Surgical Patients Research Articles

The role of geriatric assessment in the care of older adults undergoing urologic cancer surgery.

Older adults undergoing urologic cancer surgery have unique needs and require unique risk assessment and management. This review will discuss recent literature on brief screening tools to identify high risk older adults in the preoperative period and the role of comprehensive geriatric assessment (CGA) in identifying and addressing geriatric vulnerabilities for older adults undergoing urologic cancer surgery. Frailty screening tools such as the G8 can be used to identify patients who are at an increased risk of adverse postoperative outcomes such as postoperative complications and prolonged length of stay. CGA can provide more detailed information about geriatric syndromes prior to urologic cancer surgery. Screening tools for geriatric vulnerabilities and CGA are valuable tools for the urologist in identifying high-risk older adults, counseling patients on perioperative risk and addressing vulnerabilities prior to surgery. Making health system-wide changes can allow this optimal practice to reach more older surgical patients.

Gender-specific differences in bariatric surgery: epidemiology, treatment and results

This study investigates gender-specific differences in obesity and the treatment by metabolic bariatric surgery (MBS). The database includes 2393 patients (1725 women, 668 men) from for ahigh-volume center for bariatric surgery. Demographic, perioperative and follow-up data were retrospectively analyzed. Men had a significantly higher body mass index (BMI) and more frequent obesity-associated diseases. Despite the higher prevalence of obesity in men, women accounted for 80% of the surgical patients. On average men had longer operation times but with the same complication rates. Postoperatively, both sexes experienced asignificant reduction in excess body weight, which was slightly more pronounced in women. The study particularly emphasizes the need to better motivate men to undergo obesity treatment in order to reduce the health consequences of morbid obesity in this population group.

Postoperative pain trajectory and opioid requirements after laparoscopic bariatric surgery: a single-centre historical cohort study.

Concerns around delayed emergence and opioid-induced ventilatory impairment in bariatric surgery can lead to intraoperative reliance on short-acting opioids and avoidance of long-acting analgesics with potential sedative effects. Nevertheless, an overly-conservative intraoperative analgesic strategy may result in significant pain at emergence and higher opioid requirements in later phases of care. We sought to establish the pattern of intraoperative analgesic use in bariatric surgical patients as well as their postoperative pain trajectory and opioid requirements. We undertook a single-centre historical cohort study. We explored associations between intraoperative analgesic interventions and pain scores and opioid requirements in postanesthesia care units (PACUs), and associations between the quality of analgesia at emergence and subsequent pain and patient-centred recovery outcomes. We extracted perioperative data for 939 patients who underwent bariatric metabolic surgery between January 2018 and October 2019. Only 39% of patients received long-acting opioids intraoperatively and there was minimal use of nonopioid analgesic adjuncts. Nearly 80% of patients reported moderate-to-severe pain on PACU arrival; 97% of patients received intravenous opioids for rescue analgesia (mean dose, 31mg oral morphine equivalents). Lower pain scores at PACU admission and discharge were associated with subsequent lower inpatient pain scores, lower opioid requirements, shorter time to ambulation, and shorter length of hospital stay. In bariatric surgical patients, effective intraoperative analgesic strategies that improve early pain control may have an impact on recovery and pain experience. Judicious use of intraoperative opioids coupled with opioid-sparing multimodal analgesic techniques should be considered and balanced against concerns regarding opioid-related adverse effects in this patient population.

Preoperative anxiety, postoperative pain tolerance and analgesia consumption: A prospective cohort study.

Anxiety affects the patient's perception of postoperative pain and causes a significant increase in the consumption of analgesia postoperatively. This study assesses the relationship between preoperative anxiety, postoperative pain and postoperative pethidine consumption. A prospective cohort design was used. Data were collected from 100 patients who were undergoing a laparoscopic cholecystectomy at St Joseph Hospital, Jerusalem. Pain-controlled analgesia with pethidine was utilised to manage pain throughout the postoperative period. The visual analogue scale scores and pethidine consumption of all patients were recorded. Participants' mean level of pain was higher in the preoperative period (mean visual analogue scale = 1.3) compared with their mean level of pain in the postoperative period (mean visual analogue scale = 0.5). There is a statistically significant difference between the participants' level of anxiety and postoperative pain level (p < 0.001). Gender, weight, level of education and smoking were predictors of developing preoperative anxiety. Also, gender, smoking and medication were statistically significant predictors of developing postoperative pain. Furthermore, gender, medical history and medication were statistically significant predictors of pethidine consumption postoperatively. The preoperative anxiety reduction intervention should be promoted and implemented as routine care for all surgical patients.

