Perceval Sutureless Bioprosthesis for Degenerative Aortic Valve Stenosis: Initial Experience With 67 Patients

Objective: The objective of this prospective study was to evaluate the characteristics (positive and negative) of Perceval S valve in patients undergoing aortic valve replacement with a biological prosthesis. The study included 67 patients operated on at our institution and a mean follow-up period of 18 months. Methods: From June 2016 to November 2019, 209 patients underwent aortic valve replacement with a biological prosthesis. Of these, 67 patients were included in the study based on the exclusion and inclusion criteria set before the study began. Their data were recorded during their hospital stay (preoperative, intraoperative, and early and late postoperative time). Results: Fifty-four patients underwent isolated aortic valve replacement (group I) with a Perceval S prosthesis, and 13 patients had combined aortic valve replacement procedures and CABG procedures (group II). Patients were implanted with the following prosthesis sizes: S (N = 12), M (N = 18), L (N = 28), or XL (N = 9). The Perceval S valve successfully was implanted in 67 (91.8%) patients (in 6 patients, the preoperative transthoracic echocardiographic data did not coincide with intraoperative TEE and surgical measurement of the size of the annulus in the suture). Surgical approaches in patients were medial sternotomy (N = 48), mini sternotomy (N = 15), and thoracotomy through the second intercostal space to the right (N = 4). The mean clamping time of the aorta and CPB length for isolated cases was 54 and 82 minutes, respectively, and 96 and 120 minutes for combined procedures. Four (5.9%) patients died within 30 days. Conclusion: Early postoperative results showed that the Perceval S valve was safe. Further follow up is required to evaluate the long-term duration of patients with this bioprosthesis.

Comparative Outcomes of Standard Perioperative Eye Drops, Intravitreal Triamcinolone Acetonide-Moxifloxacin, and Intracameral Dexamethasone-Moxifloxacin-Ketorolac in Cataract Surgery

Background: Since the advent of cataract surgery, topical eye drops have been the mainstay of postoperative prophylaxis and treatment. Due to factors such as high expenses and poor patient compliance, there has been a growing interest and acceptance of “dropless” alternatives. The purpose of this study is to compare the effectiveness of intravitreal triamcinolone acetonide-moxifloxacin and intracameral dexamethasone-moxifloxacin-ketorolac to a standard eye drop regimen in controlling postoperative inflammation, corneal edema, and intraocular pressure (IOP) among cataract patients.Methods: A retrospective longitudinal comparative study among 619 consecutive eyes receiving either a standard eye drop regimen, intraoperative triamcinolone acetonide-moxifloxacin or dexamethasone-moxifloxacin-ketorolac was performed between October 2016 and December 2020. Primary endpoints at postoperative day one (POD1), week one (POW1), and month one (POM1) included corneal edema, anterior chamber inflammation (ACI), and IOP.Results: Throughout the postoperative time points, there were no significant differences in corneal edema between intravitreal triamcinolone acetonide-moxifloxacin versus the standard eye drop therapy (OR [95%CI]: 1.09 [0.82, 1.45], P = .54) and intracameral dexamethasone-moxifloxacin-ketorolac versus the standard eye drop treatment (OR [95% CI]: 1.22 [0.89, 1.67], P = .22). The postoperative ACI severity was lower in the dexamethasone-moxifloxacin-ketorolac group compared to the triamcinolone acetonide-moxifloxacin group by 35% on postoperative day 1 (P = .01). The differences at subsequent postoperative time points were not statistically significant (P = .27 and P = 1.00 for POW1 and POM1 respectively). IOP at POM1 follow up visit was statistically significantly higher for the triamcinolone acetonide-moxifloxacin group [mean (±SD): 15.64 (4.26)] compared to the dexamethasone-moxifloxacin-ketorolac [mean (±SD): 14.16 (4.02)] (P < .01). There was no statistical difference in rates of CME (P = .16) and there were no cases of endophthalmitis.Conclusions: Intravitreal triamcinolone acetonide-moxifloxacin and intracameral dexamethasone-moxifloxacin-ketorolac demonstrate similar levels of efficacy to a standard eye drop regimen after cataract surgery. This study reinforces them as viable alternatives to traditional postoperative drops.

