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Structural Heart : the Journal of the... Mar 2024Transcatheter aortic valve implantation (TAVI) has become a safe procedure. However, complications occur, including uncommon complications such as valve malposition,...
BACKGROUND
Transcatheter aortic valve implantation (TAVI) has become a safe procedure. However, complications occur, including uncommon complications such as valve malposition, which requires the implantation of an additional rescue valve (rescue-AV). The aim was to study the occurrence and outcomes of rescue-AV in a nationwide registry.
METHODS
The Swedish national TAVI registry was used as the primary data source, where all 6706 TAVI procedures from 2016 to 2021 were retrieved. Nontransfemoral access and planned valve-in-valve were excluded. In total, 79 patients were identified as having had a rescue-AV, and additional detailed data were collected for these patients. This dataset was analyzed for any characteristics that could predispose patients to a rescue-AV. The outcome of patients receiving rescue-AV also was studied.
RESULTS
Of the 5948 patients in the study, 1.3% had a rescue-AV. There were few differences between patients receiving 1 valve and rescue-AV patients. For patients receiving a rescue-AV, the 30-day mortality was 15.2% compared to 1.6% in the control group. A poor outcome after rescue-AV was often associated with a second complication; for example, stroke, need for emergency surgery, or heart failure. Among the patients with rescue-AV who survived at least 30 days, landmark analyses showed similar survival rates compared to the control group.
CONCLUSIONS
Among TAVI patients in a nationwide register, rescue-AV occurred in 1.3% of patients. The 30-day mortality in patients receiving rescue-AV was high, but long-term outcome among 30-day survivors was similar to the control group.
PubMed: 38481713
DOI: 10.1016/j.shj.2023.100231 -
American Journal of Obstetrics &... Apr 2024Poor outcomes from operative vaginal birth have been associated with failure to recognize malposition, breakdown in interdisciplinary communication, and deviation from...
BACKGROUND
Poor outcomes from operative vaginal birth have been associated with failure to recognize malposition, breakdown in interdisciplinary communication, and deviation from accepted guidelines. We recently implemented a safety bundle including routine intrapartum ultrasound and a structured time-out and procedural checklist aiming to reduce maternal and perinatal morbidity from operative vaginal birth.
OBJECTIVE
This study aimed to compare births where intrapartum ultrasound was used and those where it was not used during a safety bundle implementation period at Monash Health.
STUDY DESIGN
We performed a retrospective cohort study at Monash Health during the transitional phase of implementing an operative vaginal birth safety bundle. We studied all women with operative vaginal birth and fully dilated cesarean delivery with a singleton cephalic term fetus. We compared births for which intrapartum ultrasound was used and those for which it was not. The primary outcome was neonates delivered in an unexpected position. Neonatal and maternal morbidity were also assessed, including a neonatal composite of Apgar score <7 at 5 minutes, cord lactate >8 mmol/L, need for resuscitation, significant birth trauma, or neonatal intensive care unit admission. To control for confounding by indication, we estimated propensity scores for the probability of using intrapartum ultrasound for each case based on maternal and labor characteristics, and adjusted the effect estimates for the propensity scores using multivariable logistic regression models.
RESULTS
From August 2022 to July 2023, there were 1205 operative vaginal births or fully dilated cesarean deliveries at Monash Health, including 743 (61.7%) forceps, 346 (28.7%) vacuum, and 116 (9.6%) fully dilated cesarean deliveries. Over this time, we observed increased uptake of intrapartum ultrasound from 26% in August 2022 to 60% (P<.001) in July 2023, of the time-out from 21% to 58% (P<.001), and the checklist from 33% to 80% (P<.001) of operative second-stage births. Among the births where intrapartum ultrasound was used (n=509), compared with those where it was not (n=696), there were significantly more forceps births (67% vs 58%; adjusted odds ratio, 1.35; 95% confidence interval, 1.05-1.74; P=.021) and a reduction in vacuum births (24% vs 32%; adjusted odds ratio, 0.77; 95% confidence interval, 0.58-1.01; P=.059). There were no significant differences in fully dilated cesarean delivery or maternal morbidity. Intrapartum ultrasound use was associated with significantly fewer infants being delivered in an unexpected position (0.2% vs 2.2%; adjusted odds ratio, 0.08; 95% confidence interval, 0.00-0.44; P=.019) and a significant reduction in composite neonatal morbidity (22% vs 25%; adjusted odds ratio, 0.73; 95% confidence interval, 0.54-0.97; P=.031).
