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Translational Pediatrics Oct 2023Bovine jugular valved conduit (BJVC) has been reported as an optional material for right ventricular outflow tract (RVOT) reconstruction in patients with complex...
BACKGROUND
Bovine jugular valved conduit (BJVC) has been reported as an optional material for right ventricular outflow tract (RVOT) reconstruction in patients with complex congenital heart disease (CHD). It showed comparable or even better performance than homograft. However, the durability of BJVC is still very poor in infants and children. Herein, we retrospectively analyzed and evaluated the mid-term results of RVOT reconstruction by using bovine jugular vein valved conduits (Balance BJVCs) in CHD patients, with a special focus on the functional status of the conduits.
METHODS
Pediatric patients undergoing RVOT reconstruction using Balance BJVC in Guangzhou Women and Children's Medical Center from January 2018 to December 2020 were enrolled in this study. The demographic information, cardiac anatomical abnormalities, preoperative hemodynamic characteristics, surgical details, postoperative outcomes, and follow-up data of the patients were reviewed retrospectively.
RESULTS
Ninety-four patients were enrolled in this study. The median age at implantation was 22 months (range, 2-168 months), the median weight was 10.8 kg (range, 3.8-40.0 kg); 34 children (36.2%) were younger than 1 year. The most common disease in these children was pulmonary atresia with ventricular septal defect (PA/VSD) (66/94, 70.2%). The patients were followed up for a median of 43.5 months (range, 6-60 months). Late mortality occurred in 4 (4.3%). Cumulatively, conduit dysfunction at different levels occurred in 31 (33%), conduit failure in 9 (9.6%), 6 patients underwent reoperation for conduit replacement, 5 (5.3%) developed infective endocarditis (IE) within 24 months (range, 12-36 months) after the surgery. Five-year survival rate is 95.7%. The free of conduit dysfunction rates at 1, 3, and 5 years was 91.4%, 68.5%, and 50.4%, respectively. In addition, the rates of patients who were free of conduit failure at 1, 3, and 5 years were 100%, 88.9%, and 88.9%, respectively.
CONCLUSIONS
Despite the high risk of BJVC dysfunction, approximately 90% of children are free from conduit failure at 5 years after conduit implantation through aggressive transcatheter intervention without increasing the incidence of IE. Thus, BJVC remains a useful alternative material for RVOT reconstruction in patients with complex CHD.
PubMed: 37969123
DOI: 10.21037/tp-23-287 -
Annals of Gastroenterological Surgery Nov 2023Risk prediction of anastomotic leakage using anatomical and vascular factors has not been well established. This study aimed to assess the anatomical and vascular...
BACKGROUND
Risk prediction of anastomotic leakage using anatomical and vascular factors has not been well established. This study aimed to assess the anatomical and vascular factors affecting the hemodynamics of the gastric conduit and develop a novel risk stratification system in patients undergoing esophagectomy with retrosternal reconstruction.
METHODS
This retrospective cohort study analyzed 202 patients with esophageal cancer who underwent subtotal esophagectomy with gastric tube retrosternal reconstruction between January 2008 and December 2020. Risk factors for anastomotic leakage (AL), including the anatomical index (AI) and anastomotic viability index (AVI), were evaluated using a logistic regression model.
RESULTS
According to the logistic regression model, the independent risk factors for AL were preoperative body mass index ≥23.6 kg/m (odds ratio [OR], 7.97; 95% confidence interval [CI], 2.44-26.00; 0.01), AI <1.4 (OR, 23.90; 95% CI, 5.02-114.00; 0.01), and AVI <0.62 (OR, 8.02; 95% CI, 2.57-25.00; 0.01). The patients were stratified into four AL risk groups using AI and AVI as follows: low-risk group (AI ≥1.4, AVI ≥0.62 [2/99, 2.0%]), intermediate low-risk group (AI ≥1.4, AVI <0.62 [2/29, 6.9%]), intermediate high-risk group (AI <1.4, AVI ≥0.62 [8/53, 15.1%]), and high-risk group (AI <1.4, AVI <0.62 [11/21, 52.4%]).
CONCLUSION
The combination of AI and AVI strongly predicted AL. Additionally, the use of AI and AVI enabled the stratification of the risk of AL in patients who underwent esophagectomy with retrosternal reconstruction.
