Initial Single-center Experience Research Articles

Ultrasound-Guided Percutaneous Radiofrequency Ablation of Liver Metastasis From Ovarian Cancer: A Single-Center Initial Experience.

The aim of this study was to evaluate the feasibility, effectiveness, and safety of ultrasound-guided percutaneous radiofrequency ablation (RFA) for the treatment of liver metastasis from ovarian cancer (OC). A retrospective review was performed on 11 patients (mean age, 53.0 ± 10.1 years) with 22 liver metastases (mean diameter, 2.0 ± 0.8 cm) from OC undergone RFA. Radiofrequency ablation was carried out with Starburst XL electrodes (RITA Medical System, Mountain View, CA) or Cool-tip electrodes (Cool-tip Systems; Valleylab, Boulder, CO). The tumor response, time to progression, and survival after RFA were assessed. Complete ablation was achieved for all lesions. The technique effectiveness was 100%. During the follow-up period, local tumor progression was observed in 1 (4.5%) of 22 lesions. The median time to progression was 8.0 months after RFA. Three patients died because of disease progression after 13, 18, and 24 months, respectively. The mean overall survival time after RFA was 53.1 ± 10.0 months, with the 1-, 3-, and 5-year overall survival rates of 100%, 61%, and 61%, respectively. No major complications were encountered. Radiofrequency ablation as an alternative treatment strategy is feasible and effective for selected patients with liver metastasis from OC, providing a high rate of local tumor control.

Su1201 Initial Single-Center Experience of the New En-580T Double Balloon Enteroscope

Su1201 Initial Single-Center Experience of the New En-580T Double Balloon Enteroscope

Primary and Secondary Stroke Prevention Using Left Atrial Appendage Closure with Watchman Devices in Atrial Fibrillation Patients: A Single Center Experience from Mainland China.

Atrial fibrillation (AF) is associated with increased stroke risk resulting from cardiac embolism of the left atrial appendage (LAA). Stroke tends to recur in NVAF patients. Yet safety and feasibility of secondary stroke preventions with LAA closure (LAAC) have not been assessed in detail. This retrospective study was designed to compare the feasibility and safety of LAAC in primary and secondary stroke preventions, in a real-world setting of Chinese patients. From 2014 to 2015, non-valvular AF patients with CHA2DS2-VASc ≥1 were selected for percutaneous LAAC operations. Outcome observations of primary and secondary stroke preventions with Watchman devices were analyzed and compared. Overall, 122 patients were included. LAAC with Watchman devices were attempted in 115 patients, of whom 68 were for primary stroke prevention and 47 were for secondary prevention. Both the CHA2DS2-VASc score and the HASBLED score were significantly higher in the secondary prevention group (4.09 ± 1.06 vs. 1.93 ± 1.09 for CHA2DS2-VASc and 1.83 ± 1.03 vs. 1.26 ± 0.87 for HASBLED, P < 0.01). In both groups LAAC were achieved with high successful rate (98.53% in the primary prevention group and 100% in the secondary prevention group, P > 0.05) and low complication rates. The stroke rates were at a low level in both groups (1.47% in primary prevention group vs. 2.13% in secondary prevention group, P > 0.05). In our initial single-center experience, percutaneous LAA closure was a feasible and safe procedure for both primary and secondary stroke preventions in Chinese patients with nonvalvular AF.

Initial Single Centre Experience of a Novel Polymer-free Drug Eluting Stent (DES) (Cre-8) in a Real World All-Comer Patient Population

