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Kaddoura R, Bhattarai S, Abushanab D, Al-Hijji M. Percutaneous Mitral Valve Repair for Secondary Mitral Regurgitation: A Systematic Review and Meta-Analysis. Am J Cardiol 2023; 207:159-169. [PMID: 37741106 DOI: 10.1016/j.amjcard.2023.08.097] [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: 05/19/2023] [Revised: 08/10/2023] [Accepted: 08/17/2023] [Indexed: 09/25/2023]
Abstract
This systematic review and meta-analysis aimed to investigate whether percutaneous mitral valve repair (PMVr) using MitraClip was more effective than surgery or medical therapy for long-term morbidity and mortality. We searched MEDLINE, EMBASE, and CENTRAL (Cochrane Library) databases to identify relevant studies that recruited adult patients with functional or secondary mitral valve regurgitation who underwent PMVr with MitraClip implantation using appropriate search terms and Boolean operators. The odds ratios (ORs) were pooled using the random-effects model. A total of 14 studies recruiting 2,593 patients were included. Within 12 months of follow-up, patients who underwent PMVr did not maintain mitral valve regurgitation grade 2+ (OR 0.22, 95% confidence interval [CI] 0.12 to 0.41, p <0.0001, I2 = 0.0%, p = 0.52) or symptom-free heart failure (OR 0.47, 95% CI 0.29 to 0.77, p = 0.0028, I2 = 0.0%, p = 0.66) compared with their surgical counterparts. Patients were more likely to be rehospitalized for heart failure (OR 2.79, 95% CI 1.54 to 5.05, p = 0.0007, I2 = 0.0%, p = 0.51). However, there was no difference between the groups in terms of all-cause or cardiovascular mortality. Whereas, in comparison with medical therapy, PMVr significantly reduced all-cause mortality at 12 and ≥24 months of follow-up (OR 0.41, 95% CI 0.24, 0.69, p = 0.0009, I2 = 32%, p = 0.23 and OR 0.55, 95% CI 0.40, 0.75, p = 0.0002, I2 = 0.0%, p = 0.45, respectively). In conclusion, there was no difference in all-cause death at 12 or 24 months of follow-up between PMVr and the surgical approach, but the durability of valvular repair was inferior with PMVr. In comparison with medical therapy, there was a significant reduction in mortality with PMVr.
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Affiliation(s)
- Rasha Kaddoura
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Sanket Bhattarai
- Department of hematology and oncology, Bhaktapur Cancer Hospital, Dudhpati, Bhaktapur, Nepal
| | - Dina Abushanab
- Drug Information Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Al-Hijji
- Interventional Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Chuckpaiwong B, Glisson RR, Usuelli FG, Madi NS, Easley ME. Biomechanical Comparison of Nonlocked Minimally Invasive and Locked Open Achilles Tendon Simulated Rupture Repairs. Foot Ankle Int 2023; 44:913-921. [PMID: 37329183 DOI: 10.1177/10711007231178819] [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] [Indexed: 06/18/2023]
Abstract
BACKGROUND Open repair of Achilles tendon ruptures is associated with a risk of infection and other wound complications. Although percutaneous repairs reduce these complications, they may increase the risk of nerve injury. This study was designed to determine whether a percutaneous nonlocking repair can approach the gapping resistance offered by a standard open repair under conditions approximating typical postoperative physiotherapy. METHODS Ten pairs of cadavers Achilles tendons were transected in situ 5 cm above the insertion. One tendon from each pair was repaired using an open 4-strand Krackow locking loop, and the contralateral tendon was repaired with the Achillon system using the same suture material. Displacement transducers were attached to the medial, lateral, anterior, and posterior aspects of the tendon, spanning the repair. Each tendon underwent 1000 tensile loading cycles to 86.5 N, simulating passive ankle range-of-motion physiotherapy. Gapping was documented on the 1st, 50th, 100th, 500th, and 1000th cycles. The ultimate tensile strength of each repaired tendon was then measured by distracting until gross failure occurred. RESULTS Gapping of the percutaneous repairs exceeded that of conventional open repairs on the first, 500th, and 1000th load cycles. All 10 conventionally repaired tendons withstood 1000 load cycles without gross failure, but 4 of 10 percutaneous minimally invasive repairs failed, one on the 9th load cycle and the others between the 100th and 500th cycles. On average, tendons repaired with the open technique withstood 66% greater tensile load in failure testing than those repaired with the percutaneous technique. CONCLUSION Open Krackow Achilles tendon repairs may better withstand more aggressive postoperative physiotherapy than nonlocked percutaneous repairs. CLINICAL RELEVANCE The study suggests that surgeons should consider locking suture approaches to avoid loss of repair integrity with early motion.
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Affiliation(s)
- Bavornrit Chuckpaiwong
- Department of Orthopaedic Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Richard R Glisson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Naji S Madi
- Department of Orthopaedic Surgery, West Virginia University, Morgantown, WV, USA
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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3
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Paymard M, Higgins MD, Sinhal A, Musameh MD. Surgical or Percutaneous Repair of Sinus of Valsalva Rupture: Case Series and Literature Review. Heart Views 2023; 24:148-152. [PMID: 37584018 PMCID: PMC10424757 DOI: 10.4103/heartviews.heartviews_96_22] [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] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 05/11/2023] [Indexed: 08/17/2023] Open
Abstract
The rupture of the sinus of the Valsalva aneurysm is a rare but very serious condition. Rapid and accurate diagnosis and prompt treatment are critical for these cases. We present two cases of sinus of Valsalva ruptures. One case was managed with open surgical repair and the second case was treated percutaneously. We have discussed these two therapeutic approaches available to treat sinus of Valsalva rupture.
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Affiliation(s)
- Mohammad Paymard
- Department of Cardiology, The Canberra Hospital, Canberra, Australian Capital Territory, Mackay, Queensland, Australia
| | - Mark Daniel Higgins
- Depatment of Cardiology, Mackay Base Hospital, Mackay, Queensland, Australia
| | - Ajay Sinhal
- Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Muntaser D. Musameh
- Depatment of Cardiology, Mackay Base Hospital, Mackay, Queensland, Australia
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Abdelatif NMN, Batista JP. Outcomes of Percutaneous Achilles Repair Compared With Endoscopic Flexor Hallucis Longus Tendon Transfer to Treat Achilles Tendon Ruptures. Foot Ankle Int 2022; 43:1174-1184. [PMID: 35686445 DOI: 10.1177/10711007221096674] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Both percutaneous and endoscopically assisted methods are reported to produce good results in the surgical management of acute Achilles tendon ruptures. The aim of this retrospective study was to compare between a percutaneous method and a recently described isolated endoscopically assisted flexor hallucis longus (FHL) transfer method as surgical means of management in patients with acute Achilles tendon ruptures. METHODS One hundred seventeen patients were included in the current study and divided into 2 groups: 59 patients who underwent percutaneous Achilles repair (PAR Group) and 58 patients who underwent isolated endoscopic FHL transfer (FHL Group) were compared. Patients were clinically evaluated using American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Achilles tendon Total Rupture Score (ATRS), and Achilles tendon resting angle (ATRA) measures. In addition, ankle plantarflexion power, FHL dynamometry, Tegner activity levels, and return to previous levels of activity were also documented for all patients. RESULTS Nine months after surgery, patients in the FHL transfer group were more likely to be able to return to normal activities (91% vs 73%, P < .01). Thirty months after surgical treatment, we found no difference in ATRS, AOFAS, ATRA, ankle plantarflexion strength, or Tegner activity scores between study groups. Overall complications were reported in 6 patients in the FHL group (10.3%) and in 8 patients in the PAR group (13.6%). No major neurovascular or skin complications were encountered. CONCLUSION The current study demonstrated satisfactory and comparable results and complications when comparing isolated endoscopic FHL tendon transfer or percutaneous Achilles tendon repairs in the surgical management of acute Achilles tendon ruptures. LEVEL OF EVIDENCE Level III, retrospective controlled trial.
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Affiliation(s)
| | - Jorge Pablo Batista
- Ankle and Knee Section, Orthopaedics Department, Centro Artroscópico Jorge Batista, Ciudad Autónoma de Buenos Aires, Argentina.,Department of Sport Medicine, Club Atlético Boca Juniors, Buenos Aires, Argentina
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Lai LKL, So CY, Chui KL, Kam KKH, Kwok KW, Wong RHL, Cheung GSH, Lam YY, Lee APW. Plug and Clip: Percutaneous Repair of a Perforated Mitral Valve Complicating Severe Functional Mitral Regurgitation. JACC Cardiovasc Interv 2022; 15:e41-e43. [PMID: 35093277 DOI: 10.1016/j.jcin.2021.12.009] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Leo Kar Lok Lai
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chak-Yu So
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Ka-Lung Chui
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kevin Ka-Ho Kam
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka-Wai Kwok
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, China
| | - Randolph Hung-Leung Wong
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Gary Shing-Him Cheung
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yat-Yin Lam
- Hong Kong Asia Heart Center, Canossa Hospital, Hong Kong SAR, China
| | - Alex Pui-Wai Lee
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
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6
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Black NR, Chen J, Schweitzer KM. Minimally Invasive Repair of Subacute Achilles Tendon Ruptures: A Report of 2 Cases. Foot Ankle Spec 2022; 16:145-148. [PMID: 35156409 DOI: 10.1177/19386400221076944] [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] [Indexed: 11/17/2022]
Abstract
Level IV: Case report.
