Stand-alone Procedures Research Articles

Analysis of the operative utilization of concurrent rhinoplasty and endoscopic sinus surgery.

To quantify and analyze the concurrent performance of rhinoplasty (RP) (with or without septoplasty) and functional endoscopic sinus surgery (FESS). Cross-sectional analysis. Current Procedural Terminology codes were used to extract cases of RP (n = 22,360), FESS (n = 99,173), and concurrent RP with FESS (RP + FESS) (n = 1,321) within the State Ambulatory Surgery Databases of California, Florida, Maryland, and New York from 2009 to 2011. Patient demographics, surgeon volume, charge, concurrent nasal procedures, and operating room (OR) time were compared. Among the 1,321 RP + FESS combination cases, a majority involved primary rhinoplasty (n = 697, 52.8%), followed by nasal valve repair (n = 563, 42.6%) and revision rhinoplasty (n = 61, 4.6%). High-volume (n > 30), medium-volume (n = 10-30), and low-volume rhinoplasty surgeons (n ≤ 9) were observed to perform a similar number of FESS + RP combination surgeries (153, 152, and 155, respectively). A majority of RP + FESS involved two or fewer sinuses (65%). Mean OR time for RP + FESS was 189.4 ± 4.2 minutes, approximately 50 minutes shorter than the sum of standalone RP performed individually (138.8 ± 1.0 minutes) and standalone FESS (102.9 ± 0.4 minutes). RP + FESS more frequently involved fewer sinuses (compared with FESS alone) and was also less likely to involve revision rhinoplasty (compared with rhinoplasty alone); therefore, these cases may be selected for lower sinus disease burden and less complex rhinoplasty compared to standalone procedures. Procedures combining rhinoplasty and sinus surgery had a reduction in OR time compared to the hypothetical sum of two standalone procedures. NA Laryngoscope, 130:E311-E319, 2020.

Biocidal Efficacy of a Hydrogen Peroxide Lens Care Solution Incorporating a Novel Wetting Agent.

To compare the antimicrobial effects of CLEAR CARE, a 3% hydrogen peroxide (H2O2) solution formulated for simultaneous cleaning, daily protein removal, disinfection, and storage of soft (hydrophilic) hydrogel, silicone hydrogel, and gas-permeable contact lenses, and CLEAR CARE PLUS, consisting of the 3% H2O2 solution plus a novel wetting agent, polyoxyethylene-polyoxybutylene (EOBO-21). Three lots each of the 2 solutions were incubated with 5 compendial microorganisms required by the Food and Drug Administration (FDA) 510(k) and International Organization for Standardization (ISO) 14729 stand-alone procedures, 4 clinical isolates of Gram-positive and Gram-negative bacteria, and trophozoites and cysts of 2 Acanthamoeba strains that are associated with microbial keratitis. Microbial loads were evaluated after disinfection and neutralization. Both solutions exceeded the FDA/ISO stand-alone primary criteria against Gram-positive and Gram-negative compendial bacteria, yeast, and mold after only 1.5-hr disinfection/neutralization. At the recommended minimum disinfection time, bacteria were reduced by 4.4 to 5.1 logs, yeast by 4.4 to 4.9 logs, and mold by 2.9 to 3.5 logs with and without organic soil. In addition, both solutions eliminated or effectively reduced populations of clinically relevant ocular bacterial isolates (4.5-5.0 logs), Acanthamoeba trophozoites (3.4-4.2 logs), and cysts (1.5-2.1 logs). Both solutions eliminated or reduced populations of FDA/ISO compendial bacteria and fungi as well as clinically relevant microorganisms and Acanthamoeba trophozoites and cysts. The addition of EOBO-21 to the 3% H2O2 lens care solution had no impact on antimicrobial activity.

Percutaneous screw techniques for the pelvic ring and acetabulum

In the treatment of pelvic ring and acetabular fractures percutaneous screw osteosynthesis provides the advantage of minimal soft tissue damage. The techniques are frequently used in combination with open osteosynthesis and less frequently as stand-alone procedures. A preoperative planning with the aid of computed tomography (CT) and knowledge of the intraoperative radiological fluoroscopy adjustment are prerequisites for an accurate placement of the screws. This article describes the indications and techniques for frequently used percutaneous screws.

