Effects and trend of steroid dosage reduction during cardiac surgery: A three-year retrospective analysis at a tertiary medical center.

BACKGROUND: Current adult cardiac surgery guidelines recommend against the routine use of prophylactic intravenous corticosteroids during cardiopulmonary bypass (CPB) due to concerns about myocardial injury, despite their potential to reduce postoperative atrial fibrillation. Traditionally, a high dose of 1,000 mg of methylprednisolone was used to attenuate the inflammatory response associated with CPB. Our institution aligned with guideline recommendations and gradually reduced methylprednisolone dosages; thus, we reevaluated the impact on postoperative clinical outcomes. METHODS: Our study reviewed 1341 cases from a total of 1680 adult cardiac surgeries performed between June 2019 and May 2022 after excluding cases with off-pump procedures, ventricular assist device implantations, heart transplants, and aortic surgeries requiring systemic circulatory arrest. The study timely sorted periods including a baseline data from 2018, and other three periods since 2019 to analyze the effects of three different methylprednisolone dosage: 0 mg, 500 mg, and 1000 mg. We assessed the annual trends in methylprednisolone administration and compared morbidity and mortality rates across the groups. RESULTS: We observed a significant decline in steroid use, with no-steroid surgeries increasing from 23% to 66.5% by period 3. Despite the decreased use of steroids, our study showed no increase in mortality, new-onset atrial fibrillation, acute kidney injury, cerebrovascular event and prolonged ventilation when compared to baseline data. Notably, less surgical site infection rate was observed in the no-steroid group. CONCLUSION: The data indicates that a reduction or discontinuation of steroids during CPB can be performed without compromising patient outcomes. This could support a transition towards a more conservative use of steroids in adult cardiac surgery, aligning with current guidelines, and potentially reducing certain postoperative complications.

Computer-assisted image analysis of preexisting histological patterns of the cephalic vein to predict wrist arteriovenous fistula non-maturation.

BACKGROUND: We used computer-assisted image analysis to determine whether preexisting histological features of the cephalic vein influence the risk of non-maturation of wrist fistulas. METHODS: This study focused on patients aged 20-80 years who underwent their first wrist fistula creation. A total of 206 patients participated, and vein samples for Masson's trichrome staining were collected from 134 patients. From these, 94 patients provided a complete girth of the venous specimen for automatic image analysis. Maturation was assessed using ultrasound within 90 days after surgery. RESULTS: The collagen to muscle ratio in the target vein, measured by computer-assisted imaging, was a strong predictor of non-maturation in wrist fistulas. Receiver operating characteristic analysis revealed an area under the curve of 0.864 (95% confidence interval of 0.782-0.946, p < 0.001). The optimal cut-off value for the ratio was 1.138, as determined by the Youden index maximum method, with a sensitivity of 89.0% and specificity of 71.4%. For easy application, we used a cutoff value of 1.0; the non-maturation rates for patients with ratios >1 and ≤ 1 were 51.7% (15 out of 29 patients) and 9.2% (6 out of 65 patients), respectively. Chi-square testing revealed significantly different non-maturation rates between the two groups (X2 (1, N = 94) = 20.9, p < 0.01). CONCLUSION: Computer-assisted image interpretation can help to quantify the preexisting histological patterns of the cephalic vein, while the collagen-to-muscle ratio can predict non-maturation of wrist fistula development at an early stage.

Change in Abdominal Aortic Aneurysm Sac Diameter After Endovascular Repair: A Single-Center Experience From Taiwan.