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Affiliation(s)
- Natalie R Black
- School of Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Jie Chen
- Duke University Medical Center, Raleigh, North Carolina.,Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
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Melcher C, Renner C, Piepenbrink M, Fischer N, Büttner A, Wegener V, Birkenmaier C, Jansson V, Wegener B. Biomechanical comparisons of three minimally invasive Achilles tendon percutaneous repair suture techniques. Clin Biomech (Bristol, Avon) 2022; 92:105578. [PMID: 35093798 DOI: 10.1016/j.clinbiomech.2022.105578] [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: 05/21/2021] [Revised: 12/14/2021] [Accepted: 01/11/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND While no gold standard exists for the management of Achilles tendon ruptures, surgical repair is common in healthy and active patients. Minimally invasive repair methods have become increasingly popular, while biomechanical equivalency hasn't been proven yet. METHODS A mid-substance Achilles tendon rupture was created 6 cm proximal to the calcaneal insertion in 27 fresh-frozen cadaveric ankles. Specimens were randomly allocated to 1 of 3 repair techniques: Huttunen et al. (2014) (1) PARS Achilles Jig System, Nyyssönen et al. (2008) (2) Achilles Midsubstance SpeedBridge™, Schipper and Cohen (2017) (3) Dresdner Instrument and subsequently subjected to cyclic loading with 250 cycles each at 1 Hz with 4 different loading ranges (20-100 N, 20-200 N, 20-300 N, and 20-400 N). FINDINGS After 250 cycles no significant differences in elongation were observed between PARS and Dresdner Instrument(p = 1.0). Furthermore, SpeedBridge™ repairs elongated less than either Dresdner Instrument (p = 0.0006) or PARS (p = 0.102). Main elongation (85%) occurred within the first 10 cycles with a comparable elongation in between 10 and 100 and 100-250 cycles. While all repairs withstood the first 250 cycles of cyclic loading from 20 to 100 N, only the PARS (468 ± 175) and Midsubstance SpeedBridge™ (538 ± 208) survived more cycles. Within all 3 groups suture cut out was seen to be the most common failure mechanism. INTERPRETATION Within all groups early repair elongation was seen. While this was least obvious within the SpeedBridge™ technique, ultimate strengths of repairs (cycles to failure) were comparable across PARS and SpeedBridge™ with a decline in the Dresdner Instrument group.
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Affiliation(s)
- C Melcher
- University Hospital Ulm, Department of Orthopedic Surgery (RKU), Oberer Eseelsberg 45, 89081 Ulm, Germany; University Hospital LMU Munich, Department of Orthopaedics, Physical Medicine and Rehabilitation, Marchioninistr 15, 81377 Munich, Germany.
| | - C Renner
- Arthrex GmbH, Erwin-Hielscher-Straße 9, 81249 München, Germany.
| | - M Piepenbrink
- Arthrex GmbH, Erwin-Hielscher-Straße 9, 81249 München, Germany.
| | - N Fischer
- Arthrex GmbH, Erwin-Hielscher-Straße 9, 81249 München, Germany.
| | - A Büttner
- University Hospital Rostock, Department of Forensic Medicine, St. Georg-Str.108, 18055 Rostock, Germany.
| | - V Wegener
- University Hospital LMU Munich, Department of Orthopaedics, Physical Medicine and Rehabilitation, Marchioninistr 15, 81377 Munich, Germany.
| | - C Birkenmaier
- University Hospital LMU Munich, Department of Orthopaedics, Physical Medicine and Rehabilitation, Marchioninistr 15, 81377 Munich, Germany.
| | - V Jansson
- University Hospital LMU Munich, Department of Orthopaedics, Physical Medicine and Rehabilitation, Marchioninistr 15, 81377 Munich, Germany.
| | - B Wegener
- University Hospital LMU Munich, Department of Orthopaedics, Physical Medicine and Rehabilitation, Marchioninistr 15, 81377 Munich, Germany.
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Granata G, Rubbio AP, De Marco F, Barletta M, Salvatore T, Bedogni F, Maurizio T. Transcatheter Mitral Valve Repair with the PASCAL System after Early Edge-to-Edge Surgical Failure. J Cardiovasc Echogr 2021; 31:102-103. [PMID: 34485037 PMCID: PMC8388324 DOI: 10.4103/jcecho.jcecho_132_20] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/24/2021] [Indexed: 11/18/2022] Open
Abstract
We report the challenging case of percutaneous treatment of early recurrent mitral regurgitation after Alfieri edge-to-edge surgical procedure.
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Affiliation(s)
- Giuseppina Granata
- Department of Clinical and Interventional Cardiology, The Policlinico San Donato Research Hospital, Milan, Italy
| | - Antonio Popolo Rubbio
- Department of Clinical and Interventional Cardiology, The Policlinico San Donato Research Hospital, Milan, Italy
| | - Federico De Marco
- Department of Clinical and Interventional Cardiology, The Policlinico San Donato Research Hospital, Milan, Italy
| | - Marta Barletta
- Department of Clinical and Interventional Cardiology, The Policlinico San Donato Research Hospital, Milan, Italy
| | - Tanya Salvatore
- Department of Clinical and Interventional Cardiology, The Policlinico San Donato Research Hospital, Milan, Italy
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology, The Policlinico San Donato Research Hospital, Milan, Italy
| | - Tusa Maurizio
- Department of Clinical and Interventional Cardiology, The Policlinico San Donato Research Hospital, Milan, Italy
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9
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Paczesny Ł, Zabrzyński J, Domżalski M, Gagat M, Termanowski M, Szwedowski D, Łapaj Ł, Kruczyński J. Mini-Invasive, Ultrasound Guided Repair of the Achilles Tendon Rupture-A Pilot Study. J Clin Med 2021; 10:2370. [PMID: 34071173 DOI: 10.3390/jcm10112370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022] Open
Abstract
Percutaneous acute Achilles tendon rupture suturing has become a leading treatment option in recent years. A common complication after this mini-invasive procedure is sural nerve injury, which can reduce the patients’ satisfaction and final outcomes. High-resolution ultrasound is a reliable method for localizing the sural nerve, and it can be performed intra-operatively; however, the long-term results are yet unknown. The aim of the study was to retrospectively evaluate the long-term results of percutaneous Achilles tendon repair supported with real-time ultrasound imaging. We conducted 57 percutaneous sutures of acute Achilles tendon rupture between 2005 and 2015; 30 were sutured under sonographic guidance, while 27 were performed without sonographic assistance. The inclusion criteria were acute (less than 7 days) full tendon rupture, treatment with the percutaneous technique, age between 18 and 65 years, and a body mass index (BMI) below 35. The operative procedure was carried out by two surgeons, according to the surgical technique reported by Maffulli et al. In total, 35 patients were available for this retrospective assessment; 20 (16 men and 4 women) were treated with sonographic guidance, while 15 (12 men and 3 women) underwent the procedure without it. The mean follow-up was 8 years (range, 3–13 years). The sural nerve was localized 10 mm to 20 mm (mean, 15.8; SD, 3.02) laterally from the scar of the Achilles tendon tear. There was no significant difference between groups with respect to the FAOQ score (P < 0.05). High-resolution ultrasounds performed intra-operatively can minimize the risk of sural nerve injury during percutaneous Achilles tendon repair.
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10
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Otto S, Velichkov M, Hamadanchi A, Schulze PC, Moebius-Winkler S. The impact of tricuspid annular geometry on outcome after percutaneous edge-to-edge repair for severe tricuspid regurgitation. Cardiol J 2021; 28:579-588. [PMID: 33942279 DOI: 10.5603/cj.a2021.0046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/02/2020] [Revised: 02/19/2021] [Accepted: 02/25/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Percutaneous tricuspid repair using the edge-to-edge technique is a novel treatment option. More data are needed to better understand which aspects predict a favorable outcome. METHODS Twenty high-risk patients (78.6 ± 8.3 years, EuroScore II 9.1 ± 7.7%, STS score 8.8 ± 4.3) with severe symptomatic tricuspid regurgitation (TR) were treated with the MitraClip® system. All patients underwent standardized pre-, peri-, and post-procedural evaluation. Acute success was defined as successful edge-to-edge repair with TR reduction of ≥ 1 grade and survival until hospital discharge. RESULTS Fifteen (75%) patients showed acute success until discharge and 12 (60%) at 30-day followup. In 5 (25%) patients repair failed due to either unsuccessful clip implantation (n = 2), single leaflet device attachment (n = 1), TR reduction < 1 grade (n = 1), or in-hospital death (n = 1). Comparing patients with successful procedure versus those with failed repair revealed similar comorbidities but more severe right heart failure, lower left ventricular ejection fraction, worse renal function, and higher diuretic equivalent doses in the failed repair group. No differences in conventional echocardiographic parameters for TR severity but more dilated tricuspid annulus geometry (tricuspid valve annulus, coaptation depth, tenting area) in the failed repair group were observed. The success rate of non-central/non-anteroseptal jet location was only 25%. CONCLUSIONS Tricuspid annulus geometry assessment may be of crucial importance and seems to impact procedural outcomes in patients undergoing edge-to-edge tricuspid valve repair. Further investigations including advanced imaging are needed to better understand and treat this complex valve disease.