Cre-8 is a carbofilm coated cobalt-chromium amphilimus (sirolimus + organic acid) eluting stent using polymer free abluminal reservoir technology, configuration allowing increased sirolimus cellular dosing. We examined the efficacy, deliverability, deployability of Cre-8, 30- and 60-day MACCE (death, stroke, bleeding events, TLR, and rehospitalisation) in treated all-comer patients 52 consecutive patients were treated with Cre-8 stent over a 5-month period (November 2016 to March 2017) (71 vessels and 80 lesions: 50% were ACC/AHA type C, 16.3% were CTO), over half with ACS presentation (55.8%). All received dual antiplatelets and heparin. Patients had either single (n = 37, 71.2%) or multi-vessel stenting (double: 21.2%, triple 7.7%) (65 vessels stented, 6 ballooned only). 81 Cre-8 stents were deployed. Reference vessel size (mean) was 3.5 mm, longest stented length was 120 mm (mean length 30 mm). Procedural success was 100% with all stents being delivered and deployed. 1 case of acute stent thrombosis (ST) occurred due to patient factors (inadequate antiplatelet loading, antiphospholipid syndrome) and inadequate stent sizing (confirmed by IVUS). Post-dilatation performed (100%) with post-dilatation balloon greater than (74.1%) or equal to stent diameter (25.9%). Apart from 1 acute ST, all patients had no MACCE at 1 month (100%) and 2 months follow-up (73.1%). Cre-8 is safe and efficacious in our initial experience. Excellent deliverability and visibility with stent-edge markers were helpful in stent positioning. Large clinical trials are currently underway directly comparing efficacy with current DES. More data is needed.

Mechanical Thrombectomy in Acute Ischemic Stroke: Initial Single-Center Experience and Comparison with Randomized Controlled Trials

Until recently, intravenous thrombolysis was the only reperfusion therapy with proven efficacy in patients with acute ischemic stroke. However, this treatment option has low recanalization rates in large-vessel occlusions. The search for additional treatments continued until 5 randomized trials (MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, and REVASCAT) revealed the superiority of mechanical thrombectomy for anterior circulation large-vessel occlusion. After 1 year of performing thrombectomy with stent retrievers in our tertiary hospital, we intended to answer the question: is it possible to achieve similar results in a "real-world" setting? We analyzed data from our prospective observational registry, compared it with the trials aforementioned, and concluded that the answer is affirmative. Our study population of 77 patients, with a mean age of 68,2 years and 48,1% men, is comparable with these trials in much of selection criteria, baseline characteristics, and rate of previous intravenous thrombolysis (72,7%). Recovery of functional independence at 90 days was achieved in almost two thirds of patients, similarly to the referred trials. We devoted special emphasis on fast recanalization, keeping a simple image selection protocol (based on non-enhanced and computed tomography angiography) and not waiting for clinical response to thrombolysis in patients eligible for mechanical thrombectomy. We emphasize a successful recanalization rate of 87% and only 2,6% symptomatic intracranial hemorrhage. In summary, mechanical thrombectomy seems to be a safe and effective treatment option in a "real-world" scenario, with results similar to those of the recent randomized controlled trials.

TCT-12 Real World Utilization of Computed Tomography Derived Fractional Flow Reserve: Single Center Initial Experience in the United States

TCT-12 Real World Utilization of Computed Tomography Derived Fractional Flow Reserve: Single Center Initial Experience in the United States

Application of TWIST MR angiography to aid successful central venous access in challenging patients: initial single-centre experience

To investigate whether time-resolved angiography with interleaved stochastic trajectories (TWIST) with GeneRalised Autocalibrating Partially Parallel Acquisitions (GRAPPA) parallel acquisition could be used successfully to non-invasively and efficiently image patients with more complex vascular access issues. TWIST magnetic resonance angiography (MRA) in the GRAPPA algorithm was performed on 15 patients at our centre using the 1.5 T Siemens Magnetom Avanto MRI system. Images were interpreted by cardiac radiologists. TWIST provided excellent dynamic imaging of the venous system, demonstrating venous occlusion, stenoses, and collaterals, as well as providing good anatomical detail. TWIST MRA enables successful identification of candidate sites for central/tunnelled line access, whilst diagnosing complications of long-term access such as venous thrombosis or congenital venous anomalies.