An extraperitoneal single-port robotic approach to low anterior resection-Cadaveric experience.

A minimally invasive surgery (MIS) extraperitoneal (XP) approach to left-sided colorectal resection utilizing the laparoscopic approach has recently been shown to be safe and feasible and to have potential advantages over the transperitoneal approach, especially in high-risk surgical patients. The aim of this article is to provide a first cadaveric demonstration of the use of a single-port robotic platform in performing XP low anterior resection by MIS. A single-port robotic platform (DaVinci®SP™) was used to perform XP single-port low anterior resection in two cadavers with body mass indexes (BMIs) of 19 and 40 kg/m2. The single-port robotic platform with versatile arms was successfully used to perform a complete low anterior resection with splenic flexure mobilization and total mesorectal excision through a single port. A single-port robotic platform enhances complete XP dissection in the supine patient in extreme BMI ranges. Clinical studies are necessary to confirm these findings.

A clinical comparison of glycol and water-based heater-cooler systems for cardiopulmonary bypass.

While newer heater-cooler technologies using ethylene glycol-based (GB) solutions during cardiothoracic surgery have become commercially available, there is a paucity of clinical data describing their effectiveness during cardiopulmonary bypass (CPB) support. This analysis aimed to compare clinical characteristics and procedural outcomes using water-based (WB) and GB heater-cooler systems. A retrospective analysis was performed on consecutive adult patients undergoing CPB from June to October 2022 comparing WB or GB groups. The primary outcome was a composite of operative death or major morbidity. Secondary endpoints included transfusion requirements on CPB, patient cooling and warming rates, and vasoactive-inotropic scores (VIS) at case completion. P-control charts were used to monitor the weekly incidence of the composite outcome. A sub-analysis was performed to evaluate the primary outcome for cardiac surgery cases indexed by the Society of Thoracic Surgeons (STS). There were 167 patients included for analysis; 87 (52.1%) underwent CPB with a WB system and 80 (47.9%) with a GB system. GB procedure subjects were younger (p = .01), experienced longer CPB times (p = .034), and were more likely to receive thoracic transplant or aortic surgery (p = 0.015). The composite outcome of operative mortality or major morbidity occurred in 29.9% and 24% of the WB and GB groups, respectively (p = .372). P-control charts indicated a weekly mean incidence of 30% during WB practice, which decreased to 24% with GB practice. Among 106 STS-indexed cardiac surgery cases, mean composite outcome incidence decreased from 19% to 6% following our GB transition. Additionally, cooling, and warming rates indexed to patient BSA and VIS at case completion were not significantly different. Our analysis demonstrated a safe transition from WB to GB heater-cooler technologies in our practice. This early analysis suggests that GB heater coolers may be safely adopted to mitigate the risks of nontuberculous mycobacterium infections for cardiac surgical patients.

The Effect of Prognostic Nutritional Index and Systemic Inflammatory Index in Endometrioid Type Endometrial Cancer

OBJECTIVES: The primary goal of the cohort was to show the relationship between systemic inflammatory index (SII) and prognostic nutritional index (PNI) values and the prognostic factors of endometrial cancer (EC), especially lymph node (LN) involvement, and lymphovascular space invasion (LVSI), which can not generally be evaluated preoperatively. STUDY DESIGN: This is a retrospective cohort based on reviews of patient records who were diagnosed with EC and underwent treatment between January 2014 and 2021. Complete blood counts and albumin level measurements were performed within 2 weeks before treatment. RESULTS: Two hundred twenty-seven patients with endometrioid type EC were included in the cohort. The mean follow-up was 35.4 ± 19.6 months. LVSI positivity was 8.2% in the presence of low SII and 44.1% in the presence of high SII (p&lt;0.001). LVSI positivity was 23.3% in the presence of low PNI and 11.1% in the presence of high PNI (p=0.025). Low and high PNI values do not affect disease-free (DFS) and overall survival (OS) significantly. 5-year mean DFS and OS differ significantly with low and high SII values. CONCLUSİON: SII and PNI values can be used to predict the presence of LVSI in the preoperative period, and to determine the extent of LN dissection and the surgical procedure Patients with high SII values had worse survival outcomes.