PURPOSE: The purpose of this study was to investigate the change in the diameter of infrarenal abdominal aortic aneurysm (AAA) sacs after endovascular aortic repair (EVAR) in Taiwanese patients and to depict its association with clinical outcomes. MATERIALS AND METHODS: This retrospective cohort study was conducted on patients who underwent EVAR for infrarenal AAA between January 2011 and December 2016. All preoperative and follow-up computed tomography (CT) images were reviewed. Postoperative CT angiography was arranged after 1 month and annually thereafter. The maximal diameter on the axial plane and the maximal diameter perpendicular to the centerline on the coronal and sagittal planes were measured. The study examined post-EVAR sac diameter change over time and compared the differences in adverse events (AEs) among groups. RESULTS: The survey included a total of 191 patients with a median follow-up duration of 2.5 (interquartile range: 1.1-2.9) years. Overall survival rates at 1, 2, and 5 years were 92%, 81%, and 76%, respectively. According to their last CT scans, the patients were categorized into 3 groups as follows: shrinkage, stationary, and enlargement, which comprised 58 (30.4%), 118 (61.8%), and 15 (7.9%) patients, respectively. Pre-EVAR characteristics and sac diameters were similar among the groups. Sac shrinkage was exclusively observed in the first 2 years, whereas sac enlargement developed at all follow-up periods. Patients with sac enlargement had higher incidence rates of endoleaks, complications, and reintervention than the other groups. CONCLUSION: Based on our observations, post-EVAR sac shrinkage only occurs in the first 2 years; however, post-EVAR sacs may enlarge at any point and even after 5 years. In our study, patients with sac enlargement had higher rates of adverse events and reintervention.

Validation of the European system for cardiac operative risk evaluation II in a large Taiwan cardiac surgical centre.

BACKGROUND: The European System for Cardiac Operative Risk Evaluation (EuroSCORE II) is a well-established scoring system for predicting mortality in cardiac surgery. This system was derived predominantly from a European patient cohort; however, no validation of this system has been conducted in Taiwan. We sought to assess the performance of EuroSCORE II at a tertiary centre. METHODS: The 2161 adult patients receiving cardiac surgery between 2017 and 2020 in our institution were included. RESULTS: Overall, the in-hospital mortality rate was 7.89%. The performance of EuroSCORE II was assessed using the area under the receiver operator curve (AUC) for discrimination and the Hosmer-Lemeshow (H-L) test for calibration. Data were analysed for type of surgery, risk stratification, and status of the operation. EuroSCORE II had good discriminative power (AUC=0.854, 95% Confidence Interval (CI): 0.822-0.885) and good calibration (χ2=5.19, p=0.82) for all types of surgery except ventricular assist devices (AUC=0.618, 95% CI: 0.497-0.738). EuroSCORE II also showed good calibration for most types of surgery except coronary artery bypass surgery (CABG) combined procedure (P=0.033), heart transplantation (HT) (P=0.017), and urgent operation (P=0.041). EuroSCORE II significantly underestimated the risk for CABG combined procedure and urgent operations, and overestimated the risk for HT. CONCLUSION: EuroSCORE II had satisfactory discrimination and calibration power to predict surgical mortality in Taiwan. However, the model is poorly calibrated for CABG combined procedure, HT, urgent operation, and, likely, lower- and higher-risk patients.

A Novel Bubble-Mixture Method to Improve Dynamic Images in Carbon Dioxide Angiography.

PURPOSE: To present a novel method of preparing carbon dioxide (CO2) for contrast enhancement. TECHNIQUE: CO2 angiography can often produce poor image enhancement, especially in dependent vessels due to buoyancy of the gas. A new technique for premixing the CO2 gas with the patient's blood and dispersing it into the bubble mixture before injection was developed. Comparative dynamic images showed bubble-mixed CO2 angiography had less fragmentation, more even distribution, and more sustainability than the same volume of pure CO2. CONCLUSION: The alteration of CO2 gas toward a semiliquid form demonstrates an easy and reproducible concept to improve the dynamic image quality of traditional CO2 angiography.

Outcomes following endovascular or open repair for ruptured abdominal aortic aneurysm in a Chinese population.

