technical nuances, clinical outcomes, and long-term durability of each technique, incorporating findings from recent and historical studies. Also, we'd like to present two case reports from our clinic showing the application of the David procedure. Results: The David procedure involves complete excision of the aortic root and reimplantation of the native aortic valve within a Dacron graft. It offers superior long-term durability and lower reoperation rates, particularly in younger patients and those with connective tissue disorders. In contrast, the Yacoub procedure entails partial root resection and remodeling with preservation of the sinuses of Valsalva, making it a viable option for older patients or those with isolated root dilation. Conclusions: Both the David and Yacoub procedures are advanced techniques for aortic root replacement, each with unique advantages and challenges. The David procedure, with its excellent durability, has consistently delivered successful outcomes. It is especially beneficial for younger patients and those with connective tissue disorders, supporting its role as a preferred approach for long-term outcomes in this population.

Bridging the Gap: Understanding Patient and Clinician Preferences When Designing Preoperative Education Programs.

Traditionally, health information has been created from the perspective of the providers with minimum patient consultation, hindering engagement and adherence. The rate of shoulder replacements has increased over the past decade, is associated with shorter hospital stays, and patients are relying on education to be able to participate in shared decision-making. Therefore, to ensure creation of accessible education programs for shoulder replacement procedures, we explored patient and clinician preferences regarding content and device choices for a preoperative shoulder replacement education program. This study used an interpretive descriptive qualitative approach to understand patient and clinician preferences. We included a subset of patient and healthcare provider perspectives, from those who had previously completed our quantitative survey. Interviews were conducted in English by one researcher. Analysis was conducted through a descriptive thematic analysis with open coding. A total of 10 patients and 9 healthcare providers were interviewed. Findings were categorized into four main themes described the process of creating patient education material (1) methods of accessing information, (2) deciding on educational content, (3) deciding on device use, and the last theme of factors affecting engagement can be further divided as (4-1) promotors of engagement and (4-2) barriers of engagement. A multimodal program of a website with videos and a written booklet, that covers basic information regarding the surgery, timelines for recovery, sling use, use of therapeutic devices/aids post-surgery, patient expectations to improve surgery satisfaction, postoperative restrictions, pain management, rehabilitation and home supports is desired by both patients and clinicians.

Comprehensive Review of Advances in Cosmetic and Restorative Dentistry

The work aims to present a systematic overview of cosmetic and restorative dentistry developments in the last three decades. Cosmetic and restorative dentistry is another advancement area that bears changes resulting from the material, technology, and technique improvements that are supportive and cosmetic improvement for patients. This review describes trends in dental restoration, tooth replacement, and esthetic procedures and the potential impact on improving patient care. Computer-controlled digital technologies, minimally invasive techniques, and biocompatible materials have become determinative for treatments and made processes less invasive and more easily predictable. The review also provides information about the future development in the given field and highlights that more innovations and challenges are coming.

A comparison of postoperative microbiological and histological test results with the indication for revision as listed at the time of surgery in the National Joint Registry: a single-centre cohort study of metal-on-metal total hip replacement and hip resurfacing revision procedures.

Surgeons allocate an indication(s) for revision surgery on NJR Minimum Data Set forms in the immediate perioperative period, when results from intraoperative histology and microbiology samples are not available. We evaluated to what extent the postoperative diagnostics obtained for patients undergoing metal-on-metal hip arthroplasty (MoMHA) revision surgery align with the indication for revision listed in the NJR. NJR data for MoMHA revision patients (2004-2015) at a single centre were linked to hospital records of microbiology and histology testing for prosthetic joint infection (PJI) and adverse reaction to metal debris (ARMD). The Musculoskeletal Infection Society and Mirra classifications were used as "gold standards' to classify PJI and ARMD respectively and to assess the diagnostic accuracy of the clinician selected revision indication recorded on MDS forms. Of 301 cases, 5.6% (n = 17) and 3.7% (n = 11) were revised for PJI and ARMD respectively. In a further 6.6% (n = 20, PJI) and 15.6% (n = 47, ARMD) the indication for revision selected at the time of surgery did not corroborate with the test results from intraoperative samples. Diagnostic accuracy analysis revealed sensitivity and specificity of indication for surgery at the time of revision for PJI of 35.5% (95% CI, 19.2-54.6) and 97.8% (CI, 54.6-95.2) respectively, and for ARMD of 7.41% (CI, 2.06-17.9) and 97.2% (CI, 94.3-98.9) respectively. We observed that the results of histology and microbiology analyses of intraoperative samples may provide evidence to support alternative diagnoses in 20% of cases. This indicates a need for a change in the work-up of these cases to allow a more accurate prediction of the indication for revision. Alternatively, if there was evidence of a difference in outcome for patients where the indication may be changed when such data becomes available, the feasibility of a facility to add additional information from samples taken intraoperatively when it becomes available should be explored.