Circumferential viscodilation of Schlemm's canal for open-angle glaucoma: ab-interno vs ab-externo canaloplasty with tensioning suture.

PurposeTo compare the efficacy of minimally invasive ab-interno canaloplasty (ABiC) vs ab-externo canaloplasty (CP) in reducing intraocular pressure (IOP) and glaucoma medication dependence.Patients and methodsThis nonrandomized, retrospective, single-center, paired eye study assessed the 12-month outcomes of 12 patients with primary open-angle glaucoma who underwent ABiC in one eye and CP in the other eye, either as stand-alone procedures or combined with cataract extraction. Primary endpoints included mean IOP and number of glaucoma medications at 12 months postoperative. Secondary endpoints included surgical complications and secondary interventions.ResultsFour males and eight females with a mean age of 73.8±12.6 years were included. In the CP group, the mean preoperative IOP was 18.1±3.9 mmHg on 2.4±0.5 medications, which reduced to 13.5±2.2 mmHg (P<0.05) on 0.9±0.9 medications (P<0.001). In the ABiC group, the mean preoperative IOP was 18.5±3.4 mmHg on 2.4±0.5 medications and postoperative IOP was 13.8±2.2 mmHg (P<0.05) on 0.8±0.8 medications (P<0.05). There was no significant difference in IOP and medication use between treatment groups at 12 months postoperative. No serious adverse events were recorded in either group, though two patients in the CP group developed pressure spikes 10 mmHg beyond preoperative IOP.ConclusionThis paired eye study found ABiC to have comparable IOP lowering and glaucoma medication reduction to CP in open-angle glaucoma. This suggests ABiC may be a suitable method for improving aqueous outflow via the trabecular pathway. Further large-scale investigation is needed.

Development of an Oculopressor to Evaluate the Efficiency of Glaucoma Drainage Devices

Evaluation of the long-term efficiency of MIGS implants is still challenging, due to the lack of standardized clinical studies of stand-alone procedures. Moreover, the different mechanisms of the various glaucoma drainage devices are not adequately considered. The current study focusses on the development of a method for oculopression to evaluate the efficiency of glaucoma drainage devices. Explanted porcine eyes were subjected to pressure or weight load using three oculopressors with different modi operandi. The time-dependent intraocular pressure was measured using an anterior chamber maintainer. The Honan Balloon exerts variable pressure onto the eye via an air bellows, whereas the Taylor oculopressor applies a defined weight loading on the eye. A novel oculopressor with a weight loading of 60 g was developed and manufactured by means of 3-D-printing. The intraocular pressure changes observed during the experiments were similar for all tested oculopression devices, varying only in the absolute pressure values. The Honan Balloon was not suitable for the intended purpose, due to poor standardisation of the applied pressure. Oculopression using a defined weight appeared more suitable. The Taylor oculopressor, however, created intraocular pressure values of up to 203.3 ± 38.4 mmHg, which precludes its use with glaucoma patients. On the basis of these data, the new oculopression device was used in a preliminary trial with healthy human subjects, thereby preparing its use in a clinical trial. Oculopression represents a potentially suitable tool to analyse the efficiency of glaucoma drainage devices. Commercially available oculopression devices are not directly applicable for this task. Difficult handling, high intraocular pressure, and lack of standardisation complicate the use for glaucoma patients. These difficulties were overcome with the newly designed oculopressor that facilitates a well defined increase in intraocular pressure. The device is currently being used in a clinical study to evaluate the efficiency of MIGS implants.

Abstract 17086: External Support of the Cardiac Base in the Treatment of Functional Mitral Regurgitation &amp; Heart Failure

