Protezinio infekcinio endokardito chirurginis gydymas: hospitalinis ir atokus išgyvenimas

Palmyra Semėnienė1, Arimantas Grebelis1, Rasa Joana Čypienė1, Giedrė Nogienė1, Gintaras Turkevičius21 Vilniaus universiteto ligoninės Santariškių klinikų Širdies chirurgijos centras,Santariškių g, 2, LT-08661 Vilnius2 Vilniaus universiteto ligoninės Santariškių klinikų Širdies chirurgijos centras,Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Tikslas Darbo tikslas – išanalizuoti pacientų, operuotų dėl protezinio infekcinio endokardito (PIE), hospitalinio ir atokiojo laikotarpio rezultatus. Ligoniai ir metodai Retrospektyviai analizuoti 41 paciento, operuoto dėl PIE Vilniaus universiteto Širdies chirurgijos centre, pooperaciniai ir atokieji rezultatai. Analizuojamas laikotarpis nuo 2000 m. sausio 1 d. iki 2006 m. liepos 1 d. Vidutinis pacientų amžius 51,2 ± 10,1 metų. Pirma grupė – 20 pacientų – anksčiau sirgę infekciniu endokarditu (IE), antra grupė – 21 pacientas – anksčiau operuoti dėl reumatinės, įgimtos ar kitos etiologijos širdies vožtuvų patologijos. Rezultatai Hospitaliniu laikotarpiu mirė 10 pacientų (26,8%). Pirmos grupės hospitalinis mirštamumas buvo 25,0%, antros grupės – 28,6%. Hospitalinis pirmos grupės pacientų išgyvenimas buvo 75,0%, o antros – 71,4%. Praėjus 5 metams po operacijos pirmos grupės pacientų išgyvenimas buvo 59,9%, o antros – 53,5%, p > 0,005. Išvada Pacientų, operuotų dėl PIE, hospitalinis mirštamumas tebėra didelis. Nepastebėta, kad pacientų, anksčiau operuotų dėl infekcinio endokardito, pooperacinis ir atokus išgyvenimas po reoperacijos dėl PIE reikšmingai skirtųsi nuo nesirgusiųjų infekciniu endokarditu išgyvenimo. Pagrindiniai žodžiai: infekcinis endokarditas, protezinis infekcinis endokarditas Surgical treatment of prosthetic valve endocarditis: early and long-term outcome Palmyra Semėnienė1, Arimantas Grebelis1, Rasa Joana Čypienė1, Giedrė Nogienė1, Gintaras Turkevičius21 Vilnius University Cardial Surgery Centre, Santariškių str. 2, LT-08661 Vinius, Lithuania2 Vilnius University Hospital „Santariškių klinikos“, Cardial Surgery Centre,Santariškių str. 2, LT-08661 Vinius, LithuaniaE-mail: [email protected] Objective The objective of the present study was to examine in-hospital and long-term outcomes after surgical treatment of prosthetic valve endocarditis (PVE) between 1 January 2000 and 1 July 2006. Patients and methods Group 1 comprised 20 patients with previous infective endocarditis (IE) and group 2 – 21 patients without previous IE. The mean age was 51.2 ± 10.1 years. Results Ten patients (26.8%) died within 30 days post operation for PVE. In-hospital mortality of group 1 patients was 25% and of group 2 – 28.6%. The five-year survival rate is 59.9% (gr. 1) and 53.5% (gr. 2), p > 0.005. Conclusions Operation for PVE carries a high 30-day mortality and a reduced long-term survival. There was no evidence that previous infective endocarditis had an impact on survival rate in patients operated on for PVE. Key words: infective endocarditis, prosthetic valve endocarditis

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Survival rate of patients with ascending aorta aneurysm and aortic valve regurgitation in the late postoperative period

Medicina ◽

10.3390/medicina45030024 ◽

2009 ◽

Vol 45 (3) ◽

pp. 186

Author(s):

Rasa Čypienė ◽

Arimantas Grebelis ◽

Palmyra Semėnienė ◽

Diana Zakarkaitė ◽

Giedrė Nogienė ◽

...