CONCLUSION
During the implementation of a safety bundle, the use of ultrasound before operative vaginal birth was associated with fewer infants delivered in an unexpected position and reduced neonatal morbidity.
Topics: Humans; Female; Retrospective Studies; Pregnancy; Adult; Infant, Newborn; Cesarean Section; Ultrasonography, Prenatal; Apgar Score; Extraction, Obstetrical; Cohort Studies; Propensity Score; Checklist; Vacuum Extraction, Obstetrical
PubMed: 38479490
DOI: 10.1016/j.ajogmf.2024.101345 -
Revista Espanola de Enfermedades... Mar 2024Esophageal stents have become an emergent, effective treatment for esophageal perforation, whether spontaneous or iatrogenic. We report a case of iatrogenic perforation...
Esophageal stents have become an emergent, effective treatment for esophageal perforation, whether spontaneous or iatrogenic. We report a case of iatrogenic perforation secondary to malposition of a Sengstaken-Blakemore balloon (SBB), which was inserted to control acute variceal bleeding. SBB currently has very limited indications in the management of variceal bleeding given the ongoing advances in endoscopic techniques, and its use is not exempt from complications such as the one reported herein.
PubMed: 38469798
DOI: 10.17235/reed.2024.10331/2024 -
Journal of Surgical Case Reports Mar 2024An 80-year-old woman presented with painless blurring of vision and monocular diplopia in her left eye following routine phacoemulsification and monofocal intraocular...
An 80-year-old woman presented with painless blurring of vision and monocular diplopia in her left eye following routine phacoemulsification and monofocal intraocular lens (IOL) implantation 5 weeks earlier. Her uncorrected visual acuity (VA) was 6/60 correctable with pinhole to 6/21. Her best-corrected VA was 6/15 with a subjective refraction of -0.50DS/-5.25DCx37. Her corneal astigmatism was -1.25DCx74. Ophthalmic examination disclosed a severely tilted single-piece posterior chamber IOL in the capsular bag. The inferior portion of the optic was tilted posteriorly because of a twisted and malpositioned haptic. The patient underwent remedial surgery to untwist and reposition the IOL haptic which led to immediate improvement of the IOL position. Her uncorrected VA improved to 6/12 correctable with pinhole to 12 with an autorefraction of +0.25DS/-2.00DCx74 on the first postoperative day. One month postoperatively, her best-corrected VA was 6/12 with a refraction of +0.50DS/-2.50DCx82. Her final vision was limited by myopic macular degeneration.
PubMed: 38469204
DOI: 10.1093/jscr/rjae134 -
JSES International Mar 2024The Latarjet procedure is a common bony augmentation procedure for anterior shoulder instability. Historically, screw fixation is used to secure the coracoid graft to...
BACKGROUND
The Latarjet procedure is a common bony augmentation procedure for anterior shoulder instability. Historically, screw fixation is used to secure the coracoid graft to the anterior glenoid surface; however, malpositioning of the graft leads to oblique screw insertion that contributes to complications. Suture buttons (SBs) are a more recent fixation technique that have not been studied alongside standard screw fixation in the context of biomechanical models of angulated fixation. This study aims to compare the biomechanical strength of single and double, screw and SB fixation at various levels of angulation.
METHODS
Testing was performed using polyurethane models from Sawbones. The graft piece was secured with screw fixation (Arthrex, Naples, FL, USA) or suspensory button (ABS Tightrope, Arthrex, Naples, FL, USA). Single or double constructs of screws and SBs were affixed at 0°, 15°, and 30° angles to the face of the glenoid component. An aluminum testing jig held the samples securely while a materials testing system applied loads. Five constructs were used for each condition and assessed load to failure testing.
RESULTS
For single fixation constructs, suspensory buttons were 60% stronger than screws at 0° ( < .001), and 52% stronger at 15° ( = .004); however, at 30°, both were comparable ( = .180). Interestingly, single suspensory button at 15° was equivalent to a single screw at 0° ( = .310). For double fixation, suspensory buttons (DT) were 32% stronger than screws at 0° ( < .001) and 35% stronger than screws at 15° ( < .001). Both double fixation methods were comparable at 30° ( = .061). Suspensory buttons at 15° and 30° were equivalent to double screws at 0 ( = .280) and 15° ( = .772), respectively.