Introduction: Ventricular dysfunction in the presence of normal mitral leaflets is characteristic of functional mitral regurgitation (MR). Surgical treatment with mitral valve repair or replacement, address mitral valve annulus and leaflets, not the ventricular muscle. We describe early and mid-term clinical experience with extra-cardiac treatment of FMR with a novel device that is implanted on a beating heart. Hypothesis: External and adjustable support of the cardiac base can effectively reduce functional MR &amp; HF. Methods: The BACE (Basal Annuloplasty of the Cardia Externally) device is a broad belt/band of silicone that is implanted at the base of the heart, by means of slim polyester belt loops sutured on atrial and ventricular sides of the Atrio-Ventricular groove. Forty one patients (mean age 60.24 years) with functional and ischemic MR were evaluated at 10 multi-national centers between December, 2008 and June, 2018. All patients had moderately severe or severe MR (Mean MR grade 3.3) on trans-thoracic and/or trans-esophageal echocardiography, and impaired LV function (Mean EF 38.5%). Risk assessment by Logistic Euroscore showed a mean of 16.5%. Implantation of the BACE device, was performed, according to sizing performed along the base of the heart, overlapping atrial and ventricular surfaces of the atrio-ventricular groove circumferentially. Mean number of coronary grafts was 2.5. Five patients had stand-alone procedures without CABG. Procedures were performed on a beating heart with the majority of them performed off-pump. Intra-operative trans-esophageal echocardiography allowed customized inflation of specific chambers to selectively deform the annulus and sub-annular myocardium. Results: Three patients required peri-operative adjustment of the BACE device. There were no deaths related to the BACE device or device failures. The degree of MR improved from a mean of 3.4 to 0.88. This &gt;2 class improvement in MR was sustained over the 12 month follow up period in all patients. LVEDD decreased from 5.9±0.6 to 5.5±0.6 cm. Conclusions: Ischemic and functional mitral valve regurgitation can be treated by epicardial implantation and dynamic adjustment of the BACE device. Ventricular stabilization may impact HF progression.

Simultaneous Transcatheter Aortic Valve Implantation and Left Atrial Appendage Occlusion versus both Interventions as Stand-Alone Procedures

ABSTRACT Background: Patients with atrial fibrillation undergoing transcatheter aortic valve implantation (TAVI) have a worse prognosis than those in sinus rhythm. The bleeding risk associated with oral anticoagulation accounts for some of this difference. Left atrial appendage occlusion (LAAO) omits the need for oral anticoagulation in patients with atrial fibrillation. We investigated the feasibility of simultaneous TAVI and LAAO with Lotus and Watchman and compared the results to both interventions as stand-alone procedures. Methods: Fifty-two consecutive patients who underwent either TAVI with Lotus (n = 19), LAAO with Watchman (n = 23) or both procedures simultaneously (n = 10) were investigated. Procedural characteristics, in-hospital- and 30-day-outcomes defined by VARC-2 criteria were compared. Results: There was no significant difference in the amount of contrast medium used between the three groups (TAVI: 89 ± 29 mL; LAAO: 98 ± 54 mL; TAVI + LAAO: 86 ± 29mL; p = 0.923). The total procedural time was significantly longer in the combined group (TAVI: 57.1 ± 18.0 minutes; LAAO: 42.7 ± 16.0 minutes; TAVI + LAAO: 82.0 ± 18.6 minutes; p = 0.001). Procedural and device success was achieved in all patients. The length of hospital stay was lower in the isolated LAAO group but did not differ significantly in the two groups including TAVI (TAVI: 9.7 ± 4.3 days; LAAO: 2.0 ± 2.1 days; TAVI + LAAO: 10 ± 4 days; p < 0.001). One sudden cardiac death occurred in the combined group at home on day 28. There was one cerebrovascular event and one major bleeding event in the isolated TAVI group. Conclusion: Combining TAVI and LAAO with Lotus and Watchman is feasible and was comparable to both interventions as stand-alone procedures.

RF07 AORTIC VALVE REPLACEMENT WITH SUTURELESS PERCEVAL BIOPROSTHESIS IN RIGHT ANTERIOR MINITHORACOTOMY APPROACH: SINGLE CENTER EXPERIENCE WITH 461 IMPLANTS