PubMed: 37927915
DOI: 10.1002/ags3.12693 -
The Annals of Thoracic Surgery Feb 2024Studies that have assessed the Rastelli and Nikaidoh operations for transposition of the great arteries (TGA) with obstructed left ventricular outflow tract obstruction...
BACKGROUND
Studies that have assessed the Rastelli and Nikaidoh operations for transposition of the great arteries (TGA) with obstructed left ventricular outflow tract obstruction (LVOTO) have not fully evaluated the anatomic drivers that may contribute to surgical selection. We present our procedural selection process for optimizing outcomes of complex TGA in the modern era.
METHODS
This is a single-center, retrospective study that included pediatric patients who underwent either a Nikaidoh or Rastelli operation for the treatment of TGA-LVOTO, congenitally corrected TGA-LVOTO, or double-outlet right ventricle TGA type-LVOTO from June 2004 to June 2021.
RESULTS
There were 34 patients stratified by Nikaidoh (n = 16) or Rastelli (n = 18) operation. The incidence of all postoperative complications and mortality was low, and the incidence of complications between the groups was similar. Patients were more likely to have undergone a Nikaidoh than a Rastelli if they had a pulmonary annulus >5 mm (87.5% vs 11.1%), anteriorly/posteriorly oriented great vessels (88% vs 8%), remote (80% vs 11%) or restrictive (75% vs 6%) ventricular septal defect, and right ventricular hypoplasia (50% vs 0%; all, P < .05). The resulting rates of reoperation were similar between the groups (44.0% vs 37.5%; P = .24) and largely composed of conduit replacements in the Rastelli patients and valvular repairs or replacements in the Nikaidoh group. Rates of catheter-based interventions were also similar.
CONCLUSIONS
These findings suggest that for the optimal treatment of conotruncal anomalies with discordant ventriculoarterial connections, procedural selection should be based on pathoanatomic criteria that can ensure patients undergo the operation most suited to their anatomy.
Topics: Child; Humans; Infant; Transposition of Great Vessels; Ventricular Outflow Obstruction, Left; Retrospective Studies; Treatment Outcome; Ventricular Outflow Obstruction
PubMed: 37774760
DOI: 10.1016/j.athoracsur.2023.09.022 -
Journal of Clinical Medicine Sep 2023Infective endocarditis (IE) is still a life-threatening disease with frequent lethal outcomes despite the profound changes in its clinical, microbiological, imaging, and... (Review)
Review
Infective endocarditis (IE) is still a life-threatening disease with frequent lethal outcomes despite the profound changes in its clinical, microbiological, imaging, and therapeutic profiles. Nowadays, the scenario for IE has changed since rheumatic fever has declined, but on the other hand, multiple aspects, such as elderly populations, cardiovascular device implantation procedures, and better use of multiple imaging modalities and multidisciplinary care, have increased, leading to escalations in diagnosis. Since the ESC and AHA Guidelines have been released, specific aspects of diagnostic and therapeutic management have been clarified to provide better and faster diagnosis and prognosis. Surgical treatment is required in approximately half of patients with IE in order to avoid progressive heart failure, irreversible structural damage in the case of uncontrolled infection, and the prevention of embolism. The timing of surgery has been one of the main aspects discussed, identifying cases in which surgery needs to be performed on an emergency (within 24 h) or urgent (within 7 days) basis, irrespective of the duration of antibiotic treatment, or cases where surgery can be postponed to allow a brief period of antibiotic treatment under careful clinical and echocardiographic observation. Mainly, guidelines put emphasis on the importance of an endocarditis team in the handling of systemic complications and how they affect the timing of surgery and perioperative management. Neurological complications, acute renal failure, splenic or musculoskeletal manifestations, or infections determined by multiresistant microorganisms or fungi can affect long-term prognosis and survival. Not to be outdone, anatomical and surgical factors, such as the presence of native or prosthetic valve endocarditis, a repair strategy when feasible, anatomical extension and disruption in the case of an annular abscess (mitral valve annulus, aortic mitral curtain, aortic root, and annulus), and the choice of prosthesis and conduits, can be equally crucial. It can be hard for surgeons to maneuver between correct pre-operative planning and facing unexpected obstacles during intraoperative management. The aim of this review is to provide an overview and analysis of a broad spectrum of specific surgical scenarios and how their challenging management can be essential to ensure better outcomes and prognoses.