Keyword(s):

Survival Rate ◽

Nyha Class ◽

Ascending Aorta ◽

Class Iii ◽

Term Survival ◽

Long Term Survival ◽

Group 2 ◽

Late Postoperative Period ◽

Group 1

The aim of the study was to evaluate the long-term survival in patients undergoing surgical treatment for chronic aortic aneurysms with aortic regurgitation. Material and methods. We analyzed survival data of 188 patients during follow-up period of 1 month to 20 years postoperatively. The patients were divided into the following groups according to the clinical course: Group 1 – chronic dissecting aneurysm of ascending aorta with aortic regurgitation (42 patients, 22.3%); Group 2 – chronic nondissecting aneurysm of ascending aorta with aortic regurgitation (146 patients, 77.7%). Mean NYHA functional class of the patients was 3.5±0.06. In the Group 1, 64.3% of the patients were in NYHA functional class IV; 35.7% of the patients were in NYHA class III. In the Group 2, the majority of the patients (58.2%) were in class III; in class IV – 41.8%. The most common etiological factors in both groups were atherosclerosis, arterial hypertension, and Marfan’s syndrome. Results. No differences in overall and long-term survival rates between the groups were found. However, the patients who were in class III before the operation showed significantly higher overall and long-term survival rates in comparison with the survival rate of the patients who were in NYHA class IV preoperatively (overall survival rate, 91.4±3.0% vs 62.9±6.9%; and long-term survival rate, 93.2±2.7% vs 72.9±5.6; respectively). There were 24 deaths (12.8%) during the late postoperative period. The main causes of death were progressive heart failure and infective prosthetic endocarditis (Group 2), chronic heart failure and dysfunction of the conduit (Group 1). Conclusions. The analysis of patients’ long-term survival demonstrated the efficacy of surgical treatment of such a complex pathology as chronic aneurysm of the ascending aorta with aortic valve regurgitation. The survival rate in the late postoperative period was higher in NYHA class III patients. The main causes of death were chronic heart failure and infective prosthetic endocarditis.

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Proximal Tibiofibular Dislocation in Closing-Wedge High Tibial Osteotomy Increases the Risk of Medium and Long-Term Total Knee Replacement

Journal of Clinical Medicine ◽

10.3390/jcm10132743 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2743

Author(s):

Juan Sánchez-Soler ◽

Alex Coelho ◽

Raúl Torres-Claramunt ◽

Berta Gasol ◽

Albert Fontanellas ◽

...

Keyword(s):

