High-risk Surgical Patients Research Articles

Ultimate outcomes of three modalities for non-surgical gallbladder drainage in acute cholecystitis with or without concomitant common bile duct stones.

Backgrounds/AimsIn moderate and high-surgical risk patients with acute cholecystitis, studies comparing percutaneous cholecystostomy (PC) vs. endoscopic transpapillary gallbladder stenting (ETGS) vs. endoscopic ultrasound-guided transmural gallbladder stenting (EUGS) are limited. Thus, the aim of this study was to compare efficacy and recurrence of cholecystitis after PC, ETGS, or EUGS during follow-up.MethodsWe reviewed 143 moderate and high-surgical risk patients with acute cholecystitis with or without concomitant common bile duct stones who underwent PC, ETGS, or EUGS at our hospital. Technical success rate (TSR), clinical success rate (CSR), and recurrence were compared.ResultsTSR in PC or EUGS group was higher than that in the ETGS group for those with concomitant common bile duct stones (100% vs. 100% vs. 73.2%; p = 0.07) and for those without concomitant common bile duct stones (100% vs. 100% vs. 77.3%; p < 0.001). CSR in ETGS or EUGS group was higher than that in the PC group for those with concomitant common bile duct stones (96.2% vs. 100% vs. 87.5%; p = 0.41) and for those without concomitant common bile duct stones (94.1% vs. 100% vs. 63.0%; p = 0.006). Using Kaplan–Meier analysis, the overall recurrent risk was the highest in the PC group (p = 0.004).ConclusionsIn moderate and high-surgical risk patients with acute cholecystitis, EUGS provides significantly higher CSR with comparable TSR to PC. Thus, ETGS should be the first choice in those with concomitant common bile duct stones. Among the three patient groups, those who received PC had the highest rate of recurrence.

MitraClip Treatment of Moderate-to-Severe and Severe Mitral Regurgitation in High Surgical Risk Patients - Real-World 1-Year Outcomes From Japan.

The MitraClip NT System was approved for marketing in Japan on October 31, 2017, and a prospective, multi-center, single-arm Post-Marketing use Surveillance (PMS) study was launched in 2018. This is the first report of the Japan PMS study with 1-year subject outcomes.Methods and Results:A total of 500 patients were registered between April 2018 and January 2019. Patients with symptomatic chronic moderate-to-severe (3+) or severe mitral regurgitation (MR; 4+), MR with a Society of Thoracic Surgery (STS) replacement score of ≥8%, or presence of 1 pre-defined risk factor were enrolled. Primary outcome measures included acute procedural success (APS), and rate of Single Leaflet Device Attachment (SLDA) at 30 days. The overall cohort was elderly (77.9±9.48 years) with functional MR etiology in 71.6% of the subjects. The majority of subjects were New York Heart Association (NYHA) class III/IV (68.9%), with mean STS replacement score of 11.95±9.66%. The APS rate was 91.13% and the 30-day SLDA rate was 1.21%. Durable MR reduction was achieved with 88.1% of subjects at MR ≤2+ at 1 year. Significant improvement in the functional capacity was observed, with 93% of subjects at NYHA class I/II at 1 year. In the Japan PMS experience, the MitraClip procedure resulted in improvements in MR severity, with significantly improved functional outcomes. These results demonstrate safety and efficacy of MitraClip therapy in the eligible Japanese population.

Endovascular Treatment of Ruptured or Symptomatic Thoracoabdominal and Pararenal Aortic Aneurysms Using Octopus Endograft Technique: Mid-Term Clinical Outcomes