Abstract Background and Aim: Minimally invasive approach (MIA) reduces mortality and morbidity in patients referred for aortic valve replacement (AVR). Sutureless technology facilitates MIA. We describe our experience with sutureless Perceval (LivaNova, Italy) aortic bioprosthesis in right anterior minithoracotomy (RAMT) approach. Methods: Between March 2011 and December 2017, 841 patients underwent AVR with Perceval bioprosthesis. 461 patients were operated through RAMT approach. Considering only isolated AVR (530), Perceval in RAMT approach was performed in 87% of patients. Prosthesis sizes implanted were: S (n = 67), M (n = 147), L (n = 218) and XL (n = 29). Concomitant procedures were mitral valve surgery (n = 5), tricuspid valve repair (n = 1), mitral valve repair and tricuspid valve repair (n = 1), and miectomy (n = 2). Mean age was 77.2 ± 6.5, 61.12 % patients were female, and mean logistic EuroSCORE was 12.7 ± 9.9. Results: The 30-day mortality was 0.65% (3/461). Cardiopulmonary bypass and aortic cross-clamp times were 82.3 ± 30.8 and 52 ± 21.6 minutes for stand-alone procedures. In 3 patients appeared early moderate paravalvular leakage required reoperations. Permanent pacemaker implantation within the first 30 days was necessary in 5% of patients. At mean follow-up of 28.6 ± 12.4 months, survival was 97%, freedom from reoperation was 98%, and mean transvalvular pressure gradient was 11.7 ± 5 mmHg. Conclusions: AVR with Perceval bioprosthesis in RAMT approach is a safe and feasible procedure associated with low mortality and excellent hemodynamic performance. Sutureless technology facilitates RAMT approach.

In vitro follicle culture in the context of IVF.

The currently available assisted reproduction techniques for fertility preservation (i.e. in vitro maturation (IVM) and in vitro fertilization) are insufficient as stand-alone procedures as only few reproductive cells can be conserved with these techniques. Oocytes in primordial follicles are well suited to survive the cryopreservation procedure and of use as valuable starting material for fertilization, on the condition that these could be grown up to fully matured oocytes. Our understanding of the biological mechanisms directing primordial follicle activation has increased over the last years and this knowledge has paved the way toward clinical applications. New multistep in vitro systems are making use of purified precursor cells and extracellular matrix components and by applying bio-printing technologies, an adequate follicular niche can be built. IVM of human oocytes is clinically applied in patients with polycystic ovary/polycystic ovary syndrome; related knowhow could become useful for fertility preservation and for patients with maturation failure and follicle-stimulating hormone resistance. The expectations from the research on human ovarian tissue and immature oocytes cultures, in combination with the improved vitrification methods, are high as these technologies can offer realistic potential for fertility preservation.

Cryopreservation of testicular tissue in pre-pubertal and adolescent boys at risk for infertility: A low risk procedure

Cryopreservation of testicular tissue (TT) has become an increasingly attractive option for fertility preservation (FP), particularly for pre-pubertal boys at risk for gonadotoxicity from cancer therapy. At our institution, all at-risk families undergo counseling regarding infertility risk and available FP strategies, including this vulnerable patient population. As the technology required to use the acquired tissue is, as yet, unproven, it is paramount to document minimal morbidity and complications from this procedure. Herein, we report these outcomes for all pre-pubertal patients who have undergone TT biopsies for FP. We retrospectively reviewed consecutive patients who underwent unilateral open TT biopsies between January 2014 and December 2016. Patient diagnosis, age, concomitant procedures, anesthetic type, complications, procedure times, planned therapy, and bleeding were evaluated. Of a total of 34 patients, mean age at biopsy was 6.9±4.4years. Diagnoses included: leukemia/lymphoma (n=12), solid tumors (n=15) and non-neoplastic disorders (hemophagocytic lymphohistiocytosis, aplastic anemia; n=7). Twenty-two patients (64.7%) were scheduled for stem cell transplantation. Eleven (32.4%) patients had not received any chemotherapy prior to TT biopsy, while all others had exposure preceding the biopsy. Biopsies were performed in conjunction with other procedures (central line placement, bone marrow biopsy, lumbar puncture, lymph node biopsy) in 29 cases (85.3%), with stand-alone procedures performed in the remainder (n=5). In stand-alone cases, mean anesthetic time was 22±8.7min. Overall, two (5.9%) patients had complications after biopsy: 1) ipsilateral epididymo-orchitis (resolved with antibiotics) and 2) ipsilateral torsedappendix testis (managed conservatively) (Table). In this series, pre-pubertal TT biopsy for cryopreservation was safely performed, and was most often coordinated concomitantly with other medically necessary procedures. The safety profile reported herein supports performing this procedure while technological advances fulfill the requirements to make it a viable option for future fertility.