Earlier Resolution of Symptoms and Return of Function After Bridge-Enhanced Anterior Cruciate Ligament Repair As Compared With Anterior Cruciate Ligament Reconstruction

Background: Bridge-enhanced anterior cruciate ligament repair (BEAR) has noninferior patient-reported outcomes when compared with autograft anterior cruciate ligament reconstruction (ACLR) at 2 years. However, the comparison of BEAR and autograft ACLR at earlier time points—including important outcomes such as resolution of knee pain and symptoms, recovery of strength, and return to sport—has not yet been reported. Hypothesis: It was hypothesized that the BEAR group would have higher outcomes on the International Knee Documentation Committee and Knee injury and Osteoarthritis Outcome Score, as well as improved muscle strength, in the early postoperative period. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 100 patients aged 13 to 35 years with complete midsubstance anterior cruciate ligament injuries were randomized to receive a suture repair augmented with an extracellular matrix implant (n = 65) or an autograft ACLR (n = 35). Outcomes were assessed at time points up to 2 years postoperatively. Mixed-model repeated-measures analyses were used to compare BEAR and ACLR outcomes. Patients were unblinded after their 2-year visit. Results: Repeated-measures testing revealed a significant effect of group on the International Knee Documentation Committee Subjective Score ( P = .015), most pronounced at 6 months after surgery (BEAR = 86 points vs ACLR = 78 points; P = .001). There was a significant effect of group on the Knee injury and Osteoarthritis Outcome Score-Symptoms subscale scores ( P = .010), largely attributed to the higher BEAR scores at the 1-year postoperative time point (88 vs 82; P = .009). The effect of group on hamstring strength was significant in the repeated-measures analysis ( P < .001), as well as at all postoperative time points ( P < .001 for all comparisons). At 1 year after surgery, approximately 88% of the patients in the BEAR group and 76% of the ACLR group had been cleared for return to sport ( P = .261). Conclusion: Patients undergoing the BEAR procedure had earlier resolution of symptoms and increased satisfaction about their knee function, as well as improved resolution of hamstring muscle strength throughout the 2-year follow-up period. Registration: NCT02664545 (ClinicalTrials.gov identifier)

Association between retinal vessel density and postoperative time after primary repair of rhegmatogenous retinal detachment

The study aimed at a quantitative evaluation of macular vasculature after primary repair of rhegmatogenous retinal detachment (RRD) in correlation with the elapsed postoperative time. Optical coherence tomography angiography (OCT-A) was performed in 66 eyes of 33 patients in a retrospective case-control study: superficial and deep retinal vessel density (VD) of the whole image, fovea, parafovea, non-flow area, and foveal avascular zone (FAZ) were measured. Data of eyes with RRD were compared to the healthy fellow eyes in 3 groups according to the elapsed time after surgery: RD1: 6–12 months (n = 10), RD2: 1–2 years (n = 10), and RD3: 2–10 years (n = 13). In RD1 VD was significantly lower in the superficial parafoveal, deep parafoveal, and deep whole area compared to the fellow eyes. In RD3 VD was significantly lower in the superficial fovea, parafovea, whole image, and deep fovea, the non-flow area was significantly enlarged. OCT-A demonstrated a significant reduction in the superficial and deep regions of the macular vasculature after the repair of RRD. The deep area is more affected in the early postoperative period and the superficial region and the extent of the non-flow area are more involved after a longer postoperative time.

Postoperative Pain following Root Canal Filling with Bioceramic vs. Traditional Filling Techniques: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

This meta-analysis aimed to evaluate postoperative pain (POP) following root canal filling (RCF) with gutta-percha/bioceramic sealer (BCS) vs. gutta-percha/traditional sealer (TS) techniques. Electronic databases were searched for randomized trials. Subgroup analyses were performed for analgesic intake, flare-ups, postoperative time (24/48 h), pulp status, and retreatment. The search yielded 682 records, and nine studies were selected. BCS was associated with significantly lower POP vs. TS at 24 h (P = 0.04) and 48 h (P = 0.0005). In addition, non-significant trends favoring BCS for analgesic intake at 24 h (P = 0.14), flare-ups (P = 0.24) and obturation techniques at 24 h (P = 0.41) and 48 h (P = 0.33), non-significant trends for lower POP with TS vs. BCS 24 h and 48 h in vital teeth (P = 0.50, P = 0.18, respectively), and for lower POP with BCS vs. TS in non-vital teeth at 24 h and 48 h (P = 0.16, P = 0.84, respectively). POP was numerically lower with TS vs. BCS at 24 h (P = 0.65) and 48 h after retreatment (P = 0.59). Moreover, POP did not vary between fillers when the treatment was over single (P = 0.28) or multiple visits (P = 0.50). BCS was associated with significantly lower short-term POP, and with a trend for lower analgesic intake and flare-up incidence, as compared to TS.