Neuroinflammatory Approach to Surgical Trauma: Biomarkers and Mechanisms of Immune and Neuroendocrine Responses

The severity and invasiveness of clinical outcomes from organic responses to trauma are influenced by individual, surgical, and anesthetic factors. A stress response elicits neuroendocrine and immune reactions that may lead to multi-organ dysfunction. The degree of neuroinflammatory reflex activation from trauma can increase pro-inflammatory cytokine production, leading to endothelial dysfunction, glycocalyx damage, neutrophil activation, and multisystem tissue destruction. A shift in patient treatment towards a neuroinflammatory perspective has prompted a new evaluation protocol for surgical patients, required to understand surgical pathogenesis and its link to chosen anesthetic–surgical methods. The goal of this study is to summarize and disseminate the present knowledge about the mechanisms involved in immune and neuroendocrine responses, focusing on video laparoscopic surgeries. This article outlines various measures cited in the literature aimed at reducing the burden of surgical trauma. It reviews anesthetic drugs, anesthetic techniques, and intensive care procedures that are known to have immunomodulatory effects. The results show a preference for more sensitive inflammatory mediators to tissue trauma serving as care tools, indicators for prognosis, and therapeutic outcomes.

Transitions from Aerobic to Anaerobic Metabolism and Oxygen Debt during Elective Major and Emergency Non-Cardiac Surgery

Introduction: Intraoperative hemodynamic and metabolic optimization of both the high-risk surgical patients and critically ill patients remains challenging. Reductions in oxygen delivery or increases in oxygen consumption can initiate complex cellular processes precipitating oxygen debt (OXD). Methods: This study tested the hypothesis that intraoperative changes in sublingual microcirculatory flow may reflect clinically relevant transitions from aerobic to anaerobic metabolism (TRANAM). We included patients undergoing elective major and emergency non-cardiac surgery. Macro- and microcirculatory variables, oxygen extraction, and transitions of metabolism were assessed in both cohorts. Results: In the elective group, OXD was progressively increased over time, with an estimated 2.24 unit increase every 30 min (adjusted p &lt; 0.001). Also, OXD was negatively correlated with central venous pressure (ρ = −0.247, adjusted p = 0.006) and positively correlated with stroke volume variation (ρ = 0.185, adjusted p = 0.041). However, it was not significantly correlated with sublingual microcirculation variables. In the emergency surgery group, OXD increased during the first two intraoperative hours and then gradually decreased until the end of surgery. In that cohort, OXD was positively correlated with diastolic arterial pressure (ρ = 0.338, adjusted p = 0.005), mean arterial pressure (ρ = 0.278, adjusted p = 0.023), and systemic vascular resistance (ρ = 0.296, adjusted p = 0.015). Also, OXD was negatively correlated with the cardiac index (ρ = −0.352, adjusted p = 0.003), consensus proportion of perfused vessels (PPV) (ρ = −0.438, adjusted p &lt; 0.001), and Consensus PPV (small) (ρ = −0.434, adjusted p &lt; 0.001). Conclusions: TRANAM were evident in both the elective major and emergency non-cardiac surgery cohorts independent of underlying alterations in the sublingual microcirculation.

Surgery Plays a Leading Role in Breast Cancer Treatment for Patients Aged ≥90Years: A Large Retrospective Cohort Study.

The population aged ≥90 years is increasing worldwide, yet nearly 50% of elderly breast cancer (BC) patients receive suboptimal treatments, resulting in high rates of BC-related mortality. We analyzed clinical and survival outcomes of nonagenarian BC patients to identify effective treatment strategies. This single-institution retrospective cohort study analyzed patients aged ≥90 years diagnosed with stage I-III BC between 2007 and 2018. Patients were categorized into three treatment groups: traditional surgery (TS), performed according to local guidelines; current-standard surgery (CS), defined as breast surgery without axillary surgery (in concordance with 2016 Choosing Wisely guidelines)and/or cavity shaving; and non-surgical treatment (NS). Clinicopathological features were recorded and recurrence rates and survival outcomes were analyzed. We collected data from 113 nonagenarians with a median age of 93 years (range 90-99). Among these patients, 43/113 (38.1%) underwent TS, 34/113 (30.1%) underwent CS, and 36/113 (31.9%) underwent NS. The overall recurrence rate among surgical patients was 10.4%, while the disease progression rate in the NS group was 22.2%. Overall survival was significantly longer in surgical patients compared with NS patients (p=0.04). BC-related mortality was significantly higher in the NS group than in the TS and CS groups (25.0% vs. 0% vs. 7.1%, respectively; p=0.01). There were no significant differences in overall survival and disease-free survival between the TS and CS groups (p=0.6 and p=0.8, respectively), although the TS group experienced a significantly higher overall postoperative complication rate (p<0.001). Individualized treatment planning is essential for nonagenarian BC patients. Surgery, whenever feasible, remains the treatment of choice, with CS emerging as the best option for the majority of patients.