Generation of Shape Models of Calcified TAVR populations for Solid Mechanics Simulations by means of Deep Learning

Abstract Minimally invasive transcatheter aortic valve replacement (TAVR) procedure has become the preferred procedure for patients with aortic valve stenosis or insufficiency with high risk for conventional open surgery. The favorable clinical outcomes of high-risk patients led to an expansion of the cohort including intermediate and low-risk patients. A critical aspect of advancing TAVR procedures lies in preoperative planning, integrating patient-specific in-silico deployment simulation and post-deployment fluid mechanics assessments. This study introduces a novel approach to calcified TAVR patient shape modeling, addressing this problems. The model integrates an extended mesh generated by DeepCarve, encompassing the aortic arch, and a novel deep learning-based volumetric shape model of calcifications. The key innovation lies in the utilization of a conditional Convolutional Variational Autoencoder (cCVAE) to generate realistic calcification patterns, demonstrating promising preliminary results in matching actual cohort data. Future investigations should focus on data collection from diverse medical centers to validate and refine the proposed methodology. This study showcases significant progress in generating synthetic TAVR patient geometries, incorporating detailed anatomical structures such as the aortic root, valve, and arch, along with volumetric calcification patterns. These findings represent a crucial step towards enabling real-time preoperative TAVR planning, inclusive of patient- specific in-silico deployment simulation and comprehensive fluid mechanics assessments.

EE574 Cost-Consequences Analysis of the Use of TyrxTM Antibacterial Envelope in Patients Undergoing Device Replacement Procedures in Türkiye

EE574 Cost-Consequences Analysis of the Use of TyrxTM Antibacterial Envelope in Patients Undergoing Device Replacement Procedures in Türkiye

Surgical factors play a critical role in predicting functional outcomes using machine learning in robotic-assisted total knee arthroplasty.

Predictive models help determine predictive factors necessary to improve functional outcomes after total knee arthroplasty (TKA). However, no study has assessed predictive models for functional outcomes after TKA based on the new concepts of personalised surgery and new technologies. This study aimed to develop and evaluate predictive modelling approaches to predict the achievement of minimal clinically important difference (MCID) in patient-reported outcome measures (PROMs) 1 year after TKA. Four hundred thirty robotic-assisted TKAs were analysed in this retrospective study. The mean age was 67.9 ± 7.9 years; the mean body mass index (BMI) was 32.0 ± 6.8 kg/m2. The following PROMs were collected preoperatively and 1-year postoperatively: knee injury and osteoarthritis outcome score for joint replacement, Western Ontario and McMaster Universities osteoarthritis index (WOMAC) Function, WOMAC Pain. Demographic data, preoperative CT scan, implant size, implant position on the robotic system and characteristics of the joint replacement procedure were selected as predictive variables. Four machine learning algorithms were trained to predict the MCID status at 1-year post-TKA for each PROM survey. 'No MCID' was chosen as the target. Models were evaluated by class discrimination (F1-score) and area under the receiver operating characteristic curve (ROC-AUC). The best-performing model was ridge logistic regression for WOMAC Function (area under the curve [AUC] = 0.80, F1 = 0.48, sensitivity = 0.79, specificity = 0.62). Variables most strongly contributing to not achieving MCID status were preoperative PROMs, high BMI and femoral resection depth (posterior and distal), supporting functional positioning principles. Conversely, variables contributing to a positive outcome (achieving MCID) were medial/lateral alignment of the tibial component, whether the procedure was an outpatient surgery and whether the patient received managed Medicare insurance. The most predictive variables included preoperative PROMs, BMI and surgical planning. The surgical predictive variables were valgus femoral alignment and femoral rotation, reflecting the benefits of personalised surgery. Including surgical variables in predictive models for functional outcomes after TKA should guide clinical and surgical decision-making for every patient. Level III.

