Risk Factors For Reintervention Research Articles

Midterm Results and Predictors for the Postoperative Vascular Stenosis of Supravalvular Aortic Stenosis

This study reviewed the midterm outcomes of supravalvular aortic stenosis (SVAS) repair and determined the risk factors associated with postoperative aortic or pulmonary stenosis. We retrospectively reviewed 225 patients who underwent surgical correction of SVAS from 2010 to 2019. A total of 178 (79.1%), 44 (19.6%) and 3 (1.3%) patients underwent McGoon, Doty, and Brom repair, respectively. The median age at surgery was 2.2 years (interquartile range, 1.2-4.4). The median follow-up time was 3.7 years (interquartile range, 1.9-5.7). Early and late mortality rates were 3.1% and 1.4%, respectively. The overall 5-year survival rate was 97.9%. Eleven patients received reintervention, including 6 (2.8%) reoperations and 5 (2.3%) balloon dilatations. Higher preoperative pressure gradient at the distal ascending aorta or aortic arch was a risk factor for reintervention (P = 0.04). Rates of mortality and complications were not related to the surgical technique. Eleven patients (5.2%) developed sinotubular junction (STJ) stenosis. Freedom from postoperative distal artery stenosis (DAS) of type II SVAS was significantly lower than that of type I (P < 0.01). Higher preoperative pressure gradient at the STJ (P < 0.01) and concomitant bilateral or peripheral pulmonary artery (PA) stenosis (P < 0.01) were risk factors for postoperative DAS. Postoperative PA stenosis occurred more frequently in patients who received bilateral pulmonary arterioplasty (P < 0.01). Postoperative prognosis of the aortic root after SVAS repair was satisfactory. DAS and PA stenosis were common. The results of bilateral pulmonary arterioplasty were unsatisfactory. The surgical timing and technique for PA stenosis should be carefully considered.

Long-term outcome of percutaneous balloon aortic valvuloplasty for children with congenital aortic valve stenosis

Objective: To assess the efficacy and long-term outcome of percutaneous balloon aortic valvuloplasty (PBAV) for children with congenital aortic stenosis (CAS) and to explore risk factors for significant aortic regurgitation (AR) and reintervention after PBAV during follow up. Methods: This was a retrospective study. Children (≤18 years old) with CAS, who underwent PBAV in Guangdong Provincial Hospital from January 2004 to December 2018, were included in this study. Demographic, preoperative transthoracic echocardiography (TTE) and surgical data were collected. Postoperative complications were closely observed, and the patients were followed up at 1, 6, 12 months after the operation, and then at one year interval thereafter. Endpoint events included significant AR and reintervention. Reintervention was defined as any intervention that needed to be performed on the valve for various reasons, including re-PBAV, surgical valvuloplasty and valve replacement. Significant AR was defined as AR grade≥3 by TTE criteria. The results of the last TTE examination before the end of the study were collected. The Kaplan-Meier curve for long-term AR-free and intervention-free survival was plotted. Cox regression model was used to further analyze the risk factors for significant AR and reintervention after PBAV in CAS patients. Results: A total of 55 patients were enrolled in this study, and the age was 4.6(1.6, 6.5) years, with 37(67.3%) males. The peak systolic valve gradient fell from (80.3±30.6)mmHg to (38.5±18.5)mmHg(P<0.001, 1 mmHg=0.133 kPa). Surgical success rate was 89% (49/55). Acute post-PBAV AR occurred in 18 patients, including 3 patients with RA≥3 grade. In-hospital complications occurred in 6 patients (2 deaths, 2 cases of transient arrhythmia, and 2 cases of femoral artery embolization). Fifty patients accomplished the follow-up and the follow-up time was 6.2(3.4, 8.5) years. Significant AR was found in 20 patients. Significant AR-free survival rate was 53% at 5 years and 19% at 10 years. Reintervention was performed in 11 patients (4 with valvuloplasty and 7 with valve replacement), and the 5-year and 10-year intervention-free survival rates were 87% and 62%, respectively. Multivariate Cox regression analysis showed that acute post-PBAV AR was a risk factor for long-term significant AR (HR=2.398, 95%CI 1.007-5.712, P=0.048). Post-PBAV residual pressure gradient ≥ 35 mmHg (HR=4.747, 95%CI 1.116-19.329, P=0.030)and acute post-PBAV AR (HR=5.104, 95%CI 1.083-24.065, P=0.039)were risk factors for re-intervention. Conclusions: PBAV is safe and effective in the treatment of CAS in children, but attention should be paid on significant AR post procedure. Acute post-PBAV AR is a risk factor for re-intervention and significant AR post PBAV, and high post-PBAV residual pressure gradient is a risk factor for re-intervention.