Transcatheter aortic valve implantation with the new-generation Evolut R™: Comparison with CoreValve® in a single center cohort

BackgroundThe Medtronic Evolut R (EVR) is a novel transcatheter heart valve designed to allow precise implantation at the intended position and to minimize prosthesis dysfunction as well as procedural complications. Our aim was to compare short-term functional and clinical outcomes of the new EVR with the established Medtronic CoreValve (CV) system. Methods and resultsOf 151 patients undergoing transfemoral transcatheter aortic valve implantation with a self-expanding valve at our institution between January 2013 and January 2016, 86 were treated with EVR and 65 with CV. Patients treated with EVR had a significantly lower rate of more-than-mild aortic regurgitation and a higher rate of device success. Recapture maneuvers to optimize valve deployment were performed in 22.1% of the EVR procedures. Transvalvular post-procedural gradients were slightly higher in the EVR group, while no differences were observed in the incidence of safety endpoints at 30days, vascular complications, or need for permanent pacemaker implantation following asystole or complete atrioventricular block. ConclusionsThese initial single-center experience data on the short-term outcomes after EVR valve implantation show a substantially reduced rate of more-than-mild paravalvular regurgitation and higher device success, while 30-day safety outcomes were similar to the CV system. Clinical outcome data from long-term follow-up and larger scale multicenter experience are now necessary.

Removal of Caval and Right Atrial Thrombi and Masses Using the AngioVac Device: Initial Operative Experience

PurposeTo describe initial single-center experience with a thrombectomy device in managing right atrial and caval thrombi, tumors, and vegetations. Materials and MethodsA retrospective analysis of AngioVac thrombectomy performed in 16 patients (mean age 53 y ± 13; 8 men, 8 women) between August 2013 and August 2015 was performed. Indications included right atrial mass/thrombus (6/16; 37.5%) and iliocaval thrombus (10/16; 62.5%). Procedural success was defined as aspiration of > 70% volume of atrial mass/thrombus or restoration of antegrade caval flow. ResultsProcedural success was achieved in 4/6 (67%) right atrial masses/thrombi and 10/10 (100%) caval thrombi. All patients (8/8; 100%) with caval thrombus presenting with swelling/edema had improvement or resolution of symptoms. There were no procedural or periprocedural mortalities; complications included one major (6.3%; intraprocedural pulmonary embolus) and one minor (6.3%; access site hematoma not requiring transfusion) complication. Of 16 patients, 14 (87.5%) survived to discharge at a mean of 10 days ± 8 (range, 1–23 d), and 12 patients (75%) were alive at last known follow-up at a mean of 385 days ± 267 (range, 63–730 d). At a mean of 194 days ± 177 (range, 41–372 d), 4/16 (25%) patients were dead; no death was related to AngioVac thrombectomy. At a mean of 66 days ± 21 (range, 49–90 d) after intervention, 3/14 (21.4%) cases with procedural success had local recurrence of mass/thrombus. ConclusionsAngioVac thrombectomy can be performed with high procedural success with clinical benefit in patients with right atrial and caval masses/thrombi.

PS189 Safety and Efficacy of Percutaneous Left Atrial Appendage. Single Center-initial Experience

PS189 Safety and Efficacy of Percutaneous Left Atrial Appendage. Single Center-initial Experience