To determine whether emergent endovascular repair (eEVAR) can be an alternative for anatomically suitable ruptured abdominal aortic aneurysms (RAAA) in a Chinese population compared to open aneurysm repair (OAR), 36 patients with RAAA undergoing either OAR or eEVAR in National Taiwan University Hospital from 2005 to 2012 were analyzed retrospectively. Thirty-five (97.2 %) patients were treated. Among them, 20 (57.1 %) were treated by OAR and 15 (42.9 %) by eEVAR. The overall 30-day survival rate was 77.1 %. There was no significant difference in 30-day mortality rate (OAR 15.0 % vs. eEVAR 33.3 %, p = 0.201) and midterm mortality rate (OAR 20.0 % vs. eEVAR 46.7 %, p = 0.093) between these two groups. On univariate analysis, free peritoneal rupture (p < 0.001), pre-operative shock (p = 0.001) and female gender (p = 0.016) are related to a higher 30-day mortality rate, while free peritoneal rupture (p = 0.012) and pre-operative shock (p = 0.030) are associated with a higher midterm mortality rate in both repair techniques. On multivariate analysis, free peritoneal rupture was associated with higher 30-day (OR 26.0, 95 % CI 2.2-295.6, p = 0.009) and midterm (OR 13.1, 95 % CI 1.2-37.6, p = 0.032) mortality rates. In patients with RAAA, there is no significant difference in 30-day mortality and midterm mortality between eEVAR and OAR groups in our study. eEVAR could be an alternative therapy for anatomically suitable RAAA in a Chinese population.

One-stage hybrid repair to thoracoabdominal aortic aneurysm.

BACKGROUND: Open repair of a thoracoabdominal aortic aneurysm (TAAA) is associated with high rates of morbidity and mortality. This study reviewed the midterm outcomes of hybrid TAAA repair in high-risk patients at our institution. METHODS: The clinical data of patients undergoing 1-stage hybrid repair of a TAAA between June 2007 and June 2011 were retrospectively analyzed. This study represents our experience with 10 patients at a single center who underwent 1-stage visceral hybrid procedures for complex thoracoabdominal aortic pathologies. There were 9 men and 1 woman with a median age of 65.7 years. The average preoperative European System for Cardiac Operative Risk Evaluation II score was 34.1%. RESULTS: The technical success rate with completion was 100%. No procedure was abandoned because of any aortic event. The 30-day mortality rate in this study was 10%. Overall major perioperative complication rates were 20%. Major complications included renal impairment requiring permanent support in 1 patient (10%) and paraplegia in 1 patient (10%). At a median follow-up of 20.1 months (range, 0.3-39 months), the overall survival rate was 70%. The primary graft patency rate was 96.8% (32/33). Only 1 renal artery graft was occluded. CONCLUSIONS: The midterm results in selected high-risk patients with TAAA undergoing 1-stage hybrid repair were encouraging. When open repair is hazardous and branched stent grafting is not an option, hybrid repair is a viable treatment alternative. However, larger study cohorts and longer durations of follow-up are necessary to provide data on the durability of aortic stent grafts and visceral artery reconstruction.

Clinical Applications of Extracorporeal Membranous Oxygenation: A Mini-Review.

UNLABELLED: The clinical usage of extracorporeal membranous oxygenation began more than 40 years ago. Although the indications for its use have expanded over the years, it has been challenging to conduct randomized controlled trials to prove that extracorporeal membranous oxygenation is more effective than traditional approaches. Through a review of retrospective reports and data from registries, we attempted to evaluate the appropriateness of its application for acute respiratory distress syndrome, cardiopulmonary resuscitation, postcardiotomy cardiogenic shock, and sepsis. Our investigation revealed that using extracorporeal membranous oxygenation when readily available is appropriate for all patients with cardiopulmonary resuscitation or postcardiotomy cardiogenic shock, and for selected patients with acute respiratory distress syndrome or sepsis. KEY WORDS: Acute respiratory distress syndrome; Cardiopulmonary resuscitation; Extracorporeal membranous oxygenation; Postcardiotomy cardiogenic shock; Sepsis.

Type A aortic dissection during transoesophageal echocardiography: a case report.