Patients with Critical Limb Ischemia Requiring Intervention: Occurrence and Risk Factors for Reintervention

Patients with Critical Limb Ischemia Requiring Intervention: Occurrence and Risk Factors for Reintervention

Reintervention or mortality within 90 days of bariatric surgery: population-based cohort study.

Bariatric surgery carries a risk of severe postoperative complications, sometimes leading to reinterventions or even death. The incidence and risk factors for reintervention and death within 90 days after bariatric surgery are unclear, and were examined in this study. This population-based cohort study included all patients who underwent bariatric surgery in one of the five Nordic countries between 1980 and 2012. Data on surgical and endoscopic procedures, diagnoses and mortality were retrieved from national high-quality and complete registries. Multivariable Cox regression analysis was used to calculate hazard ratios (HRs), adjusted for country, age, sex, co-morbidity, type of surgery and approach, year and hospital volume of bariatric surgery. Of 49 977 patients, 1111 (2·2 per cent) had a reintervention and 95 (0·2 per cent) died within 90 days of bariatric surgery. Risk factors for the composite outcome reintervention/mortality were older age (HR 1·65, 95 per cent c.i. 1·36 to 2·01, for age at least 50 years versus less than 30 years) and co-morbidity (HR 2·66, 1·53 to 4·62, for Charlson co-morbidity index score 2 or more versus 0). The risk of reintervention/mortality was decreased for vertical banded gastroplasty compared with gastric bypass (HR 0·37, 0·28 to 0·48) and more recent surgery (HR 0·51, 0·39 to 0·67, for procedures undertaken in 2010 or later versus before 2000). Sex, surgical approach (laparoscopic versus open) and hospital volume did not influence risk of reintervention/mortality, but laparoscopic surgery was associated with a lower risk of 90-day mortality (HR 0·29, 0·16 to 0·53). Reintervention and death were uncommon events within 90 days of bariatric surgery even in this unselected nationwide cohort from five countries. Older patients with co-morbidities have an increased relative risk of these outcomes.

Frailty in patients with abdominal aortic aneurysm predicts prognosis after elective endovascular aneurysm repair

ObjectiveThe diagnostic criteria for frailty in patients with abdominal aortic aneurysm (AAA) are undefined. Our purpose was to examine the influence of new diagnostic criteria for frailty on overall survival after endovascular aneurysm repair (EVAR). MethodsWe retrospectively analyzed data for patients undergoing EVAR between 2007 and 2015. Isolated common iliac artery aneurysm and ruptured AAA were excluded. Patients were defined as having frailty when they had at least two of low Geriatric Nutritional Risk Index, sarcopenia, or nonambulatory status. We examined whether frailty affected overall survival, postoperative complications, and reintervention. ResultsOver the study period, 349 patients underwent EVAR. Thirty-three patients were excluded. The 5-year overall survival after EVAR was 76.7% for the frailty-negative group vs 43.1% for the frailty-positive group (P < .01). Age, frailty-positive status, and current cancer therapy were risk factors for overall survival. Positive frailty was the only risk factor for postoperative complications. Forty-two patients underwent reintervention. Outside instructions for use was a risk factor for reintervention after EVAR. ConclusionsAssessing frailty in patients with AAA is useful for determining risk factors for 5-year overall survival and postoperative complications.

