1
|
Wang Q, Zhou J. Ventricular apical wall rupture and ventricular aneurysm formation concurrent with ventricular septal dissection and rupture due to ST-segment elevation myocardial infarction: a case report. BMC Cardiovasc Disord 2024; 24:222. [PMID: 38654152 DOI: 10.1186/s12872-024-03879-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/05/2024] [Indexed: 04/25/2024] Open
Abstract
The most common mechanical complications of acute myocardial infarction include free-wall rupture, ventricular septal rupture (VSR), papillary muscle rupture and pseudoaneurysm. It is rare for a patient to experience more than one mechanical complication simultaneously. Here, we present a case of ST-segment elevation myocardial infarction (STEMI) complicated with three mechanical complications, including ventricular apical wall rupture, ventricular aneurysm formation and ventricular septal dissection (VSD) with VSR. Cardiac auscultation revealed rhythmic S1 and S2 with a grade 3 holosystolic murmur at the left sternal border. Electrocardiogram indicated anterior ventricular STEMI. Serological tests showed a significant elevated troponin I. Bedside echocardiography revealed ventricular apical wall rupture, apical left ventricle aneurysm and VSD with VSR near the apex. This case demonstrates that several rare mechanical complications can occur simultaneously secondary to STEMI and highlights the importance of bedside echocardiography in the early diagnosis of mechanical complications.
Collapse
Affiliation(s)
- Qianqian Wang
- The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Jingwei Zhou
- The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
- , 16, Jiangsu Road, Shinan Disrict, Qiangdao, 266000, Shandong, China.
| |
Collapse
|
2
|
Pizones J, Hills J, Kelly M, Yilgor C, Moreno-Manzanaro L, Perez-Grueso FJS, Kleinstück F, Obeid I, Alanay A, Pellisé F. Which sagittal plane assessment method is most predictive of complications after adult spinal deformity surgery? Spine Deform 2024:10.1007/s43390-024-00864-5. [PMID: 38607513 DOI: 10.1007/s43390-024-00864-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/16/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE Different methods of sagittal alignment assessment compete for predicting adverse events after adult spinal deformity (ASD) surgery. We wanted to study which method provides greater benefit. METHODS Retrospective study of 391 patients operated for ASD, with > 6 instrumented levels, fused to the pelvis, and 2 years of follow-up. Three alignment methods were analyzed 6-week postoperatively: (1) Roussouly mismatch; (2) GAP score/GAP categories; (3) T4-L1-Hip axis. Binary logistic regression generated models that best predict the following adverse events: mechanical complications (MC): in general and isolated (PJK, PJF, rod breakage); reinterventions (in general and after MC); and readmissions. ROC/AUC analysis was also implemented. In a second regression round, we added different variables that were selected on univariate analysis-demographic, surgical, and radiographic-to complete the models. RESULTS The best predictor parameters in most models were T4-L1PA mismatch and GAP score; we could not prove a predictive ability of the Roussouly mismatch. The T4-L1PA mismatch best predicted general MC, PJK, PJK + PJF, and readmission, while the GAP score best predicted PJF and reinterventions (for MC and for any complication). However, the variance explained by these models was limited (Nagelkerke's R2 = 0.031-0.113), with odds ratios ranging from 1.070 to 1.456. ROC curves plotted an AUC between 0.57 and 0.70. Introducing additional variables (demographic, surgical, and radiographic) improved prediction in all the models (Nagelkerke's R2 = 0.082-0.329) and allowed predicting rod breakage. CONCLUSION The T4-L1-Hip axis and GAP score show potential in predicting adverse events, surpassing the Roussouly method. Despite partial efficacy in complication anticipation, recognizing postoperative sagittal alignment as a key modifiable risk factor, the crucial need arises to integrate diverse variables, both modifiable and non-modifiable, for enhanced predictive accuracy. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Javier Pizones
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | | | - Michael Kelly
- Rady Children Hospital San Diego, University of California, San Diego, CA, USA
| | - Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Lucía Moreno-Manzanaro
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | - Frank Kleinstück
- Department of Orthopedics, Schulthess Klinik, Zurich, Switzerland
| | - Ibrahim Obeid
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
3
|
Zhang RS, Ro R, Bamira D, Vainrib A, Zhang L, Nayar AC, Saric M, Bernard S. Echocardiography in the Recognition and Management of Mechanical Complications of Acute Myocardial Infarction. Curr Cardiol Rep 2024:10.1007/s11886-024-02042-5. [PMID: 38526749 DOI: 10.1007/s11886-024-02042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE OF REVIEW Although rare, the development of mechanical complications following an acute myocardial infarction is associated with a high morbidity and mortality. Here, we review the clinical features, diagnostic strategy, and treatment options for each of the mechanical complications, with a focus on the role of echocardiography. RECENT FINDINGS The growth of percutaneous structural interventions worldwide has given rise to new non-surgical options for management of mechanical complications. As such, select patients may benefit from a novel use of these established treatment methods. A thorough understanding of the two-dimensional, three-dimensional, color Doppler, and spectral Doppler findings for each mechanical complication is essential in recognizing major causes of hemodynamic decompensation after an acute myocardial infarction. Thereafter, echocardiography can aid in the selection and maintenance of mechanical circulatory support and potentially facilitate the use of a percutaneous intervention.
Collapse
Affiliation(s)
- Robert S Zhang
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Richard Ro
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Daniel Bamira
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Alan Vainrib
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Lily Zhang
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Ambika C Nayar
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Muhamed Saric
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Samuel Bernard
- Division of Cardiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
| |
Collapse
|
4
|
Matteucci M, Ronco D, Kowalewski M, Massimi G, De Bonis M, Formica F, Jiritano F, Folliguet T, Bonaros N, Sponga S, Suwalski P, De Martino A, Fischlein T, Troise G, Dato GA, Serraino FG, Shah SH, Scrofani R, Kalisnik JM, Colli A, Russo CF, Ranucci M, Pettinari M, Kowalowka A, Thielmann M, Meyns B, Khouqeer F, Obadia JF, Boeken U, Simon C, Naito S, Musazzi A, Lorusso R. Long-term survival after surgical treatment for post-infarction mechanical complications: results from the Caution study. Eur Heart J Qual Care Clin Outcomes 2024:qcae010. [PMID: 38327179 DOI: 10.1093/ehjqcco/qcae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND AND AIMS Mechanical complications (MCs) are rare but potentially fatal sequelae of acute myocardial infarction (AMI). Surgery, though challenging, is considered the treatment of choice. The authors sought to study early and long-term results of patients undergoing surgical treatment for post-AMI MCs. METHODS Patients undergone surgical treatment for post-infarction MCs between 2001 through 2019 in 27 centers worldwide were retrieved from the database of CAUTION study. In-hospital and long-term mortality were the primary outcomes. Cox proportional hazards regression models were used to determine independent factors associated with overall mortality. RESULTS The study included 720 patients. The median age was 70.0 [62.0-77.0] years, with a male predominance (64.6%). The most common MC encountered was ventricular septal rupture (VSR) (59.4%). Cardiogenic shock was seen on presentation in 56.1% of patients. In-hospital mortality rate was 37.4%; in more than 50% of cases, the cause of death was low cardiac output syndrome (LCOS). Late mortality occurred in 133 patients, with a median follow-up of 4.4 [1.0-8.6] years. Overall survival at 1, 5 and 10 years was 54.0%, 48.1% and 41.0%, respectively. Older age (p < 0.001) and postoperative LCOS (p < 0.001) were independent predictors of overall mortality. For hospital survivors, 10-year survival was 65.7% and was significant higher for patients with VSR than those with papillary muscle rupture (long-rank P = 0.022). CONCLUSIONS Contemporary data from a multicenter cohort study show that surgical treatment for post-AMI MCs continues to be associated with high in-hospital mortality rates. However, long-term survival in patients surviving the immediate postoperative period is encouraging.Trial registration number: NCT03848429.
Collapse
Affiliation(s)
- Matteo Matteucci
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
| | - Daniele Ronco
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milan, Italy
| | - Mariusz Kowalewski
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior, Warsaw, Poland
| | - Giulio Massimi
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
| | - Michele De Bonis
- Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Francesco Formica
- Department of Medicine and Surgery, University of Parma, Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Federica Jiritano
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
- Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Thierry Folliguet
- Department of Cardio-Thoracic Surgery, University Hospital Henri-Mondor, Créteil, Paris, France
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Sandro Sponga
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Piotr Suwalski
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior, Warsaw, Poland
| | | | - Theodor Fischlein
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Giovanni Troise
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | | | - Shabir Hussain Shah
- Cardiovascular and Thoracic Surgery Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Roberto Scrofani
- Cardiac Surgery Unit, Fondazione Ospedale Maggiore Policlinico IRCCS Cà Granda, University of Milan, Milan, Italy
| | - Jurij Matija Kalisnik
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Andrea Colli
- Section of Cardiac Surgery, University Hospital, Pisa, Italy
| | | | - Marco Ranucci
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Matteo Pettinari
- Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Adam Kowalowka
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart Center, University of Duisburg-Essen, Essen, Germany
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Fareed Khouqeer
- Department of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Udo Boeken
- Department of Cardiovascular Surgery, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Caterina Simon
- Cardiovascular and Transplant Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Shiho Naito
- Section of Cardiac Surgery, University Hospital, Pisa, Italy
| | - Andrea Musazzi
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| |
Collapse
|
5
|
Quarto E, Zanirato A, Vitali F, Spatuzzi M, Bourret S, Le Huec JC, Formica M. Adult spinal deformity correction surgery using age-adjusted alignment thresholds: clinical outcomes and mechanical complication rates. A systematic review of the literature. Eur Spine J 2024; 33:553-562. [PMID: 37740115 DOI: 10.1007/s00586-023-07949-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE Adult spinal deformity (ASD) surgery gives good clinical outcomes but has a high rate of mechanical complications (MC). In 2016, Lafage described the age-adjusted alignment thresholds (AAAT) to adapt the correction in relation to patient's age proposing less aggressive corrections for the elderly population. The aim of this review was to clarify the effectiveness of AAAT to achieve good health-related quality of life (HRQoL) and their relationship with post-operative MC. MATERIALS AND METHODS We performed a review of the literature, including articles reporting data on post-operative HRQoL and MC rates in relation to the AAAT. Data were stratified according to whether they matched the AAAT, dividing the population in undercorrected (U), matched (M) and overcorrected (O). The quality of the included studies was assessed using the GRADE and MINORS systems. RESULTS Six articles reporting data from 1,825 patients were included. The different categories (U, M and O) had homogeneous pre-operative sagittal parameters (p > 0.05) that became statistically different after surgeries (p < 0.05). Proximal junctional kyphosis (PJK) was more frequent in the O group compared to U (p = 0.05). Post-operative HRQoL parameters were similar in the 3 groups (p > 0.05). The quality of the included studies was generally low with a high bias risk. CONCLUSION The results extrapolated from this review are interesting, as for the same HRQoL the U group had a lower MC rate. Unfortunately, the results are inconsistent, mainly because of the low quality of the included studies and the lack of reporting of some important patient- and surgery-related factors.
Collapse
Affiliation(s)
- E Quarto
- IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy.
| | - A Zanirato
- IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - F Vitali
- IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - M Spatuzzi
- IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - S Bourret
- Vertebra, Polyclinique Bordeaux Nord Aquitaine, 15 Rue Boucher, 33300, Bordeaux, France
| | - J C Le Huec
- Vertebra, Polyclinique Bordeaux Nord Aquitaine, 15 Rue Boucher, 33300, Bordeaux, France
| | - M Formica
- IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| |
Collapse
|
6
|
Gessara A, Patel MS, Estefan M, Koch JEJ, Gutman N, Mardashti A, Shetaiwi A, Quraishi NA. Restoration of the sagittal profile according to the Roussouly classification reduces mechanical complications and revision surgery in older patients undergoing surgery for adult spinal deformity (ASD). Eur Spine J 2024; 33:563-570. [PMID: 37768339 DOI: 10.1007/s00586-023-07885-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/14/2023] [Accepted: 08/04/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE The mechanical complications related to ASD remain a concern due to their morbidity and associated revision surgery. Restoration of each patient's Roussouly profile may reduce these. Our aim was to examine if the restoration of the Roussouly profile reduced these complications and revision rates in older patients operated for degenerative ASD. METHODS Retrospective analysis of a single-centre, 2-year minimum follow-up patient database. All patients undergoing corrective surgery (≥ 4 levels) for ASD were included with analysis of demographic data, operative records, restoration of Roussouly sagittal profile, mechanical complications and revision rates. Univariate and multivariate analysis was conducted. RESULTS Fifty-two patients were included (mean age was 72.3 years, average follow-up 56.3 months). Twenty-six patients had a "restored" profile (50%) and 26 an "unrestored" profile (50%). The incidence of mechanical complications was 7 (27%) and 23 (88%) for the restored and unrestored groups, respectively (p < 0.001). Revision rates were 4 (15.4%) and 18 (69.2%), respectively (p < 0.000), in the restored and unrestored profiles. Univariate analysis determined that profile restoration and BMI were associated with mechanical complications and revision surgery, whilst only the profile restoration status maintained its statistical power in multivariate analysis (p = 0.002 and p = 0.002, respectively). Age was not a significant factor in univariate analysis. The relative risk for mechanical failure and revision surgery was 5.6 times (CI 1.929-16.39) and 3.08 times (CI 1.642-5.734) greater if the profile was not restored. CONCLUSIONS Achieving each patient's ideal Roussouly profile is associated with a reduced incidence of mechanical complications and revision rates in the older population after surgery for degenerative ASD.
Collapse
Affiliation(s)
- Alan Gessara
- Queens Medical Centre, Centre for Spinal Studies and Surgery, Nottingham, UK.
| | | | - Martin Estefan
- Queens Medical Centre, Centre for Spinal Studies and Surgery, Nottingham, UK
| | - Jonathan E J Koch
- Queens Medical Centre, Centre for Spinal Studies and Surgery, Nottingham, UK
| | - Nadav Gutman
- Queens Medical Centre, Centre for Spinal Studies and Surgery, Nottingham, UK
| | - Ali Mardashti
- Queens Medical Centre, Centre for Spinal Studies and Surgery, Nottingham, UK
| | - Ali Shetaiwi
- Queens Medical Centre, Centre for Spinal Studies and Surgery, Nottingham, UK
| | - Nasir Ali Quraishi
- Queens Medical Centre, Centre for Spinal Studies and Surgery, Nottingham, UK
| |
Collapse
|
7
|
Pan C, Bourghli A, Larrieu D, Boissiere L, Pizones J, Alanay A, PelIise F, Kleinstück F, Obeid I. Sagittal alignment of diverse mechanical complications following adult spinal deformity surgery. Eur Spine J 2024:10.1007/s00586-023-08126-0. [PMID: 38270602 DOI: 10.1007/s00586-023-08126-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE To compare the sagittal alignment of patients with diverse mechanical complications (MCs) following adult spinal deformity (ASD) surgery with that of patients without MCs. METHODS A total of 371 patients who underwent ASD surgery were enrolled. The sagittal spinopelvic parameters were measured preoperatively and at the 6-month and last follow-up, and the global alignment and proportion (GAP) score was calculated. The subjects were divided into non-MC and MCs groups, and the MCs group was further divided into rod fracture (RF), screw breakage (SB), screw dislodgement (SD) and proximal junctional kyphosis (PJK) subgroups. RESULTS Preoperatively, the RF group had greater thoracolumbar kyphosis (TLK) and relative upper lumbar lordosis (RULL); the SB group had the largest pelvic incidence (PI) and lumbar lordosis (LL); the SD group had the least global sagittal imbalance; and the PJK group had the highest thoracic kyphosis (TK), TLK and RULL. At the last follow-up, the RF and SB groups featured a large PI minus LL (PI-LL), while the PJK group featured a prominent TK; all the MCs subgroups had sagittal malalignment and a higher GAP score, and the SB group had the most severe cases. Logistic regressions showed that the relative spinopelvic alignment (RSA) score was correlated with RF, SB and SD, while the RSA and age scores were associated with PJK. CONCLUSION Each patient with MCs had individual characteristics in the sagittal plane following ASD surgery, which may be helpful to understand the pathophysiology of poor sagittal alignment with its subsequent MCs and guide an eventual revision strategy.