Objective: To evaluate the effectiveness and safety of using off-the-shelf “Octopus” technique to treat ruptured or symptomatic thoracoabdominal aortic aneurysm (TAAA) and pararenal abdominal aortic aneurysm (PRAAA). Methods and Results: All cases who underwent “Octopus” technique from May 2016 to May 2019 at our center were retrospectively analyzed. A total of 10 cases (8 males) were included. The mean age was 54.5±14.2 years (range: 31–80 years). Eight cases presented as aneurysm rupture or impending rupture accepted emergency repair. Technical success, defined by placement of all endografts as planned, was achieved in all cases. A total of 30 target visceral branches were successfully cannulated, 9 celiac arteries were covered intentionally. Intraoperative endoleak was observed in 6 patients, all of them were gutter leak. During hospital stay, there was no death, no side branch occlusion or spinal cord ischemia. Median follow-up was 30 months (range: 12–50 months). One patient died of lung cancer at 14-month follow-up. There was no secondary endoleak. The primary endoleak were found spontaneously resolved in 3 cases at 7 days, 3-month, and 1-year imaging. One persistent endoleak totally resolved after sealing of gutter spaces at 4-month follow-up. The other 2 persistent endoleak decreased during follow-up, which are still under observation. The branch patency rate was 90.3% (28/31). All the 3 occluded branches were renal arteries. Branch occlusion occurred in 2 cases at 1-month follow-up and 1 case at 2-year follow-up, but renal insufficiency was not observed in these cases. Obvious aneurysm sac shrinkage (≥5 mm) was observed in all cases. The aneurysm size shrunk from 7.6±1.9 to 5.5±1.4 cm. No spinal cord ischemia occurred during follow-up. Conclusion: Treatment of ruptured TAAA and PRAAA with “Octopus” technique is feasible and safe for high surgical risk patients in the absence of fenestrated and branched devices. The long-term clinical outcomes needed to be investigated.

Enhanced peri-operative care to improve outcomes for high-risk surgical patients in Brazil: a single-centre before-and-after cohort study.

Mortality and morbidity for high-risk surgical patients are often high, especially in low-resource settings. Enhanced peri-operative care has the potential to reduce preventable deaths but must be designed to meet local needs. This before-and-after cohort study aimed to assess the effectiveness of a postoperative 48-hour enhanced care pathway for high-risk surgical patients ('high-risk surgical bundle') who did not meet the criteria for elective admission to intensive care. The pathway comprised of six elements: risk identification and communication; adoption of a high-risk post-anaesthesia care unit discharge checklist; prompt nursing admission to ward; intensification of vital signs monitoring; troponin measurement; and prompt access to medical support if required. The primary outcome was in-hospital mortality. Data describing 1189 patients from two groups, before and after implementation of the pathway, were compared. The usual care group comprised a retrospective cohort of high-risk surgical patients between September 2015 and December 2016. The intervention group prospectively included high-risk surgical patients from February 2019 to March 2020. Unadjusted mortality rate was 10.5% (78/746) for the usual care and 6.3% (28/443) for the intervention group. After adjustment, the intervention effect remained significant (RR 0.46 (95%CI 0.30-0.72). The high-risk surgical bundle group received more rapid response team calls (24% vs. 12.6%; RR 0.63 [95%CI 0.49-0.80]) and surgical re-interventions (18.9 vs. 7.5%; RR 0.41 [95%CI 0.30-0.59]). These data suggest that a clinical pathway based on enhanced surveillance for high-risk surgical patients in a resource-constrained setting could reduce in-hospital mortality.

Cost-effectiveness analysis of a resource-intensive approach versus minimally invasive strategy for high-risk transcatheter aortic valve replacement patients.

Aortic stenosis has a high mortality rate in patients who do not receive aortic valve replacement. Previously, transcatheter aortic valve replacement (TAVR) was an intervention reserved for individuals deemed high-risk for surgery. Since that time, TAVR has increasingly been offered to lower risk patients, yet it is unclear whether TAVR will meet an acceptable cost-effectiveness threshold in this group. In this cost-effectiveness study, we employed a decision tree model with Monte Carlo probability sensitivity analysis to determine the incremental cost (in US$) per quality-adjusted life year (QALY) and life year (LY) of performing the TAVR procedure using the resource-intensive approach versus the minimally invasive strategy in high-risk surgical patients.

Transapical mitral valve implantation for treatment of symptomatic mitral valve disease: a real-world multicentre experience.