Salvage Total Hip Replacement for Failed Proximal Femoral Fracture Fixation.

Salvage arthroplasty for failed proximal femoral fracture fixation is a complex procedure. This involves the removal of the primary failed or broken implant followed by a hip joint replacement procedure. The complications and technical difficulties associated with these surgeries are often difficult to anticipate. Initially, to further understand the position in the literature with regardto salvage arthroplasty, we completed an informative scoping review. Search terms were selected, and databases Embase and PubMed were utilised to form a literature search. Relevant articles were selected by two independent researchers, with a final list of nine studies reviewed and tabulated for themes to be identified and analysed. Subsequently, we retrospectively studied the notes of all the patients who underwent complex conversion arthroplasty in the same district hospitals in a span of 16 years (August 2002 to August 2018) and presented the results. Seventy-one patients underwent complex salvage arthroplasty following a failed fixation of proximal femoral fracture under the care of three different surgeons. All surgeries were carried out by the posterior approach. The demographics, intraoperative events, and postoperative follow-up have been presented through clinical and radiological assessments. With a mean age being 73.6, female patients were almost twice the number of male patients. The left hip was the more common surgical site. Implant cutout was the most common cause of failure of the primary implant. Most of these surgeries were either uncemented (31 cases, 43.66%) or hybrid (29 cases, 40.84%). The most common acetabular size to be used was 50 mm, and the most common head size used was 32 mm. A majority of the surgeries were metal on poly bearings (64 cases, 90.14%). The mean surgical time, including anesthetic,was four hours and 13 minutes. A total of 31 (44%)patients needed blood transfusion postoperatively. The infection rate was 21.13% (15 cases), being the most common surgical complication. The mean follow-up of the patients was 27.2months with the maximum follow-up being 125 months. The one-year mortality was found to be 14% (10 cases). The mean limb length discrepancy was shortening by an average of 3.84 mm. A total of 66.2% (47 cases) of patientswere shortened postoperatively. The average cup abduction and anteversion angles were 35° and 24.25°, respectively. The average position of the femoral stem was 0.31° in the varus with 40.85% (29 cases) of patients having a slightly varus stem. Upon drawing comparisons with primary hip arthroplasty for primary osteoarthritis through data available in the literature, it is obvious that salvage arthroplasty is a complex procedure with longer surgical times and onerous rehabilitation. Whilst it is not the same as revision arthroplasty, many of the characteristics in terms of surgical planning and outcomes are similar. Therefore, it is our recommendation that salvage hip arthroplasty procedures should be categorised, listed, and studied separately from primary arthroplasty in the National Joint Registry database.

A local, non-commercial tissue bank connected to an organ donor program can produce musculoskeletal allografts of uniform quality at very low costs – ten years’ experience

It is common practice that allograft tissues for knee multiligament reconstruction, meniscus transplantation, cartilage replacement and other advanced procedures are made available through commercial banks. The aim was to present the 10-year experience with a local, non-commercial tissue bank, established in 2014. The allograft bank was connected to an existing organ donor program. Following organ procurement, the musculoskeletal tissue is removed and stored immediately, fresh frozen to − 80 degrees Celsius (except hyaline cartilage, which is stored at 5 degrees Celsius). The donor is tested for contagious disease and the grafts for bacteria. When all results are negative, the grafts are released. When thawed before use a swap is cultured. Consecutive, prospectively collected data were analyzed. There were 31 donations, resulting in 1160 grafts. Only 40 grafts (3.4%) had a positive bacteria culture and were discarded. 552 recipients have been treated by use of these allografts. All grafts had negative bacterial cultures in swaps obtained before thawing, and there were no recorded transplantation related complications. The expenses for local grafts were 10–15% of the costs for grafts obtained from foreign banks. Through the local donation program, it was possible to establish a tissue bank with controlled quality grafts at minimal costs, minimizing the need for transportation of frozen grafts retrieved in other countries. Centers for specialized orthopedic surgery using allograft tissue can be self-providing and reduce costs by retrieving and handling allograft tissues locally.