PubMed: 37762834
DOI: 10.3390/jcm12185891 -
JAMA Psychiatry Dec 2023Psychotic illness is associated with anatomically distributed gray matter reductions that can worsen with illness progression, but the mechanisms underlying the specific... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Psychotic illness is associated with anatomically distributed gray matter reductions that can worsen with illness progression, but the mechanisms underlying the specific spatial patterning of these changes is unknown.
OBJECTIVE
To test the hypothesis that brain network architecture constrains cross-sectional and longitudinal gray matter alterations across different stages of psychotic illness and to identify whether certain brain regions act as putative epicenters from which volume loss spreads.
DESIGN, SETTINGS, AND PARTICIPANTS
This case-control study included 534 individuals from 4 cohorts, spanning early and late stages of psychotic illness. Early-stage cohorts included patients with antipsychotic-naive first-episode psychosis (n = 59) and a group of patients receiving medications within 3 years of psychosis onset (n = 121). Late-stage cohorts comprised 2 independent samples of people with established schizophrenia (n = 136). Each patient group had a corresponding matched control group (n = 218). A sample of healthy adults (n = 356) was used to derive representative structural and functional brain networks for modeling of network-based spreading processes. Longitudinal illness-related and antipsychotic-related gray matter changes over 3 and 12 months were examined using a triple-blind randomized placebo-control magnetic resonance imaging study of the antipsychotic-naive patients. All data were collected between April 29, 2008, and January 15, 2020, and analyses were performed between March 1, 2021, and January 14, 2023.
MAIN OUTCOMES AND MEASURES
Coordinated deformation models were used to estimate the extent of gray matter volume (GMV) change in each of 332 parcellated areas by the volume changes observed in areas to which they were structurally or functionally coupled. To identify putative epicenters of volume loss, a network diffusion model was used to simulate the spread of pathology from different seed regions. Correlations between estimated and empirical spatial patterns of GMV alterations were used to quantify model performance.
RESULTS
Of 534 included individuals, 354 (66.3%) were men, and the mean (SD) age was 28.4 (7.4) years. In both early and late stages of illness, spatial patterns of cross-sectional volume differences between patients and controls were more accurately estimated by coordinated deformation models constrained by structural, rather than functional, network architecture (r range, >0.46 to <0.57; P < .01). The same model also robustly estimated longitudinal volume changes related to illness (r ≥ 0.52; P < .001) and antipsychotic exposure (r ≥ 0.50; P < .004). Network diffusion modeling consistently identified, across all 4 data sets, the anterior hippocampus as a putative epicenter of pathological spread in psychosis. Epicenters of longitudinal GMV loss were apparent in posterior cortex early in the illness and shifted to the prefrontal cortex with illness progression.
CONCLUSION AND RELEVANCE
These findings highlight a central role for white matter fibers as conduits for the spread of pathology across different stages of psychotic illness, mirroring findings reported in neurodegenerative conditions. The structural connectome thus represents a fundamental constraint on brain changes in psychosis, regardless of whether these changes are caused by illness or medication. Moreover, the anterior hippocampus represents a putative epicenter of early brain pathology from which dysfunction may spread to affect connected areas.
Topics: Male; Adult; Humans; Female; Gray Matter; Antipsychotic Agents; Cross-Sectional Studies; Case-Control Studies; Psychotic Disorders; Brain; Magnetic Resonance Imaging
PubMed: 37728918
DOI: 10.1001/jamapsychiatry.2023.3293 -
Journal of Vascular Surgery Cases and... Sep 2023Transcarotid artery revascularization (TCAR) provides a safe alternative to carotid endarterectomy. The anatomic requirements include a 5-cm minimum clavicle to carotid...