Collapse
Affiliation(s)
- Changyu Pan
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Digital Spine Research Institute, Changsha, 410011, Hunan, China.
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, P.O.Box 84400, 11671, Riyadh, Saudi Arabia
| | - Daniel Larrieu
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Louis Boissiere
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Ahmet Alanay
- Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ferran PelIise
- Spine Surgery Unit, Hospital Universitario Vall Hebron, Barcelona, Spain
| | | | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| |
Collapse
|
8
|
Kiram A, Hu Z, Ma H, Li J, Sun X, Xu Y, Ling C, Xu H, Zhu Z, Qiu Y, Liu Z. Development of ethnicity-adjusted global alignment and proportion score to predict the risk of mechanical complications following corrective surgery for adult spinal deformity. Spine J 2024:S1529-9430(24)00006-8. [PMID: 38190891 DOI: 10.1016/j.spinee.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/20/2023] [Accepted: 12/27/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND CONTEXT Surgery for degenerative scoliosis (DS) is a complex procedure with high complication and revision rates. Based on the concept that pelvic incidence (PI) is a constant parameter, the global alignment and proportional (GAP) score was developed from sagittal alignment data collected in the Caucasian populations to predict mechanical complications. However, the PI varies among different ethnic groups, and the GAP score may not apply to Chinese populations. Thus, this study aims to assess the predictability of the GAP score for mechanical complications in the Chinese populations and develop an ethnicity-adjusted GAP score. PURPOSE To test the predictability of the original GAP score in the Chinese population and develop a Chinese ethnicity-tailored GAP scoring system. STUDY DESIGN/SETTINGS Retrospective cohort study PATIENT SAMPLE: A total of 560 asymptomatic healthy volunteers were enrolled to develop Chinese ethnicity-tailored GAP (C-GAP) score and a total of 114 DS patients were enrolled to test the predictability of original GAP score and C-GAP score. OUTCOME MEASURES Demographic information, sagittal spinopelvic parameters of healthy volunteers and DS patients were collected. Mechanical complications were recorded at a minimum of 2-year follow-up after corrective surgery for DS patients. METHODS A total of 560 asymptomatic healthy volunteers with a mean age of 61.9±14.1 years were enrolled to develop ethnicity-adjusted GAP score. Besides, 114 surgically trated DS patients (M/F=10/104) with a mean age of 60.7±7.1 years were retrospectively reviewed. Demographic data and radiological parameters of both groups, including PI, lumbar lordosis (LL), sacral slope (SS), the sagittal vertical axis (SVA), and global tilt (GT) were collected. Ideal LL, SS, and GT were obtained by calculating their correlation with PI of healthy volunteers using linear regression analysis. Relative pelvic version (RPV), relative lumbar lordosis (RLL), lordosis distribution index (LDI), and relative spinopelvic alignment (RSA) were obtained using the ideal parameters, and the Chinese population adjusted GAP score (C-GAP) was developed based on these values. The predictability of original and C-GAP for mechanical failure was evaluated using clinical and radiological data of DS patients by evaluating the area under the curve (AUC) using receiver operating characteristic curve. This study was supported the National Natural Science Foundation of China (NSFC) (No. 82272545), ($ 8,000-10,000) and the Jiangsu Provincial Key Medical Center, and the China Postdoctoral Science Foundation (2021M701677), Level B ($ 5,000-7,000). RESULTS Ideal SS=0.53×PI+9 (p=.002), ideal LL=0.48×PI+22 (p=.023) and ideal GT=0.46 × PI-9 (p=.011). were obtained by correlation analysis using sagittal parameters from those healthy volunteers, and RPV, RLL, RSA, and LDI were calculated accordingly. Then, the ethnicity-adjusted C-GAP score was developed by summing up the numeric value of calculated RPV, RLL, RSA, and LDI. The AUC was classified as ''no or low discriminatory power'' for the original GAP score in predicting mechanical complications (AUC=0.592, p=.078). Similarly, the original GAP score did not correlate with mechanical complications in DS patients. According to the C-GAP score, the sagittal parameters were proportional in 25 (21.9%) cases, moderately disproportional in 68 (59.6%), and severely disproportional in 21% (18.5%) cases. The incidence of mechanical complications was statistically different among proportioned and moderately disproportional and severely disproportional portions of the C-GAP score (p=.03). The predictability of the C-GAP score is high with an AUC=0.773 (p<.001). In addition, there is a linear correlation between mechanical complication rate and C-GAP score (χ=0.102, p=.02). CONCLUSION The Ethnicity-adjusted C-GAP score system developed in the current study provided a more accurate and reliable for predicting the risk of mechanical complications after corrective surgery for adult spinal deformity.
Collapse
Affiliation(s)
- Abdukahar Kiram
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, P.O. Box 210008, Zhongshan Road 321, Nanjing, China
| | - Zongshan Hu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, P.O. Box 210008, Zhongshan Road 321, Nanjing, China
| | - Hongru Ma
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, P.O. Box 210008, Zhongshan Road 321, Nanjing, China
| | - Jie Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, P.O. Box 210008, Zhongshan Road 321, Nanjing, China
| | - Xing Sun
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, the Clinical College of Nanjing Medical University, P.O. Box 210008, Zhongshan Road 321, Nanjing, China
| | - Yanjie Xu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, P.O. Box 210008, Zhongshan Road 321, Nanjing, China
| | - Chen Ling
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, the Clinical College of Nanjing Medical University, P.O. Box 210008, Zhongshan Road 321, Nanjing, China
| | - Hui Xu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, P.O. Box 210008, Zhongshan Road 321, Nanjing, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, P.O. Box 210008, Zhongshan Road 321, Nanjing, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, P.O. Box 210008, Zhongshan Road 321, Nanjing, China
| | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, P.O. Box 210008, Zhongshan Road 321, Nanjing, China; Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, the Clinical College of Nanjing Medical University, P.O. Box 210008, Zhongshan Road 321, Nanjing, China.
| |
Collapse
|
9
|
Chanbour H, Waddell WH, Vickery J, LaBarge ME, Croft AJ, Longo M, Roth SG, Hills JM, Abtahi AM, Zuckerman SL, Stephens BF. L1-pelvic angle: a convenient measurement to attain optimal deformity correction. Eur Spine J 2023; 32:4003-4011. [PMID: 37736775 DOI: 10.1007/s00586-023-07920-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/14/2023] [Accepted: 08/26/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE (1) Evaluate the associations between L1-pelvic angle (L1PA) and both sagittal vertical axis (SVA) and T1-pelvic angle (T1PA), and (2) assess the clinical impact of L1PA. METHODS A single-institution retrospective cohort study was undertaken for patients undergoing adult spinal deformity (ASD) surgery from 2013 to 2017. Ideal L1PA was defined as (0.5xPelvic Incidence)-21. Pearson correlation was performed to compare L1PA, SVA, and T1PA. Univariate/multivariate regression was performed to assess the effect of L1PA on mechanical complications, controlling for age, BMI, and postoperative pelvic incidence-lumbar lordosis mismatch (PI/LL). Due to the overlapping nature of patients with pseudarthrosis and rod fracture, these patients were analyzed together. RESULTS A total of 145 patients were included. Mean preoperative L1PA, SVA, and T1PA were 15.5 ± 8.9°, 90.7 ± 66.8 mm, and 27.1 ± 13.0°, respectively. Mean postoperative L1PA, SVA, and T1PA were 15.0 ± 8.9°, 66.7 ± 52.8 mm, and 22.3 ± 11.1°, respectively. Thirty-six (24.8%) patients achieved ideal L1PA. Though the correlation was modest, preoperative L1PA was linearly correlated with preoperative SVA (r2 = 0.16, r = 0.40, 95%CI = 0.22-0.60, p < 0.001) and T1PA (r2 = 0.41, r = 0.62, 95%CI = 0.46-0.76, p < 0.001). Postoperative L1PA was linearly correlated with postoperative SVA (r2 = 0.12, r = 0.37, 95%CI = 0.18-0.56, p < 0.001) and T1PA (r2 = 0.40, r = 0.62, 95%CI = 0.45-0.74, p < 0.001). Achieving ideal L1PA ± 5° was associated with a decreased risk of rod fracture/pseudarthrosis on univariate and multivariate regression (OR = 0.33, 95%CI = 0.12-0.86, p = 0.024). No association between achieving ideal L1PA and patient-reported outcomes was observed. CONCLUSION L1PA was modestly correlated with SVA and T1PA, and achieving ideal L1PA was associated with lower rates of rod fracture/pseudarthrosis. Future studies are warranted to better define the clinical implications of achieving a normal L1PA. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave Suite #4200, Nashville, TN, 37232, USA
| | - William Hunter Waddell
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Justin Vickery
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew E LaBarge
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew J Croft
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Longo
- Department of Neurological Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave Suite #4200, Nashville, TN, 37232, USA
| | - Steven G Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave Suite #4200, Nashville, TN, 37232, USA
| | - Jeffrey M Hills
- Department of Orthopedic Surgery, University of Texas, San Antonio, TX, USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave Suite #4200, Nashville, TN, 37232, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave Suite #4200, Nashville, TN, 37232, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave Suite #4200, Nashville, TN, 37232, USA.
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
| |
Collapse
|
10
|
Baroncini A, Frechon P, Bourghli A, Smith JS, Larrieu D, Pellisé F, Pizones J, Kleinstueck F, Alanay A, Kieser D, Cawley DT, Boissiere L, Obeid I. Adherence to the Obeid coronal malalignment classification and a residual malalignment below 20 mm can improve surgical outcomes in adult spine deformity surgery. Eur Spine J 2023; 32:3673-3680. [PMID: 37393421 DOI: 10.1007/s00586-023-07831-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/17/2023] [Accepted: 06/17/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE Coronal balance is a major factor impacting the surgical outcomes in adult spinal deformity (ASD). The Obeid coronal malalignment (O-CM) classification has been proposed to improve the coronal alignment in ASD surgery. Aim of this study was to investigate whether a postoperative CM < 20 mm and adherence to the O-CM classification could improve surgical outcomes and decrease the rate of mechanical failure in a cohort of ASD patients. METHODS Multicenter retrospective analysis of prospectively collected data on all ASD patients who underwent surgical management and had a preoperative CM > 20 mm and a 2-year follow-up. Patients were divided in two groups according to whether or not surgery had been performed in adherence to the guidelines of the O-CM classification and according to whether or not the residual CM was < 20 mm. The outcomes of interest were radiographic data, rate of mechanical complications and Patient-Reported Outcome Measures. RESULTS At 2 years, adherence to the O-CM classification led to a lower rate of mechanical complications (40 vs. 60%). A coronal correction of the CM < 20 mm allowed for a significant improvement in SRS-22 and SF-36 scores and was associated with a 3.5 times greater odd of achieving the minimal clinical important difference for the SRS-22. CONCLUSION Adherence to the O-CM classification could reduce the risk of mechanic complications 2 years after ASD surgery. Patients with a residual CM < 20 mm showed better functional outcomes and a 3.5 times greater odd of achieving the MCID for the SRS-22 score.
Collapse
Affiliation(s)
- Alice Baroncini
- Department of Orthopaedics and Trauma Surgery, RWTH Uniklinik Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - Paul Frechon
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- Department of Neurosurgery, Caen University Hospital, Caen, France
| | - Anouar Bourghli
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Justin S Smith
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Daniel Larrieu
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
| | - Ferran Pellisé
- Spine Surgery Unit, Vall D'Hebron Hospital, Barcelona, Spain
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | | | - Ahmet Alanay
- Spine Center, Acibadem University School of Medicine, Istanbul, Turkey
| | - David Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand
| | - Derek T Cawley
- Department of Spine Surgery, Mater Private Hospital, Dublin, Ireland
| | - Louis Boissiere
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- ELSAN, Polyclinique Jean Villar, Brugge Cedex, France
| | - Ibrahim Obeid
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- ELSAN, Polyclinique Jean Villar, Brugge Cedex, France
| |
Collapse
|
11
|
Chanbour H, Chen JW, Vaughan WE, Abtahi AM, Gardocki RJ, Stephens BF, Zuckerman SL. Which Bone Mineral Density Measure Offers a More Reliable Prediction of Mechanical Complications in Adult Spinal Deformity Surgery: Hounsfield Units or DEXA Scan? World Neurosurg 2023; 178:e657-e665. [PMID: 37543204 DOI: 10.1016/j.wneu.2023.07.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/30/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE In patients undergoing adult spinal deformity (ASD) surgery, we sought to: (1) determine the relationship between dual-energy x-ray absorptiometry (DEXA)-measured bone mineral density (BMD), T-scores, and Hounsfield units (HU), and (2) compare the ability of DEXA-measured BMD, T-scores, and HU to predict mechanical complications and reoperations. METHODS A single-institution retrospective cohort study was undertaken for cases from 2013 to 2017. INCLUSION CRITERIA ≥5-level-fusion, sagittal/coronal deformity, and 2-year follow-up. Multivariable regression controlled for age, body mass index, receiving anabolic medications, and postoperative sagittal vertical axis and pelvic-incidence lumbar-lordosis mismatch. A subanalysis was performed for osteopenic patients (-1 < T-score < -2). RESULTS Of 145 patients undergoing ASD surgery, 72 (49.6%) had both preoperative DEXA and computed tomography scans. Mean DEXA-measured BMD was 0.91 ± 0.52 g/cm2, mean T-score was -1.61 ± 1.03, and mean HU was 153.5 ± 52.8. While no correlation was found between DEXA-measured BMD and HU (r = 0.17, P = 0.144), T-score and HU had a weakly positive correlation (r = 0.31, P = 0.007). Mechanical complications occurred in 48 (66.7%) patients, including 27 (37.5%) proximal junctional kyphosis (PJK), 1 (1.4%) distal junctional kyphosis, 5 (6.9%) implant failure, 30 (41.7%) rod fracture/pseudarthrosis, 42 (58.3%) reoperations, and 16 (22.2%) reoperations due to PJK. No association was found between DEXA-measured BMD or T-scores with mechanical complications or reoperations. While univariate regression showed a significant association between lower HU and PJK (OR 0.98, 95%CI 0.97-0.99, P = 0.011), the significance was lost after multivariable analysis. When considering osteopenic patients (n = 37), only DEXA-measured BMD was an independent risk factor for PJK (OR 0.01, 95%CI 0.00-0.09, P = 0.017), with a threshold of 0.82 g/cm2 (AUC 0.70, 95%CI 0.53-0.84, P = 0.019). CONCLUSIONS Poor correlation was found between the 3 BMD modalities. DEXA-measured BMD may be superior to T-scores and HU in predicting PJK among patients with osteopenia with a threshold of BMD <0.82 g/cm2.