Long-Term Stability in Temporomandibular Joint Replacement: A Review of Related Variables.

Background: The temporomandibular joint (TMJ) is a key component of the stomatognathic system, playing a major role in maintaining mandibular stability and function. Temporomandibular disorders (TMDs) are a prevalent disease in the world, with surgical treatment being reserved for complex cases or end-stage TMJ disease. A narrative review was conducted to describe the quantitative and qualitative factors that affect TMJ prosthesis stability. Methods: Studies with a sample size equal to or greater than 10 subjects who underwent surgical procedures for joint replacement using stock or customized ATM prostheses were included. This narrative review examined some variables that may influence in terms of the longevity of the TMJ prosthesis, highlighting issues to be considered in future research. Results: The current development of TMJ prostheses is benefiting from technological advances, offering a suitable adaptation to the patient's anatomy and superior results in functionality and patient satisfaction. However, the biomechanical complexity of the TMJ shows unique challenges compared to other joints in the body, where anatomical, biomechanical, and functional requirements are high. The stability of the TMJ prosthesis is affected by multiple variables, including the selection of biocompatible materials that resist corrosion and wear, the design of the prosthesis, the diagnosis and indication for its use, and the surgeon's experience. The success of TMJ replacement can be measured by improving the patient's quality of life, reducing pain, restoring mandibular functionality, and recovering suitable facial morphology for the patient's conditions. Conclusion: There is a need for training of maxillofacial surgeons in TMJ surgery and replacement, as well as a greater focus on the research and development of systems to simplify surgical design and procedures and to optimize the results of TMJ replacement.

Assessing The Impact Of Surgical Approaches On Total HIP Replace-ment Outcomes: A Systematic Review

Total hip replacement is one of the most common and effective orthopedic surgical procedures to reduce pain and improve hip function in patients with severe conditions. This procedure has undergone many advances in the past few decades. However, there is debate among surgeons about which surgical approach is the most optimal to apply. This study aims to systematically assess and compare the outcomes of different surgical approaches in total hip replacement (THR) procedures. The method used in this study was a systematic literature review, in which literature was searched through academic databases such as PubMed, Scopus, and Google Scholar using relevant keywords. The collected data were then analyzed through three stages, namely data reduction, data presentation, and conclusion drawing. The results of this study show that each surgical method for total hip replacement has different advantages and disadvantages. The choice of surgical approach should be tailored to each patient's specific condition. Based on a review of the available literature, the anterior approach is often considered superior to the other approaches. The advantages include less surgical trauma, better postoperative pain reduction and a faster rehabilitation process. The anterior approach is considered safe, reliable and effective, and results in lower pain levels compared to other methods

The completeness of national hip and knee replacement registers.

National joint replacement registries were developed for prospective monitoring of outcomes and post-market surveillance of implants. Increasingly registry data informs practice. However, analysis of a registry can only be as good as the data it captures on the population of interest. We aimed to analyze completeness of reporting of hip and knee replacement procedures for all national registries worldwide. We analyzed annual reports and data provided following written requests to all active national hip and knee replacement registries. Coverage was defined as the proportion of hospitals in the country that participate in the registry. Procedure completeness was defined as the proportion of procedures successfully captured by the registry. 14 national registries were included, spanning years 2004 to 2022. Coverage was complete in 10. Median procedure completeness for primary hip and knee replacement across all years was 96.5% (interquartile range [IQR] 94.0-97.7%). Median procedure completeness for revisions was 88.5% (IQR 81.0-92.5%). The terminology used and method of calculation of completeness estimates in the registries were variable. National hip and knee replacement registry data generally reflects excellent coverage (full in 10 of 14 registries) and completeness (primary procedures 96.5% and revisions 88.5%) over the last 2 decades.