Attitudes of patients with metastatic cancer towards research biopsies.

To evaluate the attitudes of patients with different cancers towards research biopsies outside a clinical trial. Patients with metastatic cancer completed a questionnaire that assessed patients' willingness to consider research biopsies. Research biopsies were divided into two groups: biopsies performed as stand-alone procedures (research purposes only biopsy, RPOB) or performed during a clinically indicated biopsy (additional pass biopsy, APB). Factors analyzed included biopsy timing, biopsy site, sociodemographic information and information about prior trial participation. Univariate and multivariable analyses were conducted using random-effects logistic regression. One hundred and sixty-five patients with cancer (40 melanoma, 37 colorectal, 32 breast, 30 lung, 26 prostate) completed the questionnaire. Patients with melanoma demonstrated the greatest willingness to consider a research biopsy compared to patients with other cancer types (P<0.05). Patients' ethnicity, time since previous biopsies, time since metastatic diagnosis, and previous trial enrolment were all statistically significant for willingness to consider a research biopsy on univariate analysis. When adjusting for statistically significant variables on univariate analysis, the odds of patients considering APBs were 14.6 times greater than RPOBs (P<0.0001). Patients were also more willing to consider having blood or skin taken for research purposes (P<0.0001) compared to liver and bone biopsies. Patients with cancer show a greater willingness to consider APBs compared to RPOBs, and biopsies performed at less invasive body sites. There are differences in the attitudes of patients with different cancers towards research biopsies. Further research addressing motivations and barriers to research biopsies should be considered to increase the availability of this important resource.

Hybrid Atrial Fibrillation Ablation: Current Status and a Look Ahead.

Treatment of atrial fibrillation (AF) has evolved significantly during the last 3 decades. Successful surgical AF ablation was developed by the pioneering work of Dr James Cox in 1987 resulting in the development of the Cox-maze (CM) procedure.1 Further experience and incorporation of ablation technology allowed subsequent modifications to increase efficacy and decrease morbidity, resulting in the latest iteration—the CM IV.2 Despite the excellent results of open SA of AF, its widespread use has been limited by its morbidity, especially for stand-alone surgical procedures. Ablation lines from alternate energy sources to replace many of the surgical incisions in the cut and sew maze led to a thoracoscopic, minimally invasive, off-pump beating heart approach.1 Minimally invasive thoracoscopic surgery may improve on the results of AF catheter ablation but may not be as effective as open surgery because of limitations in creating transmural lesions in roof and floor of the left atrial posterior wall in some patients.3 In 1998, the observation by Haissaguerre et al2 that the pulmonary veins (PVs) serve as common sources of AF triggers in patients with paroxysmal AF paved the way for catheter AF ablation (CA) using radiofrequency energy. Although CA is associated with relatively low morbidity, it has been characterized by higher AF recurrence rates, especially in persistent and long-standing persistent AF.4 Because thoracoscopic SA and CA interventions may lead to incomplete isolation of the PVs and the posterior wall of left atrium, a hybrid option combining these 2 techniques was developed. The so-called hybrid strategies proposed to increase procedural success. In fact, single-center studies have demonstrated that catheter ablation may be effective in completing some of the lines created by the thoracoscopic-based SA procedure.5 Hybrid AF ablations in various centers have been variable in terms of surgical approach (thorascopic …

An Update on Implants for Minimally Invasive Glaucoma Surgery (MIGS)

For several years, the gold standard for surgical treatment of glaucoma has been trabeculectomy. Although very successful at reducing intraocular pressure (IOP), there are several potential complications of trabeculectomy, including sight-threatening ones. This has stimulated much research aimed at the development of new and effective procedures to lower IOP with an enhanced safety profile. Minimally invasive glaucoma surgery (MIGS) procedures prioritise patient safety but also demonstrate efficacy in reducing IOP. We performed an online search of peer-reviewed literature using PubMed, entering keywords relevant to this clinical discipline. In summary, there is a lack of long-term safety and efficacy data, a lack of comparative data and a lack of data on standalone (i.e. without simultaneous cataract surgery) procedures. Most implants are not yet FDA approved. Although not exhaustive, since it does not discuss MIGS procedures that are not implants, this article summarises the range of different MIGS implants that are available to the ophthalmic surgeon.