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Affiliation(s)
- Sylvia Otto
- Department of Internal Medicine I, Division of Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany.
| | - Marija Velichkov
- Department of Internal Medicine I, Division of Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany
| | - Ali Hamadanchi
- Department of Internal Medicine I, Division of Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany
| | - Sven Moebius-Winkler
- Department of Internal Medicine I, Division of Cardiology, Angiology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany
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11
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Duan X, Wei N, Wei J, Zhu Y, Kang Y, He Y, Huang J, Wang S. Effect of High-Flow Nasal Cannula Oxygen Therapy on Pediatric Patients With Congenital Heart Disease in Procedural Sedation: A Prospective, Randomized Trial. J Cardiothorac Vasc Anesth 2021; 35:2913-2919. [PMID: 33934982 DOI: 10.1053/j.jvca.2021.03.031] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/15/2021] [Accepted: 03/20/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The study was conducted to compare the outcome of high-flow nasal cannula (HFNC) oxygen therapy with conventional oxygen therapy through a simple oxygen mask for pediatric patients with congenital heart disease during percutaneous intervention while under procedural sedation. DESIGN Prospective, randomized and controlled trial. SETTING A Cantonese cardiac center in China. PARTICIPANTS Two hundred American Society of Anesthesiologists classification II pediatric patients were enrolled from April 25, 2018 to November 28, 2018. INTERVENTIONS Patients scheduled for percutaneous closure of a heart defect under deep sedation with propofol, midazolam and fentanyl by an anesthesiologist were randomized (1:1) to receive oxygen therapy through a simple oxygen mask or through the HFNC system. MEASUREMENTS AND MAIN RESULTS The primary outcome was the lowest oxygen saturation (SpO2). Secondary outcomes included the incidence of hypoxia (SpO2 < 90%), requirement for noninvasive respiratory support, change in the gastric antrum area and other adverse events. Blood gas analysis results also were compared. Oxygen therapy through the HFNC system improved the lowest SpO2 (99% [94%-100%]), as compared with the mask group (99% [72%-100%]), p < 0.001. Seven patients out of 99 (7.1%) in the mask group had hypoxia or required bag-mask ventilation, whereas no such patient was reported in the HFNC group, p < 0.001. There were no differences between the groups in terms of gastric distention, procedure length, total propofol dose, atropine use or other complications. CONCLUSION When compared with simple mask oxygenation, HFNC could reduce the incidence of desaturation, the need for airway assisted ventilation and risk of carbon dioxide retention without causing hemodynamic instability or gastric distention. It is effective for pediatric patients with non-cyanotic congenital heart disease who require procedural sedation.
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Affiliation(s)
- Xuefei Duan
- Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, PRC
| | - Ning Wei
- Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, PRC
| | - Jinfeng Wei
- Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, PRC
| | - Yi Zhu
- Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, PRC
| | - Yin Kang
- Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, PRC
| | - Yi He
- Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, PRC
| | - Jiapeng Huang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY
| | - Sheng Wang
- Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, PRC.
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Adlam D, Chan N, Baron J, Kovac J. Aortic stenosis in the time of COVID-19: Development and outcomes of a rapid turnaround TAVI service. Catheter Cardiovasc Interv 2021; 98:E478-E482. [PMID: 33565703 PMCID: PMC8014719 DOI: 10.1002/ccd.29550] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 07/27/2020] [Revised: 12/26/2020] [Accepted: 01/27/2021] [Indexed: 12/01/2022]
Abstract
The COVID‐19 pandemic has resulted in the cancellation of many elective surgical procedures. This has led to reports of an increase in mortality for patients with non‐Covid health conditions due to delayed definitive management. Patients with severe aortic stenosis have a high annual mortality if left untreated. These patients are at risk due to the reduced number of surgical aortic valve replacements and competition for intensive care facilities during the COVID‐19 pandemic. This case series suggests that the minimally invasive transcatheter aortic valve implantation is safe to continue during the COVID‐19 pandemic with adjustments to the patient pathway to minimize hospital stay and to reduce patient and staff exposure. This helps to reduce the delay of definitive treatment for patients with severe aortic stenosis.
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Affiliation(s)
- David Adlam
- Glenfield Hospital, University Hospitals, Leicester, Leicester, UK.,University of Leicester Department of Cardiovascular Sciences and Leicester NIHR Biomedical Research Unit, Leicester, UK
| | - Nathan Chan
- Glenfield Hospital, University Hospitals, Leicester, Leicester, UK
| | - Julia Baron
- Glenfield Hospital, University Hospitals, Leicester, Leicester, UK
| | - Jan Kovac
- Glenfield Hospital, University Hospitals, Leicester, Leicester, UK.,University of Leicester Department of Cardiovascular Sciences and Leicester NIHR Biomedical Research Unit, Leicester, UK
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Lee JK, Kang C, Hwang DS, Kang DH, Lee GS, Hwang JM, Song JH, Lee CW. A comparative study of innovative percutaneous repair and open repair for acute Achilles tendon rupture: Innovative usage of intraoperative ultrasonography. J Orthop Surg (Hong Kong) 2020; 28:2309499020910274. [PMID: 32186233 DOI: 10.1177/2309499020910274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE There is no definitive consensus on the optimal treatment of Achilles tendon rupture. We comparatively analyzed the clinical outcomes of two types of repair surgeries in treating Achilles tendon rupture. METHODS This retrospective study included 12 patients of Achilles tendon rupture (group A) treated with ultrasound-guided percutaneous repair and 18 patients (group B) treated with open repair. Clinical evaluation was performed using the Arner-Lindholm scale, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Achilles Tendon Total Rupture score (ATRS), visual analog scale, time to single heel raise, bilateral calf circumferences, recovery of athletic ability, and other complications. RESULTS While the Arner-Lindholm scale, AOFAS ankle-hindfoot score, ATRS, time point when single heel raise was possible, differences in bilateral calf circumference, and recovery of athletic ability compared to pre-rupture level were not significantly different between the two groups (p = 0.999, 0.235, 0.357, 0.645, 0.497, and 0.881, respectively), overall and aesthetic satisfaction levels were higher in the group treated with percutaneous repair under ultrasonography guidance (p = 0.035 and 0.001, respectively). Overall, there were no cases involving sural nerve injury in either group. CONCLUSION Innovative percutaneous repair provides not only similar clinical outcomes but also greater overall and aesthetic satisfaction levels of operative outcomes and minimal complications (i.e. sural nerve injury) compared to open repair surgeries. Therefore, percutaneous repair may be a useful technique in the treatment of Achilles tendon rupture.
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Affiliation(s)
- Jeong-Kil Lee
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Chan Kang
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Deuk-Soo Hwang
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Dong-Hun Kang
- Department of Orthopaedic Surgery, Daejeon Centum Hospital, Daejeon, Korea
| | - Gi-Soo Lee
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jung-Mo Hwang
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae-Hwang Song
- Department of Orthopaedic Surgery, Konyang University Hospital, Daejeon, Korea
| | - Cheol-Won Lee
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
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14
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Oman Z, Kumar S, Ghani A, Sayed-Ahmad Z, Horbal P, Nasir A, Forsberg M, Helmy T. Percutaneous repair of post-myocardial infarction ventricular septal rupture presenting with cardiogenic shock. Am J Cardiovasc Dis 2020; 10:376-381. [PMID: 33224586 PMCID: PMC7675175] [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: 05/23/2020] [Accepted: 09/07/2020] [Indexed: 06/11/2023]
Abstract
Ventricular septal rupture (VSR) is an uncommon and devastating complication with a high mortality rate due to limited available interventions required by expert hands in a small window of opportunity. Most commonly seen following delayed myocardial infarctions (MI), the rate of VSR has decreased partly from protocol driven reperfusion therapy; however, cases are still present, particularly when diagnosis is delayed. We present a case of a critically ill patient in cardiogenic shock following a large anterolateral wall ST-elevation MI complicated by a large VSR whom was transferred to our academic institution for percutaneous repair. Of note, such intervention was initially performed by Lock in 1988 and a comprehensive review published in 2016 noted only 273 such cases. This review noted patient cases since that initial percutaneous closure by Lock with a majority of cases utilizing an Amplatzer system; others being Clamshell and CardioSEAL. Our patient underwent the percutaneous VSR closure utilizing an Amplatzer Occluder delivery system with successful insertion of an 18 mm muscular VSD Amplatzer closure device. Although the rarely performed procedure was successful and provided invaluable insights into the treatment and management of VSR, the patient succumbed to multiple critical disease processes in the following days post intervention. Patient consent and ethics committee approval for publication, as per Saint Louis University case publication guidelines, were confirmed and approved.