Survival Rate ◽

High Tibial Osteotomy ◽

Tibial Osteotomy ◽

Closing Wedge ◽

Wedge High Tibial Osteotomy ◽

Total Knee ◽

Group 2 ◽

Group 1

Proximal tibiofibular dislocation in closing-wedge high tibial osteotomy increases the risk of medium and long-term total knee replacement. Background: High tibial osteotomy is an effective treatment for medial osteoarthritis in young patients with varus knee. The lateral closing-wedge high tibial osteotomy (CWHTO) may be managed with tibiofibular dislocation (TFJD) or a fibular head osteotomy (FHO). TFJD may lead to lateral knee instability and thereby affect mid- and long-term outcomes. It also brings the osteotomy survival rate down. Objective: To compare the CWHTO survival rate in function of tibiofibular joint management with TFJD or FHO, and to determine whether medium and long-term clinical outcomes are different between the two procedures. Material & Methods: A retrospective cohort study was carried out that included CWHTO performed between January 2005 to December 2018. Those patients were placed in either group 1 (FHO) or Group 2 (TFJD). Full-leg weight-bearing radiographs were studied preoperatively, one year after surgery and at final follow-up to assess the femorotibial angle (FTA). The Rosenberg view was used to assess the Ahlbäck grade. The Knee Society Score (KSS) was used to assess clinical outcomes and a Likert scale for patient satisfaction. The total knee replacement (TKR) was considered the end of the follow-up and the point was to analyze the CWHTO survival rate. A sub-analysis of both cohorts was performed in patients who had not been FTA overcorrected after surgery (postoperative FTA ≤ 180°, continuous loading in varus). Results: A total of 230 knees were analyzed. The follow-up period ranged from 24–180 months. Group 1 (FHO) consisted of 105 knees and group 2 (TFJD) had 125. No preoperative differences were observed in terms of age, gender, the KSS, FTA or the Ahlbäck scale; neither were there any differences relative to postop complications. The final follow-up FTA was 178.7° (SD 4.9) in group 1 and 179.5° (SD 4.2) in group 2 (p = 0.11). The Ahlbäck was 2.21 (SD 0.5) in group 1 and 2.55 (SD 0.5) in group 2 (p = 0.02) at the final follow-up. The final KSS knee values were similar for group 1 (86.5 ± 15.9) and group 2 (84.3 ± 15.8). Although a non-significant trend of decreased HTO survival in the TFJD group was found (p = 0.06) in the sub-analysis of non-overcorrected knees, which consisted of 52 patients from group 1 (FHO) and 58 from group 2 (TFJD), 12.8% of the patients required TKR with a mean of 88.8 months in group 1 compared to 26.8% with a mean of 54.9 months in the case of group 2 (p = 0.005). However, there were no differences in clinical and radiological outcomes. Conclusion: TFJD associated with CWHTO shows an increase in the conversion to TKR at medium and long-term follow-up with lower osteotomy survival than the CWHTO associated with FHO, especially in patients with a postoperative FTA ≤ 180° (non-overcorrected). There were no differences in clinical, radiological or satisfaction results in patients who did not require TKR. Level of evidence III. Retrospective cohort study.

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Application of femtolaser-assisted phacoemulsification in combined pathology of cataract and glaucoma

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-2-18-21 ◽

2021 ◽

pp. 18-21

Author(s):

A.P. Voznyuk ◽

◽

S.I. Anisimov ◽

S.Y. Anisimova ◽

L.L. Arutyunyan ◽

...

Keyword(s):

Surgical Treatment ◽

Biomechanical Properties ◽

Mean Values ◽

Long Term Follow Up ◽

The Mean ◽

Group 2 ◽

Observation Period ◽

Group 1

Purpose. To evaluate the efficacy and safety of femtolaser-assisted phacoemulsification in glaucomatous eyes in the long-term follow-up. Materials and methods. A retrospective analysis of the results of the surgical treatment of patients with combined cataract and glaucoma pathology was analyzed. The patients were divided into groups depending on the method of surgical intervention: 1) phacoemulsification with femtolaser support (26 eyes, 23 patients); 2) phacoemulsification (36 eyes, 30 patients); Results. Before surgery, there were no statistically significant differences in IOP and corneal hysteresis (СН) between groups 1 and 2. The mean values of IOP cc, IOP g and СН of group 1 before surgery were 22.7±6.1 mm Hg, 20.9±6.9 mm Hg, 8.5±1.6 mm Hg; 2 group – 22.9±8.7 mm Hg, 21.6±8.9 mm Hg, 8.9±1.6 mm Hg respectively. Average values of IOP cc, IOP g and CН 5 years after the surgical treatment in group 1 were 15.3±1.2 mm Hg, 14.4±3.4 mm Hg, 9.6±4.2 mm Hg; in group 2 – 18.0±4.2 mm Hg, 16.1±4.2 mm Hg, 8.8±2.2 mm Hg respectively. In both groups, stabilization of IOP and CH indices was noted, which remained throughout the entire observation period, which shows the normalization of the biomechanical properties of the corneoscleral membrane of the eye in the long-term postoperative period. Conclusion. Femtolaser accompaniment of phacoemulsification is an effective and safe method of cataract surgery for combined pathology. Key words: femtolaser, cataract, glaucoma, phacoemulsification.