Background: The occurrence of type A aortic dissection (TAAD) during transoesophageal echocardiography (TEE) has only been reported once. We present another case of pre-procedural type B AD with retrograde TAAD or de novo TAAD during the TEE procedure. Case summary: An 81-year-old man with a pre-existing infrarenal abdominal aortic aneurysm and highly tortuous aorta was referred to our ward for acute decompensated heart failure (ADHF) with New York Heart Association functional class II. On hospital Day 2, the patient complained of intermittent dull pain over chest and back; ADHF or acute coronary syndrome was suspected. On Day 3, we transferred the patient to the intensive care unit due to ADHF with cardiogenic shock attributed to fluid overload, atrial fibrillation with rapid ventricular response, and severe mitral regurgitation with severely impaired left ventricular ejection fraction. Given the heightened surgical risk, TEE was performed to evaluate the eligibility of mitral transcatheter edge-to-edge repair. The first mid-oesophageal long-axis view showed no evidence of dissection. After 20 min, the same view showed the occurrence of TAAD. Urgent contrast CT confirmed a TAAD extending from the aortic root to the infrarenal abdominal aorta. Due to the prohibitive risk for surgical repair of TAAD, the patient received palliative care and unfortunately passed away on hospital Day 6. Discussion: Albeit rare, TAAD could progress or de novo occur during TEE, especially in high-risk patients. Therefore, high alertness during TEE procedures is imperative. Moreover, in patients with AD and poor renal function, the risk of using TEE as an alternative diagnostic modality should be carefully considered.

Dual ProGlide versus ProGlide and Angio-Seal for Femoral Access Hemostasis after Transcatheter Aortic Valve Replacement: A Randomized Comparative Trial.

BACKGROUND: Vascular complications increase morbidity and mortality after transcatheter aortic valve replacements(TAVR), often related to failures in vascular closure devices(VCD). We intended to compare the dual Perclose ProGlide(PP) strategy to the hybrid combination of PP and Angio-Seal(AS) for femoral access hemostasis after TAVR. METHODS: A randomized controlled trial with 257 patients comparing dual PP to one PP and one AS(AS+PP) for vascular closure after transfemoral TAVR was conducted. The primary endpoint was the composite of TAVR access site-related vascular complications and life-threatening type 2/3 or 1 bleeding according to VARC-3. Secondary endpoints included additional VCD use and significant peripheral ischemia related to arteriotomy closure within one year. Modified VCD failure, defined as failure to achieve hemostasis within 5 minutes or requiring additional endovascular maneuvers, was also recorded. RESULTS: The AS+PP combination yielded lower rates of the primary endpoint(18.2% vs 29.8%; p = 0.0381), vascular complication(18.2% vs 29.8%; p = 0.0381), additional VCD usage(0.8% vs 19.0%; p < 0.0001), and modified VCD failure(9.9% vs 33.1%; p < 0.0001) than the dual PP. Bleeding complication rates were similar between the two groups. Three-month follow-up vascular duplex tests showed similar common femoral artery(CFA) diameters and peak systolic velocities(PSV) between the two groups, but additional intervention had higher PSV and smaller CFA diameters than those without. CONCLUSIONS: The combined PP+AS for large-bore femoral access hemostasis following TAVR promises to be more effective and safer than dual PP in terms of vascular complications. Moreover, additional intervention for vascular complications resulted in smaller CFA diameters(ClinicalTrials.gov number, NCT05491070).

Crossover chimney technique to preserve the internal iliac artery in abdominal aortic aneurysm with common iliac artery aneurysms.

PURPOSE: To report a new technique to preserve the internal iliac artery (IIA) in cases of aortoiliac aneurysms. TECHNIQUE: Under bilateral common femoral artery (CFA) exposure, a crossover sheath was inserted from the contralateral CFA to the ipsilateral IIA involved in the common iliac artery (CIA) aneurysm. A Viabahn stent-graft was positioned 2 cm inside the IIA. The main body abdominal stent-graft was inserted through the ipsilateral CFA with distal sealing in the external iliac artery (EIA). The gate was cannulated, and the limb extension was positioned in the contralateral CIA near the IIA orifice. After the first Viabahn deployment, a second device was deployed with a minimum 1-cm overlap inside the first Viabahn and 2 mm distal to the limb extension. For bilateral CIA aneurysms, the Viabahn and extension limb were landed in the EIA with IIA embolization. In the past year, this technique has been used in 5 patients with success. There was no acute branch occlusion or type I endoleak from the IIA or chimney graft gutters on imaging studies up to 6 months. CONCLUSION: This technique is easy to use and avoids the brachial access of the sandwich technique and the additional cost of an iliac branch device.