Transcatheter mitral valve implantation (TMVI) is a new treatment option for patients with symptomatic mitral valve (MV) disease. Real-world data have not yet been reported. This study aimed to assess procedural and 30-day outcomes of TMVI in a real-world patient cohort. All consecutive patients undergoing implantation of a transapically delivered self-expanding valve at 26 European centres from January 2020 to April 2021 were included in this retrospective observational registry. Among 108 surgical high-risk patients included (43% female, mean age 75 ± 7 years, mean STS-PROM 7.2 ± 5.3%), 25% was treated for an off-label indication (e.g. previous MV intervention or surgery, mitral stenosis, mitral annular calcification). Patients were highly symptomatic (New York Heart Association [NYHA] functional class III/IV in 86%) and mitral regurgitation (MR) was graded 3+/4+ in 95% (38% primary, 37% secondary, and 25% mixed aetiology). Technical success rate was 96%, and MR reduction to ≤1+ was achieved in all patients with successful implantation. There were two procedural deaths and 30-day all-cause mortality was 12%. At early clinical follow-up, MR reduction was sustained and there were significant reductions of pulmonary pressure (systolic pulmonary artery pressure 52 vs. 42 mmHg, p < 0.001), and tricuspid regurgitation severity (p=0.013). Heart failure symptoms improved significantly (73% in NYHA class I/II, p < 0.001). Procedural success rate according to MVARC criteria was 80% and was not different in patients treated for an off-label indication (74% vs. 81% for off- vs. on-label, p=0.41). In a real-world patient population, TMVI has a high technical and procedural success rate with efficient and durable MR reduction and symptomatic improvement.

Transcatheter aortic valve replacement – 10 years experience at Gottsegen György National Cardiovascular Center in Hungary

Transcatheter aortic valve implantation (TAVI) is an alternative treatment to surgical aortic valve replacement for elderly, high surgical risk patients. The aim of this study was to evaluate the short- and long-term outcomes of those 463 patients who underwent TAVI during the first 10 years in our TAVI program. We compare the first 200 patients' results with the further 263 patients' results. Between 11th November 2008 and 31st December 2018, 463 patients underwent TAVI. The average age of the patients was 79.6 years, the average logistic EuroSCORE was 19.0%, the average STS score was 5.2%. 72% of the patients were in NYHA III or IV stage before TAVI. 92% of TAVIs were performed from femoral arteries. Average mean gradient was 50.0 mmHg and aortic valve area was 0.55 cm2, respectively. In 2% of the cases, "valve-in-valve" intervention was performed because of the restenosis of former aortic valve prosthesis. 30-day mortality was 5.2% and the 1-year mortality was 16.4% after TAVI. Post-TAVI complications were evaluated according to the VARC-2 definitions. Major stroke occurred in 2.2% after TAVI. The most common complication was pacemaker implantation (19.9%), but their incidence was significantly reduced between the 2 groups (26.5% vs. 14.8% [p = 0.002]). The incidence of vascular access site complications was significantly higher between the 2 groups (10% vs. 20.2% [p = 0.016]), but it did not affect the mortality. Based on our results, TAVI is a safe alternative treatment for patients with severe, symptomatic aortic stenosis in our institute as well. Orv Hetil. 2022; 163(6): 229-235.

Nocturnal dexmedetomidine for prevention of delirium in critically ill surgical patients: a randomized control trial protocol

Background: Nocturnal or postoperative dexmedetomidine has been shown to reduce the incidence of delirium in critically ill surgical patients without an increase in any complications. However, it is not clear whether dexmedetomidine has preventive effect against delirium in the patients with high risk of postoperative delirium (POD) since no previous studies have clearly emphasized high-risk surgical patients. Method: In this single-center, double-blind, randomized controlled trial, we randomize 114 high risk POD patients defined by developed predictive scores and admitted to surgical intensive care units (SICUs) into 2 groups: nocturnal dexmedetomidine (9 pm – 6 am) and placebo. The outcomes were incidence of POD, delirium-free days, secondary delirium-related complications and concerned complications including hypotension and bradycardia. Other treatments apart from intervention are standardized. Intention to treat analysis is used to analyze all data. Hypothesis: We hypothesize that nocturnal dexmedetomidine giving to high-risk POD patients admitted to SICUs postoperatively would (1) reduce incidence of POD (2) improve delirium-free days (3) reduce secondary delirium-related complications (4) show no difference in hypotension and bradycardia between groups. Ethics and dissemination: The trial receives ethic approval from Siriraj Institutional Review Board. We plan to disseminate the results in peer-reviewed critical care medicine or anesthesiology-related journals, conferences nationally and internationally. Trial registration: TCTR20210217001