Transcarotid artery revascularization (TCAR) provides a safe alternative to carotid endarterectomy. The anatomic requirements include a 5-cm minimum clavicle to carotid bifurcation distance for sheath access proximal to the lesion. In the present report, we describe our experience with conduit use for patients not meeting that requirement. Patients undergoing elective TCAR with a conduit from 2021 to 2022 were retrospectively identified. After carotid artery exposure, a 6-mm prosthetic graft was anastomosed to the common carotid artery in an end-to-side fashion. After stent delivery, the conduit was ligated and oversewn. The patient demographics, procedural details, and outcomes were recorded and compared with our nonconduit TCAR experience. A total of 11 patients (64% male; age, 75 ± 5 years) underwent TCAR with a conduit, 5 (46%) for symptomatic disease, and 77 patients underwent TCAR with no conduit, 52 (60%) with symptomatic disease ( = .50). Other than a higher rate of prior coronary interventions in the conduit group (55% vs 47%; = .007), no significant differences were found in age, gender, race, comorbidities, or high risk for carotid endarterectomy criteria. In the conduit group, the average skin to carotid artery depth was 4.2 cm (range, 1.9-6.1 cm). The average clavicle to bifurcation distance was 4.4 cm (range, 3.3-4.9 cm) vs 6.5 cm (range, 3.3-9.7 cm; = .002) in the nonconduit group. Dacron was the most common conduit material used (73%). No differences were found in the mean procedure times (121 ± 32 vs 129 ± 53 minutes; = .785) or flow reversal times (14 ± 5 vs 19 ± 13 minutes; =.989) for the conduit and nonconduit cohorts, respectively. Technical success was achieved in 100% of the conduit and nonconduit cases. Excluding one outlier of a prolonged stay (7 days) for management of unrelated medical issues (gastrostomy tube placement for chronic dysphagia after mass resection and neck radiation), the mean hospital stay was 2 days (1.2 ± 0.4 intensive care unit days) compared with 3.8 ± 5.7 days for our nonconduit cohort ( = .2). Hypotension was the most common reason for delayed discharge for the conduit group (n = 3; 27%). The average follow-up was 2.7 months (range, 1-10 months). For all 11 conduit patients, the stent remained patent without stenosis, thrombus, or pseudoaneurysm at the conduit stump site on surveillance duplex ultrasound. No strokes or complications had occurred at 30 days in the conduit group compared with four strokes or transient ischemic attacks ( = .469) and 18 minor complications in the nonconduit group ( = .091). For patients lacking a sufficient distance between the clavicle and carotid artery bifurcation, a prosthetic conduit facilitates safe use of flow reversal for stent delivery and can be ligated at procedural completion without consequences.
PubMed: 37662565
DOI: 10.1016/j.jvscit.2023.101271 -
Plants (Basel, Switzerland) May 2023ecotypes adapted to native habitats with different daylengths, temperatures, and precipitation were grown experimentally under seven combinations of light intensity and...
ecotypes adapted to native habitats with different daylengths, temperatures, and precipitation were grown experimentally under seven combinations of light intensity and leaf temperature to assess their acclimatory phenotypic plasticity in foliar structure and function. There were no differences among ecotypes when plants developed under moderate conditions of 400 µmol photons m s and 25 °C. However, in response to more extreme light or temperature regimes, ecotypes that evolved in habitats with pronounced differences in either the magnitude of changes in daylength or temperature or in precipitation level exhibited pronounced adjustments in photosynthesis and transpiration, as well as anatomical traits supporting these functions. Specifically, when grown under extremes of light intensity (100 versus 1000 µmol photons m s) or temperature (8 °C versus 35 °C), ecotypes from sites with the greatest range of daylengths and temperature over the growing season exhibited the greatest differences in functional and structural features related to photosynthesis (light- and CO-saturated capacity of oxygen evolution, leaf dry mass per area or thickness, phloem cells per minor vein, and water-use efficiency of CO uptake). On the other hand, the ecotype from the habitat with the lowest precipitation showed the greatest plasticity in features related to water transport and loss (vein density, ratio of water to sugar conduits in foliar minor veins, and transpiration rate). Despite these differences, common structure-function relationships existed across all ecotypes and growth conditions, with significant positive, linear correlations (i) between photosynthetic capacity (ranging from 10 to 110 µmol O m s) and leaf dry mass per area (from 10 to 75 g m), leaf thickness (from 170 to 500 µm), and carbohydrate-export infrastructure (from 6 to 14 sieve elements per minor vein, from 2.5 to 8 µm cross-sectional area per sieve element, and from 16 to 82 µm cross-sectional area of sieve elements per minor vein); (ii) between transpiration rate (from 1 to 17 mmol HO m s) and water-transport infrastructure (from 3.5 to 8 tracheary elements per minor vein, from 13.5 to 28 µm cross-sectional area per tracheary element, and from 55 to 200 µm cross-sectional area of tracheary elements per minor vein); (iii) between the ratio of transpirational water loss to CO fixation (from 0.2 to 0.7 mol HO to mmol CO) and the ratio of water to sugar conduits in minor veins (from 0.4 to 1.1 tracheary to sieve elements, from 4 to 6 µm cross-sectional area of tracheary to sieve elements, and from 2 to 6 µm cross-sectional area of tracheary elements to sieve elements per minor vein); (iv) between sugar conduits and sugar-loading cells; and (v) between water conducting and sugar conducting cells. Additionally, the proportion of water conduits to sugar conduits was greater for all ecotypes grown experimentally under warm-to-hot versus cold temperature. Thus, developmental acclimation to the growth environment included ecotype-dependent foliar structural and functional adjustments resulting in multiple common structural and functional relationships.