A Comparison of Subxiphoid and Intercostal Wound Pain in the Same Patients Following Thoracic Surgery

Background: There is a lack of data comparing postoperative pain after subxiphoid and intercostal video-assisted thoracoscopic surgery (VATS). Pain is an individual's subjective experience and therefore difficult to compare between different individuals subjected to either procedure. This study assessed reported pain at six postoperative time points in the same patients receiving both subxiphoid and intercostal incisions for thoracic disease. Methods: Data from 26 patients who received simultaneous combined intercostal and subxiphoid VATS were retrospectively analyzed from August 2019 to April 2020. All patients received same length subxiphoid and intercostal incisions with or without drain placements. A numerical pain rating scale was administered on postoperative days (POD)-1, POD-2, POD-Discharge, POD-30, POD-90, and POD-180.Results: Bilateral uniportal VATS was performed in 11 patients and unilateral multiportal VATS in 15 patients. In the unilateral VATS group, there were no significant differences in pain reported for subxiphoid and intercostal incisions. However, in the bilateral VATS group, subxiphoid wounds resulted in significantly higher mean pain scores on POD-1, POD-2, and POD-Discharge (p = 0.0003, 0.001, and 0.03, respectively) but lower pain scores on POD-90 (p = 0.03). Conclusions: In the bilateral VATS group, higher late (3 and 6 months) postoperative pain was associated with intercostal incisions as have been reported by previous studies. Interestingly, subxiphoid incisions were found to have higher early (Day 1, 2, and Discharge) postoperative pain than intercostal incisions. More research is needed to better understand the cause of pain in a surgical area previously not thought to be prone to pain.

Elevated Systemic and Intestinal Inflammatory Response Are Associated With Gut Microbiome Disorder After Cardiovascular Surgery

Systemic inflammatory response after cardiovascular surgery is associated with poor prognosis, to which gut barrier impairment is related. To investigate whether perioperative changes of the gut microbiome are associated with systemic and intestinal inflammatory response, we examined changes of the gut microbiome, intestinal homeostasis, and systemic inflammatory response in cardiovascular patients before (Pre) surgery and on the first defecation day [postoperative time 1 (Po1)] or a week [postoperative time 2 (Po2)] postsurgery. Markedly, the enhanced systemic inflammatory response was observed in Po1 and Po2 compared with that in Pre. In line with inflammatory response, impaired gut barrier and elevated gut local inflammation were observed in Po1 and Po2. Microbiome analysis showed a remarkable and steady decline of alpha diversity perioperatively. In addition, microbial composition in the postoperation period was characterized by significant expansion of Enterococcus along with a decrease in anaerobes (Blautia, Faecalibacterium, Bifidobacterium, Roseburia, Gemmiger, [Ruminococcus], and Coprococcus), which were typically health-associated bacteria. Spearman correlation analysis showed microbiome disorder was associated with enhanced systemic inflammatory response and intestinal dysbiosis. These results suggest that microbiome disorder was related to disturbed gut homeostatic and subsequently elevates plasma endotoxin and systemic inflammatory response after cardiovascular surgery. This study not only highlights gut microbiome would be considered in future clinical practice but also proposes a promising perspective of potential diagnostic and therapeutic options for perioperative management of cardiovascular surgery patients.