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Abstract 1891: Mortality After CRT: a Synergetic Effect Between Ventricular Remodeling and Reduced Frequency of Ventricular Arrhythmias. The InSync ICD Italian Registry

Circulation ◽

10.1161/circ.116.suppl_16.ii_406 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Luigi Di Biase ◽

Maurizio Gasparini ◽

Maurizio Lunati ◽

Massimo Santini ◽

S. Filippo Neri ◽

...

Keyword(s):

Ventricular Arrhythmias ◽

Ventricular Remodeling ◽

Synergetic Effect ◽

Cardiac Resynchronization ◽

Reverse Remodeling ◽

Term Survival ◽

Group 2 ◽

Group 1

Introduction: It is currently debated whether cardiac resynchronization therapy (CRT) has an effect on the burden of ventricular arrhythmias (VA). We investigated whether the reverse remodeling after CRT may reduce the occurrence of VA. Methods : The study included 398 patients enrolled in the InSync ICD Italian Registry, treated with CRT-D and with a follow-up of at least 12 months. Spontaneous VA detected by the device were reviewed and validated. Results: After 6 months of follow-up no VA episodes occurred in 319 patients (group 1), while VA episodes persisted in the remaining 79 (group 2). At baseline, clinical and echocardiographic characteristics of the two groups were comparable: NYHA class (2.9±0.6 vs. 3.0±0.7), QRS width (166±31ms vs. 163±34ms), ejection fraction (26±7% vs. 26±6%), LVEDV (251±98ml vs. 226±45ml), LVESV (182±84ml vs. 158±38ml) (All p=NS). At 6 month visit, ventricular remodeling was apparent only in group 2 pts: LVEDV (200±83ml, p=0.042 vs. Baseline), LVESV (133±65ml, p=0.002 vs. Baseline). No changes were evident in group 2 pts: LVEDV (216±69ml, p=0.769 vs. Baseline), LVESV (160±59ml, p=0.521 vs. Baseline). The long-term survival from all-cause death resulted higher in group 1 pts (Log-rank test: p=0.032). (Figure ) Conclusions: In patients treated with CRT, a reduction of ventricular arrhythmic events occurs during the initial 12 months following implant and is correlated with the degree of ventricular remodeling induced by the therapy. Patients demonstrating the remission of arrhythmic episodes will have better survival and more pronounced long term improvements.

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Long-term Outcome of Patients With Nonoperated Prosthetic Valve Infective Endocarditis: Is Relapse the Main Issue?

Clinical Infectious Diseases ◽

10.1093/cid/ciz1177 ◽

2019 ◽

Vol 71 (5) ◽

pp. 1316-1319 ◽

Cited By ~ 3

Author(s):

Raphaël Lecomte ◽

Jean-Baptiste Laine ◽

Nahéma Issa ◽

Matthieu Revest ◽

Benjamin Gaborit ◽

...

Keyword(s):

Infective Endocarditis ◽

Mortality Rate ◽

Prosthetic Valve ◽

Prosthetic Valve Endocarditis ◽

Main Issue ◽

Term Outcome ◽

Long Term Outcome ◽

Risk Of Relapse

Abstract In nonoperated prosthetic valve endocarditis (PVE), long-term outcome is largely unknown. We report the follow-up of 129 nonoperated patients with PVE alive at discharge. At 1 year, the mortality rate was 24%; relapses and reinfection were rare (5% each). Enterococcal PVE was associated with a higher risk of relapse.

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Mitral Regurgitation: Comparison between Edge-to-Edge Repair and Valve Replacement

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230301100209 ◽

2003 ◽

Vol 11 (2) ◽

pp. 131-134 ◽

Cited By ~ 3

Author(s):

Jai Raman ◽

Pallav Shah ◽

Siven Seevanayagam ◽

John Cheung ◽

Brian Buxton

Keyword(s):