Collapse
Affiliation(s)
- Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey W Chen
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Wilson E Vaughan
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Raymond J Gardocki
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| |
Collapse
|
12
|
Saad M, Arfa M, Attia A, Lamas V, Sauleau EA, Charles YP. Proximal and distal mechanical repercussions of instrumentation by double rods and interbody grafts in adult scoliosis. Orthop Traumatol Surg Res 2023; 109:103544. [PMID: 36621636 DOI: 10.1016/j.otsr.2023.103544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/08/2022] [Accepted: 09/22/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Correction of adult scoliosis by instrumentation with double rods and interbody grafts aims to reduce the risk of pseudarthrosis with rod fracture. An increase in instrumentation rigidity can lead to an increase in stresses at the proximal and distal ends of the construct. The aim of this study was to analyze the incidence and clinical repercussions of proximal junctional kyphosis (PJK), proximal junctional failure (PJF) and iliac screw loosening. MATERIEL AND METHODS An analysis of patients operated on for adult scoliosis with instrumentation to the pelvis using 4 rods and interbody cages was carried out from a prospective register. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Scoliosis Research Society 22 (SRS-22) clinical scores and radiological parameters were collected preoperatively, postoperatively at 3 months, 1 year and 2 years. The appearance of PJK, PJF or distal screw loosening was sought; the clinical impact and the risk factors were analyzed by Bayesian inference. RESULTS Fifty-one patients with a mean age of 64.5 years were included. The clinical scores improved significantly (Pr>0.95) at 2 years: VAS back 6.9 versus 2.6, VAS leg 4.9 versus 2.5, ODI 48.2 versus 25.4, SRS-22 2.4 versus 3.5. The radiological parameters were corrected (Pr>0.95): Cobb angle 63.9° versus 22.8°, spinosacral angle (SSA) 112.4° versus 118.8°, T1-pelvic angle (TPA) 24, 8° versus 20.8°, lumbar lordosis 43.8° versus 51.0°, thoracic kyphosis 45.2° versus 53.6°. Thirteen patients (25.5%) presented with PJK and 11 (21.6%) with PJF. Seven patients (13.7%) presented with iliac screw loosening. None of these complications was associated with a significant deterioration in clinical scores. Cranial migration of the lumbar apex increased the risk of distal screw loosening: Odds-Ratio 10.31 (Pr>0.999). Two patients were re-operated on for PJF and one patient for iliac screw loosening (5.9%). No rod fracture with pseudarthrosis was found. CONCLUSION Instrumentation with double rods and interbody grafts was associated with a rate of 47.1% of mechanical repercussions at the extremity of the construct. However, these complications were not associated with a significant deterioration in clinical scores. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Maxime Saad
- Service de chirurgie orthopédique et traumatologique, CHU de Grenoble, hôpital Nord, boulevard de la Chantourne, université Grenoble Alpes, 38700 la Tronche, Grenoble, France.
| | - Maher Arfa
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, faculté de médecine, maïeutique et sciences de la santé, université de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - Aymen Attia
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, faculté de médecine, maïeutique et sciences de la santé, université de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - Vincent Lamas
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, faculté de médecine, maïeutique et sciences de la santé, université de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - Erik André Sauleau
- Service de santé publique, hôpitaux universitaires de Strasbourg, faculté de médecine, maïeutique et sciences de la santé, université de Strasbourg, 1, Place de l'hôpital, 67091 Strasbourg cedex, France
| | - Yann Philippe Charles
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, faculté de médecine, maïeutique et sciences de la santé, université de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| |
Collapse
|
13
|
Vatkar A, Najjar E, Patel M, Quraishi NA. Vertebral body tethering in adolescent idiopathic scoliosis with more than 2 years of follow-up- systematic review and meta-analysis. Eur Spine J 2023; 32:3047-3057. [PMID: 37306799 DOI: 10.1007/s00586-023-07724-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/01/2022] [Accepted: 04/17/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND CONTEXT Whilst spinal fusion remains the gold standard in the treatment of adolescent idiopathic scoliosis (AIS), anterior vertebral body tethering (AVBT) is gaining momentum with relatively few studies on its efficacy thus far. PURPOSE To conduct a systematic review reporting on the early results of AVBT for patients undergoing surgery for AIS. We aimed to systematically evaluate the relevant literature pertaining to the efficacy of AVBT with respect to degree of correction of the major curve Cobb angle, complications and revision rates. STUDY DESIGN/SETTING Systematic review. PATIENT SAMPLE Of a total of 259 articles, 9 studies met the inclusion criteria and were analysed. Overall, 196 patients of (mean age 12.08 years) underwent an AVBT procedure for correction of AIS with a mean follow-up of 34 months. OUTCOME MEASURES Degree of Cobb angle correction, complications and revision rates were used as outcome measures. METHODS A systematic review of the literature on AVBT was performed for studies published between Jan 1999-March 2021 applying the PRISMA guidelines. Isolated case reports were excluded. RESULTS Overall, 196 patients of (mean age 12.08 years) underwent an AVBT procedure for correction of AIS with a mean follow-up of 34 months. There was a significant correction of the main thoracic curve of scoliosis (mean preoperative Cobb angle 48.5°, post-operative Cobb angle at final follow-up of 20.1°, P = 0.01). Overcorrection and mechanical complications were seen in 14.3% and 27.5% of cases, respectively. Pulmonary complications including atelectasis and pleural effusion were seen in 9.7% of patients. Tether revision was performed in 7.85%, and revision to a spinal fusion in 7.88%. CONCLUSION This systematic review incorporated 9 studies of AVBT and 196 patients with AIS. The complication and revision to spinal fusion rates were 27.5% and 7.88%, respectively. The current literature on AVBT is restricted largely to retrospective studies with non-randomised data. We would recommend a prospective, multi-centre trial of AVBT with strict inclusion criteria and standardised outcome measures.
Collapse
Affiliation(s)
- Arvind Vatkar
- The Centre for Spinal Studies and Surgery (CSSS), Queen's Medical Centre, Nottingham University Hospitals, Derby Rd, Lenton, Nottingham, NG7 2UH, UK.
| | - Elie Najjar
- The Centre for Spinal Studies and Surgery (CSSS), Queen's Medical Centre, Nottingham University Hospitals, Derby Rd, Lenton, Nottingham, NG7 2UH, UK
| | - Mohammed Patel
- The Centre for Spinal Studies and Surgery (CSSS), Queen's Medical Centre, Nottingham University Hospitals, Derby Rd, Lenton, Nottingham, NG7 2UH, UK
| | - Nasir A Quraishi
- The Centre for Spinal Studies and Surgery (CSSS), Queen's Medical Centre, Nottingham University Hospitals, Derby Rd, Lenton, Nottingham, NG7 2UH, UK
| |
Collapse
|
14
|
Mao W, Yang AL, Chang SM, Li Y, Li LL, Ni HF, Dong YH. The Impact of Banana-Shaped Fragments on Trochanteric Hip Fractures Treated by PFNA. Indian J Orthop 2023; 57:1452-1460. [PMID: 37609008 PMCID: PMC10441983 DOI: 10.1007/s43465-023-00964-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023]
Abstract
Background Regarding trochanteric hip fractures, one type of posterior coronal fragments was described as the "banana-shaped fragment", while the impact of the banana-shaped fragment on mechanical stability has not been further studied. The current study investigated the association between the banana-shaped fragment and mechanical complications after surgery. Methods This retrospective cohort study included 273 patients treated by proximal femoral nail antirotation (PFNA) in the full analysis. The age, the sex, the fracture side, the follow-up time, the American Society of Anesthesiologists classification, the operators, the fracture classification, the tip-apex distance, the blade positions, the reduction quality and the bone mineral density were analyzed in relation to mechanical complications, through univariate and multivariate approaches. Results Mechanical complications happened in 33 patients. The banana-shaped fragment (adjusted odds ratio 5.240, 95% CI 2.172 to 12.641; p < 0.001), the tip-apex distance and the reduction quality showed significant association with mechanical complications in both univariate and multivariate analysis. Moreover, for 118 patients with the banana-shaped fragment, we found that the use of wire cerclage couldn't significantly lower the rates of mechanical complications (p = 0.648). Conclusions The banana-shaped fragment had a negative impact on mechanical stability of trochanteric hip fractures treated by PFNA. In the perioperative period, the BSF should be carefully evaluated, and its specific handling deserves further study.
Collapse
Affiliation(s)
- Wei Mao
- Department of Orthopedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Shanghai, 200090 People’s Republic of China
- Department of Orthopedics, Shanghai Fifth People’s Hospital, Fudan University, No. 801 Heqing Rd, Minhang District, Shanghai, 200240 China
| | - Ao-lei Yang
- Department of Orthopedics, Shanghai Fifth People’s Hospital, Fudan University, No. 801 Heqing Rd, Minhang District, Shanghai, 200240 China
| | - Shi-min Chang
- Department of Orthopedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Shanghai, 200090 People’s Republic of China
| | - Yan Li
- Division of Orthopaedics and Biotechnology, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Theme Trauma and Reparative Medicine, Department of Orthopedics and Traumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Lin-li Li
- Department of Orthopedics, Shanghai Fifth People’s Hospital, Fudan University, No. 801 Heqing Rd, Minhang District, Shanghai, 200240 China
| | - Hao-fei Ni
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - You-hai Dong
- Department of Orthopedics, Shanghai Fifth People’s Hospital, Fudan University, No. 801 Heqing Rd, Minhang District, Shanghai, 200240 China
| |
Collapse
|
15
|
Kim JE, Yoon Y, Pae A, Kwon YD. Clinical outcome of narrow diameter dental implants: a 3-year retrospective study. Maxillofac Plast Reconstr Surg 2023; 45:26. [PMID: 37526800 PMCID: PMC10393933 DOI: 10.1186/s40902-023-00394-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND This study aimed to analyze the clinical outcome and complications of narrow-diameter dental implants (NDIs) (diameter ≤3.5 mm). METHODS The 274 NDIs that met the selection criteria from 2013 to 2018 were included in the retrospective study, and the survival rates (SVR) were compared. Mechanical complications included screw loosening and fractures of the implant components, such as the implant fixture, abutment, and prosthesis. In addition, marginal bone loss (MBL) was measured immediately after surgery and 1 year after loading. RESULTS The 3-year cumulative SVR was 92.4%. Nineteen fixtures failed during the follow-up. The failure rate was significantly higher (OR=4.573, p<0.05) in smokers and was significantly higher in osteoporosis patients (OR=3.420, p<0.05). The vertical and horizontal values of MBL were 0.33±0.32 mm and 0.18±0.17 mm, respectively. Mechanical complications included screw loosening (5.5%) and porcelain fracture (2.2%), but no fractures of the fixture or components were observed. The choice of titanium and zirconium (TiZr) alloy implant was significantly more frequent in the posterior region. Bone graft was significantly more frequently done in the anterior region. CONCLUSIONS According to the high SVR and stability of NDIs, the findings of the study suggest that NDIs may be a replacement for regular diameter dental implants (RDIs) and the use of TiZr alloy could extend the indication of NDIs. In the esthetic area, contour augmentation may be a reason for increasing the frequency of bone grafts.
Collapse
Affiliation(s)
- Jae-Eun Kim
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Youngjae Yoon
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Kyung Hee University, Seoul, Republic of Korea
| | - Ahran Pae
- Department of Prosthodontics, College of Dentistry, Kyung Hee University, Seoul, Republic of Korea
| | - Yong-Dae Kwon
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Kyung Hee University, Seoul, Republic of Korea.
| |
Collapse
|
16
|
Kumar V, Kumar A, Barik S, Raj V. Letter to the Editor concerning "Does the use of postoperative brace help preventing mechanical complications following adult deformity surgery?" by J. Pizones et al. (Eur Spine J [2023]; doi: 10.1007/s00586-022-07521-3). Eur Spine J 2023; 32:2932-2933. [PMID: 37270435 DOI: 10.1007/s00586-023-07794-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 05/13/2023] [Accepted: 05/21/2023] [Indexed: 06/05/2023]
Affiliation(s)
- Vishal Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, Deoghar, India
| | - Aman Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, Deoghar, India.
| | - Sitanshu Barik
- Department of Orthopaedics, All India Institute of Medical Sciences, Deoghar, India
| | - Vikash Raj
- Department of Orthopaedics, All India Institute of Medical Sciences, Deoghar, India
| |
Collapse
|
17
|
Chanbour H, LaBarge ME, Jonzzon S, Roth SG, Abtahi AM, Stephens BF, Zuckerman SL. Is lower screw density associated with mechanical complications in adult spinal deformity surgery? Spine Deform 2023; 11:1009-1018. [PMID: 36872418 DOI: 10.1007/s43390-023-00671-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/18/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE To assess the impact of screw density on: (1) rod fracture/pseudarthrosis, (2) proximal/distal junctional kyphosis/failure (PJK/DJK/PJF), and (3) deformity correction judged by sagittal vertical axis (SVA) and T1-pelvic angle (T1PA). METHODS A single-center, retrospective cohort study of patients undergoing adult spinal deformity (ASD) surgery from 2013 to 2017 was undertaken. Screw density was calculated by dividing the number of screws placed by the total instrumented levels. Screw density was then dichotomized at our calculated mean density to ≥ 1.65 and < 1.65. Outcomes consisted of mechanical complications and the amount of correction obtained. RESULTS 145 patients underwent ASD surgery with 2-year follow-up. Mean screw density (range) was 1.6 ± 0.3 (1.00-2.00). The most common levels with missing screws were L2 (n = 59, 40.7%), L3 (n = 57, 39.3%) and L1 (n = 51, 35.2%), located mainly along the concavity in 113(80.0%) patients and apices in 98 (67.6%) patients. Rod fracture/pseudarthrosis: 23/32 (71.8%) patients with rod fracture and 35/46 (76.0%) with pseudarthrosis had missing screws within two levels of the rod fracture/pseudarthrosis. Logistic regression showed no significant association between screw density and rod fracture/pseudarthrosis. PJK/F 15/47 (31.9%) patients with PJK and 9/30 (30.0%) with PJF had missing screws within three levels of the upper instrumented vertebra (UIV). Logistic regression showed no significant association between screws density and PJK/F. Correction obtained: linear regression failed to show any significant association between screw density and SVA or T1PA correction. CONCLUSION These findings showed that no significant association was found between screw density and mechanical complications or the amount of correction obtained, though approximately 3 out of 4 patients with rod fracture/pseudarthrosis had missing screws at or within two levels of the pathology. The prevention of mechanical complications is likely multifactorial and subject to both patient's characteristics and surgical techniques. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Medical Center North T-4224, Nashville, TN, 37212, USA
| | - Matthew E LaBarge
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Soren Jonzzon
- Department of Neurological Surgery, Vanderbilt University Medical Center, Medical Center North T-4224, Nashville, TN, 37212, USA
| | - Steven G Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, Medical Center North T-4224, Nashville, TN, 37212, USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Medical Center North T-4224, Nashville, TN, 37212, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Medical Center North T-4224, Nashville, TN, 37212, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Medical Center North T-4224, Nashville, TN, 37212, USA.
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
| |
Collapse
|
18
|
Soto GE. Catastrophic left atrial tear during cryoballoon pulmonary vein isolation following chemotherapy. HeartRhythm Case Rep 2023; 9:482-485. [PMID: 37492058 PMCID: PMC10363464 DOI: 10.1016/j.hrcr.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Affiliation(s)
- Gabriel E. Soto
- Address reprint requests and correspondence: Dr Gabriel E. Soto, SoutheastHEALTH, 1701 Lacey St, Cape Girardeau, MO 63701.
| |
Collapse
|
19
|
Sanchez-Jimenez E, Fanne RA, Levi Y, Saada M, Kobo O, Roguin A. Predictors, Outcomes and Impact of Mechanical Circulatory Support of Patients With Mechanical Complications After Acute Myocardial Infarction. Cardiovasc Revasc Med 2023; 52:23-29. [PMID: 36849312 DOI: 10.1016/j.carrev.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/28/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Despite early and currently effective epicardial coronary recanalization, the mortality rate after mechanical complication (MC) remains high, especially in cardiogenic shock. There is an increase in the use of mechanical circulatory support in patients with cardiogenic shock and MC, however, evidence is still scarce and most studies exclude patients with mechanical complications. METHODS Using the National Inpatient Sample database from 2015 to 2018 to identify patients with AMI, we aimed to determine the predictors and outcomes of patients with MC, subtypes and the use of MCS. RESULTS We identified 2,427,315 patients with AMI; 2345 (0.1 %) developed MC and of them 1320 (56.3 %) received MCS. Regarding subtypes, 960 (40.9 %) had ventricular septal rupture (VSR), 540 (23.0 %) papillary muscle rupture (PMR), 530 (22.6 %) pseudoaneurysm, and 315 (13.4 %) free wall rupture (FWR). Mortality was 12 times higher (OR: 11.663, CI: 10.582-12.855, p < 0.001) in patients with MC compared to patients without MC (49.7 % vs. 4.6 %, p < 0.001) and all subtypes of MC showed a significant increase in mortality. The use of MCS was associated with decreased mortality in PMR (46.2 % to 34.8 %, p = 0.009) and pseudoaneurysm (64.7 % to 42.1 %, p < 0.001), however, with higher mortality in VSR. CONCLUSIONS The incidence of MC after an AMI is very low, nonetheless the in-hospital mortality rate remains very high. It tends to occur more in older patients and with fewer comorbidities. The subtype with the highest frequency and highest mortality was VSR. The use of mechanical circulatory support was associated with better survival in PMR and pseudoaneurysm, but not overall survival.