Hybrid repair of simultaneous multiple mycotic aortic aneurysms.

Simultaneous mycotic aortic aneurysms are a rare but life-threatening complication. We describe the technique of one stage hybrid open debranching and endovascular repair using three thoracic stent-graft devices deployed to cover the whole aorta to exclude multiple mycotic aneurysms.

Case report: Total arch replacement with a frozen elephant trunk utilizing open hybrid in-situ fenestration technique for thoracic aortic arch aneurysm.

Introduction: The frozen elephant trunk technique is a surgical procedure developed for concomitant repair of downstream descending thoracic aorta as a first stage operation for arch resections. Proximalization of the sutured anastomosis reduces technical difficulty of total arch replacement. In this procedure, an anastomosis is performed more proximally using a stent graft. Connect the head and neck vessels are created using in-situ fenestration method. Case presentation: This study presents the case of a 78-year-old woman with a large thoracic aortic arch aneurysm that was successfully treated with a modified frozen elephant trunk technique (open in situ fenestration). For this method, a hole was created in the neck branches (the left subclavian artery and left common carotid artery), and peripheral stent grafts were placed to simplify neck branch reconstruction. This minimized the risk of recurrent laryngeal nerve injury and bleeding and shortened the procedure time. Conclusion: The outcomes of this study showed a safe alternative total arch replacement procedure.

Results of streamlining TAVR procedure towards a minimalist approach: a single center experience in Taiwan.

Trans-femoral transcatheter aortic valve replacement (TF-TAVR) performed under conscious sedation (LACS) is not yet become routine practice in Taiwan. We aimed to compared the results between patients received general anesthesia (GA) versus LACS. Our cohort was divided into 3 groups: initial 48 patients received TF-TAVR under routine GA (GA group), subsequent 50 patients under routine LACS (LACS group 1), and recent 125 patients under LACS (LACS group 2). The baseline, procedural characteristics and all outcomes were prospectively collected and retrospectively compared. From Sep 2010 to July 2019, a total of 223 patients were included. The procedure time (157.6 ± 39.4 min vs 131.6 ± 30.3 vs 95.2 ± 40.0, < 0.0001), contrast medium consumption (245.6 ± 92.6 ml vs 207.8 ± 77.9 vs 175.1 ± 64.6, < 0.0001), length of intensive care unit (2 [1-5] days vs 2 [1-3] vs 1 [1-1], P = 0.0001) and hospital stay (9 [7-13] days vs 8 [6-11] vs 6 [5-9], P = 0.0001) decreased significantly with LACS, combined with a trend of less hospital acquired pneumonia (12.5% vs 6.0% vs 5.6%, P = 0.427). 1-year survival rate were also different among 3 groups (83.3% vs 90.0% vs 93.6%, P = 0.053). In our single center experience, a "minimalist" approach of TF-TAVR procedure resulted in less medical resources usage, along with more favorable clinical outcomes.

A Randomized Trial of Postoperative Handgrip Exercises for Fistula Maturation in Patients With Newly Created Wrist Radiocephalic Arteriovenous Fistulas.