Mitral Regurgitation ◽

Valve Replacement ◽

Prosthetic Valve Endocarditis ◽

Early Death ◽

Bleeding Events ◽

Long Term Follow Up ◽

Group 2 ◽

Group 1

Mitral regurgitation due to bileaflet prolapse and ischemic causes can be difficult to repair. Midterm experience of the Alfieri edge-to-edge repair as an alternative to valve replacement is reported. Twenty-six patients with severe mitral regurgitation underwent the Alfieri repair between January 1998 and December 2000 (group 1); 15 cases were due to bileaflet prolapse and 7 were of ischemic origin. During the same period, valve replacement was performed in 36 patients (group 2), 20 of whom had similar indications. Follow-up was complete to a mean of 15 months (range, 1–28 months). There was no early death in either group. During follow-up, there was no reoperation in group 1, while 2 patients in group 2 required reoperations due to prosthetic valve endocarditis. There were 4 major thromboembolic or bleeding events in group 2, and none in group 1. All patients in group 1 had trivial to mild mitral regurgitation on follow-up echocardiography. The mean mitral valve gradient was significantly higher in group 2 compared to group 1 (7.2 versus 3.2 mm Hg, p = 0.001). The edge-to-edge repair is associated with good early and midterm results. Long-term follow-up is required to evaluate the durability of this technique.

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Active Infective Native and Prosthetic Valve Endocarditis: Short- and Long-Term Outcomes of Patients after Surgical Treatment

Journal of Clinical Medicine ◽

10.3390/jcm10091868 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1868

Author(s):

Mohamed Salem ◽

Christine Friedrich ◽

Mohammed Saad ◽

Derk Frank ◽

Mostafa Salem ◽

...

Keyword(s):

Surgical Treatment ◽

Prosthetic Valve ◽

Pacemaker Implantation ◽

Prosthetic Valve Endocarditis ◽

Neurological Deficits ◽

Preoperative Embolization ◽

Duration Of Surgery ◽

Cerebral Embolization ◽

Short And Long Term

Background: Active infective endocarditis (IE) is a serious disease associated with high mortality. The current study represents our experience over 18 years with surgical treatment for active infective native and prosthetic valve endocarditis (INVE, IPVE). Method: Analysis of 413 patients (171 with IPVE vs. 242 with INVE) who underwent cardiac surgery due to IE between 2002 and 2020. Results: Patients with IPVE were significantly older (64.9 ± 13.2 years vs. 58.3 ± 15.5 years; p < 0.001) with higher EuroSCORE II (21.2 (12.7; 41.8) vs. 6.9 (3.0; 17.0); p < 0.001)) and coronary heart disease (50.6% vs. 38.0%; p < 0.011). Preoperative embolization was significantly higher within INVE (35.5% vs. 16.4%; p < 0.001) with high incidence of cerebral embolization (18.6% vs. 7.6%; p = 0.001) and underwent emergency curative surgery than the IPVE group (19.6% vs. 10.6%; p < 0.001). However, patients with IPVE were significantly represented with intracardiac abscess (44.4% vs.15.7%; p < 0.001). Intraoperatively, the duration of surgery was expectedly significantly higher in the IPVE group (356 min vs. 244 min.; p = 0.001) as well as transfusion of blood (4 units (0–27) vs. 2 units (0–14); p < 0.001). Post-operatively, the incidence of bleeding was markedly higher within the IPVE group (700 mL (438; 1163) vs. 500 mL (250; 1075); p = 0.005). IPVE required significantly more permanent pacemakers (17.6% vs. 7.5%: p = 0.002). The 30-day mortality was higher in the IPVE group (24.6% vs. 13.2%; p < 0.003). Conclusion: Patients with INVE suffered from a higher incidence of cerebral embolization and neurological deficits than patients with IPVE. Surgical treatment in INVE is performed mostly as an emergency indication. However, patients with IPVE were represented commonly with intracardiac abscess, and had a higher indication of pacemaker implantation. The short- and long-term mortality rate among those patients was still high.