Collapse
Affiliation(s)
- Erick Sanchez-Jimenez
- Cardiology Department, Hillel Yaffe Medical Center, Technion-Israel Institute of Technology, Hadera, Israel
| | - Rami Abu Fanne
- Cardiology Department, Hillel Yaffe Medical Center, Technion-Israel Institute of Technology, Hadera, Israel
| | - Yaniv Levi
- Cardiology Department, Hillel Yaffe Medical Center, Technion-Israel Institute of Technology, Hadera, Israel
| | - Majdi Saada
- Cardiology Department, Hillel Yaffe Medical Center, Technion-Israel Institute of Technology, Hadera, Israel
| | - Ofer Kobo
- Cardiology Department, Hillel Yaffe Medical Center, Technion-Israel Institute of Technology, Hadera, Israel
| | - Ariel Roguin
- Cardiology Department, Hillel Yaffe Medical Center, Technion-Israel Institute of Technology, Hadera, Israel.
| |
Collapse
|
20
|
Ouaddi NE, de Diego O, Labata C, Rueda F, Martínez MJ, Cámara ML, Berastegui E, Oliveras T, Ferrer M, Montero S, Serra J, Muñoz-Guijosa C, Lupón J, Bayés-Genis A, García-García C. Mechanical complications in STEMI: prevalence and mortality trends in the primary PCI era. The Ruti-STEMI registry. Rev Esp Cardiol (Engl Ed) 2023; 76:427-433. [PMID: 36228958 DOI: 10.1016/j.rec.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/22/2022] [Indexed: 05/28/2023]
Abstract
INTRODUCTION AND OBJECTIVES Mechanical complications confer a dreadful prognosis in ST-elevation myocardial infarction (STEMI). Their prevalence and prognosis are not well-defined in the current era of primary percutaneous coronary intervention (pPCI) reperfusion networks. We aimed to analyze prevalence and mortality trends of post-STEMI mechanical complications over 2 decades, before and after the establishment of pPCI networks. METHODS Prospective, consecutive registry of STEMI patients within a region of 850 000 inhabitants over 2 decades: a pre-pPCI period (1990-2000) and a pPCI period (2007-2017). We analyzed the prevalence of mechanical complications, including ventricular septal rupture, papillary muscle rupture, and free wall rupture (FWR). Twenty eight-day and 1-year mortality trends were compared between the 2 studied decades. RESULTS A total of 6033 STEMI patients were included (pre-pPCI period, n=2250; pPCI period, n=3783). Reperfusion was supported by thrombolysis in the pre-pPCI period (99.1%) and by pPCI in in the pPCI period (95.7%). Mechanical complications developed in 135 patients (2.2%): ventricular septal rupture in 38 patients, papillary muscle rupture in 24, and FWR in 73 patients. FWR showed a relative reduction of 60% in the pPCI period (0.8% vs 2.0%, P<.001), without significant interperiod changes in the other mechanical complications. After multivariate adjustment, FWR remained higher in the pre-pPCI period (OR, 1.93; 95%CI, 1.10-3.41; P=.023). At 28 days and 1 year, mortality showed no significant changes in all the mechanical complications studied. CONCLUSIONS The establishment of regional pPCI networks has modified the landscape of mechanical complications in STEMI. FWR is less frequent in the pPCI era, likely due to reduced transmural infarcts.
Collapse
Affiliation(s)
- Nabil El Ouaddi
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Oriol de Diego
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Servicio de Cardiología, Hospital Clínic i Provincial, Barcelona, España; PhD program, Department of Medicine Autonomous University of Barcelona, Barcelona, España
| | - Carlos Labata
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ferran Rueda
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - María José Martínez
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - María Luisa Cámara
- Cirugía Cardiaca, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Elisabet Berastegui
- Cirugía Cardiaca, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Teresa Oliveras
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Marc Ferrer
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Santiago Montero
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jordi Serra
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Christian Muñoz-Guijosa
- Cirugía Cardiaca, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Josep Lupón
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Antoni Bayés-Genis
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Cosme García-García
- Servicio de Cardiología, Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| |
Collapse
|
21
|
Sánchez-Luna JP, Amat-Santos IJ. Interventional management of mechanical complications in acute myocardial infarction. Rev Esp Cardiol (Engl Ed) 2023; 76:362-369. [PMID: 36813110 DOI: 10.1016/j.rec.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/23/2022] [Indexed: 04/29/2023]
Abstract
Mechanical complications following a myocardial infarction are uncommon, but with dramatic consequences and high mortality. The left ventricle is the most often affected cardiac chamber and complications can be classified according to the timing in early (from days to first weeks) or late complications (from weeks to years). Despite the decrease in the incidence of these complications thank to primary percutaneous coronary intervention programs -wherever this option is available-, the mortality is still significant and these infrequent complications are an emergent scenario and one of the most important causes of mortality at short term in patients with myocardial infarction. Mechanical circulatory support devices, especially if minimally invasive implantation is used avoiding thoracotomy, have improved the prognosis of these patients by providing stability until definitive treatment can be applied. On the other hand, the growing experience in transcatheter interventions for the treatment of ventricular septal rupture or acute mitral regurgitation has been associated to an improvement in their results, even though prospective clinical evidence is still missing.
Collapse
Affiliation(s)
- Juan Pablo Sánchez-Luna
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Ignacio J Amat-Santos
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| |
Collapse
|
22
|
Raganato R, Pizones J, Yilgor C, Moreno-Manzanaro L, Vila-Casademunt A, Sánchez-Márquez JM, Fernández-Baíllo N, Sánchez Pérez-Grueso FJ, Kleinstück F, Alanay A, Obeid I, Pellisé F. Sagittal realignment: surgical restoration of the global alignment and proportion score parameters: a subgroup analysis. What are the consequences of failing to realign? Eur Spine J 2023:10.1007/s00586-023-07649-w. [PMID: 37000217 DOI: 10.1007/s00586-023-07649-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/18/2023] [Accepted: 03/09/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION The Global Alignment and Proportion (GAP) score incorporates three domains directly modified with surgery (relative pelvic version-RPV, relative lumbar lordosis-RLL, lumbar distribution index-LDI) and one indirectly restored (relative spinopelvic alignment-RSA). We analyzed our surgical realignment performance and the consequences of domain-specific realignment failure on mechanical complications and PROMs. MATERIALS AND METHODS From an adult spinal deformity prospective multicenter database, we selected patients: fused to pelvis, upper instrumented vertebra at or above L1, and 2 years of follow-up. Descriptive, univariate and multivariate analyses were employed. RESULTS The sample included 333 patients. RLL-6w showed the highest success rate (58.3% aligned), but 16.5% of patients were classified in the "Severe hypolordosis" and "Hyperlordosis" subgroups. RPV-6w was the most challenging to realign, with 51.6% moderate or severe retroversion. Regarding RSA-6w, 21.9% had severe positive malalignment. Correct alignment of RPV-6w (p = 0.025) and RSA-6w (p = 0.002) proved to be protective factors against the development of mechanical complications. Severe pelvic retroversion (p = 0.026) and severe positive malalignment (p = 0.007) were risk factors for mechanical complications. RSA-6w "Severe positive malalignment" was associated with less improvement in PROMs: ∆ODI (8.83 vs 17.2; p = 0.011), ∆SRS-22 total (0.54 vs 0.87; p = 0.007), and ∆SF-36PCS (3.47 vs 7.76; p = 0.04); MCID for ODI (37.0 vs 55.5%; p = 0.023), and SRS-22 (40.8 vs 60.1%; p = 0.015); and PASS for ODI (17.6 vs 31.7%; p = 0.047). CONCLUSIONS RPV was the most underperformed modifiable parameter. Severe pelvic retroversion and severe positive malalignment influenced the occurrence of mechanical complications. Severe positive malalignment affected PROMs improvement.
Collapse
Affiliation(s)
- Riccardo Raganato
- Spine Unit, Department of Orthopedic Surgery, Hospital La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Javier Pizones
- Spine Unit, Department of Orthopedic Surgery, Hospital La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain.
| | - Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Lucía Moreno-Manzanaro
- Spine Unit, Department of Orthopedic Surgery, Hospital La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | | | - José Miguel Sánchez-Márquez
- Spine Unit, Department of Orthopedic Surgery, Hospital La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Nicomedes Fernández-Baíllo
- Spine Unit, Department of Orthopedic Surgery, Hospital La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | | | - Frank Kleinstück
- Department of Orthopedics, Schulthess Klinik, Zurich, Switzerland
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ibrahim Obeid
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
23
|
Pizones J, Boissiere L, Moreno-Manzanaro L, Vila-Casademunt A, Perez-Grueso FJS, Sánchez-Márquez JM, Baíllo NF, Kleinstück F, Alanay A, Pellisé F, Obeid I. Does the use of postoperative brace help preventing mechanical complications following adult deformity surgery? Eur Spine J 2023; 32:914-925. [PMID: 36592207 DOI: 10.1007/s00586-022-07521-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE There is scarce information regarding the effectiveness of postoperative braces in decreasing mechanical complications and reinterventions following adult deformity surgery. METHODS Retrospective matched cohort study from a prospective adult deformity multicenter database. We selected operated patients, fused to the pelvis, > 6 instrumented levels, and minimum 2 year follow-up. Three hundred and eighty patients were separated into two groups (Brace-3 months TLSO-vs No Brace) and then matched controlling for age, gender and frailty. We studied demographic, intraoperative, and postoperative spinopelvic parameters. Both groups were compared regarding complications and reinterventions in the first 2 postoperative years, using univariate and multivariate logistic regression analysis. RESULTS We finally analyzed 359 matched patients, mean age of 65.3 ± 8.9 years, frailty-index (0.43 ± 0.15), and mostly females (84%). 224 patients wore a postoperative brace (B) and 135 didn't (NoB). They showed no difference in intraoperative variables and postoperative spinopelvic alignment. They differed (P < 0.05) in: Pelvic incidence (B:58° ± 13 vs NoB:54.5° ± 13); BMI (B:25.8 ± 4 vs NoB:27.4 ± 5); upper instrumented vertebra (B:81.7% T8-L1 vs NoB:72.6% T8-L1), and the use of multiple rods (B:47.3% vs NoB:18.5%). Univariate analysis showed a higher rate of mechanical complications and reinterventions when not using a brace. As well as higher NRS-back and leg pain at 6 weeks. However, multivariate analysis selected the use of multiple rods as the only independent factor protecting against mechanical complications (OR: 0.38; CI 95% 0.22-0.64) and reinterventions (OR: 0.41; CI 95% 0.216-0.783). CONCLUSION After controlling for potential confounders, our study could not identify the protective effect of postoperative braces preventing mechanical complications and reinterventions in the first two postoperative years.
Collapse
Affiliation(s)
- Javier Pizones
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - Louis Boissiere
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | - Lucía Moreno-Manzanaro
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | | | - José Miguel Sánchez-Márquez
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Nicomedes Fernández Baíllo
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Frank Kleinstück
- Department of Orthopedics, Schulthess Klinik, Zurich, Switzerland
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Ibrahim Obeid
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| |
Collapse
|
24
|
Itou J, Kuramitsu Y, Hatta S, Okazaki K. AP3×ML3 reduction quality classification for femoral trochanteric fractures: validation for reliability focusing on positive medial cortical support. J Orthop Surg Res 2023; 18:64. [PMID: 36694258 PMCID: PMC9875386 DOI: 10.1186/s13018-023-03555-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION This study evaluated the validity of the AP3 × ML3 reduction quality classification, which applies the concept of positive medial cortical support. METHODS A total of 120 trochanteric fractures classified as AO Foundation/Orthopedic Trauma Association 31A1 and A2 were retrospectively analyzed. The validity of the AP3 × ML3 classification was evaluated by comparison with the Baumgaertner reduction quality criteria. When using the AP3 × ML3 classification, reduction quality was divided into three classes based on the degree of anterior cortical contact between the proximal and distal fragments. Reduction quality was also divided into three classes when using the Baumgaertner criteria. The frequency of mechanical complications, including cut-out, delayed union, and excessive migration of the lag screw, was retrospectively assessed. Intra-observer and inter-observer reliability was assessed using the intraclass correlation coefficient (ICC). RESULTS Mechanical complications included 4 cases of cutout (3.3%) and 1 of delayed union (0.8%). Mechanical complications occurred for all levels of reduction quality in both classifications, except for the acceptable of the Baumgaertner criteria. When reduction quality was rated as good, acceptable, and poor the incidence of mechanical complications was 2.5%, 5.7%, and 16%, respectively, under the AP3 × ML3 classification and 3.3%, 0%, and 15.0%, respectively, under the Baumgaertner criteria. The ICC was 0.80 for intra-observer reliability and 0.57 for inter-observer reliability when using the AP3 × ML3 classification and 0.85 and 0.34, respectively, when using the Baumgaertner criteria. CONCLUSION The AP3 × ML3 classification was reliable and easy to use compared with the widely used Baumgaertner reduction quality criteria. Level of evidence 4.
Collapse
Affiliation(s)
- Junya Itou
- grid.410818.40000 0001 0720 6587Department of Orthopaedic Surgery, Tokyo Women’s Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666 Japan
| | - Yujiro Kuramitsu
- grid.410818.40000 0001 0720 6587Department of Orthopaedic Surgery, Tokyo Women’s Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666 Japan
| | - Satoshi Hatta
- Department of Orthopaedic Surgery, Funabashi General Hospital, 1-13-1 Kitamoto-Cho, Funabashi, Chiba 273-0864 Japan
| | - Ken Okazaki
- grid.410818.40000 0001 0720 6587Department of Orthopaedic Surgery, Tokyo Women’s Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666 Japan
| |
Collapse
|
25
|
Chanbour H, Roth SG, LaBarge ME, Steinle AM, Hills J, Abtahi AM, Stephens BF, Zuckerman SL. The postoperative course of mechanical complications in adult spinal deformity surgery. Spine Deform 2023; 11:175-85. [PMID: 36063294 DOI: 10.1007/s43390-022-00576-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE (a) Describe the time course of each mechanical complication, and (b) compare radiographic measurements and preoperative patient-reported outcome measures (PROMs) among each mechanical complication type. METHODS A single-institution case-control study was undertaken of patients undergoing adult spinal deformity (ASD) surgery from 2009-2017. Exposure variables included patient demographics, operative variables, radiographic measurements, and preoperative PROMs, including Oswestry Disability Index (ODI), Numeric Rating Scale Back/Leg-pain scores (NRS-Back/Leg), and EuroQol-5D (EQ-5D). The primary outcomes were occurrence of a mechanical complication and time to complication. Due to overlapping occurrence, rod fracture and pseudarthrosis were grouped into one composite category. RESULTS 145 patients underwent ASD surgery and were followed for at least 2 years. 30/47 (63.8%) patients with proximal junctional kyphosis (PJK) required reoperation, whereas 27/31 (87.1%) patients with pseudarthrosis/rod fracture required reoperation (63.8% vs. 87.1%, Χ2 = -0.23, 95% CI -0.41, -0.05, p = 0.023). Cox regression showed no significant difference in time to reoperation between PJK and rod fracture/pseudarthrosis (HR = 0.97, 95% CI 0.85-1.11, p = 0.686). Distal junctional kyphosis (DJK) (N = 3; 2 reoperation) and implant failures (N = 4; 0 reoperations) were rare. Patients with PJK had significantly lower Hounsfield Units preoperatively compared to those with pseudarthrosis/rod fracture (138.2 ± 43.8 vs. 160.3 ± 41.0, mean difference (MD) = -22.1, 95% CI -41.8, -2.4, p = 0.028), more prior fusions (51.1% vs. 25.8%, Χ2 = 0.253, 95% CI 0.41, 0.46, p = 0.026), fewer instrumented vertebrae (9.2 ± 2.6 vs. 10.7 ± 2.5, MD = -1.5, 95% CI -2.7, -0.31, p = 0.013), and higher postoperative thoracic kyphosis (TK) (46.3 ± 12.7 vs. 34.9 ± 10.6, MD = 11.4, 95% CI 5.9, 16.9, p < 0.001). Higher postoperative C7 sagittal vertical axis (SVA) did not achieve a significant difference (80.7 ± 72.1 vs. 51.9 ± 57.3, MD = 28.8, 95% CI -1.9, 59.5, p = 0.066). No differences were seen in preoperative PROMs. CONCLUSION Patients with pseudarthrosis/rod fracture had a higher reoperation rate compared to those with PJK with similar time to reoperation. Moreover, patients with PJK had higher postoperative TK, lower Hounsfield Units, more prior fusions, and fewer instrumented levels compared to those with pseudarthrosis/rod fracture. The results of this single-institution study suggest that even though mechanical complications are often analyzed as a single group, important differences may exist between them. LEVEL OF EVIDENCE III.