Mid-Term Valve-Related Outcomes After Transcatheter Tricuspid Valve-in-Valve or Valve-in-Ring Replacement

BackgroundTranscatheter aortic and pulmonary valves have been used to treat stenosis or regurgitation after prior surgical tricuspid valve (TV) replacement or repair. Little is known about intermediate-term valve-related outcomes after transcatheter tricuspid valve replacement (TTVR), including valve function, thrombus, and endocarditis. ObjectivesThe authors sought to evaluate mid-term outcomes in a large cohort of patients who underwent TTVR after surgical TV repair or replacement, with a focus on valve-related outcomes. MethodsPatients who underwent TTVR after prior surgical TV replacement or repair were collected through an international registry. Time-related outcomes were modeled and risk factors assessed. ResultsData were collected for 306 patients who underwent TTVR from 2008 through 2017 at 80 centers; 52 patients (17%) had a prior history of endocarditis. Patients were followed for a median of 15.9 months after implantation (0.1 to 90 months), with 64% of patients estimated to be alive without TV reintervention or a valve-related event at 3 years. The cumulative 3-year incidence of death, reintervention, and valve-related adverse outcomes (endocarditis, thrombosis, or significant dysfunction) were 17%, 12%, and 8%, respectively. Endocarditis was diagnosed in 8 patients 2 to 29 months after TTVR, for an annualized incidence rate of 1.5% per patient-year (95% confidence interval: 0.45% to 2.5%). An additional 8 patients were diagnosed with clinically relevant valve thrombosis, 3 in the short term, 2 within 2 months, and 3 beyond 6 months. Only 2 of these 8 patients received anticoagulant therapy before thrombus detection (p = 0.13 vs. patients without thrombus). Prior endocarditis was not a risk factor for reintervention, endocarditis, or valve thrombosis, and there was no difference in valve-related outcomes according to TTVR valve type. ConclusionsTV dysfunction, endocarditis, and leaflet thrombosis were uncommon after TTVR. Patients with prior endocarditis were not at higher risk for endocarditis or other adverse outcomes after TTVR, and endocarditis occurred with similar frequency in different valve types. Though rare, leaflet thrombosis is an important adverse outcome, and further study is necessary to determine the appropriate level of prophylactic therapy after TTVR.

Long-Term Outcomes of Coarctation Repair Through Left Thoracotomy

Optimal surgical approach for repair of coarctation of the aorta (CoA) remains controversial. This study aimed to evaluate reintervention rates and its predictors by using a strategy of resection with extended end-to-end anastomosis (REEEA) through left thoracotomy. A retrospective analysis was performed for all patients who underwent isolated CoA repair or simultaneous repair of CoA and ventricular septal defect repair by REEEA between January 2000 and December 2015 at Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Patients with complex congenital heart disease were excluded. Transverse arch hypoplasia was defined as echocardiographic z-score lower than-2 or by documentation in medical or operative reports. Reintervention was defined as the need for balloon angioplasty or reoperation. Hypertension was defined as antihypertensive medication use or blood pressure greater than or equal to the 95th percentile. A total of 251 patients with median age at repair of 14.6 days met inclusion criteria. Repair was by left thoracotomy in 226 (90%). Follow-up data were available for 186 of 251 patients, with median follow-up time of 5.4 years (range, 0.2 to 15.3 years); 169 (91%) of these patients underwent thoracotomy. There were no early deaths or early reoperations. A proximal transverse arch z-score lower than-4.1 or a distal transverse arch z-score of less than-2.8 was predictive of repair through sternotomy. Only 4 (2%) patients required reintervention (2 patients had balloon angioplasties, 2 had reoperations). Transverse arch hypoplasia was a risk factor for reintervention (p= 0.048), but surgical approach was not (p= 0.35). Late hypertension was identified in only 33 of 186 (18%) patients. Repair of CoA, even with associated transverse arch hypoplasia, by REEEA through left thoracotomy has a low mortality, low reintervention rate, and low incidence of late hypertension.

Reintervention following stage 1 palliation: A report from the NPC-QIC Registry.

