Multivariate Analysis of Key Factors in Clinical Results of Postcardiotomy Circulatory Support

Background. Outcomes after VAD implantation may be dependent on institutional procedural volume. Specifically, it is claimed that high volumes are associated to better clinical results. This study aims to determine if this procedure is safe even in low‐volume center. Methods. Single center, retrospective cohort study, including Heart Failure consecutive patients who received long-term VAD from 2007 to 2017. Primary outcome was survival to transplant or ongoing MCS at 1-year. Survival analysis was performed using Kaplan-Meier method. Results. Data concerning 50 adult patients were examined; 35 male (70%), mean age 49+/- 8 years. VAD was implanted as BTT in 48 and DT in 2. Devices implanted were: HeartMate II in 18 (36%), HeartWare in 20 (40%), HeartMate III in 12 (24%). Outcomes were: Death in 16 (32%), heart transplant in 24 (48%), uneventful ongoing support 10 (20%). Data were analysed according to pre and post-heart team creation and 2 groups of 25 patients were identified: 2007-2013 (mean INTERMACS level 3.1) and 2014-2017 (mean INTERMACS level 3.9) showing 1-year survival of 56% and 80% respectively. According to the type of device implanted, 3 groups were identified: HMII = 18 (mean INT. level 2.7), HW=20 (mean INT. level 3.3) and HMIII=12 (mean INT. level 3.7), showing survival of 52%, 78% and 91% respectively. Conclusions. Long term MCS can be implanted at low-volume centers with survival rate not inferior to high volume centers. A Heart team specifically trained in heart failure is probably more important than institutional volume in determining outcomes after VAD implantation.

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The Relationship between English Language Adoption and Global Digital Inequality

System and Technology Advancements in Distance Learning ◽

10.4018/978-1-4666-2032-2.ch009 ◽

2014 ◽

pp. 124-133

Author(s):

Hui-Wen Vivian Tang ◽

Mu-Shang Yin ◽

Ru-Shuo Sheu

Keyword(s):

Economic Development ◽

Multivariate Analysis ◽

Comparative Analysis ◽

English Language ◽

Dominant Factor ◽

Key Factors ◽

Digital Inequality ◽

Global Digital Divide ◽

Information And Communication ◽

The Relationship

The aim of this study was to investigate whether differences in information and communication technology (ICT) readiness and access across countries were fundamentally related to the variable of English language adoption. A one-way multivariate analysis of variance (MANOVA) was utilized to comparatively examine the developments of ICT readiness and use among 149 countries categorized into four groups based on levels of English language adoption and economic development. The results of the comparative analysis showed that English language adoption is not a dominant factor in determining the global digital divide. The results suggest that much of the differences in ICT development across countries are attributable to levels of economic development. Limitations and implications for additional studies on specifying key factors widening the global technology gap are discussed.

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Why are tapes better than wires in knotless rotator cuff repairs? An evaluation of force, pressure and contact area in a tendon bone unit mechanical model

Journal of Experimental Orthopaedics ◽

10.1186/s40634-020-00321-y ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Carlos Maia Dias ◽

Sérgio B. Gonçalves ◽

António Completo ◽

Martina Tognini ◽

Manuel Ribeiro da Silva ◽

...

Keyword(s):

Contact Force ◽

Contact Area ◽

Mechanical Model ◽

Clinical Results ◽

Peak Force ◽

Key Factors ◽

Force Variation ◽

Cuff Repair ◽

Retear Rate ◽

Force Pressure

Abstract Purpose Knotless repairs have demonstrated encouraging performance regarding retear rate reduction, but literature aiming at identifying the specific variables responsible for these results is scarce and conflictive. The purpose of this paper was to evaluate the effect of the material (tape or wire suture) and medial tendon passage (single or double passage) on the contact force, pressure and area at the tendon bone interface in order to identify the key factors responsible for this repairs´ success. Methods A specific knotless transosseous equivalent cuff repair was simulated using 2 tape or suture wire loaded medial anchors and 2 lateral anchors, with controlled lateral suture limb tension. The repair was performed in a previously validated sawbones® mechanical model. Testing analyzed force, pressure and area in a predetermined and constant size “repair box” using a Tekscan® sensor, as well as peak force and pressure, force applied by specific sutures and force variation along the repair box. Results Tapes generate lower contact force and pressure and double medial passage at the medial tendon is associated with higher contact area. Suture wires generate higher peak force and pressure on the repair and higher mean force in their tendon path and at the medial bearing row. Force values decrease from medial to lateral and from posterior to anterior independently of the material or medial passage. Conclusion Contrary to most biomechanical literature, suture tape use lowers the pressure and force applied at the tendon bone junction, while higher number of suture passage points medially increases the area of contact. These findings may explain the superior clinical results obtained with the use uf suture tapes because its smaller compressive effect over the tendon may create a better perfusion environment healing while maintaining adequate biomechanical stability.

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IS EMERGENCY CHOLECISTOSTOMY STILL VALID IN THE MANAGEMENT OF ACUTE CHOLECYSTITIS? ANALYSIS OF OUR EXPERIENCE IN A SERIES OF 145 PATIENTS

British Journal of Surgery ◽

10.1093/bjs/znab160.022 ◽

2021 ◽

Vol 108 (Supplement_3) ◽

Author(s):

M Pujante Menchón ◽

M Mella Laborde ◽

l Rius Acebes ◽

J Aparicio Navarro ◽

M Morales Calderón ◽

...