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Long-term results of surgical treatment of thyroid adenomas

Kazan medical journal ◽

10.17816/kmj2019-892 ◽

2019 ◽

Vol 100 (6) ◽

pp. 892-897

Author(s):

Stanislav Olegovich Artyukhin ◽

Vladimir Georgievich Aristarhov ◽

Denis Anatolyevich Puzin

Keyword(s):

Surgical Treatment ◽

Needle Aspiration ◽

Long Term Results ◽

Fine Needle ◽

Thyroid Adenomas ◽

Follicular Tumor ◽

Group 3 ◽

Group 2 ◽

Group 1

Aim. To study the long-term results of surgical treatment of patients with thyroid adenomas. Methods. From 2004 to 2006, 667 patients with follicular adenomas of the thyroid gland, including 134 (20.1%) men and 533 (79.9%) women, were operated on in the surgical department №2 of city clinical hospital №11 of Ryazan. 3 groups of patients were defined: group 1 operated on for solitary adenomas of the thyroid gland, 103 patients, hemithyreoidectomy performed; group 2 operated on for multiple adenomas of the thyroid in both lobes, 101 patients, thyroidectomy performed; group 3 32 patients operated on for multiple adenomas of the thyroid in the same lobe, hemithyreoidectomy performed. Patients were examined 14 years after the surgery. Results. Hypothyroidism was diagnosed in: group 1 18 (17.5%) patients, group 2 101 (100%), group 3 0. All patients with hypothyroidism were compensated with hormone replacement therapy. Permanent hypoparathyroidism was diagnosed only in group 2 8 (4.8%) patients. Unilateral laryngeal paralysis was found in group 1 in 1 (0.9%) patient, group 2 in 2 (1.9%) patients, group 3 contained no such patients. Recurrence (node more than 1 cm according to ultrasound) was observed in group 1 in 12 (11.7%) patients; fine-needle aspiration found colloidal nodes in 8 (7.8%) patients (Bethesda II), in 4 (3.9%) follicular tumor (IV). Group 2 had no recurrences. In group 3 11 (34.3%) patients had recurrence; fine-needle aspiration found colloidal nodes in 1 (3.1%) patient (Bethesda II), in 10 (31.3%) follicular tumor (Bethesda IV). Conclusion. In solitary adenomas it is possible to perform organ-saving operations, which reduces the percentage of postoperative complications; in multiple adenomas, the optimal volume of surgery is thyroidectomy; when multiple adenomas are localized in one lobe, the chance of recurrence of the disease (31.3%) is high leading to re-surgery.

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Alterations in ALK/ROS1/NTRK/MET drive a group of infantile hemispheric gliomas

Nature Communications ◽

10.1038/s41467-019-12187-5 ◽

2019 ◽

Vol 10 (1) ◽

Cited By ~ 32

Author(s):

Ana S. Guerreiro Stucklin ◽

Scott Ryall ◽

Kohei Fukuoka ◽

Michal Zapotocky ◽

Alvaro Lassaletta ◽

...

Keyword(s):

Tyrosine Kinases ◽

Receptor Tyrosine Kinases ◽

Therapeutic Strategies ◽

Low Grade ◽

High Grade ◽

Term Survival ◽

Group 3 ◽

Group 2 ◽

Group 1

Abstract Infant gliomas have paradoxical clinical behavior compared to those in children and adults: low-grade tumors have a higher mortality rate, while high-grade tumors have a better outcome. However, we have little understanding of their biology and therefore cannot explain this behavior nor what constitutes optimal clinical management. Here we report a comprehensive genetic analysis of an international cohort of clinically annotated infant gliomas, revealing 3 clinical subgroups. Group 1 tumors arise in the cerebral hemispheres and harbor alterations in the receptor tyrosine kinases ALK, ROS1, NTRK and MET. These are typically single-events and confer an intermediate outcome. Groups 2 and 3 gliomas harbor RAS/MAPK pathway mutations and arise in the hemispheres and midline, respectively. Group 2 tumors have excellent long-term survival, while group 3 tumors progress rapidly and do not respond well to chemoradiation. We conclude that infant gliomas comprise 3 subgroups, justifying the need for specialized therapeutic strategies.

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