Introduction: We aimed to substantiate the benefit of postoperative handgrip exercises (HGEs) in enhancing the maturation of an arteriovenous wrist fistula. Methods: We randomly assigned 119 patients aged 20 to 80 years who had wrist arteriovenous fistulas (AVFs) to undergo either a basic HGE program (group A), an advanced program (group B), or an advanced-plus upper arm banding program (group C). Outcomes were assessed by ultrasonographic evaluation of the diameter and flow at each follow-up. The attending nephrologist decided the clinical use of the fistula. Results: We identified no significant differences among the HGE groups in the mean diameter and blood flow 14, 30, 60, and 90 days after the creation of the wrist AVF (P = 0.55, 0.88, 0.21, and 0.19 for the diameter; 0.94, 0.81, 0.49, and 0.56 for the flow, respectively). The intent-to-treat analysis also found no difference in the clinical use of fistulas for hemodialysis (HD) (P = 0.997). Conclusion: In patients with a newly created wrist AVF, advancing frequency, with or without adding intensity using an upper arm tourniquet, of postoperative HGEs did not enhance the growth of the fistula or increase the rate of clinical use over 3 months. (ClinicalTrials.gov ID: NCT03077815).

Serial neurocognitive changes following transcatheter aortic valve replacement: comparison between low and intermediate-high risk groups.

BACKGROUND: Data comparing the neurocognitive trajectory between low and intermediate-high risk patients following transcatheter aortic valve replacement (TAVR) is never reported. AIMS: To report serial neurocognitive changes up to 1 year post-TAVR in low and intermediate-high risk groups as well as overall cohort. METHODS: Prospective neurological assessments (NIHSS and Barthel Index), global cognitive tests (MMSE and Alzheimer Disease Assessment Scale-Cognitive Subtest, ADAS-cog) and executive performances (Color Trail Test A and B and verbal fluency), were applied at baseline, 3 months and 1 year post-TAVR. RESULTS: In overall cohort, persistent improvement to 1 year in MMSE, ADAS-cog, Color Trail Test A and B was found. According to the STS score, the study cohort was divided into low (<4%, N = 81) and intermediate-high (≧4%, N = 75) risk groups. The baseline neurologic and cognitive performance was significantly worse in intermediate-high risk group. Slight improvement on general neurological functions (Barthel index and proportion of NIHSS>0 patients) at 1 year could be observed only in intermediate-high risk group. In global cognitive assessments, improvement in MMSE and ADAS-cog at 1 year was found in both groups, but the proportion of cognitive improvement was more obvious in intermediate-high risk group. In Color Trail Tests and verbal fluency, significant and persistent improvement up to 1 year could be observed only in low risk group. CONCLUSIONS: TAVR was associated with persistent improvement in global cognitive function, as well as in attention and psychomotor processing speed, up to 1 year in overall cohort. However, improvement in tests for executive functions can only be seen in low risk group.

Infected aneurysms of the suprarenal abdominal aorta.

BACKGROUND: Infected aneurysm of the suprarenal abdominal aorta is rare and can be fatal without surgery. There have been only sporadic case reports or small case series. We review our experience with 14 patients over 13 years. METHODS: Retrospective chart review. RESULTS: Between 1997 and 2010, 14 cases of infected aneurysms of the suprarenal abdominal aorta were treated at our hospital. There were 11 men with median age of 75.5 years (range, 35-88). Of the 13 pathogens isolated, the most common responsible microorganism was nontyphoid Salmonella in eight (62%) followed by Staphylococcus aureus in three (23%) and Streptococcus in two patients (15%). At the first admission, six patients had medical treatment alone, five patients underwent early open in situ graft repair, and three patients underwent hybrid endovascular stenting and visceral debranching. Of the six medically treated patients, two patients died in the hospital because of aneurysm rupture, and two patients underwent late open in situ graft repair because of aneurysm progression or rupture. Of the five open surgically treated patients, one patient died in the hospital because of nosocomial sepsis, and four patients were alive without major postoperative complication. Of the three endovascularly treated patients, one patient died in the hospital because of intestinal ischemia, one patient died 6 months later because of postoperative complication, and one patient was alive with complications of paraplegia, renal failure, and permanent dialysis. The aneurysm-related mortality rate was 33% (2/6) in medical treatment alone, 20% (1/5) in open in situ grafting, and 67% (2/3) in hybrid endovascular stenting. CONCLUSIONS: Infected aneurysm of the suprarenal abdominal aorta was rare. Nontyphoid Salmonella was the most common responsible microorganism. Open in situ graft repair remained a preferred and durable treatment strategy.