Transcatheter aortic valve replacement in the developing world: Lessons learnt and its implications for practice

BackrgroundTranscatheter aortic valve replacement (TAVR) has become an accepted modality of treatment in intermediate and high surgical risk patients of symptomatic severe calcific aortic stenosis (AS). We herein report Indian data of 84 intermediate and high-risk patients who underwent TAVR at two Armed Forces cardiac centres. MethodsMost of the patients underwent TAVR in cardiac catheterization lab by percutaneous transfemoral approach, under conscious sedation. Patients were followed up and echocardiographic parameters were assessed after six months of procedure. ResultsTotal of 84 intermediate and high-risk patients underwent TAVR between Jan 2017 and June 2021. Mean age of population was 71.5 ± 8.4 years; 28.5% of patients had bicuspid aortic valve and Mean STS score was 6.34 ± 2.08. Majority (92.8%) patients underwent the procedure under conscious sedation. Self-expanding valves were used in 72.6% and balloon expandable in 27.4% of patients. Predilatation was done in 64% patients while 13% cases underwent post dilatation. Procedural mortality was 2.3%. Rate of permanent pacemaker implantation was 4.9%. Ischemic stroke occurred in 1.1% of patents. There was no case of severe paravalvular leak. Emergency surgical aortic valve replacement was done in 2.4% patients. Procedural success in this study was 97.6%. All-cause mortality was 9.5% at 6 months. ConclusionsTAVR is an effective treatment modality in intermediate and high-risk Indian patients with severe aortic stenosis. Patients with bicuspid or previous bio prosthetic aortic valves also have a good outcome post TAVR.

T2Candida Assay in the Diagnosis of Intraabdominal Candidiasis: A Prospective Multicenter Study.

The T2Candida magnetic resonance assay is a direct-from-blood pathogen detection assay that delivers a result within 3–5 h, targeting the most clinically relevant Candida species. Between February 2019 and March 2021, the study included consecutive patients aged >18 years admitted to an intensive care unit or surgical high-dependency unit due to gastrointestinal surgery or necrotizing pancreatitis and from whom diagnostic blood cultures were obtained. Blood samples were tested in parallel with T2Candida and 1,3-β-D-glucan. Of 134 evaluable patients, 13 (10%) were classified as having proven intraabdominal candidiasis (IAC) according to the EORTC/MSG criteria. Two of the thirteen patients (15%) had concurrent candidemia. The sensitivity, specificity, positive predictive value, and negative predictive value, respectively, were 46%, 97%, 61%, and 94% for T2Candida and 85%, 83%, 36%, and 98% for 1,3-β-D-glucan. All positive T2Candida results were consistent with the culture results at the species level, except for one case of dual infection. The performance of T2Candida was comparable with that of 1,3-β-D-glucan for candidemic IAC but had a lower sensitivity for non-candidemic IAC (36% vs. 82%). In conclusion, T2Candida may be a valuable complement to 1,3-β-D-glucan in the clinical management of high-risk surgical patients because of its rapid results and ease of use.

Low-vacuum negative pressure wound therapy protocol for complex wounds with exposed vessels.

Treating high-risk surgical patients with complex wounds over exposed blood vessels is a challenge. Guided wound healing may be the only treatment possible. Negative pressure wound therapy (NPWT) is not recommended in these cases. The authors challenged these current recommendations and share their preliminary experience. The authors adapted a NPWT protocol that uses low-vacuum continuous pressure (-80mmHg) with a silicone sheath and gauze/foam dressing between the wound bed and the device. They monitored the clinical features of patients' wounds to detect bleeding/ischaemia early on. Dressings were changed every 72-96 hours. This protocol was followed in five male patients (aged 23-68 years) with complex wounds over exposed vessels. Two cases were foot crush injuries, one midfoot amputation, one hand self-subamputation and one vascular bypass infection. Comorbidities included monoarterial limbs/stump, severe arteriopathy and psychiatric disorder. The exposed vessels were femoral, radial and ulnar, anterior and posterior tibial arteries and veins. Mean treatment lasted 37 days (range 20-61 days). No episodes of severe bleeding/ischaemia of the extremities were observed. Treatment was discontinued once debridement was complete and granulation tissue allowed spontaneous closure/grafting. All wounds appeared stable at 1-year follow-up. The low-vacuum NPWT protocol was successful in solving five difficult cases. This regimen reduces risks associated with NPWT use on wounds with exposed vessels. The authors believe further validation is required to strengthen the evidence. However, preliminary data are encouraging and might help to change future NPWT recommendations by extending the indications for its use to exposed vessels.