Collapse
|
26
|
Oe S, Yamato Y, Hasegawa T, Yoshida G, Banno T, Arima H, Ide K, Yamada T, Kurosu K, Nakai K, Yuki T, Matsuyama Y. The validation study of preoperative surgical planning for corrective target in adult spinal deformity surgery with 5-year follow-up for mechanical complications. Eur Spine J 2022; 31:3662-72. [PMID: 36245039 DOI: 10.1007/s00586-022-07420-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/05/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE We used the Hamamatsu formula as an indicator of correction goals in surgery for adult spinal deformity (ASD). However, it is reported that correction according to Global Alignment and Proportion (GAP) score and the Roussouly algorithm reduces implant-related complications. The purpose of this study was to validate three preoperative plannings for the incidence of complications. METHODS Patients who underwent ASD surgery and followed up for 5 years were included. The Hamamatsu formula was also divided into three groups: ideal (I), moderate (M), and under (U). The GAP score was divided into three groups: proportioned (P), moderately disproportioned (MD), and severely disproportioned (SD). Patients who met the postoperative Roussouly classification algorithm were defined as the restored (R) group and those who did not were defined as the non-restored (NR) group. Proximal junctional kyphosis (PJK) and rod fractures were investigated. RESULTS In the Hamamatsu formula, there were 51, 108, and 44 patients in Groups I, M, and U, respectively, with no significant differences in their complications. In the GAP score, there were 45, 71, and 87 patients in the P, MD, and SD group, respectively, with no significant differences in their complications. In the Roussouly classification, there were 102 and 101 patients in the R and NR group, respectively, with a significant difference in their complication rate (R/NR = 51%:70%; P = 0.005). PJK was significantly lower in the R group (R/NR = 15%:30%; P = 0.010). CONCLUSION Correction according to the Roussouly algorithm is useful for the prevention of mechanical complications, especially PJK.
Collapse
|
27
|
Quarto E, Zanirato A, Pellegrini M, Vaggi S, Vitali F, Bourret S, Le Huec JC, Formica M. GAP score potential in predicting post-operative spinal mechanical complications: a systematic review of the literature. Eur Spine J 2022; 31:3286-3295. [PMID: 36153789 DOI: 10.1007/s00586-022-07386-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 07/18/2022] [Accepted: 09/10/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE In 2017, the GAP score was proposed as a tool to reduce mechanical complications (MC) in adult spinal deformity (ASD) surgery: the reported MC rate for the GAP proportioned category was only 6%, which is clearly lower to the MC rate reported in the literature. The aim of this study is to analyse if the most recent literature confirms the promising results of the original article. MATERIALS AND METHODS Using the PRISMA flow chart, we reviewed the literature to analyse GAP score capacity in predicting MC occurrence. We included articles clearly reporting ASD surgery MC stratified by GAP categories and the score's overall capacity to predict MC using the area under the curve (AUC). The quality of the included studies was evaluated using GRADE and MINORS systems. RESULTS Eleven retrospective articles (1,517 patients in total) were included. The MC distribution per GAP category was as follows: GAP-P, 32.8%; GAP-MD, 42.3%; GAP-SD, 55.4%. No statistically significant difference was observed between the different categories using the Kruskal-Wallis test (p = 0.08) and the two-by-two Pearson-Chi square test (P Vs MD, p = 0.300; P Vs SD, p = 0.275; MD Vs SD, p = 0.137). The global AUC was 0.68 ± 0.2 (moderate accuracy). The included studies were of poor quality according to the GRADE system and had a high risk of bias based on the MINORS criteria. CONCLUSION The actual literature does not corroborate the excellent results reported by the original GAP score article. Further prospective studies, possibly stratified by type of MC and type of surgery, are necessary to validate this score.
Collapse
Affiliation(s)
- E Quarto
- Clinica Ortopedica, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy.
| | - A Zanirato
- Clinica Ortopedica, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - M Pellegrini
- Clinica Ortopedica, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - S Vaggi
- Clinica Ortopedica, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - F Vitali
- Clinica Ortopedica, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - S Bourret
- Vertebra, Polyclinique Bordeaux Nord Aquitaine, 15 Rue Boucher, 33300, Bordeaux, France
| | - J C Le Huec
- Vertebra, Polyclinique Bordeaux Nord Aquitaine, 15 Rue Boucher, 33300, Bordeaux, France
| | - M Formica
- Clinica Ortopedica, IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| |
Collapse
|
28
|
Garduño-Crespo A, Del Carmen Velázquez-Núñez M, Cervantes-Guzmán BE, Ibañez-Cervantes G, Vargas-De-León C. Mechanical complications of weekly care and maintenance versus once every 10 days of the peripherally inserted central catheter line insertion site in newborns: A propensity score-matched cohort study in Mexico. J Pediatr Nurs 2022; 67:e100-e105. [PMID: 36109280 DOI: 10.1016/j.pedn.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the mechanical complications of weekly care and maintenance versus once every 10 days of the peripherally inserted central catheter (PICC) line insertion site versus once every 10 days in newborns. DESIGN AND METHODS Prospective propensity score matched cohort study. Care and maintenance of the PICC line insertion site were performed on days 7 and 10 during January 2018 to December 2019. To compare mechanical complications, propensity score matching was performed. Propensity scores were used to determine the relative risks and hazard ratios by using logistic regressions with log-link function and Cox regressions, respectively. RESULTS We included 175 newborns hospitalized in the neonatal intensive care unit (NICU) who underwent insertion of a PICC line. Ninety-six received weekly care and maintenance, and 79 received care and maintenance every 10 days. Weekly care and maintenance were associated with more breakage (RR 1.98, 95% CI 1.68-2.34); occlusions (RR 0.81, 95% CI 0.46-1.42) and accidental withdrawals (RR 1.31, 95% CI 0.93-1.84) were not different between care and maintenance every 7 and 10 days. A survival analysis was performed, showing that weekly care and maintenance are a risk factor for removal for mechanical complications (HR 7.61, 95% CI 3.05-19.01). CONCLUSION We concluded that care and maintenance of the PICC in newborns every 10 days have fewer complications than when performing care and maintenance every 7 days. PRACTICE IMPLICATIONS Newborns requiring intravenous therapy will benefit from care and maintenance every 10 days, and this practice could potentially spread to other NICUs.
Collapse
Affiliation(s)
- Andrea Garduño-Crespo
- Jefatura de Clínica de Catéteres, Hospital Juárez de México, Ciudad de México, Mexico
| | | | | | - Gabriela Ibañez-Cervantes
- División de Investigación, Hospital Juárez de México, Ciudad de México, Mexico; Seccción de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Cruz Vargas-De-León
- División de Investigación, Hospital Juárez de México, Ciudad de México, Mexico; Seccción de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, Mexico.
| |
Collapse
|
29
|
Hong CC, Tan SHS, Saha S, Pearce CJ. Fibula fixation in the treatment of tibial pilon fractures - Is it really necessary? Foot Ankle Surg 2022; 28:891-897. [PMID: 34953685 DOI: 10.1016/j.fas.2021.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is a lack of consensus about the role of fibula fixation in these complex fractures, with only two clinical studies in the literature. We hypothesize that the fibula fracture need not be fixed in the tibial pilon fractures if primary stability can be achieved with tibial fixation alone. METHODS We reviewed 79 patients with operatively treated tibial pilon with associated fibula fractures from 2007 to 2017 and divided them into two groups; patients with fibula fracture fixation and those without fixation. The primary outcome measure was any mechanical complications. Secondary outcomes were wound complications and other morbidities. RESULTS There were 54 (68.4%) patients with fibula fixation and 25 (31.6%) patients without fixation. There were no statistically significant differences in mechanical complications between the two groups. However, patients without fibula fixation were noted to have more wound complications (44% vs 25.9%, p = 0.108) although this was not statistically significant. In terms of removal of implant (ROI), there were no differences noted in patients with or without fibula fixation (33.3% vs 28%, p = 0.796). There were also no significant differences in ROI for those fixed with plate and screws when compared to those fixed with Rush rod and K wire within the group with fibula fixation. CONCLUSION Fibula fixation in the treatment of tibial pilon fractures is not routinely necessary and does not result in decreased mechanical complications such as malunion, delayed union, nonunion and implant failure. Fibula fracture fixation should be reserved for cases where it may aid reduction or provide additional stability.
Collapse
Affiliation(s)
- Choon Chiet Hong
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore.
| | - Si Heng Sharon Tan
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore.
| | - Soura Saha
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore.
| | - Christopher Jon Pearce
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore.
| |
Collapse
|
30
|
Egrise F, Kirsch M, Remen T, Roche O, Bevilacqua S, Mainard D. Articulated bipolar vs. non-articulated conventional spacers: A comparative study of results from two-stage treatment of chronic septic arthritis in prosthetic or native hips. Orthop Traumatol Surg Res 2022; 108:103302. [PMID: 35477037 DOI: 10.1016/j.otsr.2022.103302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/07/2021] [Accepted: 01/03/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Infection is a serious complication of 0.2-0.7% of primary total hip arthroplasties (THA) and 1-22% of prosthetic revisions. The objective of our study was to compare two types of spacers (unipolar versus bipolar) for two-stage revisions of periprosthetic hip infections. The primary hypothesis was that bipolar spacers have fewer mechanical complications than unipolar spacers. The secondary hypothesis was that bipolar spacers decrease the rate of septic revisions and promote primary prosthesis reimplantation. MATERIAL AND METHOD This retrospective, monocentric, multi-operator study was carried out between January 2012 and July 2018, including patients operated on for septic arthritis of the native or prosthetic hip (two-stage procedure). The patients were divided into two groups: group A, including the articulated spacers and group B, including the unipolar spacers. We studied the complications of the spacers and the course of the infection over a minimum of two years. Functional status was assessed by the Postel Merle d'Aubigné (PMA) score, the Harris Hip Score (HHS) and pre- and postoperative patient satisfaction scores. RESULTS We collected data for 39 hips from 37 patients (mean age 63, 22 men and 14 women: 16 patients in group A, 21 in group B). We found no mechanical complications in group A versus 12 (52%) in group B. At 2 years, 93.8% of patients in group A no longer had any signs indicative of an active infection, compared with 71.4% in group B. In group A, the median PMA score increased from 5.5 (4-10.5) to 13.5 (12.5-15.5) and the HHS score from 27.5 (17-41.5) to 79 (64.5-89.5), postoperatively. In the final group B, the PMA score increased from 7 (6-9) to 14 (12-16) and the HHS score from 24 (11-41) to 72 (48-82) postoperatively. CONCLUSION The use of articulated spacers in THA or septic THA two-stage revision significantly reduces the occurrence of mechanical complications in the short term, as well as the pain between the two procedures. LEVEL OF PROOF IV.
Collapse
Affiliation(s)
- François Egrise
- Service de chirurgie orthopédique, traumatologique et arthroscopique, hôpital central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Centre chirurgical Emile Gallé, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France.
| | - Mathias Kirsch
- Service de chirurgie orthopédique, traumatologique et arthroscopique, hôpital central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Centre chirurgical Emile Gallé, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France
| | - Thomas Remen
- Unité de Méthodologie, Datamanagement et Statistiques (UMDS), CHU Nancy, 54000, France
| | - Olivier Roche
- Centre chirurgical Emile Gallé, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France
| | - Sybille Bevilacqua
- Service de chirurgie orthopédique, traumatologique et arthroscopique, hôpital central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Centre chirurgical Emile Gallé, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France
| | - Didier Mainard
- Service de chirurgie orthopédique, traumatologique et arthroscopique, hôpital central, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France; Centre chirurgical Emile Gallé, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France; Université de Lorraine, CNRS, IMoPA, 54000 Nancy, France
| |
Collapse
|
31
|
Hernández-Pascual C, Santos-Sánchez JÁ, García-González JM, Silva-Viamonte CF, Pablos-Hernández C, Ramos-Pascua L, Mirón-Canelo JA. Long-term outcomes of distal locking in extracapsular fractures treated with trochanteric Gamma3 nails. J Orthop Traumatol 2021; 22:48. [PMID: 34825977 PMCID: PMC8620307 DOI: 10.1186/s10195-021-00609-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/31/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Few publications have assessed long-term results of distal locking of short endomedullary nails for extracapsular hip fracture. Virtually all of them focus on immediate differences. Criteria for the use of static or dynamic locking are unclear in most nailing systems, and use is advised in unstable fracture patterns or with risk of bell-clapper effect, but often influenced by the "orthopaedic school". MATERIALS AND METHODS This is a historical cohort study on patients diagnosed and operated in 2014 and followed up until endpoint, considered as consolidation or major complication, plus evaluation of overall long-term survival. They were categorised as static distal locking (ST) or dynamic distal locking (DN). Both are comparable, except for all stable pre-operative classifications, Fracture Mobility Score (FMS) at discharge, and immediate post-operative loading, all of which were in favour of DN. RESULTS Consolidation took place in > 95% of patients, with a non-statistically significant delay trend in ST. Less than 6% in both ST and DN had major complications, with no differences. Most cases suffered early cut-out. Significant fracture collapse was the most frequent minor complication. There were more statistically significant minor and total complications in ST. Infection, without differences, can precede cut-out. Lateral thigh pain was similar and could be related to back-out. In DN, 21.1% of cases were truly dynamised. We did not find differences in mobility or in long-term survival. CONCLUSIONS Any type of distal locking seems to be safe for consolidation, despite a slightly longer consolidation time in static locking. Early cut-out was the main complication, while others were very infrequent, which is an advantage over helical blade devices. There was a higher rate of minor and overall mechanical complications in ST, but infection and lateral thigh pain were similar. Most non-traumatic mechanical complications occurred around 5-6 weeks. About one in five of the DN truly dynamised, with all cases occurring before 8 weeks. Mobility until endpoint and overall long-term survival were not influenced by the locking mode used. LEVEL OF EVIDENCE Therapeutic study, level 2b.
Collapse
Affiliation(s)
- Carlos Hernández-Pascual
- Department of Trauma and Orthopaedic Surgery, Hospital Universitario de Salamanca, Pso. San Vicente 58-182, 37004, Salamanca, Spain.
| | - José Ángel Santos-Sánchez
- Department of Radiology, Hospital Universitario de Salamanca, Pso. San Vicente 58-182, 37004, Salamanca, Spain
| | | | - Carlos Fernando Silva-Viamonte
- Department of Statistics, Faculty of Medicine, Universidad de Salamanca, Campus Miguel de Unamuno, Avda. Alfonso X el Sabio s/n, 37007, Salamanca, Spain
| | - Carmen Pablos-Hernández
- Department of Geriatrics, Hospital Universitario de Salamanca, Pso. San Vicente 58-182, 37004, Salamanca, Spain
| | - Luis Ramos-Pascua
- Department of Trauma and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Avda. de Córdoba, s/n, 28041, Madrid, Spain
| | - José Antonio Mirón-Canelo
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad de Salamanca, Campus Miguel de Unamuno, Avda. Alfonso X el Sabio s/n, 37007, Salamanca, Spain
| |
Collapse
|
32
|
Mir T, Uddin M, Shah A, Khan MZ, Sheikh M, Rab T. ST elevation myocardial infarction and kidney transplant: A large cohort study: STEMI and renal transplant. J Cardiol 2021; 79:270-276. [PMID: 34565688 DOI: 10.1016/j.jjcc.2021.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The literature on outcomes of ST-elevation myocardial infarction (STEMI) amongst kidney transplant recipients (KTR) is limited. OBJECTIVE To study the outcomes of STEMI among KTR. METHODS Data from the national readmissions database (NRD) sample that constitutes 49.1% of the stratified sample of all hospitals in the USA were analyzed for hospitalizations with STEMI among KTR for the years 2012-2018. Complications associated with STEMI were extracted using International Classification of Diseases codes. RESULTS A total of 588,668 index KTR hospitalizations (mean age 57.67±14.22 years; female 44.5%) of which 3,496 (0.59%) had STEMI were recorded in the NRD for the years 2012-2018. A total of 11,676 (1.98%) patients died during the hospitalization. In-hospital mortality among STEMI was higher, 465 (13.3%), than without-STEMI 11,211 (1.92%). Among the complications, mechanical complications occurred among 1.0% vs 0.02%, cardiogenic shock 10.6 vs 0.3%, ventricular arrythmias 8.3% vs 0.8%, conduction block 6.9% vs 2%, stroke 4.1% vs 1.9%, and acute kidney injury 31.6% vs 28.3% among STEMI and without-STEMI respectively. Among coronary procedures, coronary angiography was performed among 1,999 (57.2%) of which 1,777 (50.8%) had percutaneous coronary intervention (PCI). On coarsened exact matching of baseline characteristics, PCI was less likely associated with mortality, odds ratio 0.39 (95% confidence interval 0.24-0.64; p=0.0002). The trends of mortality among STEMI were steady (p-trend 0.11). PCI trend increased (p-trend 0.008) and incidence of STEMI decreased over the study years 2012 (0.66%)-2018(0.474%). A total of 84,810 (14.4%) patients were readmitted in 30 days of which 696 (20%) patients were among the STEMI subgroup. CONCLUSION STEMI is not an uncommon complication among KTR and is associated with significant mechanical complications. Improvement in cardiovascular risk factors might improve the STEMI rates among KTR.