Long-term outcomes comparison of Bentall-De Bono-versus valve-sparing aortic root replacement: An updated systematic review and reconstructed time-to-event meta-analysis

BackgroundFor patients with aortic root dilatation and a structurally normal aortic valve (AV) undergoing composite aortic valve-graft (Bentall-De Bono) versus valve-sparing aortic root replacement (VSARR) procedures there are conflicting data regarding early and long-term benefits. We undertook a study-level meta-analysis to compare the results of both procedures. MethodsThree databases were assessed, and both randomized trials and observational studies were considered eligible. Kaplan-Meier curves of long-term survival and reoperation risk were reconstructed and compared with Cox linear regression and incidence rate ratios (IRR) with 95 % confidence intervals (CI). Landmark analysis and time-varying hazard ratio (HR) were analyzed. Odds ratios (OR) were calculated for early mortality, postoperative stroke, and re-exploration for postoperative bleeding. A random effects model was used. Sensitivity analyses included leave-one-out-analysis, meta-regression and subgroups analysis. Results1456 articles were identified, including 39 observational studies, totaling 14,651 patients (Bentall-De Bono = 9557 and VSARR = 5094). Twelve studies were adjusted. The mean weighted follow-up was 5.05 ± 3.7 years. VSARR was associated with significantly greater survival (HR = 0.50; 95 % CI, 0.45–0.57; p < 0.0001) at 15-year follow-up. The reoperation risk was higher following VSARR (HR = 1.30; 95 % CI, 1.03–1.63; p = 0.02.), although time-varying HR model and landmark analysis reported an increased risk of reoperation within 5 years after VSARR (HR = 1.57; 95 % CI, 1.23–2.01; p < 0.001), after which the difference disappeared. Subgroups analysis of studies excluding aortic dissection showed a comparable rate of late reoperation. ConclusionsVSARR is associated with improved long-term survival compared to Bentall-De Bono. The risk of late reoperation is higher within 5 years following VSARR, after which the two procedures are comparable.

COMPARISON OF THE EFFECTS OF STANDARD NOZZLES AND EXTENSION TUBES ON THE EROSION OF PMMA USING PULSATING WATER JET TECHNOLOGY

The study of bone cement disintegration is important for advancing orthopedic and trauma surgery outcomes. Bone cement, commonly used in joint replacement procedures, plays a vital role in fixation implants. However, the long-term stability and integrity of bone cement are critical for the success of these procedures. This study focuses on the use of ultrasonic pulsating water jet technology for the selective removal of bone cement, aiming to provide a precise and efficient method for revision surgeries. The disintegration efficiency is measured in terms of depth, width and volume of the disintegrated bone cement as a result of variations in the nozzle geometry, supply pressure and traverse speed. Two different nozzle types, the standard nozzle insert and nozzle with an extension tube of 100 mm having a diameter of 0.3 mm, are used. Two supply pressure levels were taken as 10 and 20 MPa with five levels of traverse speeds as 0.5, 1, 1.5, 2 and 2.5 mm/s. The results showed an increased disintegration efficiency for all experimental conditions using an extension tube nozzle as compared to a standard nozzle (20 – 25% in terms of disintegration volume). Also, the disintegration efficiency increased with higher pressure level values (8.2 mm3 and 4.85 mm3 for p = 20 and 10 MPa, respectively) and lower traverse speed values. The results showed a promising direction in terms of the utilization of an ultrasonic pulsating jet with a modified nozzle type for higher bone cement disintegration efficiency.

