scholarly journals Previous Stenting Doesn’t Affect Outcome of Extensive Endarterectomy for Diffuse Coronary Artery Total Occlusions: A Propensity Score Matching Analysis

2021 ◽  
Vol 24 (2) ◽  
pp. E243-E248
Author(s):  
Hamdy Singab ◽  
Gamal Sami
Keyword(s):  
Retrospective Study ◽  
Coronary Artery ◽  
Postoperative Complications ◽  
Propensity Score ◽  
Survival Time ◽  
Propensity Score Matching ◽  
Graft Patency ◽  
Primary Study ◽  
Outcome Parameters ◽  
Propensity Score Matching Analysis

Background and aim: Extensive diffuse coronary artery total occlusions (CTOs) constitute a challenging surgical problem. Extensive coronary endarterectomy (CE) combined with CABG was suggested as a revascularization technique. It was claimed that previous stenting may affect outcome. The present study aimed to report the outcome of LAD endarterectomy for CTO and to determine the effect of previous stenting on this outcome. Patients and methods: The present retrospective study was conducted on 194 patients with CTO indicated for left anterior descending artery (LAD) endarterectomy. To reduce the bias related to unbalanced patients selection, propensity score matching analysis was used. According to the propensity score, 194 patients were included in the analysis. They comprised 66 patients with previous stent and 128 patients without previous stent. Patients were followed for a median (range) of 74.0 (6.0-149.0) months. The primary study outcome was LAD graft patency. Other outcome parameters included postoperative complications, hospital and ICU stay, and mortality. Results: Comparison between the studied groups regarding outcome parameters revealed no significant differences regarding graft patency (93.9% versus 89.1%; P = .27), graft survival (median [95% CI]: 134.3 months [127.0-141.5] versus 135.2 months [128.4-142.0]; P = .35), patients’ survival (93.9% versus 91.4%) and patients’ survival time (median [95% CI]: 132.3 months [125.0-139.5] versus 138.0 months [132.0-144.1]; P = .75]. Conclusion: The present study supports using CE as an adjuvant technique with CABG in patients with TCOs.   Patients and methods: The present retrospective study was conducted on 194 patients with CTO indicated for left anterior descending artery (LAD) endarterectomy. To reduce the bias related to unbalanced patients selection, propensity score matching analysis was used. According to the propensity score, 194 patients were included in the analysis. They comprised 66 patients with previous stent and 128 patients without previous stent. Patients were followed for a median (range) of 74.0 (6.0-149.0) months. The primary study outcome was LAD graft patency. Other outcome parameters included postoperative complications, hospital and ICU stay and mortality.   Results: Comparison between the studied groups regarding outcome parameters revealed no significant differences regarding graft patency (93.9 % versus 89.1; p=0.27), graft survival [median (95% CI): 134.3 months (127.0-141.5) versus 135.2 months (128.4-142.0); p=0.35], patients’ survival (93.9 % versus 91.4 %) and patients’ survival time [median (95% CI): (132.3 months (125.0-139.5) versus 138.0 months (132.0-144.1); p= 0.75].   Conclusions: The present study supports use CE as an adjuvant technique with CABG in patients with TCOs.

Safety and effectiveness of mucosal traction using a snare combined with endoclips to assist the resection of esophageal intraepithelial neoplasia: a propensity score matching analysis

2021 ◽  
Author(s):  
Qiang Zhang ◽  
Zhou-yang Lian ◽  
Jian-Qun Cai ◽  
Yang Bai ◽  
Zhen Wang
Keyword(s):  
Postoperative Complications ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Operation Time ◽  
Intraepithelial Neoplasia ◽  
R0 Resection ◽  
En Bloc ◽  
Propensity Score Matching Analysis ◽  
Significant Difference ◽  
Traction Group

Summary Currently, the reports on esophageal endoscopic submucosal dissection (ESD) assisted by traction with a snare are rare. Because a snare is a commonly used endoscopic accessory and is easily available, its application in mucosal traction is worth exploring. The present study aims to evaluate the safety and effectiveness of snare-endoclip traction-assisted ESD for esophageal intraepithelial neoplasia. Cases of esophageal intraepithelial neoplasia resected using ESD in the Digestive Endoscopy Center of Guangzhou Nanfang Hospital, China from June 2013 to March 2019 were retrospectively analyzed. The procedure of snare-endoclip traction-assisted ESD was compared with nontraction-assisted ESD by using a propensity score matching analysis. Operation time, en bloc and R0 resection, intra- and postoperative complications, and surgery-related costs were mainly evaluated. Overall, 99 cases of esophageal intraepithelial neoplasia under tissue biopsy were included in the present study. Further, 22 exact matched pairs were obtained. There were no differences in en bloc and R0 resection rates, intra- and postoperative complications, and costs of disposable surgical accessories between the traction group and the nontraction group. However, median operation time showed a significant difference: traction group, 50.0 min (range, 20–100 min); nontraction group, 70.0 min (range, 35–133 min), P=0.012. In conclusion, snare-endoclip traction-assisted ESD for esophageal intraepithelial neoplasia was safe and shortened operation time in the study, thereby improving the efficiency of ESD. Despite the additional use of a snare and endoclips for traction, the total costs of endoscopic accessories seemed not to be increased.

Prognosis of amyotrophic lateral sclerosis patients undergoing tracheostomy invasive ventilation therapy in Japan

2020 ◽  
Vol 91 (3) ◽  
pp. 285-290 ◽  
Author(s):  
Naoki Hayashi ◽  
Naoki Atsuta ◽  
Daichi Yokoi ◽  
Ryoichi Nakamura ◽  
Masahiro Nakatochi ◽  
...  
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Prognostic Factors ◽  
Propensity Score ◽  
Survival Time ◽  
Propensity Score Matching ◽  
Invasive Ventilation ◽  
Propensity Score Matching Analysis ◽  
Als Patients ◽  
Prospective Longitudinal ◽  
Lateral Sclerosis

ObjectiveThe aim of this study is to describe and clarify the factors affecting the prognosis of Japanese patients with amyotrophic lateral sclerosis (ALS) undergoing tracheostomy invasive ventilation (TIV) therapy.MethodsWe conducted a prospective longitudinal observational case-control study using a multicentre registry. ALS patients who started TIV therapy after registration (TIV group) and those who did not receive TIV (non-TIV group) were included. We compared the survival time between the TIV group and the non-TIV group using a propensity score matching analysis and evaluated the prognostic factors in the TIV group.ResultsFrom February 2006 to January 2018, 190 patients in the TIV group and 1093 patients in the non-TIV group were included in this study. The mean age of disease onset and usage rate of gastrostomy and non-invasive ventilation therapy differed between the groups. In the propensity score matching analysis using known prognostic factors, the median overall survival time of the TIV group was significantly greater than that of the non-TIV group (11.33 years vs 4.61 years; p<0.001). Analysis using the Cox proportional hazard model suggested that older age of onset and respiratory onset was an independent factor for poor prognosis after starting TIV therapy.ConclusionWe showed that there was a significant difference of approximately 7 years in life expectancy between Japanese ALS patients who did and did not receive TIV therapy.

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