Collapse
Affiliation(s)
- Tanveer Mir
- Internal Medicine, Detroit Medical Center Wayne State University, Detroit, MI, United States.
| | - Mohammed Uddin
- Internal Medicine, Detroit Medical Center Wayne State University, Detroit, MI, United States
| | - Asif Shah
- Internal Medicine, Redmond Regional Medical Center, Rome, GA, United States
| | - Mohammad Zia Khan
- Division of Cardiology, University of Virginia, Morgantown, WV, United States
| | - Mujeeb Sheikh
- Division of Cardiology, Promedica Toledo, Toledo, OH, United States
| | - Tanveer Rab
- Division of Cardiology, Emory University, Atlanta, GA, United States
| |
Collapse
|
33
|
Brennan S, Sulong S, Barrett M. Left ventricular pseudoaneurysm: an inadvertent consequence of COVID-19-a case report. Eur Heart J Case Rep 2021; 5:ytab203. [PMID: 34458676 PMCID: PMC8374318 DOI: 10.1093/ehjcr/ytab203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/23/2021] [Accepted: 05/06/2021] [Indexed: 11/13/2022]
Abstract
Background Left ventricular pseudoaneurysm (LVP) is an uncommon but serious mechanical complication of acute myocardial infarction (AMI). The immediate medical complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are well recognized, but its indirect effect on patients and healthcare systems is potentially less perceivable. Case summary In this report, a 72-year-old man who was anxious about attending hospital during the SARS-CoV-2 pandemic was eventually found to have a total right coronary artery occlusion after a delayed emergency department presentation. He ultimately developed severe symptomatic heart failure and cardiac magnetic resonance imaging (CMR) revealed that a large LVP with concomitant severe ischaemic mitral regurgitation had evolved from his infarct. The patient was successfully discharged home after the surgical replacement of his mitral valve and repair of his LVP. Discussion This case highlights a salient downstream effect of Coronavirus disease 2019 (COVID-19): the delay in presentation, diagnosis, and management of common treatable conditions such as AMI. It also underscores the importance of non-invasive multimodal imaging on the timely identification of the mechanical complications of AMI. In particular, CMR can play a crucial role in the characterization and management of LVP.
Collapse
Affiliation(s)
- Stephen Brennan
- Department of Cardiology, St. Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland
| | - Saadah Sulong
- Department of Cardiology, St. Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland
| | - Matthew Barrett
- Department of Cardiology, St. Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland
| |
Collapse
|
34
|
Abstract
The incidence of late presentation of myocardial infarction varies between 8.5% and 40%. Late revascularization of an infarct-related artery may limit infarct size and remodeling, reduce electrical instability, and may provide supplemental blood supply to that area via collaterals. Randomized clinical trials have shown a benefit of revascularization in symptomatic and hemodynamically unstable latecomers. Image stress testing can be beneficial to guide management of asymptomatic late presenters. Higher rates of myocardial infarction complications occur with late presentations, so a high level of suspicion is required for early diagnosis. Surgical repair remains the gold standard for management of mechanical complications.
Collapse
Affiliation(s)
- Joe Aoun
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Suite 1901, Houston, TX 77030, USA
| | - Neal S Kleiman
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Suite 1901, Houston, TX 77030, USA
| | - Sachin S Goel
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Suite 1901, Houston, TX 77030, USA.
| |
Collapse
|
35
|
Coll G, Abed Rabbo F, de Schlichting E, Coste A, Chazal J, Garcier JM, Peyre H, Sakka L. Mechanical complications of cerebrospinal fluid shunt. Differences between adult and pediatric populations: myths or reality? Childs Nerv Syst 2021; 37:2215-2221. [PMID: 33768313 DOI: 10.1007/s00381-021-05125-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Shunt malfunctions seem more frequent in children (44 to 81%) than in adults (18 to 29%). Because of discrepancies between studies, it is not possible to affirm this disparity. The objective was to verify whether the incidence of cerebrospinal fluid (CSF) shunt malfunctions is higher in children than adults. METHODS We present a retrospective series of child and adult patients who underwent CSF shunt placement between 2000 and 2013 with a Sophysa SM8® valve. RESULTS 599 adults and 98 children (sex ratio 1.28) underwent CSF shunt placement. Age at first surgery ranged between 1 day of life and 90 years (mean of 55.8 years, SD 25.8, median 64.8 years). The mean follow-up was 4 years (SD 4.264, 0-16; median 3 years). The cumulative complication rate was 25.5% (178/697). Mechanical complications were disconnection (25.1%), migration (11.8%), intracranial catheter obstruction (8.9%) and malposition (8.4%). The mean delay for the first revision was 1.90 years (0-13.9), (SD 2.73, median 0.5). The probability of shunt failure was 65% at 10 years in the child group and 36% at 10 years in the adult group. Moreover, in the child group, 33% of revisions occurred during the first year after shunt placement versus 17% in the adult group. Thus, the probability of shunt failure was higher in children than in adults (log-rank test, p < 0.001). CONCLUSIONS This is the first retrospective study, comparing children and adults undergoing CSF shunt using the same valve, able to confirm the higher rate of complications in children.
Collapse
Affiliation(s)
- Guillaume Coll
- Service de Neurochirurgie B, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, 58 rue Montalembert, F-63000, Clermont-Ferrand, France
| | - Francis Abed Rabbo
- Service de Neurochirurgie B, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, 58 rue Montalembert, F-63000, Clermont-Ferrand, France. .,Laboratoire d'Anatomie et d'Organogenèse, Laboratoire de Biophysique Sensorielle, NeuroDol, faculté de médecine, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France.
| | | | - Aurélien Coste
- Service de Neurochirurgie B, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, 58 rue Montalembert, F-63000, Clermont-Ferrand, France
| | - Jean Chazal
- Service de Neurochirurgie B, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, 58 rue Montalembert, F-63000, Clermont-Ferrand, France.,Laboratoire d'Anatomie et d'Organogenèse, Laboratoire de Biophysique Sensorielle, NeuroDol, faculté de médecine, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| | - Jean-Marc Garcier
- Service de Radiologie Pédiatrique, CHU Clermont-Ferrand, F-63000, Clermont-Ferrand, France
| | - Hugo Peyre
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75005, Paris, France
| | - Laurent Sakka
- Service de Neurochirurgie B, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, 58 rue Montalembert, F-63000, Clermont-Ferrand, France.,Laboratoire d'Anatomie et d'Organogenèse, Laboratoire de Biophysique Sensorielle, NeuroDol, faculté de médecine, Université Clermont Auvergne, F-63000, Clermont-Ferrand, France
| |
Collapse
|
36
|
Yoneyama K, Ishibashi Y, Koeda Y, Itoh T, Morino Y, Shimohama T, Ako J, Ilari Y, Yoshioka K, Kunishima T, Inami S, Ishikawa T, Sugimura H, Kozuma K, Sugi K, Yoshino H, Akashi YJ. Association between acute myocardial infarction-to-cardiac rupture time and in-hospital mortality risk: a retrospective analysis of multicenter registry data from the Cardiovascular Research Consortium-8 Universities (CIRC-8U). Heart Vessels 2021; 36:782-789. [PMID: 33452916 PMCID: PMC8093173 DOI: 10.1007/s00380-020-01762-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/18/2020] [Indexed: 11/24/2022]
Abstract
Despite the known association of cardiac rupture with acute myocardial infarction (AMI), it is still unclear whether the clinical characteristics are associated with the risk of in-hospital mortality in patients with AMI complicated by cardiac rupture. The purpose of this study was to investigate the association between the time of cardiac rupture occurrence and the risk of in-hospital mortality after AMI. We conducted a retrospective analysis of multicenter registry data from eight medical universities in Eastern Japan. From 10,278 consecutive patients with AMI, we included 183 patients who had cardiac rupture after AMI, and examined the incidence of in-hospital deaths during a median follow-up of 26 days. Patients were stratified into three groups according to the AMI-to-cardiac rupture time, namely the > 24-h group (n = 111), 24-48-h group (n = 20), and < 48-h group (n = 52). Cox proportional hazards regression analysis was used to estimate the hazard ratio (HR) and the confidence interval (CI) for in-hospital mortality. Around 87 (48%) patients experienced in-hospital death and 126 (67%) underwent a cardiac surgery. Multivariable Cox regression analysis revealed a non-linear association across the three groups for mortality (HR [CI]; < 24 h: 1.0, reference; 24-48 h: 0.73 [0.27-1.86]; > 48 h: 2.25 [1.22-4.15]) after adjustments for age, sex, Killip classification, percutaneous coronary intervention, blood pressure, creatinine, peak creatine kinase myocardial band fraction, left ventricular ejection fraction, and type of rupture. Cardiac surgery was independently associated with a reduction in the HR of mortality (HR [CI]: 0.27 [0.12-0.61]) and attenuated the association between the three AMI-to-cardiac rupture time categories and mortality (statistically non-significant) in the Cox model. These data suggest that the AMI-to-cardiac rupture time contributes significantly to the risk of in-hospital mortality; however, rapid diagnosis and prompt surgical interventions are crucial for improving outcomes in patients with cardiac rupture after AMI.
Collapse
Affiliation(s)
- Kihei Yoneyama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki-City, Kanagawa, 216-8511, Japan
| | - Yuki Ishibashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki-City, Kanagawa, 216-8511, Japan
| | - Yorihiko Koeda
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Tomonori Itoh
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Takao Shimohama
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yuji Ilari
- Division of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Koichiro Yoshioka
- Division of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Tomoyuki Kunishima
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki-City, Kanagawa, 216-8511, Japan
| | - Shu Inami
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan
| | - Tetsuya Ishikawa
- Department of Cardiology, Saitama Medical Center, Dokkyo Medical University, Koshigaya, Japan
| | - Hiroyuki Sugimura
- Division of Cardiology, Nikko Medical Center, Dokkyo Medical University, Nikko, Japan
| | - Ken Kozuma
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Keiki Sugi
- Division of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hideaki Yoshino
- Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki-City, Kanagawa, 216-8511, Japan.
| |
Collapse
|
37
|
Bari TJ, Hallager DW, Hansen LV, Dahl B, Gehrchen M. Reducing revision rates following Pedicle Subtraction Osteotomy surgery: a single-center experience of trends over 7 years in patients with Adult Spinal Deformity. Spine Deform 2021; 9:803-815. [PMID: 33400231 DOI: 10.1007/s43390-020-00256-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/08/2020] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN This is a single-center, retrospective study. OBJECTIVE To assess if implemented changes to clinical practice have reduced mechanical complications following pedicle subtraction osteotomy (PSO) surgery. Adult spinal deformity (ASD) is increasing in prevalence with concurrent increasing demands for surgical treatment. The most extensive technique, PSO, allows for major correction of rigid deformities. However, surgery-related complications have been reported in rates up to 77% and especially mechanical complications occur at unsatisfactory frequencies. METHODS We retrospectively included all patients undergoing PSO for ASD between 2010 and 2016. Changes to clinical practice were introduced continuously in the study period, including rigorous patient selection; inter-disciplinary conferences; implant-material; number of surgeons; surgeon experience; and perioperative standardized protocols for pain, neuromonitoring and blood-loss management. Postoperative complications were recorded in the 2-year follow-up period. Competing risk survival analysis was used to assess cumulative incidence of revision surgery due to mechanical complications. The Mann-Kendall test was used for analysis of trends. RESULTS We included 185 patients undergoing PSO. The level of PSO changed over the study period (P < 0.01) with L3 being the most common level in 2010 compared to L4 in 2016. Both preoperative and surgical corrections of sagittal vertical axis were larger towards the end of the study period. The 2-year revision rate due to mechanical failure steadily declined over the study period from 52% in 2010 to 14% for patients treated in 2016, although without statistically significant trend (P = 0.072). In addition, rates of mechanical complications steadily declined over the study period and significant decreasing trends were observed in time trend analyses of overall complications, major complications and rod breakage. CONCLUSIONS We observed decreased risks of revision surgery due to mechanical complications following PSO in patients with ASD over a 7-year period. We attribute these improvements to advancements in patient selection, surgical planning and techniques, surgeon experience and more standardized perioperative care. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Tanvir Johanning Bari
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Dennis Winge Hallager
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lars Valentin Hansen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Benny Dahl
- Department of Orthopedics and Scoliosis Surgery, Texas Children's Hospital and Baylor College of Medicine, 6621 Fannin St, Houston, TX, 77030, USA
| | - Martin Gehrchen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| |
Collapse
|
38
|
Bonnet G, Panagides V, Becker M, Rivière N, Yvorel C, Deney A, Lattuca B, Duband B, Moussa K, Juenin L, Pamart T, Semaan C, Uhry S, Noirclerc N, Vincent F, Vignac M, Palermo V, Martin AS, Zeitouni M, Van Belle E, Tirouvanziam A, Manchuelle A, Chamandi C, Kerneis M, Boukantar M, Belle L, De Poli F, Angoulvant D, Meneveau N, Robin M, Pansieri M, Bonello L, Motreff P, Bouisset F, Isaaz K, Cetran L, Khalife K, Lesizza P, Adjedj J, Benamer H, Cayla G. ST-segment elevation myocardial infarction: Management and association with prognosis during the COVID-19 pandemic in France. Arch Cardiovasc Dis 2021; 114:340-351. [PMID: 33926830 PMCID: PMC9056233 DOI: 10.1016/j.acvd.2021.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/11/2021] [Accepted: 01/18/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Systems of care have been challenged to control progression of the COVID-19 pandemic. Whether this has been associated with delayed reperfusion and worse outcomes in French patients with ST-segment elevation myocardial infarction (STEMI) is unknown. AIM To compare the rate of STEMI admissions, treatment delays, and outcomes between the first peak of the COVID-19 pandemic in France and the equivalent period in 2019. METHODS In this nationwide French survey, data from consecutive STEMI patients from 65 centres referred for urgent revascularization between 1 March and 31 May 2020, and between 1 March and 31 May 2019, were analysed. The primary outcome was a composite of in-hospital death or non-fatal mechanical complications of acute myocardial infarction. RESULTS A total of 6306 patients were included. During the pandemic peak, a 13.9±6.6% (P=0.003) decrease in STEMI admissions per week was observed. Delays between symptom onset and percutaneous coronary intervention were longer in 2020 versus 2019 (270 [interquartile range 150-705] vs 245 [140-646]min; P=0.013), driven by the increase in time from symptom onset to first medical contact (121 [60-360] vs 150 [62-420]min; P=0.002). During 2020, a greater number of mechanical complications was observed (0.9% vs 1.7%; P=0.029) leading to a significant difference in the primary outcome (112 patients [5.6%] in 2019 vs 129 [7.6%] in 2020; P=0.018). No significant difference was observed in rates of orotracheal intubation, in-hospital cardiac arrest, ventricular arrhythmias and cardiogenic shock. CONCLUSIONS During the first peak of the COVID-19 pandemic in France, there was a decrease in STEMI admissions, associated with longer ischaemic time, exclusively driven by an increase in patient-related delays and an increase in mechanical complications. These findings suggest the need to encourage the population to seek medical help in case of symptoms.