Single ventricle heart disease with aortic arch hypoplasia has high morbidity and mortality, with the greatest risk after stage 1 palliation. Residual lesions often require catheter-based or surgical reintervention to minimize risk. We sought to describe the types, frequency, and risk factors for re-intervention between stage 1 and stage 2 palliation, utilizing the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) registry. The NPC-QIC registry, consisting of patients discharged after stage 1 palliation, was queried. Hybrid stage 1 palliation patients were excluded from this study. The primary risk factor was shunt type and the primary outcome was re-intervention. Of 1156 patients, (50%) had re-intervention. There was no difference in total rate of re-intervention by shunt type (BT shunt 52% vs. RVPA shunt 48%; P=.17). Patients with a BT shunt had increased re-intervention during stage 1 hospitalization (P=.002). During the interstage period, following discharge from stage 1 palliation, patients with a BT shunt had increased aortic arch re-intervention (P<.005), while patients with an RVPA shunt had increased re-intervention on the shunt and the pulmonary arteries (P=.02). Postoperative mechanical ventilation >14 d (P<.01) was the only risk factor associated with re-intervention by multivariable analysis, regardless of shunt type. Re-intervention between stage I and stage 2 palliation is common. There is no difference in cumulative frequency of re-intervention between shunt types, though types and timing of re-intervention varied between shunt types. Longitudinal assessment of the NPC-QIC database is important to identify long term outcomes of patients requiring re-intervention.

Reintervention Burden and Vessel Growth After Surgical Reimplantation of a Pulmonary Artery During Childhood.

Children requiring reimplantation of a branch pulmonary artery (PA) are at risk for postoperative stenosis and impaired growth of the reimplanted PA. Outcomes and risk factors for reintervention and impaired growth are incompletely described. We reviewed data on patients who underwent reimplantation of a branch PA between 1/1/99 and 5/1/15 at a single center. The primary outcome was reintervention to treat postoperative stenosis. The secondary outcome was "catch-up" growth (faster diameter growth of the affected PA compared with the unaffected PA from the preoperative to follow-up measurements.). Twenty-six patients were identified with a total follow-up of 102.2 patient-years (median 2.5years). Diagnoses included LPA sling (n=12) and isolated PA of ductal origin with (n=7) or without (n=7) tetralogy of Fallot (ToF). All had primary repair of the anomalous PA. Seventeen (65%) had reintervention with median time to first reintervention of 69 (range 1-1005) days and median of 1.5 (range 1-6) reinterventions. 94% of reinterventions were transcatheter (53% balloon and 41% stent angioplasty). Patients with reintervention were younger (hazard ratio 0.75 per log-day, p=0.02) and lower weight (hazard ratio 0.18 per log-kg, p=0.02) at initial repair. Of the 18 with PA growth data, 8 (44%) had catch-up growth. There were no identified differences between those who did and did not demonstrate catch-up growth. Despite a practice of primary reimplantation and aggressive postoperative reintervention, these results suggest that changes in strategy are needed or that there are intrinsic patient factors that have more influence on longer-term reimplanted PA growth.

Long-Term Outcomes After Surgical Pulmonary Arterioplasty and Risk Factors for Reintervention

Although surgical patch arterioplasty is the conventional therapy for branch pulmonary artery (PA) stenosis, limited data exist on long-term outcomes. We examined the incidence of and risk factors for reintervention after surgical arterioplasty for branch PA stenosis in biventricular congenital heart disease. This retrospective cohort study included patients with 2-ventricle physiology who underwent patch arterioplasty for PA stenosis at a single high-volume congenital heart center during a 10-year period. Freedom from surgical or percutaneous reintervention for recurrent PA stenosis was evaluated. Univariate and multivariable Cox regression analyses were performed to determine risk factors for reintervention. Among 135 patients, the median age at patch arterioplasty was 0.9 years. Survival to hospital discharge (or 30 days postoperatively) was 96%. During a median follow-up period of 4.0 years, reintervention for PA stenosis occurred in 38 of 115 patients (33%) at a median time to reintervention of 1.4 years. The overall 10-year reintervention rate was 54%. In univariate analysis, age less than 30 days at initial arterioplasty, congenital PA stenosis (vs acquired), and bilateral PA stenosis (vs unilateral) were significantly associated with reintervention. In multivariable analysis, neonatal age (adjusted hazard ratio, 3.6; p= 0.002) and bilateral PA stenosis (adjusted hazard ratio, 2.8; p= 0.005) remained independently associated with reintervention. Long-term reintervention for recurrent PA stenosis after patch arterioplasty is common. Patients with bilateral PA stenosis or age younger than 30 days at the time of the index pulmonary arterioplasty are at higher risk for reintervention. These patients may benefit from frequent monitoring or novel approaches to repair.