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Affiliation(s)
- Zach Oman
- Center for Comprehensive Cardiovascular Care, Saint Louis UniversitySaint Louis, Missouri, USA
| | - Sundeep Kumar
- Center for Comprehensive Cardiovascular Care, Saint Louis UniversitySaint Louis, Missouri, USA
| | - Ali Ghani
- Center for Comprehensive Cardiovascular Care, Saint Louis UniversitySaint Louis, Missouri, USA
| | - Ziad Sayed-Ahmad
- Center for Comprehensive Cardiovascular Care, Saint Louis UniversitySaint Louis, Missouri, USA
| | - Piotr Horbal
- Department of Internal Medicine, Saint Louis UniversitySaint Louis, Missouri, USA
| | - Ammar Nasir
- Center for Comprehensive Cardiovascular Care, Saint Louis UniversitySaint Louis, Missouri, USA
| | - Michael Forsberg
- Center for Comprehensive Cardiovascular Care, Saint Louis UniversitySaint Louis, Missouri, USA
| | - Tarek Helmy
- Center for Comprehensive Cardiovascular Care, Saint Louis UniversitySaint Louis, Missouri, USA
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15
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Batchelor W, Lindenfeld J. Remembering the "Forgotten Valve": Further Insight Into Transcatheter Tricuspid Valve Repair for Right Heart Failure. JACC Heart Fail 2020; 8:277-279. [PMID: 32241535 DOI: 10.1016/j.jchf.2020.02.001] [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] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 11/16/2022]
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16
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Čretnik A, Kosanović M, Košir R. Long-Term Results With the Use of Modified Percutaneous Repair of the Ruptured Achilles Tendon Under Local Anaesthesia (15-Year Analysis With 270 Cases). J Foot Ankle Surg 2019; 58:828-836. [PMID: 31474397 DOI: 10.1053/j.jfas.2018.11.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/27/2017] [Indexed: 02/03/2023]
Abstract
Controversy regarding the optimal treatment of fresh total Achilles tendon rupture remains. This article presents results with the use of modified percutaneous Achilles tendon repair under local anesthesia performed from January 1991 to December 2005 with a 2- to 10-year follow-up. There were 270 procedures in 247 male patients (92.51%) and 20 female patients (7.49%), mean ± SD age 38.7 ± 11.56 (range 20 to 83) years, in all consecutively treated patients within 7 days after acute total rupture; 3 patients sustained ruptures on both sides in different periods. Postoperative care consisted of wearing a cast or soft cast or functional immobilization for 6 weeks. The procedure was well tolerated in all patients. There were 3 (1.11%) complete and 5 (1.85%) partial repeat ruptures (8 [2.96%] altogether). Fourteen patients (5.18%) developed transient sural neuritis that spontaneously resolved in 2 to 10 months. One case (0.3%) of deep venous thrombosis was successfully treated. There were 25 (9.36%) major and minor complications altogether, with no cases of increased postoperative dorsiflexion, deep infection, or necrosis. Forty-four patients (16.48%) had a slightly decreased range of ankle motion, and 216 (80.89%) patients, including all high-caliber athletes, resumed all their previous activities. The mean American Orthopedic Foot and Ankle Society hindfoot-ankle score was 96.10 points. Long-term results of the analyzed modified method suggest a reasonable treatment option for acute total Achilles tendon ruptures, with a low number of complications and repeat rupture rate and return to preinjury activities comparable to those of open procedures.
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Affiliation(s)
- Andrej Čretnik
- Professor of Surgery, General and Trauma Surgeon, Department of Traumatology, University Clinical Centre Maribor, Maribor, Slovenia.
| | - Miloš Kosanović
- Orthopaedic and Trauma Surgeon, Department of Traumatology, General and Teaching Hospital Celje, Celje, Slovenia
| | - Roman Košir
- Assistant, General Surgeon, Department of Traumatology, University Clinical Centre Maribor, Maribor, Slovenia
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17
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Abstract
This review outlines the first trial experience with transcatheter therapy for mitral regurgitation (MR), developed from the EVEREST II MitraClip trial in a trial population comprised predominantly of patients with degenerative mitral regurgitation (DMR). Subsequent experience with MitraClip and several other devices has been mostly in functional MR patients. At the same time, there has been ongoing experience with MitraClip in DMR, and a variety of other devices have been developed for catheter-based treatment of MR. Annuloplasty devices have been indicated for DMR, and the potential for transcatheter annuloplasty to be used, in conjunction with other catheter techniques, such as chordal replacement, as it is in standard mitral repair, is developing. Transcatheter mitral valve replacement will clearly have some role for MR of both functional and degenerative etiologies, when repair is not feasible or fails. This review will discuss the evidence base and future development of these mitral repair and replacement approaches for DMR.
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Affiliation(s)
- Ted Feldman
- NorthShore University HealthSystem, Evanston, IL, USA
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18
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Bhatia N, Kaiser CA, Fredi JL. Emergent Percutaneous Closure of Left Ventricular Free Wall Perforation During Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:1534-1535. [PMID: 30031721 DOI: 10.1016/j.jcin.2018.05.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 05/15/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Nirmanmoh Bhatia
- Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Clayton A Kaiser
- Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Cardiovascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph L Fredi
- Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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19
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Yudi MB, Love B, Nadir A, Kini A, Sharma SK. Percutaneous Closure of Left Ventricular Pseudoaneursym With Septal Occluder Device and Coils: A Multimodality Imaging Approach. JACC Cardiovasc Interv 2017; 10:e159-e161. [PMID: 28823771 DOI: 10.1016/j.jcin.2017.06.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/07/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Matias B Yudi
- Department of Interventional Cardiology, Mount Sinai Medical Center, New York, New York.
| | - Barry Love
- Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, New York
| | - Adnan Nadir
- Department of Interventional Cardiology, Mount Sinai Medical Center, New York, New York
| | - Annapoorna Kini
- Department of Interventional Cardiology, Mount Sinai Medical Center, New York, New York
| | - Samin K Sharma
- Department of Interventional Cardiology, Mount Sinai Medical Center, New York, New York
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20
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Zayni R, Coursier R, Zakaria M, Desrousseaux JF, Cordonnier D, Polveche G. Activity level recovery after acute Achilles tendon rupture surgically repaired: a series of 29 patients with a mean follow-up of 46 months. Muscles Ligaments Tendons J 2017; 7:69-77. [PMID: 28717614 DOI: 10.11138/mltj/2017.7.1.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Achilles tendon rupture is a common injury but its optimal management is still controversial. When decided, surgical repair can be performed by open or percutaneous techniques. Till now, there is no agreement on the ideal type of surgical management. PURPOSE To compare the outcomes of the percutaneous and open surgical treatment for acute Achilles tendon rupture and to assess the postoperative activity level recovery. METHODS Between 2008 and 2013, 29 patients were surgically treated for acute Achilles tendon rupture in our institution. 16 patients were operated by percutaneous technique and 13 by open repair. All patients received the same postoperative rehabilitation protocol. Patients were evaluated objectively and subjectively after an average of 46 months (23-91). RESULTS 96.6% of patients had excellent and good results according to subjective assessment. No significant difference was observed with respect to the examined clinical variables between the open and percutaneous repair groups. 20.68% of patients had minor complications related to the operation with lesser complications in the percutaneous group. 89.6% of patients resumed sport activity with an average delay of 7,7 months (4-24) and 57,7% of them resumed at a level equal or superior to their level before injury, with higher rate in the percutaneous group. CONCLUSION Percutaneous technique has similar satisfactory outcomes to open surgery in repairing acute ruptured Achilles tendon with lesser complications and higher activity level recovery rate. LEVEL OF EVIDENCE Retrospective comparative study. Level III.
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Affiliation(s)
- Richard Zayni
- Department of Orthopedic Surgery. Groupe Hospitalier de l'Est de la Meurthe-et-Moselle (GHEMM), France
| | - Raphaël Coursier
- Department of Orthopedic Surgery. Groupement Hospitalier de l'Institut Catholique de Lille (GHICL), France
| | - Moudasser Zakaria
- Department of Orthopedic Surgery. Groupement Hospitalier de l'Institut Catholique de Lille (GHICL), France
| | - Jean-François Desrousseaux
- Department of Orthopedic Surgery. Groupement Hospitalier de l'Institut Catholique de Lille (GHICL), France
| | - Denis Cordonnier
- Department of Orthopedic Surgery. Groupement Hospitalier de l'Institut Catholique de Lille (GHICL), France
| | - Gilles Polveche
- Department of Orthopedic Surgery. Groupement Hospitalier de l'Institut Catholique de Lille (GHICL), France
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21
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Nickenig G, Kowalski M, Hausleiter J, Braun D, Schofer J, Yzeiraj E, Rudolph V, Friedrichs K, Maisano F, Taramasso M, Fam N, Bianchi G, Bedogni F, Denti P, Alfieri O, Latib A, Colombo A, Hammerstingl C, Schueler R. Transcatheter Treatment of Severe Tricuspid Regurgitation With the Edge-to-Edge MitraClip Technique. Circulation 2017; 135:1802-1814. [PMID: 28336788 DOI: 10.1161/circulationaha.116.024848] [Citation(s) in RCA: 261] [Impact Index Per Article: 37.3] [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: 08/05/2016] [Accepted: 03/13/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Current surgical and medical treatment options for severe tricuspid regurgitation (TR) are limited, and additional interventional approaches are required. In the present observational study, the safety and feasibility of transcatheter repair of chronic severe TR with the MitraClip system were evaluated. In addition, the effects on clinical symptoms were assessed. METHODS Patients with heart failure symptoms and severe TR on optimal medical treatment were treated with the MitraClip system. Safety, defined as periprocedural adverse events such as death, myocardial infarction, stroke, or cardiac tamponade, and feasibility, defined as successful implantation of 1 or more MitraClip devices and reduction of TR by at least 1 grade, were evaluated before discharge and after 30 days. In addition, functional outcome, defined as changes in New York Heart Assocation class and 6-minute walking distance, were assessed. RESULTS We included 64 consecutive patients (mean age 76.6±10 years) deemed unsuitable for surgery who underwent MitraClip treatment for chronic, severe TR for compassionate use. Functional TR was present in 88%; in addition, 22 patients were also treated with the MitraClip system for mitral regurgitation as a combined procedure. The degree of TR was severe or massive in 88% of patients before the procedure. The MitraClip device was successfully implanted in the tricuspid valve in 97% of the cases. After the procedure, TR was reduced by at least 1 grade in 91% of the patients, thereof 4% that were reduced from massive to severe. In 13% of patients, TR remained severe after the procedure. Significant reductions in effective regurgitant orifice area (0.9±0.3cm2 versus 0.4±0.2cm2; P<0.001), vena contracta width (1.1±0.5 cm versus 0.6±0.3 cm; P=0.001), and regurgitant volume (57.2±12.8 mL/beat versus 30.8±6.9 mL/beat; P<0.001) were observed. No intraprocedural deaths, cardiac tamponade, emergency surgery, stroke, myocardial infarction, or major vascular complications occurred. Three (5%) in-hospital deaths occurred. New York Heart Association class was significantly improved (P<0.001), and 6-minute walking distance increased significantly (165.9±102.5 m versus 193.5±115.9 m; P=0.007). CONCLUSIONS Transcatheter treatment of TR with the MitraClip system seems to be safe and feasible in this cohort of preselected patients. Initial efficacy analysis showed encouraging reduction of TR, which may potentially result in improved clinical outcomes.