Abstract 4132152: Cardiovascular Procedures for Hospitalized Patients with Hypertrophic Cardiomyopathy requiring Valvular Heart Repair/Replacement or Coronary Artery Revascularizations: A Risk-Stratified Analysis of a Large National Database

Background: Hypertrophic cardiomyopathy (HCM) is associated with increased mortality mainly due to sudden cardiac arrest. However, it is not clear how HCM affects in-hospital mortality among patients hospitalized due to other cardiovascular conditions requiring intervention. Methods: National Inpatient Sample (NIS) database was queried from 2016 to 2020 to identify hospitalized patients with a diagnosis of HCM. Patients with HCM were stratified based on their concomitant cardiovascular conditions necessitating interventions. Results: Data pertinent to 278,995 admission cases with HCM was analyzed. Of this, 15,035 cases had concomitant non-ST elevation MI (NSTEMI), and 1,230 cases had ST-elevation MI (STEMI). Additionally, 15,100 cases were diagnosed with aortic valve diseases (AVD), 33,580 had concomitant mitral valve diseases (MVD), 5,580 cases had tricuspid valve diseases (TVD), and 16,815 cases had pulmonary valve diseases (PVD). Cardiovascular procedures were more common among HCM patients with concomitant STEMI (43.5%) followed by HCM patients with AVD (17.1%) and HCM patients with NSTEMI (16.9%). Stratification of mortality rate based on cardiovascular procedures and the underlying indication revealed CABG to have the highest mortality rate for HCM patients with STEMI (25%), followed by PCI for HCM patients with STEMI and HFrEF (12.5%). HCM patients with NSTEMI undergoing revascularization had higher mortality when PCI was performed for HFrEF cases and when CABG was performed for HFpEF cases. For HCM patients with AVD requiring repair or replacement, TAVR was superior to SAVR if performed in patients with HFpEF but was inferior among HFrEF subgroup in terms of in-hospital mortality. For subgroup of HCM patients with MVD, transcatheter replacement was associated with a lower mortality than surgical repair regardless of concomitant heart failure. Data was insufficient for HCM patients with concomitant TVD or PVD undergoing repair or replacement procedures. Conclusions: Among hospitalized patients with HCM, concomitant HFrEF but not HFpEF is associated with a significantly higher mortality rate regardless of the underlying cardiovascular conditions requiring revascularization or heart valvular repair. A more comprehensive preoperative risk assessment could delineate the ideal procedures for HCM patients with certain comorbidities and specific need.

Clinical utility of echocardiography in internal medicine: a narrative review

Echocardiography has emerged as an invaluable tool in internal medicine, providing real-time, non-invasive evaluation of cardiac structure and function. Its clinical utility spans a wide range of applications, including the diagnosis and management of heart failure, valvular heart diseases, and cardiomyopathies, as well as systemic conditions like sepsis and chronic kidney disease. The ability to perform bedside echocardiography has made it particularly useful in critical care settings, allowing for rapid assessment of cardiac function in hemodynamically unstable patients. Echocardiography also plays a key role in guiding therapeutic interventions, from fluid management to valvular repair and replacement procedures. Despite its many advantages, echocardiography is not without limitations. Image quality may be compromised in patients with obesity, lung disease, or prior thoracic surgery, necessitating alternative imaging modalities like cardiac magnetic resonance imaging or computed tomography. Operator expertise is another critical factor influencing diagnostic accuracy, underscoring the importance of proper training. Recent advancements, including artificial intelligence integration and portable devices, are expected to further expand the role of echocardiography, making it more accessible in diverse clinical settings. This narrative review highlights the broad clinical utility of echocardiography in internal medicine, its challenges, and the future directions that promise to enhance its role in patient care.

Feasibility of automated surveillance of implantable devices in orthopaedics via clinical data warehouse: the Studio study