Metabolic Syndrome but not Obesity Adversely Affects Outcomes after Open Aortoiliac Bypass Surgery

Although the incident risk of peripheral artery disease increases in patients with metabolic syndrome, several authors report favorable outcomes in obese patients after arterial bypass surgery. We examine the effect of the so-called "obesity paradox" and metabolic syndrome on outcomes after open aortoiliac bypass surgery. We identified patients between 2004 and 2015 who had open surgical bypass for aortoiliac occlusive disease. We excluded patients with endovascular repair and those treated primarily for aneurysmal disease. Variables that were analyzed included preoperative medical history, Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease II classification, Rutherford classification, intra-operative, and postoperative outcomes. Metabolic syndrome was defined by World Health Organization criteria: diabetes and 2 or more of dyslipidemia, hypertension, and obesity (body mass index > 30kg/m2). Data were analyzed by stratified Kaplan-Meier and multiple Cox regression for outcomes including long-term mortality and reintervention rate. There were 154 open bypass surgery patients during the study period with a median age of 60years (interquartile range [IQR] 53-68), median glomerular filtration rate 76.1mL/min (IQR 54-102), and 58% female prevalence. In all, 53 patients had metabolic syndrome (4%), and 14 patients (9%) were obese but did not have metabolic syndrome. Primary bypass graft patency was 89.0±2.7% at 1 year and 77.4±4.1% at 5 years and was not significantly different between metabolic syndrome, obese, and nonmetabolic syndrome patients. Reintervention rate for the entire cohort was 25.3±3.7% at 1 year and 40.6±4.7% at 5 years. In those with and without metabolic syndrome, reintervention rate at 1 and 5 years was 33.0±6.8% vs. 21.1±4.2% and 56.1±7.9% vs. 30.7±5.4%, respectively (log-rank P=0.003). In multivariable analyses, metabolic syndrome (hazard ratio [HR] 1.8, P=0.036) and critical limb ischemia (CLI) (HR: 3.2, P=0.001) were the only independent predictors of reintervention. Neither obesity nor the individual components comprising metabolic syndrome was a risk for reintervention. Multivariate analysis demonstrated age, female gender, CLI, and nonobesity as the independent risk factors for long-term mortality. Our study supports the "obesity paradox" that obesity by itself is not a risk factor for reintervention and was a protective factor for mortality after open aortoiliac bypass surgery. Bypass graft patency and major amputation rates were not affected. Although the individual components do not predispose to worse outcome, metabolic syndrome is a constellation of factors that, together, are associated with adverse events.

The Use and Outcomes of Small, Medium and Large Premounted Stents in Pediatric and Congenital Heart Disease.

We sought to describe the use and outcomes of small, medium and large premounted stents in patients with congenital heart disease, including incidence of and risk factors for re-intervention and development of in-stent stenosis. Premounted stents offer several advantages over traditional manually crimped bare-metal stents, especially in small patients. There are no data describing the medium-term effectiveness and outcomes of premounted stents in congenital heart disease. We performed a single-center retrospective review of all small, medium and large premounted stents implanted over an 8-year period. Premounted stents were implanted in 71 vessels within 59 patients with a 97% success rate. Regardless of implantation site, premounted stent implantation resulted in significant improvements in vessel size and pressure gradient (p<0.0001). Over a median follow-up duration of 3.1years [interquartile range (IQR) 1.3-5.2], 25 patients (43%) required re-intervention (18 catheter based, 3 surgical and 4 hybrid) at a median time of 1.4years (IQR 0.9-3.0) from implant. Factors associated with re-intervention included age ≤1.9years [hazard ratio (HR) 2.4, p=0.03], weight ≤11.5kg (HR 2.5, p=0.03) and bare-metal premounted stents compared to covered premounted stents (HR 4.2, p=0.001). In-stent stenosis was diagnosed in 42% of premounted stents which underwent follow-up angiography. No identified characteristics were associated with in-stent stenosis, including "oversizing" the premounted stent. Small, medium and large premounted stents are effective in treating vascular stenosis in congenital heart disease. Frequent follow-up is required, especially in smaller patients with expected somatic growth, and to evaluate forin-stent stenosiswhich occurs in nearly half of premounted stents.