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Affiliation(s)
- Georg Nickenig
- From Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (G.N., C.H., R.S.); Heart Center Osnabrück-Bad Rothenfelde, Schüchterman Klinik, Bad Rothenfelde, Germany (M.K.); Department of Cardiology, Ludwig- Maximilians University Munich, Germany (J.H., D.B.); Hamburg Universitary Cardiovascular Center, Germany (J.S., E.Y.); Heart Center, University of Cologne, Germany (V.R., K.F.); Department of Cardiac and Vascular Surgery, University Hospital Zürich, Switzerland (F.M., M.T.); Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Canada (N.F.); Department of Cardiology, Policlinico San Donato, Milan, Italy (G.B., F.B.); Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy (P.D., O.A.); and Department of Interventional Cardiology, Ospedale San Raffaele Milano, Milan, Italy (A.L., A.C.).
| | - Marek Kowalski
- From Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (G.N., C.H., R.S.); Heart Center Osnabrück-Bad Rothenfelde, Schüchterman Klinik, Bad Rothenfelde, Germany (M.K.); Department of Cardiology, Ludwig- Maximilians University Munich, Germany (J.H., D.B.); Hamburg Universitary Cardiovascular Center, Germany (J.S., E.Y.); Heart Center, University of Cologne, Germany (V.R., K.F.); Department of Cardiac and Vascular Surgery, University Hospital Zürich, Switzerland (F.M., M.T.); Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Canada (N.F.); Department of Cardiology, Policlinico San Donato, Milan, Italy (G.B., F.B.); Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy (P.D., O.A.); and Department of Interventional Cardiology, Ospedale San Raffaele Milano, Milan, Italy (A.L., A.C.)
| | - Jörg Hausleiter
- From Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (G.N., C.H., R.S.); Heart Center Osnabrück-Bad Rothenfelde, Schüchterman Klinik, Bad Rothenfelde, Germany (M.K.); Department of Cardiology, Ludwig- Maximilians University Munich, Germany (J.H., D.B.); Hamburg Universitary Cardiovascular Center, Germany (J.S., E.Y.); Heart Center, University of Cologne, Germany (V.R., K.F.); Department of Cardiac and Vascular Surgery, University Hospital Zürich, Switzerland (F.M., M.T.); Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Canada (N.F.); Department of Cardiology, Policlinico San Donato, Milan, Italy (G.B., F.B.); Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy (P.D., O.A.); and Department of Interventional Cardiology, Ospedale San Raffaele Milano, Milan, Italy (A.L., A.C.)
| | - Daniel Braun
- From Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (G.N., C.H., R.S.); Heart Center Osnabrück-Bad Rothenfelde, Schüchterman Klinik, Bad Rothenfelde, Germany (M.K.); Department of Cardiology, Ludwig- Maximilians University Munich, Germany (J.H., D.B.); Hamburg Universitary Cardiovascular Center, Germany (J.S., E.Y.); Heart Center, University of Cologne, Germany (V.R., K.F.); Department of Cardiac and Vascular Surgery, University Hospital Zürich, Switzerland (F.M., M.T.); Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Canada (N.F.); Department of Cardiology, Policlinico San Donato, Milan, Italy (G.B., F.B.); Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy (P.D., O.A.); and Department of Interventional Cardiology, Ospedale San Raffaele Milano, Milan, Italy (A.L., A.C.)
| | - Joachim Schofer
- From Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (G.N., C.H., R.S.); Heart Center Osnabrück-Bad Rothenfelde, Schüchterman Klinik, Bad Rothenfelde, Germany (M.K.); Department of Cardiology, Ludwig- Maximilians University Munich, Germany (J.H., D.B.); Hamburg Universitary Cardiovascular Center, Germany (J.S., E.Y.); Heart Center, University of Cologne, Germany (V.R., K.F.); Department of Cardiac and Vascular Surgery, University Hospital Zürich, Switzerland (F.M., M.T.); Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Canada (N.F.); Department of Cardiology, Policlinico San Donato, Milan, Italy (G.B., F.B.); Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy (P.D., O.A.); and Department of Interventional Cardiology, Ospedale San Raffaele Milano, Milan, Italy (A.L., A.C.)
| | - Ermela Yzeiraj
- From Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (G.N., C.H., R.S.); Heart Center Osnabrück-Bad Rothenfelde, Schüchterman Klinik, Bad Rothenfelde, Germany (M.K.); Department of Cardiology, Ludwig- Maximilians University Munich, Germany (J.H., D.B.); Hamburg Universitary Cardiovascular Center, Germany (J.S., E.Y.); Heart Center, University of Cologne, Germany (V.R., K.F.); Department of Cardiac and Vascular Surgery, University Hospital Zürich, Switzerland (F.M., M.T.); Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Canada (N.F.); Department of Cardiology, Policlinico San Donato, Milan, Italy (G.B., F.B.); Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy (P.D., O.A.); and Department of Interventional Cardiology, Ospedale San Raffaele Milano, Milan, Italy (A.L., A.C.)
| | - Volker Rudolph
- From Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (G.N., C.H., R.S.); Heart Center Osnabrück-Bad Rothenfelde, Schüchterman Klinik, Bad Rothenfelde, Germany (M.K.); Department of Cardiology, Ludwig- Maximilians University Munich, Germany (J.H., D.B.); Hamburg Universitary Cardiovascular Center, Germany (J.S., E.Y.); Heart Center, University of Cologne, Germany (V.R., K.F.); Department of Cardiac and Vascular Surgery, University Hospital Zürich, Switzerland (F.M., M.T.); Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Canada (N.F.); Department of Cardiology, Policlinico San Donato, Milan, Italy (G.B., F.B.); Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy (P.D., O.A.); and Department of Interventional Cardiology, Ospedale San Raffaele Milano, Milan, Italy (A.L., A.C.)
| | - Kai Friedrichs
- From Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (G.N., C.H., R.S.); Heart Center Osnabrück-Bad Rothenfelde, Schüchterman Klinik, Bad Rothenfelde, Germany (M.K.); Department of Cardiology, Ludwig- Maximilians University Munich, Germany (J.H., D.B.); Hamburg Universitary Cardiovascular Center, Germany (J.S., E.Y.); Heart Center, University of Cologne, Germany (V.R., K.F.); Department of Cardiac and Vascular Surgery, University Hospital Zürich, Switzerland (F.M., M.T.); Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Canada (N.F.); Department of Cardiology, Policlinico San Donato, Milan, Italy (G.B., F.B.); Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy (P.D., O.A.); and Department of Interventional Cardiology, Ospedale San Raffaele Milano, Milan, Italy (A.L., A.C.)
| | - Francesco Maisano
- From Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (G.N., C.H., R.S.); Heart Center Osnabrück-Bad Rothenfelde, Schüchterman Klinik, Bad Rothenfelde, Germany (M.K.); Department of Cardiology, Ludwig- Maximilians University Munich, Germany (J.H., D.B.); Hamburg Universitary Cardiovascular Center, Germany (J.S., E.Y.); Heart Center, University of Cologne, Germany (V.R., K.F.); Department of Cardiac and Vascular Surgery, University Hospital Zürich, Switzerland (F.M., M.T.); Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Canada (N.F.); Department of Cardiology, Policlinico San Donato, Milan, Italy (G.B., F.B.); Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy (P.D., O.A.); and Department of Interventional Cardiology, Ospedale San Raffaele Milano, Milan, Italy (A.L., A.C.)
| | - Maurizio Taramasso
- From Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (G.N., C.H., R.S.); Heart Center Osnabrück-Bad Rothenfelde, Schüchterman Klinik, Bad Rothenfelde, Germany (M.K.); Department of Cardiology, Ludwig- Maximilians University Munich, Germany (J.H., D.B.); Hamburg Universitary Cardiovascular Center, Germany (J.S., E.Y.); Heart Center, University of Cologne, Germany (V.R., K.F.); Department of Cardiac and Vascular Surgery, University Hospital Zürich, Switzerland (F.M., M.T.); Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Canada (N.F.); Department of Cardiology, Policlinico San Donato, Milan, Italy (G.B., F.B.); Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy (P.D., O.A.); and Department of Interventional Cardiology, Ospedale San Raffaele Milano, Milan, Italy (A.L., A.C.)