Operating Room Efficiency in Bariatric Surgery: The Effect of Team Member Experience on Operative Times in Laparoscopic Roux-en-Y Gastric Bypass

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a complex procedure. Increasing case experience improves operative times for surgeons. Less is known about the impact of experience of other surgical team members. Methods: One hundred seventy-nine consecutive LRYGB cases were analyzed. Total operating room times (ORT) and surgical times (STs) were tabulated, and linear regression was used to detect correlation between these times and the case counts of surgical team members. Efficiency measures were evaluated for cases done synchronously on a given day versus individual cases. Results: Minimum case count of any scrub nurse present showed a statistically significant relationship to both ORT and ST, with mean decreases of 0.686 ± 0.224 and 0.561 ± 0.207 min per one-case increase in experience, respectively. Successive cases averaged less than standalone procedures. Conclusions: Case count of the least experienced scrub nurse appeared to have a significant impact on efficiency in LRYGB. LRYGB cases performed successively showed improved efficiency.

IN WHICH PATIENTS IS IT POSSIBLE TO PERFORM STANDALONE LATERAL LUMBAR INTERBODY FUSION WITHOUT CAGE SUBSIDENCE?

ABSTRACT Objective: To identify the factors related to the non-occurrence of cage subsidence in standalone lateral lumbar interbody fusion procedures. Methods: Case-control study of single level standalone lateral lumbar interbody fusion (LLIF) including 86 cases. Patients without cage subsidence composed the control group (C), while those in the subsidence group (S) developed cage subsidence. Preoperative data were examined to create a risk score based on correlation factors with S group. The proven risk factors were part of an evaluation score. Results: Of the 86 cases included, 72 were in group C and 14 in group S. The following risk factors were more prevalent in group S compared to C group: spondylolisthesis (93% vs 18%; p&lt;0.001); scoliosis (31% vs 12%; p=0.033); women (79% vs 38%; p=0.007); older patients (average 57.0 vs 68.4 years; p=0.001). These risk factors were used in a score (0-4) to evaluate the risk in each case. The patients with higher risk scores had greater subsidence (p&lt;0.001). Scores ≥2 were predictive of subsidence with 92% sensitivity and 72% specificity. Conclusions: It was possible to correlate the degree of subsidence in standalone LLIF procedures using demographic (age and gender) and pathological (spondylolisthesis and scoliosis) data. With a score based on risk factors and considering any score &lt;2, the probability of non-occurrence of subsidence following standalone LLIF (negative predictive value) was 98%.

Cardiovascular implantable electronic device lead extraction: evidence, techniques, results, and future directions.

Cardiovascular implantable electronic devices are widely used to treat symptomatic arrhythmias, prevent sudden cardiac death, and improve symptoms and cardiac function. Continued population growth and expanding indications have resulted in a progressive increase in the number of cardiovascular implantable electronic device implantations. Mirroring this growth, an increasing number of leads require removal because of a variety of indications. Transvenous lead extraction continues to evolve with better techniques and risk-management strategies. This review highlights the indications, techniques, procedural outcomes, and future directions of arrhythmia device management and extraction. Indications for extractions are reviewed in light of newly published data. Same day contralateral reimplantation has been shown to be safe in patients with localized pocket infection. Alternative extraction techniques, utilizing the femoral and internal jugular veins, provide additional routes for device removal as stand-alone procedures or in cases of difficult extraction via the subclavian vein. Preprocedural imaging to identify adherence sites and cardiac perforation can help to reduce complications. Routine capsulectomy at generator change does not seem to reduce the risk of device infection, and multiple trials are underway to assess other methods of reducing infections as part of a lead management strategy. Improvement in technology, alternative routes of extraction and preprocedural imaging continue to add to procedural efficacy and reduce complication rates of lead extraction.

Contemporary use of balloon aortic valvuloplasty in the era of transcatheter aortic valve implantation.