Risk factors for long-term outcome in photoselective vaporization of the prostate

Objective: The aim of this retrospective cohort study was to investigate long-term risk factors for reintervention after photoselective vaporization of the prostate (PVP).Material and methods: In total, 566 consecutive patients with benign prostatic hyperplasia (BPH) underwent PVP between February 2005 and April 2011. Mean follow-up was 36.42 ± 21.4 months. Perioperative parameters were evaluated, including surgery time, delivered energy, catheterization and duration of hospitalization, intraoperative and postoperative complications, as well as reintervention rates in manifest reobstruction. Follow-up comprised the International Prostate Symptom Score and quality of life questionnaire (IPPS-QoL), maximal flow rate (Qmax) and postvoiding residual volume (PVR).Results: Mean operation time was 69.8 ± 29.3 min. Mean catheterization and hospitalization times were 1.49 ± 1.19 days and 2.67 ± 2.19 days, respectively. There was ongoing oral anticoagulation for 20.1% of the patients (n = 114). The overall retreatment rate was 17.6% (101 out of 566 patients) after a mean time of 9.21 months (range 0–64 months). Of these, 88 patients (15.55%) had a reobstruction and 13 (2.3%) had urethral strictures. In multivariate analysis, age, prostate volume, total applied energy, specific laser energy usage, preoperative symptomatic (IPSS/QoL) and functional obstruction grade (Qmax/PVR) were not identified as risk factors for reintervention. A poor postoperative Qmax (< 15 ml/s) measured immediately after removal of the transurethral catheter was identified as a risk factor for undergoing a reintervention (p = 0.005).Conclusions: PVP is an effective method for BPH treatment, allowing for sustained long-term improvement of the voiding function. Poor immediate postoperative urinary flow after removal of the transurethral catheter (Qmax < 15 ml/s) is a significant risk factor for reintervention.

Endovascular stent-graft treatment for graft-vein anastomotic stenosis in haemodialysis patients with arteriovenous grafts.

In this study, we investigated the patency of endovascular stent grafts in haemodialysis patients with arteriovenous grafts, the modes of patency loss, and the risk factors for re-intervention. Haemodialysis patients with graft-vein anastomotic stenosis of their arteriovenous grafts who were treated with endovascular stent-grafts between 2008 and 2013 were entered into this retrospective study. Primary and secondary patency, modes of patency loss, and risk factors for intervention were recorded. Cumulative circuit primary patency rates decreased from 40.0% at 6 months to 7.3% at 24 months. Cumulative target lesion primary patency rates decreased from 72.1% at 6 months to 22.0% at 24 months. Cumulative secondary patency rates decreased from 81.3% at 12 months to 31.6% at 36 months. Patients with a history of cerebrovascular accident had a significantly higher risk of secondary patency loss, and graft puncture site stenosis jeopardised the results of stent-graft treatment. Our data can help to improve outcomes in haemodialysis patients treated with stent-grafts for venous anastomosis of an arteriovenous graft.

Performance of Bridging Stent-grafts in Fenestrated and Branched Aortic Endografting