Safety and Efficacy of Laparoscopic Versus Open Gastrectomy in Patients With Advanced Gastric Cancer Following Neoadjuvant Chemotherapy: A Meta-Analysis

BackgroundGiven the expanding clinical applications of laparoscopic surgery and neoadjuvant chemotherapy in advanced gastric cancer treatment, there is an emerging need to summarize the few evidences that evaluated the safety and efficacy of laparoscopic versus open gastrectomy in patients with advanced gastric cancer (AGC) following neoadjuvant chemotherapy (NAC).MethodsFrom January 1 to 2, 2021, we searched Ovid Embase, PubMed, Cochrane central register Trials (Ovid), and web of science to find relevant studies published in English, and two authors independently performed literature screening, quality assessment of the included studies, data extraction, and data analysis. This study was registered with PROSPERO (CRD42021228845).ResultsThe initial search retrieved 1567 articles, and 6 studies were finally included in the meta-analysis review, which comprised 2 randomized control trials and 4 observational studies involving 288 laparoscopic gastrectomy (LG) and 416 open gastrectomy (OG) AGC patients treated with NAC. For intraoperative conditions, R0 resection rate, blood transfusion, intraoperative blood loss, number of lymph nodes dissected, proximal margin, and distal margin were comparable between LG group and open OG group. For postoperative short-term clinical outcomes, LG has significantly less postoperative complications (OR = 0.65, 95%CI: 0.42–1.00, p = 0.05) and shorter postoperative time to first aerofluxus (WMD = -0.57d, 95%CI: -0.89–0.25, p = 0.0004) than OG, and anastomotic leakage, pulmonary infection, pleural effusion, surgical site infection, thrombosis, intestinal obstruction, peritoneal effusion or abscess formation, postoperative time to first defecation, postoperative time to first liquid diet, and postoperative length of stay were comparable between the two groups. For postoperative survival outcomes, there were no significant differences in disease-free survival (DFS) and overall survival (OS) between the two groups.ConclusionThe available evidences indicated that LG is an effective and feasible technology for the treatment of AGC patients treated with NAC, and LG patients have much less postoperative complications and faster bowel function recovery than OG patients.Systematic Review RegistrationPROSPERO database (identifier, CRD42021228845).

Application Research of Perioperative Clinical Pathway Based on Accelerated Rehabilitation Surgery Strategy in Patients with ERCP

Objective: To explore the effects of perioperative clinical pathway of accelerated rehabilitation surgery strategy in patients undergoing cholangiopancreatography (ERCP). Methods: Randomly selected 40 patients undergoing ERCP from our hospital which is People’s Hospital, Jingjiang City, for research, and divided the patients into two groups. The 20 patients who were given conventional education methods were set as the reference group, and the 20 patients who were given perioperative clinical pathway care with accelerated rehabilitation surgery strategies were the research group, where the clinical nursing effect of the two groups was statistically compared. Results: According to clinical observation and statistics, the study group’s postoperative time to eat for the first time, time to get out of bed, hospitalization time, and surgical blood loss were better than those of the reference group, P<0.05; the anxiety and depression scores of the study group were lower than those after nursing in the reference group, P<0.05; the incidence of complications in the study group was lower than that in the reference group, and patient satisfaction was higher than that in the reference group, where both P<0.05. Conclusion: The application of perioperative clinical pathway care based on the strategy of accelerated rehabilitation surgery can achieve significant results in ERCP patients, which can effectively improve the surgical indicators of patients and reduce the risk of complications.

The Change Tendency of Postoperative Symptoms in Thyroid Cancer Patients

Aims: To detect the health‐related quality of life (HRQoL) of Thyroid cancer (TC) patients and analyze the change tendency of TC patient’s reported symptoms after surgery. Methods: A total of 102 TC patients who underwent thyroid surgery from September 2020 to January 2021 were enrolled in this study, and received a survey on HRQoL (EORTC QLQ-C30) and disease-specific symptoms (THYCA-QoL) at 1 month and 3 months after surgery. Results: Almost all the patients experienced TC specific symptoms after surgery. At 1 month after surgery, throat/mouth problems, voice problems, neuromuscular problems, concentration problems, and less interest in sex were the top 5 reported complains. But at 3 months after surgery, less interest in sex was the top 1 reported complain, followed by throat/mouth problems, voice problems, psychological problems, neuromuscular problems and concentration problems. Meanwhile, the scores of most specific symptoms were decreased with the increase of postoperative time, while scores of less interest in sex were increased. Fatigue, insomnia and dyspnea were the most often reported common cancer-related symptoms for TC patients at 1 and 3 months after surgery. Interestingly, the scores of fatigue measured at 3 months after surgery were much lower than those measured at 1 month after surgery. Conclusions: Throat/mouth problems, voice problems, neuromuscular problems, concentration problems, less interest in sex and fatigue are the important patient reported complains that we should pay more attention after surgery.