Anxiety and depression are common in surgical oncology patients: Results of a prospective cohort study

BackgroundThe oncology patient population is vulnerable to elevated levels of anxiety and depression. These states of psychological distress have been associated with negative effects on treatment course and outcomes, but reported prevalence rates are varied. The General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) questionnaires are screening tools that can be utilized to assess the levels of anxiety and depression, respectively. MethodsThis prospective, surgeon-blinded study assessed the preoperative prevalence of anxiety and depression in patients with abdominal malignancies who underwent curative-intent resection. Postoperative outcomes and survival were assessed. ResultsOverall, 218 patients were enrolled and included in the final analysis. Patients were stratified into groups by severity of anxiety and depression. 67 (31 %) patients reported at least mild anxiety as defined by GAD-7 score of 5 +, and 74 (34 %) patients reported at least mild depression, as defined by PHQ-9 score of 5 +. Functional status as defined by Eastern Cooperative Oncology Group scores was associated with anxiety (P = 0.003) and depression (P = 0.024). Depression was associated with race and ethnicity (P = 0.014) and marital status (P = 0.021), with Hispanic/Latino and unpartnered patients reporting higher rates of depression. ConclusionAnxiety and depression are common in the surgical oncology population, affecting a third of the patient population in this prospective study. In addition to a thorough social assessment, the GAD-7 and PHQ-9 questionnaires can be utilized preoperatively to identify patients with psychological distress. SynopsisAnxiety and depression were assessed preoperatively in patients with abdominal malignancies who underwent curative-intent resection. These states of psychological distress were highly prevalent, affecting a third of the population, and significantly associated with certain vulnerable groups.

Identification of needs of family members of surgical intensive care unit patients: a cross-sectional study

Identification of needs of family members of surgical intensive care unit patients: a cross-sectional study

Sociodemographic and Psychosocial Factors Affecting the Psychological Well-being of Preoperative Surgical Patients

PurposeThis study aimed to determine the subjective psychological well-being levels and sociodemographic and psychosocial factors affecting the psychological well-being of preoperative surgical patients. DesignThis was a cross-sectional study. MethodsThis study was conducted between January 15, 2021 and July 15, 2021. The sample consisted of 236 surgical patients in a public hospital in the Thrace region of Turkey. Data were collected using a personal information form and the five-item World Health Organization Well-Being Index (WHO-5). The data were analyzed using numbers, percentages, mean, standard deviation, independent samples t test, one-way analysis of variance, Tukey's multiple comparison test, and linear regression analysis. FindingsParticipants had a mean WHO-5 score of 10.76 ± 6.21, indicating low subjective psychological well-being. Economic status, chronic disease status, history of surgery, having been on psychiatric medication or receiving professional psychological support, tobacco use, experiencing a significant life change in the last 3 months, and reporting experiencing frequent stress in everyday life were significant predictors of WHO-5 scores. ConclusionsPreoperative surgical patients have low subjective psychological well-being, and their sociodemographic and psychosocial factors affect their psychological well-being.

Cervical facet joint degeneration, facet joint angle and paraspinal muscle degeneration are correlated with degenerative cervical spondylolisthesis at C4/5: A propensity score-matched study