Retrospective comparison of clinical outcomes between endovenous laser and saphenous vein-sparing surgery for treatment of varicose veins.

BACKGROUND: The purpose of the present study was to compare management of varicose veins by endovenous laser ablation (EVL) and a vein-sparing procedure (CHIVA: Conservatrice et Hémodynamique de l'Insuffisance Veineuse en Ambulatoire) for management of varicose veins. METHODS: Data from 82 consecutive patients with great saphenous vein (GSV) reflux and primary varicose veins presenting to the vascular clinic at the Far Eastern Memorial Hospital between June and December 2005 were reviewed. Of these, 74 who met the inclusion criteria were included in this study. CHIVA was performed by a double division of the refluxing saphenous vein (i.e., proximal and distal ligation), and EVL was performed using 10-14 W beginning approximately 4 cm below the saphenofemoral junction to the level of the knee. Phlebectomy for significant branch varicose veins on the leg was routinely performed in all patients. Outcome measures included postoperative thrombophlebitis, bruising, pain, assessment of ultrasonographic and clinical symptoms (measured by the Venous Clinical Severity Score [VCSS]) and comparison of quality of life survey scores obtained preoperatively and postoperatively (measured by the Aberdeen Varicose Veins Score [AVVQ] and RAND-36). Patients were examined one week post-procedurally and again at 1, 3, 6, and 12 months. RESULTS: Endovenous laser ablation and CHIVA were performed on 54 and 20 patients, respectively. The EVL patients had significantly higher pain scores and bruising than the CHIVA group (p<0.001). The VCSS of varicose, edema, pigmentation, and inflammation were significantly reduced after both EVL and CHIVA; however, patients treated by EVL had significantly more pain postoperatively than those treated by CHIVA (p=0.003). Twenty-two of 54 (40.7%) and 3 of 17 (17.6%) patients in the EVL and CHIVA groups, respectively, required sclerotherapy for residual varicosities (p=0.026). Both groups benefited significantly from surgery in disease-specific perceptions. CONCLUSIONS: The CHIVA patients had less pain postoperatively and a significantly higher sclerotherapy-free period compared to patients in the EVL group. Further follow-up studies to compare long-term results of various approaches to surgically managing varicose veins are needed.

Impact of conduction disturbances on left ventricular mass regression and geometry change following transcatheter aortic valve replacement.

Our study aimed to compare the difference of LV mass regression and remodeling in regard of conduction disturbances (CD) following transcatheter aortic valve replacement (TAVR). A prospective analysis of 152 consecutive TAVR patients was performed. 53 patients (34.9%) had CD following TAVR, including 30 (19.7%) permanent pacemaker implantation and 23 (15.2%) new left bundle branch block. In 123 patients with 1-year follow-up, significant improvement of LV ejection fraction (LVEF) (baseline vs 12-month: 65.1 ± 13.2 vs 68.7 ± 9.1, P = 0.017) and reduced LV end-systolic volume (LVESV) (39.8 ± 25.8 vs 34.3 ± 17.1, P = 0.011) was found in non-CD group (N = 85), but not in CD group (N = 38). Both groups had significant decrease in LV mass index (baseline vs 12-month: 148.6 ± 36.9 vs. 136.4 ± 34.7 in CD group, p = 0.023; 153.0 ± 50.5 vs. 125.6 ± 35.1 in non-CD group, p < 0.0001). In 46 patients with 3-year follow-up, only non-CD patients (N = 28) had statistically significant decrease in LV mass index (Baseline vs 36-month: 180.8 ± 58.8 vs 129.8 ± 39.1, p = 0.0001). Our study showed the improvement of LV systolic function, reduced LVESV and LV mass regression at 1 year could be observed in patients without CD after TAVR. Sustained LV mass regression within 3-year was found only in patients without CD.