| | - Neil Fam
- From Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (G.N., C.H., R.S.); Heart Center Osnabrück-Bad Rothenfelde, Schüchterman Klinik, Bad Rothenfelde, Germany (M.K.); Department of Cardiology, Ludwig- Maximilians University Munich, Germany (J.H., D.B.); Hamburg Universitary Cardiovascular Center, Germany (J.S., E.Y.); Heart Center, University of Cologne, Germany (V.R., K.F.); Department of Cardiac and Vascular Surgery, University Hospital Zürich, Switzerland (F.M., M.T.); Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Canada (N.F.); Department of Cardiology, Policlinico San Donato, Milan, Italy (G.B., F.B.); Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy (P.D., O.A.); and Department of Interventional Cardiology, Ospedale San Raffaele Milano, Milan, Italy (A.L., A.C.)
| | - Giovanni Bianchi
- From Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (G.N., C.H., R.S.); Heart Center Osnabrück-Bad Rothenfelde, Schüchterman Klinik, Bad Rothenfelde, Germany (M.K.); Department of Cardiology, Ludwig- Maximilians University Munich, Germany (J.H., D.B.); Hamburg Universitary Cardiovascular Center, Germany (J.S., E.Y.); Heart Center, University of Cologne, Germany (V.R., K.F.); Department of Cardiac and Vascular Surgery, University Hospital Zürich, Switzerland (F.M., M.T.); Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Canada (N.F.); Department of Cardiology, Policlinico San Donato, Milan, Italy (G.B., F.B.); Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy (P.D., O.A.); and Department of Interventional Cardiology, Ospedale San Raffaele Milano, Milan, Italy (A.L., A.C.)
| | - Francesco Bedogni
- From Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (G.N., C.H., R.S.); Heart Center Osnabrück-Bad Rothenfelde, Schüchterman Klinik, Bad Rothenfelde, Germany (M.K.); Department of Cardiology, Ludwig- Maximilians University Munich, Germany (J.H., D.B.); Hamburg Universitary Cardiovascular Center, Germany (J.S., E.Y.); Heart Center, University of Cologne, Germany (V.R., K.F.); Department of Cardiac and Vascular Surgery, University Hospital Zürich, Switzerland (F.M., M.T.); Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Canada (N.F.); Department of Cardiology, Policlinico San Donato, Milan, Italy (G.B., F.B.); Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy (P.D., O.A.); and Department of Interventional Cardiology, Ospedale San Raffaele Milano, Milan, Italy (A.L., A.C.)
| | - Paolo Denti
- From Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (G.N., C.H., R.S.); Heart Center Osnabrück-Bad Rothenfelde, Schüchterman Klinik, Bad Rothenfelde, Germany (M.K.); Department of Cardiology, Ludwig- Maximilians University Munich, Germany (J.H., D.B.); Hamburg Universitary Cardiovascular Center, Germany (J.S., E.Y.); Heart Center, University of Cologne, Germany (V.R., K.F.); Department of Cardiac and Vascular Surgery, University Hospital Zürich, Switzerland (F.M., M.T.); Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Canada (N.F.); Department of Cardiology, Policlinico San Donato, Milan, Italy (G.B., F.B.); Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy (P.D., O.A.); and Department of Interventional Cardiology, Ospedale San Raffaele Milano, Milan, Italy (A.L., A.C.)
| | - Ottavio Alfieri
- From Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (G.N., C.H., R.S.); Heart Center Osnabrück-Bad Rothenfelde, Schüchterman Klinik, Bad Rothenfelde, Germany (M.K.); Department of Cardiology, Ludwig- Maximilians University Munich, Germany (J.H., D.B.); Hamburg Universitary Cardiovascular Center, Germany (J.S., E.Y.); Heart Center, University of Cologne, Germany (V.R., K.F.); Department of Cardiac and Vascular Surgery, University Hospital Zürich, Switzerland (F.M., M.T.); Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Canada (N.F.); Department of Cardiology, Policlinico San Donato, Milan, Italy (G.B., F.B.); Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy (P.D., O.A.); and Department of Interventional Cardiology, Ospedale San Raffaele Milano, Milan, Italy (A.L., A.C.)
| | - Azeem Latib
- From Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (G.N., C.H., R.S.); Heart Center Osnabrück-Bad Rothenfelde, Schüchterman Klinik, Bad Rothenfelde, Germany (M.K.); Department of Cardiology, Ludwig- Maximilians University Munich, Germany (J.H., D.B.); Hamburg Universitary Cardiovascular Center, Germany (J.S., E.Y.); Heart Center, University of Cologne, Germany (V.R., K.F.); Department of Cardiac and Vascular Surgery, University Hospital Zürich, Switzerland (F.M., M.T.); Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Canada (N.F.); Department of Cardiology, Policlinico San Donato, Milan, Italy (G.B., F.B.); Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy (P.D., O.A.); and Department of Interventional Cardiology, Ospedale San Raffaele Milano, Milan, Italy (A.L., A.C.)
| | - Antonio Colombo
- From Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (G.N., C.H., R.S.); Heart Center Osnabrück-Bad Rothenfelde, Schüchterman Klinik, Bad Rothenfelde, Germany (M.K.); Department of Cardiology, Ludwig- Maximilians University Munich, Germany (J.H., D.B.); Hamburg Universitary Cardiovascular Center, Germany (J.S., E.Y.); Heart Center, University of Cologne, Germany (V.R., K.F.); Department of Cardiac and Vascular Surgery, University Hospital Zürich, Switzerland (F.M., M.T.); Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Canada (N.F.); Department of Cardiology, Policlinico San Donato, Milan, Italy (G.B., F.B.); Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy (P.D., O.A.); and Department of Interventional Cardiology, Ospedale San Raffaele Milano, Milan, Italy (A.L., A.C.)
| | - Christoph Hammerstingl
- From Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (G.N., C.H., R.S.); Heart Center Osnabrück-Bad Rothenfelde, Schüchterman Klinik, Bad Rothenfelde, Germany (M.K.); Department of Cardiology, Ludwig- Maximilians University Munich, Germany (J.H., D.B.); Hamburg Universitary Cardiovascular Center, Germany (J.S., E.Y.); Heart Center, University of Cologne, Germany (V.R., K.F.); Department of Cardiac and Vascular Surgery, University Hospital Zürich, Switzerland (F.M., M.T.); Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Canada (N.F.); Department of Cardiology, Policlinico San Donato, Milan, Italy (G.B., F.B.); Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy (P.D., O.A.); and Department of Interventional Cardiology, Ospedale San Raffaele Milano, Milan, Italy (A.L., A.C.)
| | - Robert Schueler
- From Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (G.N., C.H., R.S.); Heart Center Osnabrück-Bad Rothenfelde, Schüchterman Klinik, Bad Rothenfelde, Germany (M.K.); Department of Cardiology, Ludwig- Maximilians University Munich, Germany (J.H., D.B.); Hamburg Universitary Cardiovascular Center, Germany (J.S., E.Y.); Heart Center, University of Cologne, Germany (V.R., K.F.); Department of Cardiac and Vascular Surgery, University Hospital Zürich, Switzerland (F.M., M.T.); Department of Interventional Cardiology, St. Michael's Hospital, Toronto, Canada (N.F.); Department of Cardiology, Policlinico San Donato, Milan, Italy (G.B., F.B.); Department of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy (P.D., O.A.); and Department of Interventional Cardiology, Ospedale San Raffaele Milano, Milan, Italy (A.L., A.C.)