The development of transcatheter aortic valve implantation (TAVI) has increased the use of balloon aortic valvuloplasty (BAV) in treating aortic stenosis. We evaluated our use of BAV in an academic tertiary referral center with a developing TAVI program. We reviewed 69 consecutive stand-alone BAV procedures that were performed in 62 patients (mean age, 77 ± 10 yr; 62% men; baseline mean New York Heart Association functional class, 3 ± 1) from January 2009 through December 2012. Enrollment for the CoreValve(®) clinical trial began in January 2011. We divided the study cohort into 2 distinct periods, defined as pre-TAVI (2009-2010) and TAVI (2011-2012). We reviewed clinical, hemodynamic, and follow-up data, calculating each BAV procedure as a separate case. Stand-alone BAV use increased 145% from the pre-TAVI period to the TAVI period. The mean aortic gradient reduction was 13 ± 10 mmHg. Patients were successfully bridged as intended to cardiac or noncardiac surgery in 100% of instances and to TAVI in 60%. Five patients stabilized with BAV subsequently underwent surgical aortic valve replacement with no operative deaths. The overall in-hospital mortality rate (17.4%) was highest in emergent patients (61%). The implementation of a TAVI program was associated with a significant change in BAV volumes and indications. Balloon aortic valvuloplasty can successfully bridge patients to surgery or TAVI, although least successfully in patients nearer death. As TAVI expands to more centers and higher-risk patient groups, BAV might become integral to collaborative treatment decisions by surgeons and interventional cardiologists.

A combined method for the design and optimization of intensified distillation systems

The sequential design method (SDM) is a recently introduced distillation column design method based on the correspondence between the simple column and the alternative sequences design parameters. It can be defined as a method that combines the alternatives generation step with the design procedure. The Multi-Objective Differential Evolution (MODE) algorithm instead, is based on the minimization or maximization of a defined objective function; it is a strong method that allows the evaluation of a large number of alternatives.The SDM is characterized by a poor control of the error propagation among the sequences, the MODE algorithm by a high computational time. It was obtained that a proper combination of the methods allows the compensation of the drawbacks of the stand-alone procedures. For the case study considered, when the MODE algorithm is initialized with the SDM, a 39% reduction of the computational time was observed. If the combination between the methods is realised at the beginning of the design procedure, the reduction of the computational time was of about 28%. The time reduction was due to a narrower initialization of the MODE algorithm with the parameters obtained applying the SDM. Moreover, when some overestimated design values where used to initialize the MODE algorithm, it is still possible to identify a configuration very close to the optimum.

Guías de la European Association for Cardiothoracic Surgery 2013 sobre el tratamiento quirúrgico de la fibrilación auricular

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and has a prevalence of 1-2% in the general population, but is higher with increasing age and in patients with concomitant heart disease. Although the Cox-maze III procedure has a cure rate over 90%, due to its technical difficulty, alternative techniques have been developed. There are now multiple energy sources and multiple potential lesion patterns addressing the surgical treatment of atrial fibrillation, both for patients undergoing this concomitantly with other cardiac surgical procedures, and also as stand-alone procedures. This document brings together all major guidelines in this area and reviews the evidence and provides recommendations where those guidelines were lacking. It concludes that atrial fibrillation surgery is an effective intervention for patients with all types of atrial fibrillation undergoing concomitant cardiac surgery in order to reduce the incidence of atrial fibrillation. There is some evidence that this translates into reduced risk of stroke, heart failure and longer survival. In addition, symptomatic patients with atrial fibrillation may be considered for surgery after failed catheter intervention, or even as an alternative to catheter intervention where either catheter ablation is contraindicated or by patient choice.

How to design effective priority rules: Example of simple assembly line balancing

Priority rule-based methods (PRBMs) rely on problem-specific knowledge to construct good solutions in a very short time. They can be used as stand-alone procedures or can be integrated into (partial) enumeration procedures, like branch and bound or dynamic programming, and heuristic solution methods. PRBMs are especially important for solving NP-hard optimization problems.In this paper, we formulate general design principles on how to construct good-performing PRBMs, based on a thorough computational investigation. Our principles allow to construct effective PRBMs already ad hoc, i.e. without time-consuming data mining algorithms. We conduct our analysis on the example of the NP-hard Simple Assembly Line Balancing Problem (SALBP), on which with small modifications most situations in the planning of assembly lines are based. We also provide a cross-validation of our results and illustrate the application of the formulated principles.