CONCLUSION
These measurements indicate that the suspensory button has a significantly higher load to failure capacity over the screw fixation technique, perpendicularly and with up to 15° of angulation. These analyses also indicate that the suspensory button fixation offers superior strength even when positioned more obliquely than the screw fixation. Therefore, suspensory button fixation may confer more strength while offering greater margin for error when positioning the graft.
PubMed: 38464447
DOI: 10.1016/j.jseint.2023.09.008 -
Journal of Surgical Case Reports Mar 2024Intra-aortic balloon pumps (IABPs) are used to mechanically temporize a failing heart by decreasing afterload while increasing coronary perfusion pressure of the heart...
Intra-aortic balloon pumps (IABPs) are used to mechanically temporize a failing heart by decreasing afterload while increasing coronary perfusion pressure of the heart while more definitive treatment is sought. We report a case of a 65-year-old male with nonischemic cardiomyopathy, atrial fibrillation, thyroiditis, and non-Hodgkin lymphoma who presented with worsening heart failure. He underwent a percutaneous placement of a left axillary IABP with seemingly no complications. Approximately 3 weeks post-placement, the patient was taken for a heart transplant when an intraoperative transesophageal echo showed that the IABP was in the aortic arch and ascending aorta, instead of its proper placement in the descending aorta. The patient's arterial line showed waveforms appropriate for an IABP patient, and the patient showed no signs indicative of improper placement. This erroneous placement carried the potential to affect the aortic valve function, injure the aortic intima and/or occlude the aortic arch vessels. .
PubMed: 38455981
DOI: 10.1093/jscr/rjae092 -
PloS One 2024Extrusion of electrodes outside the cochlea and tip fold overs may lead to suboptimal outcomes in cochlear implant (CI) recipients. Intraoperative measures such as...
A scoping review on the clinical effectiveness of Trans-Impedance Matrix (TIM) measurements in detecting extracochlear electrodes and tip fold overs in Cochlear Ltd devices.
BACKGROUND
Extrusion of electrodes outside the cochlea and tip fold overs may lead to suboptimal outcomes in cochlear implant (CI) recipients. Intraoperative measures such as Trans-Impedance Matrix (TIM) measurements may enable clinicians to identify electrode malposition and direct surgeons to correctly place the electrode array during surgery.
OBJECTIVES
To assess the current literature on the effectiveness of TIM measurements in identifying extracochlear electrodes and tip fold overs.
METHODS
A scoping review of studies on TIM-based measurements were carried out using the Databases-Medline/PubMed, AMED, EMBASE, CINAHL and the Cochrane Library following PRISMA guidelines. Eleven full texts articles met the inclusion criteria. Only human studies pertaining to TIM as a tool used in CI were included in the review. Further, patient characteristics, electrode design, and TIM measurement outcomes were reported.
RESULTS
TIM measurements were available for 550 implanted ears with the subjects age ranged between 9 months to 89 years. Abnormal TIM measurements were reported for 6.55% (36). Tip fold over was detected in 3.64% (20) of the cases, extracochlear electrodes in 1.45% (8), and 1.45% (8) were reported as buckling. Slim-modiolar electrode array designs were more common (54.71%) than pre-curved (23.34%) or lateral wall (21.95%) electrode array. Abnormal cochlear anatomy was reported for five ears (0.89%), with normal cochlear anatomy for all other patients.
CONCLUSION
TIM measurement is a promising tool for the intraoperative detection of electrode malposition. TIM measurement has a potential to replace intraoperative imaging in future. Though, TIM measurement is in its early stages of clinical utility, intuitive normative data sets coupled with standardised criteria for detection of abnormal electrode positioning would enhance its sensitivity.
Topics: Humans; Cochlea; Cochlear Implantation; Cochlear Implants; Electric Impedance; Electrodes, Implanted; Treatment Outcome
PubMed: 38452034
DOI: 10.1371/journal.pone.0299597 -
Indian Journal of Plastic Surgery :... Feb 2024Biointegration of polyurethane (PU) implants providing their stable position years after surgery ensures predictable results of breast augmentation and...