Percutaneous edge to edge systemic tricuspid valve repair for the treatment of severe tricuspid valve regurgitation in patients with systemic right ventricle: The first descriptive cohort

Patients with systemic right ventricle (mostly congenitally-corrected transposition of the great arteries or transposition of the great arteries corrected by atrial switch) commonly develop significant systemic tricuspid valve regurgitation and systemic right ventricular dysfunction in adulthood, both of which presenting a therapeutic dilemma for the care team. Percutaneous edge to edge repair could be a alternative to surgery. Seven high-risk surgical patients with severe systemic tricuspid regurgitation undergoing a percutaneous repair were included between July 2020 and March 2021. Our study is a prospective analysis of short and mid-term clinical, biological, echocardiographic and MRI outcomes with an expected minimum follow-up of 2 years. The first data tend to show a significant benefit of the repair on clinical status (dyspnea severity, quality of life, test exercise performance), a decrease of BNP level and an improvement of tricuspid regurgitation and right ventricular volume and function measured by echocardiography and MRI. Besides, the rate of failure and complications seems to be very low. Percutaneous edge to edge repair of systemic tricuspid regurgitation might be a safe and effective therapeutic option in high-risk surgical adult patients.

Efficacy and Safety of Conversion of Percutaneous Cholecystostomy to Endoscopic Transpapillary Gallbladder Stenting in High-risk Surgical Patients

Introduction: Endoscopic transpapillary gallbladder stenting (ETGBS) has been used as an alternative to percutaneous cholecystostomy in patients with acute cholecystitis who are considered unfit for surgery. However, there are few data on the efficacy and safety of ETGBS replacement of percutaneous cholecystostomy in high-risk surgical patients. This study aimed to evaluate the feasibility, efficacy, and safety of ETGBS to replace percutaneous cholecystostomy in high-risk surgical patients.

Transcatheter Edge to Edge Mitral Valve Repair (MitraClip) Step by Step Guide

Surgical mitral valve repair has been the gold standard treatment for severe degenerative mitral regurgitation. However, a segment of patient population is considered too high risk for surgery because of their age and/or comorbidities.Catheter-based interventions have been developed during the last decade to address mitral regurgitation in high surgical risk patients. MitraClip System (Abbott Vascular, Santa Clara, CA, USA) is FDA approved in high risk patients with primary or secondary mitral regurgitation who meet certain criteria. This article touches briefly on indications for transcatheter edge to edge mitral valve repair (TEER) and focuses on describing procedural steps to perform TEER usig MitraClip device. These steps include preoperative assessment and planning using TEE images, transseptal access to mitral valve, introducing transseptal sheath, steerable guide catheter (SGC), and clip delivery system (CDS), crossing the mitral valve, grasping the leaflets in desired location, and deployment. Procedural steps are also demonstrated in a brief video. Surgical mitral valve repair has been the gold standard treatment for severe degenerative mitral regurgitation. However, a segment of patient population is considered too high risk for surgery because of their age and/or comorbidities.Catheter-based interventions have been developed during the last decade to address mitral regurgitation in high surgical risk patients. MitraClip System (Abbott Vascular, Santa Clara, CA, USA) is FDA approved in high risk patients with primary or secondary mitral regurgitation who meet certain criteria. This article touches briefly on indications for transcatheter edge to edge mitral valve repair (TEER) and focuses on describing procedural steps to perform TEER usig MitraClip device. These steps include preoperative assessment and planning using TEE images, transseptal access to mitral valve, introducing transseptal sheath, steerable guide catheter (SGC), and clip delivery system (CDS), crossing the mitral valve, grasping the leaflets in desired location, and deployment. Procedural steps are also demonstrated in a brief video.