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MacMahon A, Deland JT, Do H, Soukup DS, Sofka CM, Demetracopolous CA, DeBlis R. MRI Evaluation of Achilles Tendon Rotation and Sural Nerve Anatomy: Implications for Percutaneous and Limited-Open Achilles Tendon Repair. Foot Ankle Int 2016; 37:636-43. [PMID: 26843545 DOI: 10.1177/1071100716628915] [Citation(s) in RCA: 12] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Limited-open and percutaneous Achilles tendon (AT) repair techniques have limited visibility, which may result in sural nerve violation and poor tendon targeting. The goal of this study was to assess the in vivo rotation of the AT and its distance to the sural nerve in ruptured and nonruptured ATs to develop guidelines to aid in limited-open and percutaneous repair techniques. METHODS A retrospective review was conducted to identify magnetic resonance imaging (MRI) studies of patients with ruptured and healthy (nonruptured) ATs. AT rotation and distance to the sural nerve in the anterior-posterior (A-P) and medial-lateral (M-L) planes were measured at the level of and proximal to the ankle. RESULTS The AT was externally rotated in both ruptured and nonruptured cohorts. Ruptured ATs showed greater external rotation than nonruptured ATs at the ankle (15.8 ± 16.2 degrees vs 5.9 ± 9.0 degrees, P = .008) but not at 10 cm proximal to the tendon's insertion (10.9 ± 10.9 degrees vs 6.1 ± 8.4 degrees, P = .139). Proximal AT rotation was negatively correlated with rupture height (r = -0.477, P = .029). At 4 cm proximal to the AT insertion, the sural nerve was closer anteriorly to and farther laterally from the AT in ruptures than in nonruptures (P < .001). At 10 cm proximal to the AT insertion, the sural nerve was farther posteriorly and laterally from the AT in ruptures than in nonruptures (P = .027 and P < .001, respectively). CONCLUSION We found that the AT was more externally rotated in ruptured than in nonruptured tendons at the ankle and that its distance to the sural nerve differed between the 2 cohorts in the A-P and M-L planes, likely due to increased AT rotation and swelling with ruptures. To minimize sural nerve injury and improve tendon targeting, we suggest an external rotation of 11 degrees at the proximal end of the rupture and 16 degrees at the distal end when using percutaneous and limited-open AT repair devices to try to minimize sural nerve violation and increase tendon capture, which can decrease rates of complication and rerupture. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Aoife MacMahon
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan T Deland
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Huong Do
- Department of Epidemiology and Biostatistics, Hospital for Special Surgery, New York, NY, USA
| | - Dylan S Soukup
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Carolyn M Sofka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | | | - Ryan DeBlis
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
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23
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Clanton TO, Haytmanek CT, Williams BT, Civitarese DM, Turnbull TL, Massey MB, Wijdicks CA, LaPrade RF. A Biomechanical Comparison of an Open Repair and 3 Minimally Invasive Percutaneous Achilles Tendon Repair Techniques During a Simulated, Progressive Rehabilitation Protocol. Am J Sports Med 2015; 43:1957-64. [PMID: 26063402 DOI: 10.1177/0363546515587082] [Citation(s) in RCA: 81] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While the nonoperative management of Achilles tendon ruptures is a viable option, surgical repair is preferred in healthy and active populations. Recently, minimally invasive percutaneous repair methods with assistive devices have been developed. HYPOTHESIS/PURPOSE The purpose of this study was to biomechanically analyze 3 commercially available, minimally invasive percutaneous techniques compared with an open Achilles repair during a simulated, progressive rehabilitation program. It was hypothesized that no significant biomechanical differences would exist between repair techniques. STUDY DESIGN Controlled laboratory study. METHODS A simulated, midsubstance Achilles rupture was created 6 cm proximal to the calcaneal insertion in 33 fresh-frozen cadaveric ankles. Specimens were then randomly allocated to 1 of 4 different Achilles repair techniques: (1) open repair, (2) the Achillon Achilles Tendon Suture System, (3) the PARS Achilles Jig System, or (4) an Achilles Midsubstance SpeedBridge Repair variation. Repairs were subjected to a cyclic loading protocol representative of progressive postoperative rehabilitation: 250 cycles at 1 Hz for each loading range: 20-100 N, 20-200 N, 20-300 N, and 20-400 N. RESULTS The open repair technique demonstrated significantly less elongation (5.2 ± 1.1 mm) when compared with all minimally invasive percutaneous repair methods after 250 cycles (P < .05). No significant differences were observed after 250 cycles between the Achillon, PARS, or SpeedBridge repairs, with mean displacements of 9.9 ± 2.2 mm, 12.2 ± 4.4 mm, and 10.0 ± 3.9 mm, respectively. When examined over smaller cyclic intervals, the majority of elongation, regardless of repair, occurred within the first 10 cycles. Within the first 10 cycles, open repairs achieved 71.2% of the total elongation observed after 250 cycles. Corresponding values for the Achillon, PARS, and SpeedBridge repairs were 81.8%, 77.9%, and 69.0%, respectively. No significant differences were observed in the total number of cycles to failure between minimally invasive percutaneous repairs and open repairs. Minor differences in the mechanism of failure were noted; however, the majority of all repairs failed at the suture-tendon interface. CONCLUSION Minimally invasive percutaneous repair techniques demonstrated a susceptibility to significant early repair elongation when compared with open repairs. However, the ultimate strengths of repairs (cycles to failure) were comparable across all techniques. CLINICAL RELEVANCE The reduced early elongation of open repairs suggests that patients treated with this technique may be able to progress through an earlier and/or more aggressive postoperative rehabilitation protocol with a lower risk of early irrevocable repair elongation or gapping about the repair site. However, in cases where cosmesis or wound-healing complications are of significant concern, minimally invasive percutaneous techniques provide a biomechanically reasonable alternative based on their repair strengths (cycles to failure). These repairs may need to be protected longer postoperatively to allow for biological healing and avoid early repair elongation and potential gapping between the healing tendon ends.
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Affiliation(s)
- Thomas O Clanton
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
| | | | | | | | | | | | | | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
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Abstract
Endovascular repair has replaced open surgical repair as the standard of care for treatment of abdominal and thoracic aortic aneurysms in appropriately selected patients owing to its decreased morbidity and length of stay and excellent clinical outcomes. Similarly, there is a progressive trend toward total percutaneous repair of the femoral artery using percutaneous suture-mediated closure devices over open surgical repair due to decreased complications and procedure time. This article describes the techniques of closure for large-bore vascular access most commonly used in endovascular treatment of abdominal and thoracic aortic aneurysms, but could similarly be applied to any procedure requiring large-bore arterial access, such as transcatheter aortic valve replacement.
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Affiliation(s)
- Charles J McGraw
- Department of Vascular and Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, FL
| | - Ripal T Gandhi
- Department of Vascular and Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, FL.
| | - Geogy Vatakencherry
- Department of Vascular and Interventional Radiology, Kaiser Permanente, Los Angeles, CA
| | - Frederic Baumann
- Department of Vascular and Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, FL
| | - James F Benenati
- Department of Vascular and Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, FL
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Zietek P, Karaczun M, Kruk B, Szczypior K. Percutaneous, Minimally Invasive Repair of Traumatic and Simultaneous Rupture of Both Achilles Tendons: A Case Report. J Foot Ankle Surg 2015; 55:642-4. [PMID: 26002678 DOI: 10.1053/j.jfas.2015.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 04/23/2014] [Indexed: 02/03/2023]
Abstract
Achilles injury is a common musculoskeletal disorder. Bilateral rupture of the Achilles tendon, however, is much less common and usually occurs spontaneously. Complete, traumatic, and bilateral ruptures are rare and typically require long periods of immobilization before the patient can return to full weightbearing. A 52-year-old male was hospitalized for bilateral traumatic rupture to both Achilles tendons. No risk factors for tendon rupture were found. Blood samples revealed no peripheral blood pathologic features. Both tendons were repaired with percutaneous, minimally invasive surgery using the Achillon(®) tendon suture system. Rehabilitation was begun 4 weeks later. An ankle-foot orthosis was prescribed to provide ankle support with an adjustable range of movement, and active plantar flexion was set at 0° to 30°. The patient remained non-weightbearing with the ankle-foot orthosis device and performed active range-of-motion exercises. At 8 weeks after surgery, we recommended that he begin walking with partial weightbearing using a foot-tibial orthosis with the range of motion set to 45° plantar flexion and 15° dorsiflexion. At 10 weeks postoperatively, he was encouraged to return to full weightbearing on both feet. Beginning rehabilitation as soon as possible after minimally invasive surgery, compared with 6 weeks of immobilization after surgery, provided a rapid resumption to full weightbearing. We emphasize the clinical importance of a safe, simple treatment program that can be followed for a patient with damage to the Achilles tendons. To our knowledge, ours is the first report of minimally invasive repair of bilateral simultaneous traumatic rupture of the Achilles tendon.
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Affiliation(s)
- Pawel Zietek
- Orthopedist, Department of Orthopaedics and Traumatology, Pomeranian Medical University, Szczecin, Poland.
| | - Maciej Karaczun
- Orthopedist, Department of Orthopaedics and Traumatology, Pomeranian Medical University, Szczecin, Poland
| | - Bartosz Kruk
- Orthopedist, Department of Orthopaedics and Traumatology, Pomeranian Medical University, Szczecin, Poland
| | - Karina Szczypior
- Physiotherapist, Department of Orthopaedics and Traumatology, Pomeranian Medical University, Szczecin, Poland
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Rassaf T, Balzer J, Zeus T, Rammos C, Shayganfar S, Hall SV, Wagstaff R, Kelm M. Safety and efficacy of deep sedation as compared to general anaesthesia in percutaneous mitral valve repair using the MitraClip system. Catheter Cardiovasc Interv 2014; 84:E38-42. [PMID: 24909413 DOI: 10.1002/ccd.25570] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 03/01/2014] [Revised: 04/16/2014] [Accepted: 05/31/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To characterize the safety and efficacy of deep sedation (DS) as compared to general anaesthesia (GA) in percutaneous mitral valve repair (PMVR) using the MitraClip system. BACKGROUND PMVR with the MitraClip system has emerged as a therapeutic alternative to surgical valve repair in high-risk patients. The PMVR procedure is typically performed under GA. Due to their high surgical risk, avoidance of GA in many of those patients would be desirable. METHODS In an open-label observational study 21 patients with severe mitral regurgitation were randomized to either GA or DS using propofol. Primary endpoints of this comparison were related to safety with rate of conversion from DS to GA, bleeding, aspiration, and pneumonia. Secondary endpoints were related to efficacy with procedural, in-hospital, and mid-term outcome at 1 month. RESULTS All clips have been implanted successfully in both groups. No conversion from DS to GA was necessary. Four patients undergoing GA suffered from upper respiratory tract infections and two from peripheral vascular complications during placement of central venous catheter for GA. Short- and mid-term efficacy were comparable in both groups with a reduced hospital stay in the DS group. CONCLUSION PVMR in high-risk patients performed under DS is as safe and effective as with GA, preventing complications related to GA and shortening hospital stay.