BackgroundTotal hip, knee and shoulder arthroplasties (THKSA) are increasing due to expanding demands in ageing population. Material surveillance is important to prevent severe complications involving implantable medical devices (IMD) by taking appropriate preventive measures. Automating the analysis of patient and IMD features could benefit physicians and public health policies, allowing early issue detection and decision support. The study aimed to demonstrate the feasibility of automated cohorting of patients with a first arthroplasty in two hospital data warehouses (HDW) in France.MethodsThe study included adult patients with an arthroplasty between 2010 and 2019 identified by 2 data sources: hospital discharge and pharmacy. Selection was based on the health insurance thesaurus of IMDs in the pharmacy database: 1,523 distinct IMD references for primary THSKA. In the hospital discharge database, 22 distinct procedures for native joint replacement allowing a matching between IMD and surgical procedure of each patient selected. A program to automate information extraction was implemented in the 1st hospital data warehouse using natural language processing (NLP) on pharmacy labels, then it was then applied to the 2nd hospital.ResultsThe e-cohort was built with a first arthroplasty for THKSA performed in 7,587 patients with a mean age of 67.4 years, and a sex ratio of 0.75. The cohort involved 4,113 hip, 2,630 knee and 844 shoulder surgical patients. Obesity, cardio-vascular diseases and hypertension were the most frequent medical conditions.DiscussionThe implementation of an e-cohort for material surveillance will be easily workable over HDWs France wild. Using NLP as no international IMD mapping exists to study IMD, our approach aims to close the gap between conventional epidemiological cohorting tools and bigdata approach.ConclusionThis pilot study demonstrated the feasibility of an e-cohort of orthopaedic devices using clinical data warehouses. The IMD and patient features could be studied with intra-hospital follow-up and will help analysing the infectious and unsealing complications.

The development of a Hub & Spoke network for transcatheter aortic valve replacement procedures: the operational model of the Interventional Cardiology Unit at the IRCCS San Raffaele Hospital (OSR Hub-Spoke)

Recently, an increase in the number of patients with severe aortic stenosis eligible for transcatheter aortic valve implantation (TAVI) has been observed worldwide. In order to reduce waiting lists, provide to all patients referred to us equal access to care and to further improve the collaboration with spoke centers, we developed a specific Hub & Spoke specific protocol for TAVI. According to our protocol, a clinical selection (with echo and computed tomography scan) is done by Spoke centers, the case is discussed with a multidisciplinary team online and the procedure is planned (access, valve type size). At day 0, the patient is admitted in Spoke centers where blood samples are taken; at day 1, the patient is transferred to a Hub center for the TAVI procedure and after 2 h of observation, if no adverse events are registered, the patient is transferred back to the Spoke center. Since 2019, an agreement among our center and two hospitals has been signed. According to this Hub & Spoke model, a total of 72 patients with aortic stenosis were treated with TAVI (mean age 83 years, 48.6% female, median Society of Thoracic Surgeons risk 2.4 ± 1.1%, left ventricular ejection fraction 58.0 ± 7.75%). More frequently CoreValve Evolut R (47.2%) was used. Only 2 patients had a prolonged admission at Hub and were not transferred at day 1 (1 vascular complication and 1 intra-procedural resuscitated cardiac arrest). This Hub & Spoke model guaranteed shortening of waiting lists, more effective turnover of bed, equal access to care to patients referred to our center. In addition, it helped also to increase Awareness and education as well as appropriate training of the teams from spoke facilities.

Rhythm disorders in patients after a transcatheter aortic valve replacement procedure

Rhythm disorders in patients after a transcatheter aortic valve replacement procedure

Cost-effective Skin Marking in Joint Replacement Surgery: A Comparative Study between Methylene Blue Ink and Commercially Available Skin Markers.

This study aimed to assess and compare the effectiveness and safety of methylene blue ink and commercially available surgical marker pens in pre-operative skin marking for joint replacement procedures. The objective was to evaluate the visibility of the surgical instruments during the operation and their influence on the occurrence of infections after the surgery, providing valuable information on the practical use and cost-effectiveness. This retrospective randomized study involved 150 total cases, which included knee replacements, total hip replacements, and hip hemiarthroplasty performed between 2020 and 2023. The same surgeon conducted all procedures, and the patients were randomly assigned to two groups: One marked with methylene blue ink and the other with a commercially available sterile marker pen. Limb preparation followed an identical protocol for both groups. The primary outcomes assessed were the visibility of markings at the end of the procedure and the incidence of post-operative infections. The visibility of markings was satisfactory in both groups, with the methylene blue group displaying more pronounced visibility. Importantly, there were no cases of post-operative infections or permanent tattooing attributed to either marking method. This study demonstrates that both methylene blue ink and commercially available surgical marker pens provide effective skin markings for surgical procedures without increasing the risk of post-operative infections or causing permanent tattooing. Methylene blue ink showed more evident marking post-procedure and ink form remains a cheaper alternative.