Keyword(s):

Multivariate Analysis ◽

Acute Cholecystitis ◽

Antibiotic Treatment ◽

Clinical Results ◽

Cerebrovascular Diseases ◽

Complication Rates ◽

Systemic Involvement ◽

Conservative Group ◽

Time Of Admission

Abstract INTRODUCTION Laparoscopic cholecystectomy may not be suited in elderly patients with comorbidities. Our objective is to evaluate whether our indication for cholecystostomy is in accordance with the 2018 Tokio Guidelines and to determine the clinical-epidemiological and analytical characteristics as well as the clinical results depending on the treatment (surgical, conservative or cholecystostomy). MATERIAL AND METHODS Retrospective observational study with patients diagnosed with acute cholecystitis between the 25/01/2019 and the 13/03/2020. RESULTS Out of 145 patients, 87 (60%) underwent cholecystectomy (average age 63 years), 47 (32,4%) treated conservatively (74,8) and 11 (7,6%) by cholecystostomy (85,8). The multivariate analysis showed that suffering from cardio and cerebrovascular diseases, CKD, taking anticoagulants and altered levels of creatinine, Quick or CRP, multiplies by 5.2, 6.4, 10.9, 4.6, 1.2 and 1.1 the probability of cholecystostomy versus cholecystectomy (p < 0,005). Both the time of admission and of antibiotic treatment was longer in the cholecystostomy group (15.2 and 11.5 days) compared to conservative (7 and 9) and surgical (5.3 and 5.8) (p = 0,000 and p = 0,011). Only one patient in the cholecystostomy group underwent subsequent surgery compared to 50% in the conservative group. The mortality rate did no differ. Out of 11 cholecystostomies, 6 met the Tokio Guidelines criteria. CONCLUSIONS 1. Patients undergoing cholecystostomy are older, multipathological and present greater systemic involvement (KD, coagulopathy and elevated APR). They require a longer hospital stay and duration of antibiotic treatment. 2. 54,54% of the cholecystostomies performed were adapted to the 2018 Tokio Guidelines. 3. Conservative treatment means higher long-term complication rates.

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Clinical results with an ePTFE inflow conduit for mechanical circulatory support

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2003.09.029 ◽

2004 ◽

Vol 23 (12) ◽

pp. 1366-1370 ◽

Cited By ~ 20

Author(s):

Tofy Mussivand ◽

Roland Hetzer ◽

Ettore Vitali ◽

Bart Meyns ◽

Philippe Noirhomme ◽

...

Keyword(s):

Mechanical Circulatory Support ◽

Clinical Results ◽

Circulatory Support

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DETERMINANTS OF CLINICAL RESULTS OF MECHANICAL CIRCULATORY SUPPORT FOR POSTCARDIOTOMY VENTRICULAR FAILURE

ASAIO Journal ◽

10.1097/00002480-199603000-00124 ◽

1996 ◽

Vol 42 (2) ◽

pp. 34

Author(s):

M. Kitamura ◽

M. Hachida ◽

H. Nishida ◽

M. Endo ◽

A. Hashimoto ◽

...

Keyword(s):

Mechanical Circulatory Support ◽

Clinical Results ◽

Circulatory Support ◽

Ventricular Failure

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Survival Following Edge‐to‐Edge Transcatheter Mitral Valve Repair in Patients With Cardiogenic Shock: A Nationwide Analysis

Journal of the American Heart Association ◽

10.1161/jaha.120.019882 ◽

2021 ◽

Author(s):

Gilbert H. L. Tang ◽

Rodrigo Estevez‐Loureiro ◽

Yang Yu ◽

Julie B. Prillinger ◽

Syed Zaid ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Cardiogenic Shock ◽

Mitral Valve Repair ◽

Case Series ◽

Clinical Results ◽

National Database ◽

Circulatory Support ◽

Valve Repair ◽

Transcatheter Mitral Valve Repair

Background Edge‐to‐edge transcatheter mitral valve repair as salvage therapy in high surgical risk patients with severe mitral regurgitation presenting with cardiogenic shock (CS) has been described in small case series, but large clinical results have not been reported. This study aimed to evaluate outcomes of transcatheter mitral valve repair with MitraClip in patients with mitral regurgitation and CS using a large national database. Methods and Results From January 2014 to March 2019, we identified hospitalizations for CS in patients with mitral valve disease using data from Centers for Medicare and Medicaid Services. Those with a prior surgical or percutaneous mitral valve intervention were excluded. We compared survival between patients who underwent MitraClip during the index hospitalization and those who did not using propensity‐matched analysis. The analysis included 38 166 patients (mean age, 71±11 years, 41.6% women) of whom 622 (1.6%) underwent MitraClip. MitraClip was increasingly used during CS hospitalizations over the study period ( P <0.001). After matching, patients receiving MitraClip had significantly lower in‐hospital mortality (odds ratio, 0.6; 95% CI, 0.47–0.77; P <0.001) and 1‐year mortality (hazard ratio, 0.76; 95% CI, 0.65–0.88; P <0.001) compared with those without MitraClip. The survival benefit associated with MitraClip was consistent across subgroups of interest, with the exception of patients requiring acute mechanical circulatory support or hemodialysis at index. Conclusions In patients with mitral regurgitation presenting with CS, use of MitraClip is increasing and associated with greater in‐hospital and 1‐year survival. Further studies are warranted to optimize patient selection and procedure timing for those receiving MitraClip as a treatment option in CS.

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