Collapse
Affiliation(s)
- Guillaume Bonnet
- Université de Paris, Paris Cardiovascular Research Center (PARCC), INSERM, UMR-S970, 75015 Paris, France
| | - Vassili Panagides
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, 13015 Marseille, France
| | - Mathieu Becker
- CHR Metz -Thionville, Metz Hôpital de Mercy, 57530 Metz, France
| | - Nicolas Rivière
- University of Bordeaux, Cardio-thoracic intensive care unit, CHU de Bordeaux, 33600 Pessac, France
| | - Cédric Yvorel
- Cardiology Department, CHU de Saint Etienne, 42270 Saint Priest-en-Jarez, France
| | - Antoine Deney
- Cardiology Department, Rangueil University Hospital, 31400 Toulouse, France
| | - Benoit Lattuca
- Cardiology Department, Nimes University Hospital, Montpellier University, 30029 Nîmes, France
| | - Benjamin Duband
- Cardiology Department, University Hospital Gabriel Montpied, 63000 Clermont-Ferrand, France
| | - Karim Moussa
- Cardiology Department, Avignon Hôpital Center, 84140 Avignon, France
| | - Léa Juenin
- Cardiology Department, University Hospital of Montpellier, University of Montpellier, 34000 Montpellier, France
| | - Thibault Pamart
- University of Burgundy Franche-Comté, EA3920, University Hospital Besancon, 25000 Besançon, France
| | - Carl Semaan
- Cardiology Department, University Hospital of Tours, 37000 Tours, France
| | - Sabrina Uhry
- Cardiology Department, CH de Haguenau, 67500 Haguenau, France
| | | | | | - Maxime Vignac
- Université de Paris, Paris Cardiovascular Research Center (PARCC), INSERM, UMR-S970, 75015 Paris, France
| | - Vincenzo Palermo
- Cardiology Department, Marie Lannelongue Hospital, 92350 Le Plessis-Robinson, France
| | - Anne Sophie Martin
- CHU Henri Mondor, Service de cardiologie interventionnelle, AP-HP, 94010 Créteil, France
| | - Michel Zeitouni
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), 75013 Paris, France
| | | | | | | | - Chekrallah Chamandi
- Cardiology Department, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université de Paris, INSERM U970, 75015 Paris, France
| | - Mathieu Kerneis
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), 75013 Paris, France
| | - Madjid Boukantar
- CHU Henri Mondor, Service de cardiologie interventionnelle, AP-HP, 94010 Créteil, France
| | - Loïc Belle
- Centre Hospitalier Annecy Genevois, 74370 Epagny Metz-Tessy, France
| | - Fabien De Poli
- Cardiology Department, CH de Haguenau, 67500 Haguenau, France
| | - Denis Angoulvant
- Cardiology Department, University Hospital of Tours, 37000 Tours, France
| | - Nicolas Meneveau
- University of Burgundy Franche-Comté, EA3920, University Hospital Besancon, 25000 Besançon, France
| | - Marie Robin
- Cardiology Department, University Hospital of Montpellier, University of Montpellier, 34000 Montpellier, France
| | - Michel Pansieri
- Cardiology Department, Avignon Hôpital Center, 84140 Avignon, France
| | - Laurent Bonello
- Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, 13015 Marseille, France
| | - Pascal Motreff
- Cardiology Department, University Hospital Gabriel Montpied, 63000 Clermont-Ferrand, France
| | - Frédéric Bouisset
- Cardiology Department, Rangueil University Hospital, 31400 Toulouse, France; Department of Epidemiology, INSERM UMR 1027, 31000 Toulouse, France
| | - Karl Isaaz
- Cardiology Department, CHU de Saint Etienne, 42270 Saint Priest-en-Jarez, France
| | - Laura Cetran
- University of Bordeaux, Cardio-thoracic intensive care unit, CHU de Bordeaux, 33600 Pessac, France
| | - Khalifé Khalife
- CHR Metz -Thionville, Metz Hôpital de Mercy, 57530 Metz, France
| | | | - Julien Adjedj
- Arnaud Tzanck Institute, 06700 Saint Laurent du Var, France
| | - Hakim Benamer
- Institut Jacques Cartier, Ramsay Générale de Santé, ICPS, 91300 Massy, France
| | - Guillaume Cayla
- Cardiology Department, Nimes University Hospital, Montpellier University, 30029 Nîmes, France.
| | | |
Collapse
|
39
|
Ham DW, Kim HJ, Choi JH, Park J, Lee J, Yeom JS. Validity of the global alignment proportion (GAP) score in predicting mechanical complications after adult spinal deformity surgery in elderly patients. Eur Spine J 2021; 30:1190-1198. [PMID: 33528658 DOI: 10.1007/s00586-021-06734-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/30/2020] [Accepted: 01/11/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE This study aimed to validate the usefulness of the global alignment proportion (GAP) score to predict postoperative mechanical failure in the elderly (mean age, 70.5 years) individuals with severe sagittal imbalance. METHODS A total of 84 patients were enrolled: mechanical complications (MC), minor mechanical complications (mMC), proximal junctional failure (PJF), and revision surgery occurred in 61% (51/84), 58% (49/84), 44% (37/84), and 13% (11/84) of the patients, respectively. The GAP score was calculated using the X-ray obtained in the early postoperative period. The validity of the GAP score's predictive ability was evaluated by calculating the area under the curve (AUC) of the receiver operating characteristics curve. Univariate logistic regression analysis and Cochran-Armitage test of trend were performed to determine the association between mechanical complications and GAP score. RESULTS The discriminatory power of GAP score to predict MC, mMC, and PJF was "moderately accurate," with an AUC of 0.839 (confidence interval [CI] 0.755-0.824, p < 0.001), 0.836 (CI 0.749-0.923, p < 0.001), and 0.702 (CI 0.588-0.851, p < 0.001), respectively. The GAP score showed a statistically significant association with MC, mMC, and PJF in univariate logistic regression analysis and Cochran-Armitage test for trend. However, it was not significantly associated with revision surgery. CONCLUSION This study showed promising results regarding the GAP score's predictive power for MC, mMC, and PJF in the elderly population with degenerative kyphoscoliosis. Using the GAP score, we can determine the patient's specific correction goal preoperatively to prevent mechanical failure based on individual patient's characteristics such as pelvic incidence.
Collapse
Affiliation(s)
- Dae-Woong Ham
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Seoul National University Bundang Hospital, 166 Gumiro Bundang-gu, Seongnam, 463-707, Republic of Korea.
| | - Jae Heouk Choi
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jiwon Park
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Junpyo Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin S Yeom
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
40
|
Briosa E Gala A, Hinton J, Sirohi R. Cardiogenic shock due to acute severe ischemic mitral regurgitation. Am J Emerg Med 2020; 43:292.e1-292.e3. [PMID: 33153833 PMCID: PMC8084113 DOI: 10.1016/j.ajem.2020.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/23/2022] Open
Abstract
The reduction in patients presenting with ST-elevation myocardial infarction (STEMI) during the COVID19 crisis could have resulted from fears about developing COVID-19 infection in hospital. Patients who delay presenting with STEMI are more likely to develop mechanical complications, including acute ischemic mitral regurgitation (MR). We present a 69-year-old women with an inferior STEMI and cardiogenic shock due to acute ischemic MR who delayed presenting to hospital due to the fear of COVID-19. Early identification of this mechanical complication using transthoracic echocardiography in the Emergency Department enabled the team to target her optimisation. Ultimately these patients require urgent surgery to repair the mitral valve and revascularize the myocardium but they are often too unwell to undergo surgery and even when it is feasible the outcomes are poor.
Collapse
Affiliation(s)
- Andre Briosa E Gala
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom.
| | - Jonathan Hinton
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom
| | - Rohit Sirohi
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom
| |
Collapse
|
41
|
Phang CC, Foo MWY, Johnson DW, Wu SY, Hao Y, Jayaballa M, Koniman R, Chan CM, Oei EL, Chong TT, Htay H. Comparison of outcomes of urgent-start and conventional-start peritoneal dialysis: a single-centre experience. Int Urol Nephrol 2020; 53:583-590. [PMID: 32895864 DOI: 10.1007/s11255-020-02630-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND There has been a growing interest in urgent-start peritoneal dialysis (PD) in patients with end-stage kidney disease to avoid central venous catheter use and its complications. This study aimed to compare clinical outcomes between urgent-start PD (defined as PD commencement within 2 weeks of PD catheter insertion) and conventional-start PD. METHODS This was a single-centre retrospective cohort study of all incident PD patients at Singapore General Hospital between January 2017 and February 2018. The primary outcome was dialysate leak. Secondary outcomes included catheter malfunction, catheter readjustment, exit-site infection, peritonitis, technique and patient survival. RESULTS A total of 187 incident PD patients were included. Of these, 66 (35%) initiated urgent-start PD. Dialysate leak was significantly higher in urgent-start PD compared with conventional-start PD groups (7.6% versus 0.8%; p = 0.02) whilst catheter malfunction (4.5% vs. 3.3%; p = 0.70) and catheter readjustment (1.5% vs. 2.5%; p = 1.00) were comparable between the two groups. Exit-site infection was comparable (IRR: 0.66 95% CI 0.25-1.74) whilst peritonitis was significantly higher in urgent-start PD compared with conventional-start PD (incidence risk ratio (IRR) 3.10, 95% confidence interval (CI) 1.29-7.44). Time to first episode of peritonitis, particularly Gram-positive peritonitis was significantly shorter with urgent-start PD. Technique survival (hazards ratio (HR) 1.95, 95% CI 0.89-4.31) and patient survival (HR 1.46, 95% CI 0.44-4.87) were comparable between the two groups. CONCLUSION Urgent-start PD was associated with higher risks of dialysate leak and peritonitis but comparable technique and patient survival compared to conventional-start PD.
Collapse
Affiliation(s)
- Chee Chin Phang
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Marjorie Wai Yin Foo
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - David W Johnson
- Princess Alexandra Hospital, Brisbane, Australia.,Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia.,Metro South and Ipswich Nephrology and Transplant Services (MINTS), Logan City, Australia
| | - Sin Yan Wu
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Ying Hao
- Health Services Research Centre (HSRC), Singapore Health Services (SingHealth), Singapore, Singapore
| | - Mathini Jayaballa
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Riece Koniman
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Choong Meng Chan
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Elizabeth Ley Oei
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Tze Tec Chong
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore.
| |
Collapse
|
42
|
Sánchez Vega JD, Alonso Salinas GL, Viéitez Flórez JM, Ariza Solé A, López de Sá E, Sanz Ruiz R, Burgos Palacios V, Raposeiras-Roubín S, Gómez Varela S, Sanchis J, Silva Melchor L, Martínez-Seara X, Malagón López L, Zamorano Gómez JL, Sanmartín Fernández M; CIVIAM Study Investigators. Temporal trends in postinfarction ventricular septal rupture: the CIVIAM Registry. ACTA ACUST UNITED AC 2021; 74:757-64. [PMID: 32883644 DOI: 10.1016/j.rec.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/21/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Postinfarction ventricular septal rupture is a rare but severe complication of myocardial infarction with high mortality rates. Our goal was to analyze which factors could have an impact on mortality due to this entity over the past decade, including those related to mechanical circulatory support. METHODS The CIVIAM registry is an observational, retrospective, multicenter study carried out in Spain. We designed a comparative analysis, focused on description of in-hospital management and in-hospital and 1-year total mortality as the primary endpoints, dividing the total observation time into 2 equal temporal periods (January 2008 to June2013 and July 2013 to December 2018). RESULTS We included 120 consecutive patients. Total mortality during this period was 61.7% at 1-year follow-up. Patients in the second period were younger. One-year mortality was significantly reduced in the second period (75.6% vs 52.7%, P=.01), and this result was confirmed after adjustment by confounding factors (OR, 0.40; 95%CI, 0.17-0.98). Surgical repair was attempted in 58.7% vs 70.3%, (P=.194), and percutaneous closure in 8.7% and 6.8%, respectively (P=.476). Heart transplant was performed in 1 vs 5 patients (2.2% vs 6.8%, P=.405). The main difference in the clinical management between the 2 periods was the greater use of venoarterial extracorporeal membrane oxygenatiom in the second half of the study period (4.4% vs 27%; P=.001). CONCLUSIONS Postinfarction ventricular septal rupture still carries a very high mortality risk. There has been a progressive trend to increased support with venoarterial extracorporeal membrane oxygenatiom and greater access to available corrective treatments, with higher survival rates.
Collapse
|
43
|
Barla M, Egrise F, Zaharia B, Bauer C, Parot J, Mainard D. Prospective assessment of trochanteric fracture managed by intramedullary nailing with controlled and limited blade back-out. Orthop Traumatol Surg Res 2020; 106:613-619. [PMID: 32249158 DOI: 10.1016/j.otsr.2019.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 08/26/2019] [Accepted: 11/25/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The main objective of the present prospective study was to assess mechanical complications associated with an original intramedullary nail with limited and controlled blade back-out in the treatment of trochanteric fracture. MATERIAL AND METHOD All patients treated for trochanteric fracture in a single orthopedic/traumatologic surgery department over a 2-year period were included. Minimum follow-up was 6 months. Fracture stability was assessed on the AO criteria. The TFP® intramedullary nail has a monobloc helicoid blade. Its main feature is the controlled and limited blade back-out, optimizing fracture site compression in weight-bearing, without the drawback of excessive back-out. The main endpoint was onset of mechanical complications: cut-out, intra-articular protrusion, non-union, and pain. Baumgaertner's Tip-Apex Distance (TAD), blade centering within the femoral head and fracture reduction were also assessed. RESULTS One hundred thirty-eight patients (mean age, 83 years) were operated on, and 118 followed up. There were 9 mechanical complications (7.6%): 4 cut-outs (3.4%), 3 intra-articular protrusions (2.5%), 1 non-union (0.8%) and 1 case of pain (0.8%). TAD length was not associated with complications rate. Poor reduction was significantly associated with more complications (p=0.02), as was blade malpositioning. Mean back-out was 3.3mm, affecting 22 nails (19%). There were no complications in case of back-out, versus a 9.4% rate in absence of back-out, although this difference was not significant (p=0.21). There were no postoperative infections. CONCLUSION The TFP® nail is useful for fixation of trochanteric fracture, whether stable or unstable, due to its low rate of mechanical complications compared to the literature.