PubMed: 37653958
DOI: 10.3390/plants12102041 -
Zhonghua Xin Xue Guan Bing Za Zhi Aug 2023To evaluate the feasibility and preliminary clinical results of transcatheter pulmonary valve replacement (TPVR) with the domestically-produced balloon-expandable... (Observational Study)
Observational Study
To evaluate the feasibility and preliminary clinical results of transcatheter pulmonary valve replacement (TPVR) with the domestically-produced balloon-expandable Prizvalve system. This is a prospective single-center observational study. Patients with postoperative right ventricular outflow tract (RVOT) dysfunction, who were admitted to West China Hospital of Sichuan University from September 2021 to March 2023 and deemed anatomically suitable for TPVR with balloon-expandable valve, were included. Clinical, imaging, procedural and follow-up data were analyzed. The immediate procedural results were evaluated by clinical implant success rate, which is defined as successful valve implantation with echocardiography-assessed pulmonary regurgitation
conduit, and one patient was treated with trans-annular patch technique. The indications of TPVR included RVOT obstruction and regurgitation (3 cases), isolated obstruction (1 case), and isolated regurgitation (1 case). Of the 4 patients with varying severity of ROVT obstruction, the average preprocedural peak jet velocity of RVOT was 3.5 m/s, and the average peak pressure gradient was 50.0 mmHg. Except for one patient, who had previously been implanted with a covered Cheatham-Platinum (CP) stent due to severe stenosis of the main pulmonary artery, other patients underwent pre-stenting with a covered CP stent before TPVR. Clinical implant success was achieved in all of the 5 patients, and there was no serious periprocedural complications. The average trans-pulmonary peak jet velocity and peak pressure gradient derived from postprocedural echocardiography was 2.3 m/s and 21.2 mmHg, respectively. All patients experienced significant symptom relief after the procedure. All patients completed 3-month follow-up, and 4 completed 6-month follow-up. There was no case of infectious endocarditis during follow-up. All patients were graded as NYHA functional class one at the latest follow-up. TPVR using the domestically-produced balloon-expandable Prizvalve system is safe and feasible for the treatment of patients with post-surgical RVOT dysfunction and suitable landing-zone anatomy. The safety, effectiveness, and long-term valve durability of the Prizvalve system deserve further research. Topics: Male; Humans; Pulmonary Valve; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Constriction, Pathologic; Prospective Studies; Ventricular Outflow Obstruction; Treatment Outcome; Cardiac Catheterization; Transcatheter Aortic Valve Replacement
PubMed: 37583330
DOI: 10.3760/cma.j.cn112148-20230608-00336 -
Interventional Neuroradiology : Journal... Aug 2023Recent developments in neurointerventional research have seen the emergence of the middle meningeal artery (MMA) as an effective conduit for intra-arterial (IA) therapy... (Review)
Review
Recent developments in neurointerventional research have seen the emergence of the middle meningeal artery (MMA) as an effective conduit for intra-arterial (IA) therapy for a number of pathologies. Here, we review the anatomical, pathophysiological and experimental basis for utilisation of the MMA for IA treatment of migraine headache. We explore the in-human case literature for the treatment of headaches with IA lidocaine and discuss considerations and challenges for future research.
PubMed: 37574789
DOI: 10.1177/15910199231195470