Invited Commentary

Rapid deployment and sutureless valves are being implanted with increasing frequency—particularly in Europe—but specific patient populations for these devices remain to be defined. Theron and colleagues [1Theron A. Gariboldi V. Grisoli D. et al.Rapid deployment of aortic bioprosthesis in elderly patients with small aortic annulus.Ann Thorac Surg. 2016; 101: 1434-1442Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar] have focused on the use of rapid deployment valves in a clinically important subgroup of patients in this issue of The Annals, namely, elderly patients with a small aortic annulus. Severe aortic stenosis is often accompanied by fibrosis and calcification of the aortic root in elderly patients, resulting in an inability to insert an adequately sized prosthesis. Simple implantation of a hemodynamically superior valve would be preferable to annular enlargement procedures in elderly patients. Aortic annular enlargement is associated with prolonged aortic cross-clamp and cardiopulmonary bypass times [2Kulik A. Al-Saigh M. Chan V. et al.Enlargement of the small aortic root during aortic valve replacement: is there a benefit?.Ann Thorac Surg. 2008; 85: 94-100Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar] and can be particularly challenging in patients with a calcified aortic root. Previous studies have demonstrated excellent hemodynamic performance for rapid deployment and sutureless valves [3Folliguet T.A. Laborde F. Zannis K. et al.Sutureless Perceval aortic valve replacement: results of two European centers.Ann Thorac Surg. 2012; 93: 1483-1488Abstract Full Text Full Text PDF PubMed Scopus (173) Google Scholar, 4Borger M.A. Moustafine V. Conradi L. et al.A randomized multicenter trial of minimally invasive rapid deployment versus conventional full sternotomy aortic valve replacement.Ann Thorac Surg. 2015; 99: 17-25Abstract Full Text Full Text PDF PubMed Scopus (150) Google Scholar]. Furthermore, a recent randomized clinical trial demonstrated significant reductions in early transvalvular gradients and prevalence of patient-prosthesis mismatch—despite a relatively small sample size—in patients receiving a rapid deployment valve compared with similarly sized conventional bioprostheses [4Borger M.A. Moustafine V. Conradi L. et al.A randomized multicenter trial of minimally invasive rapid deployment versus conventional full sternotomy aortic valve replacement.Ann Thorac Surg. 2015; 99: 17-25Abstract Full Text Full Text PDF PubMed Scopus (150) Google Scholar]. The hemodynamic benefits of these devices, combined with their rapid implantation times and subsequent reduction in myocardial ischemia [3Folliguet T.A. Laborde F. Zannis K. et al.Sutureless Perceval aortic valve replacement: results of two European centers.Ann Thorac Surg. 2012; 93: 1483-1488Abstract Full Text Full Text PDF PubMed Scopus (173) Google Scholar, 4Borger M.A. Moustafine V. Conradi L. et al.A randomized multicenter trial of minimally invasive rapid deployment versus conventional full sternotomy aortic valve replacement.Ann Thorac Surg. 2015; 99: 17-25Abstract Full Text Full Text PDF PubMed Scopus (150) Google Scholar, 5Schlomicher M. Haldenwang P.L. Moustafine V. Bechtel M. Strauch J.T. Minimal access rapid deployment aortic valve replacement: initial single-center experience and 12-month outcomes.J Thorac Cardiovasc Surg. 2015; 149: 434-440Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar], may make them an ideal option in elderly patients with a small aortic annulus. In addition, rapid deployment valves appear to facilitate minimally invasive operations. Minimally invasive rapid deployment valve implantation may represent an effective and financially attractive alternative to transcatheter aortic valve replacement procedures in medium-risk elderly patients. One may expect lower paravalvular leak rates and possibly decreased pacemaker implantation requirements compared with transcatheter aortic valve replacement. Results of two large, nearly completed U.S. Food and Drug Administration approval trials will hopefully shed more light on the use of these devices in elderly patients with small aortic annuli and whether they represent a good alternative to transcatheter aortic valve replacement in this patient population. Rapid Deployment of Aortic Bioprosthesis in Elderly Patients With Small Aortic AnnulusThe Annals of Thoracic SurgeryVol. 101Issue 4PreviewAortic valve replacement in elderly patients with a small aortic annulus remains challenging. Patient–prosthesis mismatch (PPM) should be prevented without impacting operative mortality. Hemodynamic benefits resulting from rapid-deployment aortic valve replacement with the Edwards Intuity bioprosthesis for this indication were evaluated. Full-Text PDF