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Affiliation(s)
- Tienush Rassaf
- Medical Faculty, Department of Medicine, Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
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Demetracopoulos CA, Gilbert SL, Young E, Baxter JR, Deland JT. Limited-Open Achilles Tendon Repair Using Locking Sutures Versus Nonlocking Sutures: An In Vitro Model. Foot Ankle Int 2014; 35:612-618. [PMID: 24651713 DOI: 10.1177/1071100714524550] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several limited-open Achilles tendon repair techniques that use locking or nonlocking sutures have been developed, but direct comparisons of in vitro mechanical properties have not yet been reported in the literature. It was our hypothesis that loads applied to the repaired Achilles tendon would be better resisted by limited-open techniques that use locking stitches compared with limited-open repairs that use nonlocking stitches. METHODS The Achilles tendons of 31 fresh-frozen cadaver lower limbs were incised 4 cm proximal to the calcaneal insertion. Tendons were then repaired using 1 of 2 limited-open Achilles tendon repair tools, one using 3 nonlocking sutures and the other using a combination of locking and nonlocking sutures. Repaired specimens were cycled to 1000 cycles from 20 to 100 N and from 20 to 190 N followed by a single load to failure test. Nonparametric analyses were performed to compare the number of cycles to gapping and total load to failure between the 2 repair techniques. RESULTS During cyclic loading, more cycles occurred prior to detection of 2-mm and 9.5-mm gaps in the locking suture construct compared with the nonlocking suture construct ( P = .012 and P = .005, respectively). There was no difference in the number of cycles to a gap of 5 mm ( P = .053). The locking suture construct also resisted a significantly greater load to failure compared with the nonlocking suture construct ( P < .001; median 385.0 and 299.6 N, respectively). CONCLUSION Limited-open repair techniques using locking sutures provided greater construct strength under both cyclic and ultimate loads compared with a repair technique that used only nonlocking sutures. CLINICAL RELEVANCE Limited-open Achilles tendon repairs using locking sutures are better able to resist forces simulating early accelerated rehabilitation than repairs using nonlocking sutures.
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Affiliation(s)
| | - Susannah L Gilbert
- 2 Hospital for Special Surgery, Department of Biomechanics, New York, NY, USA
| | - Elizabeth Young
- 1 Hospital for Special Surgery, Foot and Ankle Service, New York, NY, USA
| | - Josh R Baxter
- 2 Hospital for Special Surgery, Department of Biomechanics, New York, NY, USA
| | - Jonathan T Deland
- 1 Hospital for Special Surgery, Foot and Ankle Service, New York, NY, USA
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28
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Demetracopoulos CA, Gilbert SL, Young E, Baxter JR, Deland JT. Limited-Open Achilles Tendon Repair Using Locking Sutures Versus Nonlocking Sutures: An In Vitro Model. Foot Ankle Int 2014. [PMID: 24651713 DOI: 10.1177/1071100714524550.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several limited-open Achilles tendon repair techniques that use locking or nonlocking sutures have been developed, but direct comparisons of in vitro mechanical properties have not yet been reported in the literature. It was our hypothesis that loads applied to the repaired Achilles tendon would be better resisted by limited-open techniques that use locking stitches compared with limited-open repairs that use nonlocking stitches. METHODS The Achilles tendons of 31 fresh-frozen cadaver lower limbs were incised 4 cm proximal to the calcaneal insertion. Tendons were then repaired using 1 of 2 limited-open Achilles tendon repair tools, one using 3 nonlocking sutures and the other using a combination of locking and nonlocking sutures. Repaired specimens were cycled to 1000 cycles from 20 to 100 N and from 20 to 190 N followed by a single load to failure test. Nonparametric analyses were performed to compare the number of cycles to gapping and total load to failure between the 2 repair techniques. RESULTS During cyclic loading, more cycles occurred prior to detection of 2-mm and 9.5-mm gaps in the locking suture construct compared with the nonlocking suture construct ( P = .012 and P = .005, respectively). There was no difference in the number of cycles to a gap of 5 mm ( P = .053). The locking suture construct also resisted a significantly greater load to failure compared with the nonlocking suture construct ( P < .001; median 385.0 and 299.6 N, respectively). CONCLUSION Limited-open repair techniques using locking sutures provided greater construct strength under both cyclic and ultimate loads compared with a repair technique that used only nonlocking sutures. CLINICAL RELEVANCE Limited-open Achilles tendon repairs using locking sutures are better able to resist forces simulating early accelerated rehabilitation than repairs using nonlocking sutures.
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Affiliation(s)
| | - Susannah L Gilbert
- 2 Hospital for Special Surgery, Department of Biomechanics, New York, NY, USA
| | - Elizabeth Young
- 1 Hospital for Special Surgery, Foot and Ankle Service, New York, NY, USA
| | - Josh R Baxter
- 2 Hospital for Special Surgery, Department of Biomechanics, New York, NY, USA
| | - Jonathan T Deland
- 1 Hospital for Special Surgery, Foot and Ankle Service, New York, NY, USA
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Carmont MR, Silbernagel KG, Edge A, Mei-Dan O, Karlsson J, Maffulli N. Functional Outcome of Percutaneous Achilles Repair: Improvements in Achilles Tendon Total Rupture Score During the First Year. Orthop J Sports Med 2013; 1:2325967113494584. [PMID: 26535234 PMCID: PMC4555500 DOI: 10.1177/2325967113494584] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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] [Indexed: 12/16/2022] Open
Abstract
Background: Randomized studies have so far failed to show a difference in outcome between operative and nonoperative management of Achilles tendon rupture, provided that no rerupture occurs. Percutaneous Achilles repair has been suggested to result in superior patient satisfaction compared with open repair in patients with an acute Achilles tendon rupture, but there are no outcome data available with validated methods describing the progression of recovery during the first year. Purpose: To evaluate the outcome of patients with a ruptured Achilles tendon, managed by percutaneous repair, during the first year following repair with a valid, reliable, and responsive outcome measure. Furthermore, the effects of time between injury and surgery, age, and complications on outcome were also evaluated. Study design: Case series. Methods: A total of 73 patients (60 males and 13 females) with a mean age of 45.5 years were included. Patient age, length of time between injury and surgery, and complications were documented. Patients were evaluated using the Achilles tendon Total Rupture Score (ATRS) at 3, 6, 9, and 12 months following repair. Results: The median ATRS results at 3, 6, 9, and 12 months were 42.5, 73, 83, and 89, respectively. The number of patients who reported excellent or good scores (ATRS >84) at 3, 6, 9, and 12 months were 3%, 36%, 57%, and 69%, respectively. There were no significant differences in outcome at each time point for those patients undergoing early (≤48 hours) compared with late surgery or between those <65 and those >65 years of age. The complication rate was 13.5%. Patients who had a complication had a lower ATRS result at 3 months following surgery, but there were no differences after that time point. Conclusion: The patients in the present study reported marked improvement in function between 3 and 6 months following surgery, with continuing but less steep improvement up to 1 year following surgery. The presence of a complication other than rerupture did not affect the end-stage outcome but did affect that at 3 months following surgery. Clinical Relevance: This study demonstrates improving scores with time over the first year following surgery, against which other treatment methods can be compared.
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Affiliation(s)
- Michael R Carmont
- Department of Orthopaedic Surgery, Princess Royal Hospital, Telford, Shropshire, UK
| | | | - Antonia Edge
- Department of Orthopaedic Surgery, Princess Royal Hospital, Telford, Shropshire, UK
| | - Omer Mei-Dan
- Department of Sports Medicine, University of Colorado Hospitals, Boulder, Colorado, USA
| | - Jón Karlsson
- Department of Orthopaedic Surgery, Sahlgrenska University Hospital, MöIndal, Sweden
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, London, UK
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Doral MN, Bozkurt M, Turhan E, Dönmez G, Demirel M, Kaya D, Ateşok K, Atay OA, Maffulli N. Achilles tendon rupture: physiotherapy and endoscopy-assisted surgical treatment of a common sports injury. Open Access J Sports Med 2010; 1:233-40. [PMID: 24198562 PMCID: PMC3781874 DOI: 10.2147/oajsm.s10670] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [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] [Indexed: 11/23/2022] Open
Abstract
Although the Achilles tendon (AT) is the strongest tendon in the human body, rupture of this tendon is one of the most common sports injuries in the athletic population. Despite numerous nonoperative and operative methods that have been described, there is no universal agreement about the optimal management strategy of acute total AT ruptures. The management of AT ruptures should aim to minimize the morbidity of the injury, optimize rapid return to full function, and prevent complications. Since endoscopy-assisted percutaneous AT repair allows direct visualization of the synovia and protects the paratenon that is important in biological healing of the AT, this technique becomes a reasonable treatment option in AT ruptures. Furthermore, Achilles tendoscopy technique may decrease the complications about the sural nerve. Also, early functional postoperative physiotherapy following surgery may improve the surgical outcomes.
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Affiliation(s)
- Mahmut Nedim Doral
- Department of Orthopedics and Traumatology, Turkey ; Department of Sports Medicine, Hacettepe University School of Medicine, Sihhiye, Ankara, Turkey
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