Introduction: Bridging stent-grafts (BSGs) are used to connect the target vessel with the main body during fenestrated or branched aortic endografting (f/bEVAR). At present, no dedicated device is available as BSG and different combinations of stent-grafts and relining stents have been proposed. Aims of this study were to assess the performance of the BSGs and to address potential risk factors for poor outcomes. Methods: Between 01/2010 and 03/2014, 150 consecutive patients underwent f/bEVAR and 515 target vessels were revascularized. Main measure outcome was any BSG-related complication. A logistic regression analysis including target vessel type, type of endografting (fenestrated or branched) and type of BSG identified potential risk factors for the main measure outcome. Results: The main body consisted of only fenestrations in 72 patients (48%), only branches in 68 patients (45%) and a combination of both in 10 patients (7%). Fenestrated devices were implanted mainly by Crawford type 4 and juxtarenal aneurysms (n = 57, p < 0.001). The target vessels included 104 celiac-, 139 superior mesenteric-, 268 renal- and 3 other arteries. The technical success amounted to 99.6% (511 out of 515 target vessels). Balloon expandable BSG were mainly used (n 490, 95.7%) and in 329 was relining stent combined (64.4%). Main reasons for technical failure were the dislocation of the main body (n = 2) and unsuccessful cannulation (n = 2). One could be revascularized by means of the periscope technique. Three renal arteries in two patients (0.5%) occluded perioperatively. After a mean follow-up of 11 months (range 1–41), 5 other renal artery occlusions (0.9%) occurred and 17 BSG-reinterventions (3%) were performed (Figure: residual distal type 1 endoleak celiac artery after renal extension). No SMA occlusion was reported. The patency and freedom-from-reintervention rate at 2 years amounted to 97% and 93% respectively. Revascularization of the renal artery and use of a branched main body were the only independent risk factors for occlusion (odds ratio: 11.7; 95% CI: 1.4–91.9 P = 0.03 and 3.4; 95% CI: 0.9–13.3 P = 0.03, respectively). The branched main body was also risk factor for reintervention (odds ratio 4.0; 95% CI: 1.2–13.4 P = 0.002). Of note, use of relining stents seems not to prevent BSG-related complications. Conclusion: The currently used BSGs are showed low occlusion and reintervention rates. Outcomes after bEVAR and revascularization of the renal arteries might be improved by means of a dedicated device. SMA-related complications are rare or probably underestimated due to the associated mortality.

Preliminary Results from a Multicenter Registry of Infection in Abdominal Aortic Endovascular Repair (R.I.-EVAR)

endografting (fenestrated or branched) and type of BSG identified potential risk factors for the main measure outcome. Results: The main body consisted of only fenestrations in 72 patients (48%), only branches in 68 patients (45%) and a combination of both in 10 patients (7%). Fenestrated devices were implanted mainly by Crawford type 4 and juxtarenal aneurysms (n ¼ 57, p < 0.001). The target vessels included 104 celiac-, 139 superior mesenteric-, 268 renal- and 3 other arteries. The technical success amounted to 99.6% (511 out of 515 target vessels). Balloon expandable BSG were mainly used (n 490, 95.7%) and in 329 was relining stent combined (64.4%). Main reasons for technical failure were the dislocation of the main body (n ¼ 2) and unsuccessful cannulation (n ¼ 2). One could be revascularized by means of the periscope technique. Three renal arteries in two patients (0.5%) occluded perioperatively. After a mean follow-up of 11 months (range 1e41), 5 other renal artery occlusions (0.9%) occurred and 17 BSG-reinterventions (3%) were performed (Figure: residual distal type 1 endoleak celiac artery after renal extension). No SMA occlusion was reported. The patency and freedom-from-reintervention rate at 2 years amounted to 97% and 93% respectively. Revascularization of the renal artery and use of a branched main body were the only independent risk factors for occlusion (odds ratio: 11.7; 95% CI: 1.4e91.9 P ¼ 0.03 and 3.4; 95% CI: 0.9e 13.3 P ¼ 0.03, respectively). The branched main body was also risk factor for reintervention (odds ratio 4.0; 95% CI: 1.2e13.4 P ¼ 0.002). Of note, use of relining stents seems not to prevent BSGrelated complications. Conclusion: The currently used BSGs are showed low occlusion and reintervention rates. Outcomes after bEVAR and revascularization of the renal arteries might be improved by means of a dedicated device. SMA-related complications are rare or probably underestimated due to the associated mortality.

Reintervention after thoracic endovascular aortic repair of complicated aortic dissection