Prior studies have hypothesized that degenerative cervical spondylolisthesis (DCS) may be influenced by loss of stability due to disc, facet joint or cervical alignment. Meanwhile, it is commonly believed that the facet joints and paraspinal muscles participate in maintaining cervical spine stability. However, the impact of paraspinal muscle morphology and detailed facet joint features on DCS requires further investigation. To compare facet joint characteristics, disc degeneration and muscle morphology between patients with DCS and those without DCS. Retrospective cohort study. Consecutive surgical patients with degenerative cervical spondylosis from June 2016 to August 2023 were recruited. DCS was assessed on X-ray based on the translation distance. Cervical facet joint degeneration (CFD), the facet joint angle on the axial plane (FA-A) and the facet joint angle on the sagittal plane (FA-S), and facet joint tropism (FT) were measured on computerized tomography (CT). Paraspinal muscle degeneration was assessed on magnetic resonance imaging (MRI) including by the adjusted cross-sectional area (aCSA), the functional aCSA, the fat infiltration ratio (FI%). The Pfirrmann grade of the cervical disc was also evaluated. Demographic and clinical data were compared in matched and unmatched cohorts. Disc degeneration, muscle degeneration and facet joint characteristics, including FA, FT and CFD, were compared between patients with and without DCS. Furthermore, the degree of CFD was compared with that of adjacent segments in both groups. Additionally, logistic regression was performed to determine independent risk factors for DCS. Finally, the receiver operating characteristic (ROC) curve, area under the curve (AUC) and cutoff value for the risk factors were calculated. A total of 431 surgical patients were propensity score matched for age, sex and BMI, and 146 patients were included in the final analysis, with 73 patients in the DCS group and 73 patients in the non-DCS group. DCS patients exhibited more severe CFD at C4/5 (segment with spondylolisthesis). Additionally, DCS was generally associated with more severe CFD, a more horizontal FA-S, more FT and worse paraspinal muscle health but similar disc degeneration. In addition, anterior spondylolisthesis was related to more severe CFD and decreased functional aCSA of the flexors and extensors. Finally, more severe CFD, a more horizontal FA-S and a higher FI% on deep extensor were revealed to be risk factors for DCS, with cutoff values of 1.5, 44.5̊ and 37.1%, respectively. This study demonstrated that CFD, the FA and FT and parasipnal muscle degeneration were associated with DCS. And may provide novel insight into the pathogenesis and nature history of DCS and suggest the evolution of degeneration in the cervical spine.

Knowledge, attitude, and practice of non-emergency surgical patients toward anesthesia

This study aimed to investigate the knowledge, attitude, and practice (KAP) of non-emergency surgical patients toward anesthesia. This cross-sectional study was conducted between May and October 2023 at Zibo Central Hospital among non-emergency surgical patients. A total of 429 valid questionnaires were enrolled (mean age: 42.81 ± 13.17 years old; 227 (52.91%) females). The mean KAP scores were 7.79 ± 3.95 (possible range: 0–18), 32.35 ± 2.80 (possible range: 8–40), and 18.14 ± 3.96 (possible range: 6–24), respectively. Multivariate logistic regression analysis showed that knowledge (OR = 1.095, 95% CI 1.036–1.158, P = 0.001) and previous poor anesthesia experience (OR = 0.081, 95% CI 0.017–0.386, P = 0.002) were independently associated with practice. Non-emergency surgical patients had inadequate knowledge, positive attitude, and proactive practice towards anesthesia. It is crucial for healthcare professionals to implement targeted educational interventions to inform patients about the anesthesia process, potential risks, and benefits.

Effects of red blood cell transfusion on patients undergoing cardiac surgery in Queensland – a retrospective cohort study

BackgroundPacked red blood cell (pRBC) transfusion is a relatively safe and mainstay treatment commonly used in cardiac surgical patients. However, there is limited evidence on clinical effects of transfusing blood nearing end-of shelf life that has undergone biochemical changes during storage.ObjectiveTo investigate evidence of associations between morbidity/mortality and transfusion of blood near end of shelf-life (> 35 days) in cardiac surgical patients.MethodsData from the Queensland Health Admitted Patient Data Collection database 2007–2013 was retrospectively analysed. Coronary artery bypass graft and valvular repair patients were included. Multivariable logistic regression was used to examine the effect of pRBC age (< 35 days vs. ≥ 35 days) on in-hospital mortality and morbidity. As secondary analysis, outcomes associated with the number of pRBC units transfused (≤ 4 units vs. ≥ 5 units) were also assessed.ResultsA total of 4514 cardiac surgery patients received pRBC transfusion. Of these, 292 (6.5%) received pRBCs ≥ 35 days. No difference in in-hospital mortality or frequency of complications was observed. Transfusion of ≥ 5 units of pRBCs compared to the ≤ 4 units was associated with higher rates of in-hospital mortality (5.6% vs. 1.3%), acute renal failure (17.6% vs. 8%), infection (10% vs. 3.4%), and acute myocardial infarction (9.2% vs. 4.3%). Infection carried an odds ratio of 1.37 between groups (CI = 0.9–2.09; p = 0.14) and stroke/neurological complications, 1.59 (CI = 0.96–2.63; p = 0.07).ConclusionIn cardiac surgery patients, transfusion of pRBCs closer to end of shelf-life was not shown to be associated with significantly increased mortality or morbidity. Dose-dependent differences in adverse outcomes (particularly where units transfused were > 4) were supported.

Pre-warming Surgical Patients

Pre-warming Surgical Patients

Can caloric restriction improve outcomes of elective surgeries?