Collapse
Affiliation(s)
- Manuela Barla
- CHRU, Hôpital Central, 29, avenue du Maréchal de Lattre-de-Tassigny, 54000 Nancy, France.
| | - François Egrise
- CHRU, Hôpital Central, 29, avenue du Maréchal de Lattre-de-Tassigny, 54000 Nancy, France
| | - Bogdan Zaharia
- CHRU, Hôpital Central, 29, avenue du Maréchal de Lattre-de-Tassigny, 54000 Nancy, France
| | - Camille Bauer
- CHRU, Hôpital Central, 29, avenue du Maréchal de Lattre-de-Tassigny, 54000 Nancy, France
| | - Jauffrey Parot
- CHRU, Hôpital Central, 29, avenue du Maréchal de Lattre-de-Tassigny, 54000 Nancy, France
| | - Didier Mainard
- CHRU, Hôpital Central, 29, avenue du Maréchal de Lattre-de-Tassigny, 54000 Nancy, France
| |
Collapse
|
44
|
Pizones J, Perez-Grueso FJS, Moreno-Manzanaro L, Vila-Casademunt A, Boissiere L, Yilgor C, Fernández-Baíllo N, Sánchez-Márquez JM, Talavera G, Kleinstück F, Acaroglu ER, Alanay A, Pellisé F, Obeid I. Ideal sagittal profile restoration and ideal lumbar apex positioning play an important role in postoperative mechanical complications after a lumbar PSO. Spine Deform 2020; 8:491-498. [PMID: 31925761 DOI: 10.1007/s43390-019-00005-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 10/13/2019] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN Retrospective analysis of prospectively collected data. OBJECTIVE To determine the influence of postoperative ideal lordosis distribution and ideal sagittal harmony on mechanical complications in patients undergoing one-level lumbar pedicle subtraction osteotomy (L-PSO). Many variables have been associated with mechanical complications after L-PSO. However, the impact of restoring the ideal inflexion point, lumbar apex, and sagittal shape is still underexplored. METHODS Analyzed risk factors were: age and patient-related variables, PSO level, interbody cages, rod material/diameter, number of rods, upper instrumented vertebra, lower instrumented vertebra, PI-LL mismatch, global tilt (GT), postoperative level of lumbar apex (LApex), postoperative level of inflexion point (InfxP), and postoperative type of Roussouly sagittal profile (R-type). These last variables were compared to ideal (based on pelvic incidence). Univariate and multivariate analyses were performed to identify risks for mechanical complications with a minimum 2-year follow-up. RESULTS A total of 87 patients were included. Mean follow-up was 4.5 ± 1.7 years. 40.2% of the patients suffered postoperative mechanical complications (7 PJK, 4 PJF, 18 pseudoarthrosis/rod breakage, 6 screw pullout). Mean time for complications was 584 ± 416 days from surgery. Univariate analysis showed that age (63 vs 57 years; P = 0.04), BMI (28.1 vs 25.9; P = 0.024), preoperative-GT (50.7° vs 38.7°; P < 0.001), postoperative-GT (28.9° vs 23.4°; P = 0.018), postoperative LApex location mismatched from ideal (77.8% vs 22.2%; P = 0.036), and postoperative R-type mismatched from ideal (67.6% vs 22.6%; P < 0.001) were significantly related to mechanical complications. The independent factors selected by multivariate analysis were: postoperative R-type mismatched from ideal OR 11.3 (95% CI 3.9-32.6; P < 0.001), age OR 1.05 (95% CI 1-1.1; P = 0.03), and LApex matching OR 0.5 (95% CI 0.27-0.97; P = 0.04). The further the LApex was from its ideal position, the higher the risk of mechanical complications (P = 0.036). CONCLUSIONS Over other multiple suspected risk factors, proper lumbar apex position and ideal sagittal shape restoration played an important role in postoperative mechanical complications after L-PSO. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Javier Pizones
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | | | - Lucía Moreno-Manzanaro
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | - Louis Boissiere
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | - Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Nicomedes Fernández-Baíllo
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - José Miguel Sánchez-Márquez
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Gloria Talavera
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Frank Kleinstück
- Department of Orthopedics, Schulthess Klinik, Zurich, Switzerland
| | | | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Ibrahim Obeid
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | | |
Collapse
|
45
|
Koeda Y, Itoh T, Ishikawa Y, Morino Y, Mizutani T, Ako J, Nakano M, Yoshioka K, Ikari Y, Inami S, Sakuma M, Taguchi I, Ishikawa T, Sugimura H, Sugi K, Matsumoto K, Mitarai T, Kunishima T, Akashi YJ, Nomura T, Fukushi K, Yoshino H. A multicenter study on the clinical characteristics and risk factors of in-hospital mortality in patients with mechanical complications following acute myocardial infarction. Heart Vessels 2020; 35:1060-1069. [PMID: 32239276 DOI: 10.1007/s00380-020-01586-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/13/2020] [Indexed: 12/22/2022]
Abstract
Mechanical complications (MCs) following acute myocardial infarction (AMI), such as ventricular septal rupture (VSR), free-wall rupture (FWR), and papillary muscle rupture (PMR), are fatal. However, the risk factors of in-hospital mortality among patients with MCs have not been previously reported in Japan. The purpose of this study was to evaluate the prognostic factors of in-hospital mortality in these patients. The study cohort consisted of 233 consecutive patients with MCs from the registry of 10 facilities in the Cardiovascular Research Consortium-8 Universities (CIRC-8U) in East Japan between 1997 and 2014 (2.3% of 10,278 AMI patients). The authors conducted a retrospective observational study to analyse the correlation between the subtypes of MCs with in-hospital mortality, clinical data, and medical treatment. We observed a decreasing incidence of MC (1997-2004: 3.7%, 2005-2010: 2.1%, 2011-2014: 1.9%, p < 0.001). In-hospital mortality among patients with MCs was 46%. Thirty-three percent of patients with MCs were not able to undergo surgical repair due to advanced age or severe cardiogenic shock. In-hospital mortality among patients who had undergone surgical repair was 29% (VSR: 21%, FWR: 33%, PMR: 60%). In patients with MCs, hazard ratio for in-hospital mortality according to multivariate analysis of without surgical repair was 5.63 (95% CI 3.54-8.95). In patients with surgical repair, the hazard ratios of blow-out-type FWR (5.53, 95% confidence interval (CI) 2.22-13.76), those with renal dysfunction (3.11, 95% CI 1.37-7.05), and those receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) (3.79, 95% CI 1.81-7.96) were significantly high. Although primary percutaneous coronary intervention (PCI) is associated with decreased incidence of MCs, high in-hospital mortality persisted in patients with MCs that also presented with renal dysfunction and in those requiring VA-ECMO. Early detection and surgical repair of MCs are essential.
Collapse
Affiliation(s)
- Yorihiko Koeda
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan
| | - Tomonori Itoh
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan.
| | - Yu Ishikawa
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Yahaba-cho, Shiwa-gun, Iwate, 028-3695, Japan
| | - Tomohiro Mizutani
- Division of Cardiology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Junya Ako
- Division of Cardiology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Masataka Nakano
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Tokyo, Japan
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Tokyo, Japan
| | - Yuji Ikari
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Tokyo, Japan
| | - Shu Inami
- Department of Cardiovascular Medicine, Dokkyo Medical University, Shimotsuga, Japan
| | - Masashi Sakuma
- Department of Cardiovascular Medicine, Dokkyo Medical University, Shimotsuga, Japan
| | - Isao Taguchi
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Tetsuya Ishikawa
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hiroyuki Sugimura
- Division of Cardiology, Nikko Medical Center, Dokkyo Medical University, Nikko, Japan
| | - Keiki Sugi
- Division of Cardiology, Saitama Medical University, Saitama, Japan
| | - Kazuo Matsumoto
- Division of Cardiology, Saitama Medical University, Saitama, Japan
| | - Takanobu Mitarai
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tomoyuki Kunishima
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takahiro Nomura
- Division of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kei Fukushi
- Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Hideaki Yoshino
- Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | | |
Collapse
|
46
|
Mariggiò E, Iori AP, Micozzi A, Chistolini A, Latagliata R, Berneschi P, Giampaoletti M, La Rocca U, Bruzzese A, Barberi W, Foà R, Morano SG. Peripherally inserted central catheters in allogeneic hematopoietic stem cell transplant recipients. Support Care Cancer 2020; 28:4193-9. [PMID: 31900609 DOI: 10.1007/s00520-019-05269-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Central venous catheters (CVC) are essential for the management of patients with hematologic malignancies, facilitating chemotherapy infusion, antibiotics, parenteral nutrition, blood products, and blood samples collection. In this population, peripherally inserted central catheters (PICC) seem to be associated with lower complications, compared with conventional percutaneously inserted devices (CICC). Data on the PICC in allogeneic hematopoietic stem cell recipients (allo-HSCT) are limited. METHODS We have prospectively evaluated the safety and efficacy of 100 polyurethanes or silicone PICC, inserted into 100 adult allo-HSCT recipients, at the Hematology of Sapienza University of Rome (Italy), between October 2012 and August 2017. RESULTS The median duration of PICC placement was 117 days. Overall, 68% of patients maintained the device for the entire transplant procedure and PICC were removed after day 100 from allo-HSCT; of these, 44% did not experienced any PICC-related complications. Catheter-related bloodstream infections (CRBSI) occurred in 32% of patients (2.5/1000 PICC days), associated with thrombosis in 8 cases. CRBSI were observed in 42% of patients with polyurethane and 20% with silicone PICC (p = 0.02). Catheter-related thrombosis occurred in 9% of patients, never requiring anticipated PICC removal. Mechanical complications occurred in 15% of cases (1.2/1000 PICC days). On the whole, adverse events were manageable and did not affect transplant outcome. No deaths related to PICC-complications were observed. CONCLUSIONS PICC are a safe and reliable long-term venous access in allo-HSCT recipients.
Collapse
|
47
|
Nejjari M, Cacoub L, Digne F. [Management of non-rhythmic complications of TAVI procedures]. Ann Cardiol Angeiol (Paris) 2019; 68:439-442. [PMID: 31676032 DOI: 10.1016/j.ancard.2019.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 12/20/2022]
Abstract
Transcatheter aortic valve (TAVI) is the treatment of choice in patients with severe symptomatic aortic stenosis at high surgical risk. Recent data have also shown favorable results in patients considered to have an intermediate operative risk, which broadens the application of this new technology. Despite its success, the TAVI procedure has been associated with life-threatening complications. Advances in preoperative screening and patient selection have reduced the incidence of these complications. When these complications occur, early recognition and rapid management are essential. The purpose of this review is to describe non-rhythmic mechanical complications attributable to TAVI procedures with their predictive factors, how to prevent and manage them.
Collapse
Affiliation(s)
- M Nejjari
- Département d'hémodynamique, centre cardiologique du Nord, 32, rue des Moulins-Gémeaux, 93200 Saint-Denis, France.
| | - L Cacoub
- Département d'hémodynamique, centre cardiologique du Nord, 32, rue des Moulins-Gémeaux, 93200 Saint-Denis, France
| | - F Digne
- Département d'hémodynamique, centre cardiologique du Nord, 32, rue des Moulins-Gémeaux, 93200 Saint-Denis, France
| |
Collapse
|
48
|
Abstract
Objectives Different criteria for assessing the reduction quality of trochanteric fractures have been reported. The Baumgaertner reduction quality criteria (BRQC) are relatively common and the Chang reduction quality criteria (CRQC) are relatively new. The objectives of the current study were to compare the reliability of the BRQC and CRQC in predicting mechanical complications and to investigate the clinical implications of the CRQC. Methods A total of 168 patients were assessed in a retrospective observational study. Clinical information including age, sex, fracture side, American Society of Anesthesiologists (ASA) classification, tip-apex distance (TAD), fracture classification, reduction quality, blade position, BRQC, CRQC, bone quality, and the occurrence of mechanical complications were used in the statistical analysis. Results A total of 127 patients were included in the full analysis, and mechanical complications were observed in 26 patients. The TAD, blade position, BRQC and CRQC were significantly associated with mechanical complications in the univariate analysis. Only the TAD (p = 0.025) and the CRQC (p < 0.001) showed significant results in the multivariate analysis. In the comparison of the receiver operating characteristic curves, the CRQC also performed better than the BRQC. Conclusion The CRQC are reliable in predicting mechanical complications and are more reliable than the BRQC. Future studies could use the CRQC to assess fracture reduction quality. Intraoperatively, the surgeon should refer to the CRQC to achieve good reduction in trochanteric fractures. Cite this article: Bone Joint Res 2019;8:502–508.
Collapse
Affiliation(s)
- Wei Mao
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Haofei Ni
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Linli Li
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Yiqun He
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Xujun Chen
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Han Tang
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Youhai Dong
- Department of Orthopaedics, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| |
Collapse
|
49
|
Pizones J, Moreno-Manzanaro L, Sánchez Pérez-Grueso FJ, Vila-Casademunt A, Yilgor C, Obeid I, Alanay A, Kleinstück F, Acaroglu ER, Pellisé F. Restoring the ideal Roussouly sagittal profile in adult scoliosis surgery decreases the risk of mechanical complications. Eur Spine J 2019; 29:54-62. [PMID: 31641904 DOI: 10.1007/s00586-019-06176-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 09/06/2019] [Accepted: 10/05/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE There are still no data proving whether restoring the ideal sagittal profile (according to Roussouly classification) in adult scoliosis (AS) patients leads to any additional benefit, especially regarding mechanical complications. METHODS Retrospective analysis of operated AS patients recorded in a prospective multicenter database. Demographic and radiographic (preoperative and 6-week postoperative) data were analyzed. Patients with and without mechanical complications were compared looking especially at the surgical restoration of the ideal (based on Pelvic Incidence) sagittal profile. Univariate and multivariate analysis was performed to identify causes of mechanical complications at 2-year minimum follow-up. RESULTS Ninty-six AS patients were analyzed. Thirty-nine patients suffered a mechanical complication (18 PJK, 11 pseudoarthrosis, 10 screw pull-out), and 57 patients had no mechanical complications. Postoperatively, 72% of patients not matching the ideal Roussouly-type suffered mechanical complications compared to 15% of matched patients (P < 0.001). Univariate analysis showed that older patients 64.9 ± 13 versus 40.7 ± 15.6 years (P < 0.001), higher postoperative Global Tilt (27° vs. 14.7°) and Pelvic Tilt (25° vs. 16°) (P < 0.001), upper instrumented vertebra at the thoracolumbar junction (62% vs. 21%) (P < 0.001), fixation to the Iliac (76% vs. 6%) (P < 0.001), and postoperative Roussouly-type mismatch (72% vs. 15%) (P < 0.001) significantly increased the rate of mechanical complications. Multivariate logistic regression analysis selected: postoperative Roussouly-type mismatch (OR = 41.9; 95%CI = 5.5-315.7; P < 0.001), iliac instrumentation (OR = 19.4; 95%CI = 2.6-142.5; P = 0.004), and age (OR = 1.1; 95%CI = 1.02-1.16; P = 0.004), as the most important variables. CONCLUSIONS Adult scoliosis surgery should restore the ideal Roussouly sagittal profile to decrease the rate of mechanical complications, especially in patients older than 65, instrumented to the pelvis. These slides can be retrieved under Electronic Supplementary Material.
Collapse
Affiliation(s)
- Javier Pizones
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - Lucía Moreno-Manzanaro
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | | | - Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ibrahim Obeid
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Frank Kleinstück
- Department of Orthopedics, Schulthess Klinik, Zurich, Switzerland
| | | | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | |
Collapse
|
50
|
Tsai CH, Hsu HC, Chen HY, Fong YC, Ho MW, Chou CH, Chen YW, Shie MY, Lin TL. A preliminary study of the novel antibiotic-loaded cement computer-aided design-articulating spacer for the treatment of periprosthetic knee infection. J Orthop Surg Res 2019; 14:136. [PMID: 31096988 DOI: 10.1186/s13018-019-1175-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/29/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In comparison to static spacers, articulating spacers have been shown to result in a similar infection eradication rate in two-stage revision of periprosthetic knee infections. However, the optimal construct for articulating spacers has not been identified yet. The aim of this study was to present a preliminary result of treatment for periprosthetic knee infection using a novel computer-aided design (CAD)-articulating spacer. METHODS We retrospectively reviewed 32 consecutive cases of chronic periprosthetic knee infection occurring from January 2015 to December 2015. In these cases, we used an antibiotic-loaded, optimized CAD-articulating spacer based on the retrieved knee prosthesis. Evaluation included infection eradication rate, the Hospital of Special Surgery (HSS) knee score, range of motion (ROM), and spacer-related mechanical complications. All cases were regularly followed-up for 2 years minimum. RESULTS Twenty-eight of 32 patients (87.5%) had infection eradication; 18 patients (56.3%) received reimplantation successfully. The mean interval between spacer insertion and reimplantation was 8.8 months (range 4.0-12.5 months). The mean HSS knee score and ROM significantly increased during each interval (p < 0.0001 for both). The mean HSS knee scores were 31.2 (range 20-48) at initial visit, 65.4 (range 60-78.8) at 1 month after spacer insertion, and 84.2 (range 78-90) at 3 months after reimplantation (p < 0.0001). The mean ROM were 72.0° (range 15-100°), 85.6° (range 35-110°), and 102.0° (range 80-122°), respectively (p = 0.002). Two (6.3%) spacer-related mechanical complications occurred. CONCLUSIONS The CAD-articulating spacer in two-staged revision of periprosthetic knee infection significantly controlled infection, improved clinical outcomes, increased ROM, and decreased mechanical complications in the preliminary study. Further larger clinical studies are needed to confirm the findings presented here.
Collapse
|