This study assessed predictive factors for reintervention after thoracic endovascular aortic repair (TEVAR) for complicated aortic dissection (C-AD). An institutional review of consecutive TEVAR for C-AD was performed. Between 2000 and 2011, 41 patients underwent TEVAR for a C-AD involving the descending thoracic aorta. Primary indications included aneurysm >55 mm in 24, rapid aneurysmal enlargement or impending rupture in 6, saccular aneurysm >20 mm in 1, malperfusion in 1, intractable chest pain in 3, and rupture in 6. Technical success was achieved in 100%. The 30-day mortality rate was 5% (n = 2). Fourteen secondary procedures were performed in 13 patients (32%) for indications of device migration in 2, proximal type I endoleak in 5, distal type I endoleak in 2, type II endoleak in 1, aneurysmal evolution of the descending thoracic aorta in 2, aneurysmal expansion of the dissected abdominal aorta in 1, and retrograde dissection in 1. Multivariate analysis demonstrated that oversizing ≥20% (odds ratio [OR], 16; P = .011), bare-spring stent in the proximal landing zone of the stent graft (OR, 12; P = .032), and anticoagulant therapy (OR, 78; P = .03) were significant factors for reintervention. On univariate analysis, large aneurysm was a risk factor for reintervention (P = .002), whereas complete false lumen thrombosis at the stent graft level was protective (P < .05). This study confirms the feasibility of TEVAR for C-AD, although the rate of reintervention is high. Excessive oversizing, a bare-spring stent graft in the proximal landing zone, large aortic dilatation, and anticoagulant therapy were factors associated with reintervention. Complete false lumen thrombosis at the stent graft level was protective.

Single-Center Experience of Arch Reconstruction in the Setting of Norwood Operation

Arch reconstruction is a key part of the Norwood operation for hypoplastic left heart syndrome and is related to late morbidity. Since 2003, our surgical technique has been standardized to a right ventricle to pulmonary artery conduit, arch reconstruction with homograft patch, and Damus-Kaye-Stansel anastomosis onto homograft patch, with partial or complete resection of any coarctation ridge. We studied the impact of the surgical approach on arch reinterventions and outcome. A retrospective review of echocardiogram, catheterizations, and hospital records of patients who underwent stage1 reconstruction from January 2003 to December 2010 was performed. A total of 289 patients underwent stage 1 reconstruction during this period. Age and body weight at operation were 9.3 ± 25 days and 3.1 ± 0.6 kg. Early survival was 86%. Seventy-three patients (25%) underwent intervention for recoarctation: balloon angioplasty (n = 68) or surgical intervention (n = 11). Eighteen patients underwent multiple interventions for recoarctation. Size of ascending aorta and incomplete resection of ductal tissue were risk factors for reintervention (p = 0.01 and p = 0.02). Patients with an ascending aorta diameter less than 2 mm had significantly higher reintervention rates (p = 0.01). Our standard technique for the Norwood operation has good results but further intervention for recoarctation is common. Size of ascending aorta and incomplete resection of coarctation tissue were risk factors for recoarctation. Complete resection of coarctation tissue may reduce the incidence of recoarctation. A small ascending aorta may predict late arch problems.

Corticosteroid Injection for Carpal Tunnel Syndrome: A 5-Year Survivorship Analysis

The purpose of our study was to determine the rate of carpal tunnel decompression (CTD) following local corticosteroid injection for carpal tunnel syndrome (CTS), as well as identifying predictors of requiring further intervention and eventual decompression. All patients diagnosed with CTS in our unit over a 6-year period were prospectively assessed. Patients were diagnosed using a combination of clinical presentation and nerve conduction studies. Patients were managed with open carpal tunnel decompression or corticosteroid injection. There were 1,564 consecutive patients diagnosed with CTS over the study period, of whom 824 (53%) underwent a corticosteroid injection as their primary treatment. We performed a survivorship analysis of these patients and used Kaplan-Meier survivorship methodology to determine the 5-year rate of re-intervention. Risk factors for re-intervention were also determined. The overall 5-year Kaplan-Meier rate of secondary CTD was 15% at 1year and 33% at 5years. The need for secondary CTD was independently associated with female gender, diabetes mellitus and positive nerve conduction studies at diagnosis. Steroid injection is an appropriate treatment in carefully selected patients. Those who are female, diabetic and have neurophysiological confirmation of diagnosis have the highest risk of relapse. These results may be used to guide initial treatment and counsel patients about the risk relapse.

MP-05.15 Long-Term Experience and Risk Factors for Reintervention in Photoselective Vaporisation of the Prostate (GreenlightTM)

MP-05.15 Long-Term Experience and Risk Factors for Reintervention in Photoselective Vaporisation of the Prostate (GreenlightTM)