Scoring Model Based on Nodal Metastasis Prediction Suggesting an Alternative Treatment to Total Gastrectomy in Proximal Early Gastric Cancer.

PurposeTotal gastrectomy (TG) with lymph node (LN) dissection is recommended for early gastric cancer (EGC) but is not indicated for endoscopic resection (ER). We aimed to identify patients who could avoid TG by establishing a scoring system for predicting lymph node metastasis (LNM) in proximal EGCs.Materials and MethodsBetween January 2003 and December 2017, a total of 1,025 proximal EGC patients who underwent TG with LN dissection were enrolled. Patients who met the absolute ER criteria based on pathological examination were excluded. The pathological risk factors for LNM were determined using univariate and multivariate logistic regression analyses. A scoring system for predicting LNM was developed and applied to the validation group.ResultsOf the 1,025 cases, 100 (9.8%) showed positive LNM. Multivariate analysis confirmed the following independent risk factors for LNM: tumor size >2 cm, submucosal invasion, lymphovascular invasion (LVI), and perineural invasion (PNI). A scoring system was created using the four aforementioned variables, and the areas under the receiver operating characteristic curves in both the training (0.85) and validation (0.84) groups indicated excellent discrimination. The probability of LNM in mucosal cancers without LVI or PNI, regardless of size, was <2.9%.ConclusionsOur scoring system involving four variables can predict the probability of LNM in proximal EGC and might be helpful in determining additional treatment plans after ER, functioning as a good indicator of the adequacy of treatments other than TG in high surgical risk patients.

Transcatheter Aortic Valve Replacement in High-Risk Surgical Patient with Severe Aortic Insufficiency

Background: Transcatheter aortic valve replacement (TAVR) is approved by the FDA for severe aortic stenosis (AS) in patients of all surgical risk categories but has yet to be studied for its utility in aortic insufficiency (AI), despite the need for a safe alternative to surgery for prohibitive surgical risk patients. Case Report: We describe a case of a female patient who presented with acute decompensated congestive heart failure (CHF) with New York Heart Association (NYHA) Class IV symptoms. She was found to have severe AI leading to acute decompensation. Two years prior to this, she had aortic valve endocarditis that had potentially resulted in severe AI. Considering her underling comorbidities including diabetes mellitus, hypertension, morbid obesity and multiple myeloma on active chemotherapy at the time of evaluation, the patient was a high-risk surgical candidate for surgical aortic valve repair (SAVR) in view of elevated risk of mortality, infection, and poor wound healing. After critical and comprehensive assessment, transcatheter aortic valve intervention was considered to be an appropriate choice of treatment. TAVR was successfully performed that resulted in immediate improvement of aortic valve function. On subsequent follow-ups, she demonstrated markedly improved symptoms and reduced status to NYHA Class II HF symptoms. Conclusion: TAVR is a potential treatment modality for patients with severe AI who are poor surgical candidates for SAVR. We hope our case contributes to the growing pool of studies investigating the utility of TAVR procedure in patients with severe AI.

EUS-guided gallbladder drainage as a treatment for acute perforated cholecystitis.

Acute perforated cholecystitis is a rare but severe complication of acute cholecystitis. Currently, EUS-GBD using LAMS is the preferred choice for gallbladder drainage in high-risk surgical patients with acute cholecystitis unfit for cholecystectomy. However, it has been suggested to avoid this procedure when there is suspicion of gallbladder perforation or necrosis. The evidence of EUS-GBD in this setting is scarce. Our case demonstrates that EUS-GBD with LAMS can be effective in the management of type II perforation of the gallbladder.

Does high surgical risk affect the management and outcomes of percutaneous cholecystostomy in acute cholecystitis? A single-center retrospective analysis