Biointegration of polyurethane (PU) implants providing their stable position years after surgery ensures predictable results of breast augmentation and reconstruction almost eliminating implant factor as a cause of complications. However, in rare cases PU implants appear to be not connected to the surrounding tissues. The aim of the study was to determine the incidence of PU implant nonadherence after primary breast augmentations and augmentation mastopexies with dual plane implant position, to analyze possible causes, and to propose preventive measures and treatment possibilities of this complication. The results of primary aesthetic surgeries in 333 patients with dual plane PU implant placement were analyzed. Patients were evaluated clinically, and pictures and videos taken in different periods after the surgery were compared. Particular attention was given to the changes in implant position and the appearance of asymmetries over time. PU implant nonadherence was found in seven patients. It can be divided into primary and secondary and may be complete or partial. Primary nonadherence was found in two cases (0.6%), and secondary in five (1.5%) cases. Possible influencing factors could have been traumatic surgical technique, seroma, hematoma, or physical trauma. The average follow-up was 33 months (1 month-15 years). Biointegration is mandatory for the long-term predictable results with PU implants. PU implant nonadherence leads to implant malposition and may cause typical complications connected to non-PU implants. Improvements in surgical maneuvers, manufacturing process, and weight reduction of the implant may be beneficial for the stability of the results. V.
PubMed: 38450018
DOI: 10.1055/s-0043-1778644 -
BMC Musculoskeletal Disorders Mar 2024In total hip arthroplasty (THA) after failed transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH), deformity of the proximal femur...
BACKGROUND
In total hip arthroplasty (THA) after failed transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH), deformity of the proximal femur has been reported to affect stem placement. The aims of this study were to evaluate the morphological changes in the proximal femur, muscle atrophy, and soft tissue thickening in THA after TRO and the clinical outcomes.
METHODS
The TRO group included 17 patients (18 hips) who underwent THA after failed TRO. The control group included 21 patients (28 hips) who underwent primary THA for ONFH. To evaluate the deformity of the proximal femur before THA, we measured the anteroposterior and mediolateral diameters of the femur on computed tomographic slices 5 mm proximal to the lesser trochanter. To evaluate muscle atrophy and soft tissue thickening, we measured the thicknesses of the psoas major, iliac, and gluteus medius muscles and the anterior capsule of the hip joint.
RESULTS
The ratio of the anteroposterior to mediolateral diameters of the proximal femur was significantly greater in the TRO group (p < 0.01). The thicknesses of the muscles did not differ between the two groups, whereas the anterior capsule was significantly thicker in the TRO group (p < 0.05). Varus or valgus stem alignment (> 3°) was frequent in the TRO group (p < 0.01).
CONCLUSIONS
The round shape of the proximal femur was deformed after TRO compared with primary THA for ONFH, which may have caused malposition of the stem. In addition, we should pay attention to anterior protrusion of the proximal femur and thickening of the anterior capsule.
Topics: Humans; Arthroplasty, Replacement, Hip; Femur Head; Muscular Atrophy; Osteotomy; Osteonecrosis
PubMed: 38439044
DOI: 10.1186/s12891-024-07299-z -
Arthroscopy Techniques Feb 2024The accurate positioning of the femoral tunnel is crucial for the success of anterior cruciate ligament reconstruction. Malpositioning of the tunnel is believed to be...
App-Based Analysis of Fluoroscopic Images According to Bernard-Hertel Method for the Determination of Femoral Tunnel Positioning in Anterior Cruciate Ligament Reconstruction.
The accurate positioning of the femoral tunnel is crucial for the success of anterior cruciate ligament reconstruction. Malpositioning of the tunnel is believed to be one of the most important reasons for graft failure. While use of anatomic landmarks and industry-supplied aiming devices aid the surgeon in placing the drill pin in the correct position, fluoroscopic imaging is an additional tool used intraoperatively to verify pin placement. While interpretation of fluoroscopic imaging is frequently based on eyeball measurement, a more accurate analysis of a lateral image uses the quadrant method by Bernard-Hertel. This method has been primarily used for scientific research due to its complexity and has not been integrated into clinical routine yet. We present a digital app-based approach to easily quantify the femoral pin position based on the quadrant method. This approach is mobile and easy to use. Quantification of pin position of femoral bone tunnel on a lateral fluoroscopic image may be used for quality control and teaching purposes or may provide the surgeon with additional information during ACL reconstruction.
PubMed: 38435250
DOI: 10.1016/j.eats.2023.10.006