Energy restriction (ER) is a nutrition method to reduce the amount of energy intake while maintaining adequate nutrition. In clinical medicine, applications of ER have been implicated in longevity, mortality, metabolic, immune, and psychological health. However, there are limited studies showing the clinical benefit of ER within the immediate surgical setting. A specific, clinically oriented summary of the potential applications of ER is needed to optimize surgery outcomes for patients. The purpose of this article is to examine how ER can be used for perioperative optimization to improve outcomes for the patient and surgeon. It will also explore how these outcomes can feasibly fit in with enhanced recovery after surgery protocols and can be used as a method for nutrition optimization in surgery. Despite evidence of caloric restriction improving outcomes in critically ill surgical patients, there is not enough evidence to conclude that ER, perioperatively across noncritically ill cohorts, improves postoperative morbidity and mortality in elective surgeries. Nevertheless, a contemporary account of how ER techniques may have a significant role in reducing risk factors of adverse surgical outcomes in this cohort, for example, by encouraging preoperative weight loss contributing to decreased operating times, is reviewed.

Clinical features of unilateral multilobar and hemispheric polymicrogyria (PMG)-related epilepsy and seizure outcome with different treatment options.

To provide evidence for choosing surgical or nonsurgical treatment for epilepsy in patients with unilateral multilobar and hemispheric polymicrogyria (PMG). We searched published studies until September 2022 related to unilateral multilobar and hemispheric PMG and included patients who were followed up at the Pediatric Epilepsy Centre of Peking University First Hospital in the past 10 years. We summarized the clinical characteristics and compared the long-term outcomes after surgical or nonsurgical (anti-seizure medications, ASMs) treatment. A total of 70 patients (49 surgical, 21 non-surgical) with unilateral multilobar and hemispheric PMG were included. The median age at epilepsy onset was 2.5 years (1.0-4.1). The most common seizure types were focal and atypical absence seizures. In the whole cohort, 87.3% had hemiparesis and 67.1% had electrical status epilepticus during slow sleep (ESES). There were significant differences in age at epilepsy onset, extent of lesion, and EEG interictal discharges between the two groups. At the last follow-up (median 14.1 years), the rates of seizure-freedom (81.6% vs. 57.1%, p = 0.032) and ASM discontinuation (44.4% vs. 6.3%, p = 0.006) were higher in the surgical group than in the nonsurgical group. Patients in the surgical group had a higher rate of seizure-freedom with complete resection/disconnection than with subtotal resection (87.5% vs. 55.6%, p = 0.078), but with no statistically significant difference. In the nonsurgical group, more extensive lesions were associated with worse seizure outcomes. Cognition improved postoperatively in 90% of surgical patients. In patients with unilateral multilobar and hemispheric PMG, the age of seizure onset, the extent of the lesion and EEG features can help determine whether surgery should be performed early. Additionally, surgery could be more favorable for achieving seizure freedom and cognitive improvement sooner. We aim to summarize clinical characteristics and compare the long-term outcomes after surgical and nonsurgical (ASM) treatment to provide a basis for treatment decisions for patients with unilateral multilobar and hemispheric polymicrogyria (PMG)-related epilepsy. We found that patients with unilateral hemispheric and multilobar PMG had significantly higher rates of seizure freedom and ASM discontinuation with surgical treatment than with nonsurgical treatment. In the surgical group, seizure outcomes were better in patients treated with complete resection/disconnection than in those treated with subtotal resection, but the difference was not statistically significant.

Chinese expert consensus on transfemoral transcatheter aortic valve replacement for pure aortic regurgitation (2023)

Transcatheter aortic valve replacement (TAVR) was initially used to treat aortic stenosis (AS), and gradually expanded into aortic regurgitation (AR) treatment. Scholars worldwide have explored the use of marketed transfemoral TAVR (TF-TAVR) valves for AR patients, offering another option for high-risk surgical patients. However, AR presents distinct challenges compared to AS, including anatomical differences, valve selection, procedural nuances, and complication profiles. Overall, TF-TAVR for AR is more complex with lower success rate than for AS. In order to promote the safe and standardized TF-TAVR for AR in China, the Structural Heart Disease Group of Chinese College of Cardiovascular Physician drafted this consensus. The writing expert team focused on key clinical challenges in TF-TAVR for AR patients, combining evidence from literature up to September 1, 2023, to formulate nine core viewpoints. These encompass indications, valve selection, preoperative evaluation, intraoperative techniques, complication prevention and management, postoperative care, and other aspects.