We compared the management and results of percutaneous cholecystostomy (PC) in high surgical risk (HSR) and normal surgical risk (NSR) acute cholecystitis (AC) patients. The patients were divided into two groups: 60 patients with NSR and 30 patients with HSR. Pre-PC laboratory values, PC efficiency in terms of AC complications, catheter withdrawal method and duration, catheter-related complications, AC recurrence rate, mortality rate, presence of dyspeptic complaints in definitive PC, and cholecystectomy rate were compared. Technical and clinical success were achieved in 90 (100%) patients and, 85 (94.4%) patients with PC, respectively. The mortality developed in the HSR group; however, it was not seen in the NSR group (p=0.003). Five (83.3%) out of 6 (6.7%) patients with the American Society of Anesthesiology classification system (ASA) IV score developed mortality. With PC, clinical success was achieved in all 8 (100%) patients with suspected perforated cholecystitis and 6 (75%) of 8 patients with suspected emphysematous cholecystitis on abdominal CT in the non-acute abdomen. PC complications were seen in 8 (8.8%) and recurrent cholecystitis in 8 (12.5%) patients. The hospital stay was longer, and the rate of definitive treatment with PC was higher in the HSR group (p=0.019, p=0.008). C-reactive protein and procalcitonin levels were higher in the NSR group (p&lt;0.001, p=0.001). Dyspeptic complaints did not observe in 28 (73.7%) of the 38 patients without operation during the 33.3-month follow-up. The rate was not different between the groups (p=0.713). PC provides high clinical success in AC-related major complications, severe infection, and the presence of serious comorbid diseases. Mortality was observed only in ASA IV patients. The definitive cure rate of PC was higher in patients with HSR.

The Alfred, Cabrini and Epworth Transcatheter Aortic Valve Implantation (ACE-TAVI) Registry: Description and Short-Term Clinical Outcomes

Aortic valve stenosis is the most common valvular disease in developed countries. Transcatheter aortic valve implantation (TAVI) has evolved to be the new standard of care for inoperable, high and intermediate surgical risk patients with aortic stenosis.

Механічна вентиляція легень, керована об’ємом або тиском під час нейрохірургічних операцій. Чи є перевага?

Актуальність. Однією з головних технологій сучасної анестезіології є механічна вентиляція легень (МВЛ). На даний час в інтенсивній терапії широко визнаною є протективна технологія МВЛ. Доцільність застосування даної технології в операційній, особливо у хворих з інтактними легенями, є не такою очевидною. Більшість наукових робіт, що висвітлюють дану проблему, стосується хворих з абдомінальною патологією, і менш висвітленою вона залишається у пацієнтів з нейрохірургічною патологією. Пацієнти, які оперуються з приводу нейрохірургічної патології, відносяться до групи хворих високого хірургічного ризику, це і змотивувало нас провести дане дослідження. Метою дослідження було вивчити доцільність застосування протективної МВЛ під час операційних втручань у нейрохірургічних хворих. Матеріали та методи. Нами обстежено 46 хворих, які знаходилися на стаціонарному лікуванні у КНП «8 МКЛ м. Львова» з приводу патології хребта та яким було виконане операційне втручання — вертебропластика із спондилодезом. Пацієнти були розподілені на дві групи: у першій групі (34 хворі) МВЛ проводили за технологією S-IPPV — синхронізована примусова вентиляція легень з контролем по об’єму, а в другій групі (12 хворих) МВЛ проводилась за технологією PCV — вентиляція, керована тиском. Результати. Ми ретроспективно визначили частоту виникнення післяопераційних легеневих ускладнень (ПОЛУ) у хворих першої та другої групи. З 34 хворих першої групи ознаки ПОЛУ були виявлені у 17 осіб (50 %), а з 12 хворих другої групи ПОЛУ було виявлено у 4 (33,3 %). Слід зауважити, що МВЛ у хворих обох груп не відрізнялася за такими параметрами, як частота дихання, кінцево-альвеолярний тиск на видиху та фракція кисню в дихальній суміші. Висновки. Порівняно невелика кількість хворих не дозволяє, очевидно, робити остаточні висновки, проте слід звернути увагу на те, що МВЛ (особливо керована об’ємом) сприяє виникненню післяопераційних легеневих ускладнень у пацієнтів з інтактними легенями в доопераційний період. А застосування МВЛ, керованої тиском, має тенденцію до зменшення частоти виявлення легеневих ускладнень в післяопераційному періоді. Якщо врахувати, що частота дихання, кінцево-альвеолярний тиск на видиху та фракція кисню в дихальній суміші були порівнянні у хворих обох груп, можна припустити, що фактором, який впливає на частоту виникнення ПОЛУ, є механіка вентиляції легень.