Robotic simple prostatectomy: Initial single-center experience in Taiwan

ObjectiveFor patients with symptomatic large volume benign prostate hyperplasia, open simple prostatectomy has traditionally been the treatment of choice but laparoscopic simple prostatectomy (LSP) has become an effective surgical option. Since the first case of LSP was described in 2002, surgeons have continued to expand the use of minimally invasive surgery. In 2008, the first case of robotic simple prostatectomy (RSP) was reported. We herein report our initial experience with robotic simple prostatectomy. Materials and methodsWe performed retropubic robotic simple prostatectomy using a transperitoneal approach in 10 patients. All of them had significant symptomatic prostate enlargement confirmed by abdominal or transrectal ultrasound (mean 138.2 mL). Demographic data, perioperative outcomes, and functional outcomes were recorded. ResultsThe median age of patients was 68 years (range 60–76 years). The median International Prostate Symptom Score at baseline was 24 (range 18–34). The median operation time was 150 minutes (range 130–180 minutes). The median estimated blood loss was 100 mL (range 50–850 mL). Intraoperative blood transfusion was required in one patient (10%). The median resected prostate weight was 77.5 g (range 60–120 g). The median hospital stay was 5 days (range 3–5 days). The median urethral catheterization was 12 days (range 9–14 days). All of these patients gained significant improvement in maximum urine flow rate (preoperative vs. postoperative 9.8 mL/min vs. 21.5 mL/min, p = 0.001) and postvoid residual urine (preoperative vs. postoperative 125 mL vs. 10 mL, p = 0.001). ConclusionRobotic simple prostatectomy is a feasible alternative for a greatly enlarged prostate gland with acceptable complications.

0049: FDG-PET imaging for the management of suspected inflammatory cardiomyopathies beyond cardiac sarcoidosis: a single center initial experience

FDG-positron emission tomography (PET) has high diagnostic accuracy in cardiac sarcoidosis (CS). Beyond CS, the non invasive diagnosis of inflammatory cardiomyopathies (IC) is challenged by a lower diagnostic performance of usual tools as magnetic resonance imaging (MRI). 17 consecutive patients with suspected IC had a FDG-PET to detect myocardial inflammation. From all clinical data including PET, we classified patients in either CS or non-CS and respective PET data were compared. The clinical impact of adding PET in the non-CS group was evaluated by comparing diagnosis and management proposed by an expert blind to PET with final diagnosis and management actually held in practice. 6 patients had CS, all with positive PET. In the 11 non-CS patients, 7 had a positive PET. All had MRI late gadolinium enhancement in FDG uptake areas, suggesting a true positivity of PET for the presence of inflammation. PET data were all significantly different between CS and nonCS patients with positive PET, particularly the coefficient of variation of cardiac SUV which is an index of heterogeneity of FDG uptake was significantly greater in CS patients (0,4 vs 0,17 p<0,002). In non-CS patients, 2 were classified as certain IC, 2 as excluded IC, and 7 as possible IC by an expert blind to PET. Adding PET in clinical practice, IC was excluded for 5 of the 7 patients with possible IC, 2 patients remained with a possible IC diagnosis and the 2 certain IC were confirmed. PET did not change patient management in terms of endomyocardial biopsy or immunosuppressive therapy. Some patients with suspected IC had a positive FDG-PET in favour of myocardial inflammation, with a different pattern from that observed in CS. Adding PET to usual diagnostic tools led to a decrease of possible IC diagnosis that turned in excluded IC. These preliminary data suggest a potential role of PET for the non-invasive diagnosis of IC that will need further investigations. Abstract 0049 – Figure: FDG uptake concordant with MRI-LGE

MERS-CoV: Middle East respiratory syndrome corona virus: Can radiology be of help? Initial single center experience

Human infection with a novel coronavirus named Middle East respiratory syndrome coronavirus (MERS-CoV) was first identified in Saudi Arabia and the Middle East in September, 2012. The aim of this study was to establish the most pathognomonic radiological sign(s) to diagnose MERS CoV. Patients and methodsThis is a retrospective descriptive study. All patients were subjected to serial X-ray. High resolution non-contrast CT chest was also obtained for 10 patients. The scans were reviewed for findings including consolidation, ground-glass opacities, nodules, reticular opacities and hilar and mediastinal adenopathy. ResultsA total of 12 patients were included in our study with prevalence of males (2:1) with ages ranging between 18 and 76years having an average age of 36±2years. The outcome of these patients was as follows: 6 were treated with average hospital stay ranging between 21 and 35days, one case died after 14days, and 5 cases were transferred to Central Governmental hospital according the local authority rules. ConclusionsMERS CoV virus may have a specific pattern in chest X-ray and CT developing a single or multiple opacities progressing into a widespread multifocal bilateral patches of ground glass opacities or confluent consolidation resembling organizing pneumonia.

Radioembolization Using Yttrium-90 Microspheres as Bridging and Downstaging Treatment for Unresectable Hepatocellular Carcinoma Before Liver Transplantation: Initial Single-Center Experience

IntroductionHCC is the sixth most common malignancy worldwide and is the third most common cause of cancer related mortality. Moreover, the incidence of HCC is increasing. Surgical treatments for HCC including resection and/or transplantation provide the best curative outcomes in early stages. Unfortunately, many patients present at an advanced stage. Currently, locoregional therapies have an emerging role in the management of HCC for bridging to liver transplantation and for downstaging the disease to within transplant criteria. Radioembolization is among commonly used locoregional therapies. ObjectiveTo describe our initial experience with the use of Therasphere® as bridging or downstaging modality before liver transplantation, including our institutional indications, technique and outcome. Materials and MethodsWe retrospectively examined our database for liver transplantation after the use of Therasphere®. Nine patients were identified and reported. ResultsThey were 5 females and 4 males. Their current age range is 40–72 years with a mean of 53.8 ± 9.5 years. Three patients had Therasphere® as downstaging treatment to our institutional transplantation criteria. Our institution is using UCSF criteria as a cut off limit for liver transplantation as primary treatment modality. The other 6 patients had Therasphere® as bridging for liver transplantation especially when other modalities are not possible. None of these lesions were treated by any other locoregional treatment before or after Therasphere®. Follow-up after liver transplantation ranged between 3.7 and 60.1 months (mean of 15.8 ± 17.7 months). All patients are still living, no retransplantation was done and none of them showed evidence of disease recurrence (100% graft, patient and disease free survival). ConclusionOur initial experience showed that Therasphere® is a promising therapeutic tool for both downstaging and bridging of HCC before liver transplant.

Initial Single-Center Experience with the Ovation Stent-Graft System in the Treatment of Abdominal Aortic Aneurysms: Application to Challenging Iliac Access Anatomies

To present our preliminary results with the Ovation(™) abdominal stent-graft system in abdominal aortic aneurysms (AAA) with narrow (≤7 mm) or angulated iliac vessels. From April 2012 to January 2014, 42 patients (97% men; mean age, 71 years; range, 55-89 years) with AAAs of 55.5 mm (50-79 mm) were treated with the Ovation device. Primary end points included technical success and freedom from early secondary interventions, any type of endoleak, and aneurysm-related death. Limb occlusion was studied with respect to iliac access diameter and angulation. Iliac angulation between 90° and 120° or <90° was considered moderate or severe, respectively. The postoperative follow-up was 7.8 ± 4.6 months (mean ± standard deviation). Infrarenal neck angulation was 26° ± 26°. AAA neck length and diameter were 27.3 ± 10.5 and 24.1 ± 3.2 mm, respectively. Forty-five percent of patients had at least 1 vessel of ≤7-mm diameter, and almost half of patients (24 of 44) had at least 1 iliac artery of moderate or severe angulation. Technical and treatment success were 100% and 95%, respectively. No stent-graft migration or type I, III, or IV endoleaks occurred. Type II endoleaks were identified in 5 patients, leading to sac enlargement in 2 and necessitating an embolization attempt that was unsuccessful in 1 case. No limb occlusion occurred, irrespective of the iliac diameter or angulation. Our 1-year results of the Ovation stent-graft system demonstrate excellent safety and effectiveness. The easy navigation through highly angulated and stenosed iliac vessels ensures high technical success in cases of challenging iliac anatomy. Follow-up is ongoing.

Minimal access rapid deployment aortic valve replacement: Initial single-center experience and 12-month outcomes

A single-center observational study was initialized to evaluate the feasibility of rapid deployment aortic valve replacement using the Edwards Intuity valve system (Edwards Lifesciences Corp, Irvine, Calif) in a minimally invasive setting. A total of 60 implantations have been performed at the Ruhr University Hospital Bergmannsheil using a minimal access technique. We present the first short-term and 12-month clinical and hemodynamic results. Aortic valve replacement using a partial sternotomy was performed in all patients. Patients' mean age was 75.5 (±6.2) years. The mean logistic European System for Cardiac Operative Risk Evaluation was 8.4 ± 4.2, and 39% (n = 23) of patients were female. A clinical follow-up for echocardiographic assessment was performed after 12 months. The 30-day mortality rate was 1.7% (n = 1). The mean postoperative transprosthetic gradient was 11.7 (±4.3) mm Hg. The mean effective orifice area was 1.8 (±0.3) cm(2). One case of higher-grade regurgitation (aortic insufficiency >+1) occurred. The late mortality rate was 5.1% (3/59). After 12 months, the mean transprosthetic gradient was 10.3 (±3.8) mm Hg. The mean effective orifice area of 1.8 (±0.3) cm(2) remained unchanged. The mean implantation time was 9 (±3) minutes. The mean crossclamp time was 26 (±7) minutes. The average bypass time was 56 (±16) minutes. Reproducible short crossclamp and bypass times were achieved in a minimally invasive setting. The valve shows good hemodynamic performance comparable to other sutureless or rapid deployment valves. Nevertheless, future follow-up investigation has to be awaited to gain more data concerning durability and safety issues.

Retrospective Evaluation Of Novel Percutaneous Left Atrial Appendage Ligation Using The LARIAT Suturing Device: Single Center Initial Experience.

The left atrial appendage (LAA) is the source of considerable thromboemboli responsible for embolic strokes in patients with atrial fibrillation (AF). The LARIAT™ suturing device has been used to ligate the LAA and negate the use of systemic anticoagulation. However, its efficacy and stroke outcome is still unknown. We retrospectively evaluated the clinical status and risk of occurrence of systemic emobolic events, strokes, transient ischemic attacks, and procedure related complications in patients after LAA ligation using the LARIAT™ device. Permanent suture was successfully delivered in 21 patients. Mean follow up time was 17.2+-3.3 months. The average HAS-BLED score was 3.3+/-1.1. Only 1 patient developed clinical symptoms of stroke 7 days post procedure. One patient had uncomplicated perioperative bleeding not requiring blood transfusion. One patient developed transient ECG changes of ischemia during mapping for ablation following the LAA ligation and subsequently, underwent bypass surgery. Three patient developed post-procedural pericarditis and were medically managed. Three patients died from non-LAA ligation related conditions including congestive heart failure, lung cancer, and severe coronary disease. We observed a 32% and 30% reduction in the annual risk of stroke when compared to the expected risk of stroke based on the CHADS2 and CHA2DS2-VASc score respectively. LAA ligation using the LARIAT™ suturing device is clinically feasible in carefully selected patients. This study has the longest follow up period to date, however further studies are required to determine the efficacy of stroke reduction and long-term clinical outcomes.

Regulatory T-Cells Support Stem Cell Therapy in Safe Minimization of Immunosuppression in Living Donor Renal Transplantation- Initial Single Centre Experience.

Regulatory T-Cells Support Stem Cell Therapy in Safe Minimization of Immunosuppression in Living Donor Renal Transplantation- Initial Single Centre Experience.

The management of peritoneal surface malignancies: Single-center initial experience

The management of peritoneal surface malignancies: Single-center initial experience