Journal of Clinical Medicine最新文献

{"title":"Impact of Hepatitis B Infection on Patient and Graft Survival After Kidney Transplantation.","authors":"Anissa Paschereit, Vivien Greese, Kayo Sakurayama, Michael Duerr, Fabian Halleck, Lutz Liefeldt, Mira Choi, Klemens Budde, Marcel G Naik","doi":"10.3390/jcm14062124","DOIUrl":"10.3390/jcm14062124","url":null,"abstract":"<p><p><b>Objectives</b>: Chronic Hepatitis B virus (HBV) infection is a significant global health issue, with dialysis patients at increased risk and reduced response to HBV vaccination. The effects of HBV serological status on kidney transplant outcomes, particularly for patients with resolved or inactive HBV infection, needs more data, especially from current era. This study evaluated the impact of chronic and non-active HBV infection on patient and graft survival after kidney transplantation. <b>Methods</b>: Retrospective analysis was conducted of kidney-only transplant recipients at our center from 1 January 1990 to 31 August 2019 (end of observation). Patients were grouped by their HBV serostatus before transplantation into three categories: HBV negative (HBsAg-/Anti-Hbc-), non-active HBV infection (HbsAg-/Anti-Hbc+) and chronic HBV infection (HbsAg+/Anti-Hbc+). Primary outcomes included patient survival, graft survival, and overall graft and patient survival, analyzed using Kaplan-Meier (KM) curves, log-rank tests, Restricted mean survival times (RMST), and Accelerated failure time (AFT) models. <b>Results</b>: Among 2490 patients, 2197 were HBV negative, 218 had non-active HBV, and 75 had chronic HBV. Over a mean follow-up of 8.1 years, mortality and graft failure rates were highest in chronic HBV patients (49% and 37%), followed by non-active HBV (39% and 29%) and HBV-negative patients (30% and 20%). KM analysis revealed significantly lower overall survival rates for chronic HBV and non-active HBV groups compared to HBV-negative patients (<i>p</i> = 0.006). RMST confirmed significant reductions in survival for the non-active group (12.57 vs. 14.17 years, <i>p</i> = 0.007). Cox regression and AFT models identified older recipient/donor age, Hepatitis-C-virus coinfection, and broad antigen mismatches as negative predictors, while living donors improved outcomes. <b>Conclusions</b>: While unadjusted Kaplan-Meier curves and RMST analysis suggested differences in patient and graft survival, further thorough multivariable AFT analysis did not show a significant association between non-active or chronic HBV infection and patient or graft survival after kidney transplantation.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Freezing of Gait in Parkinson's Disease: A Machine-Learning-Based Approach in ON and OFF Medication States.","authors":"Georgios Bouchouras, Georgios Sofianidis, Konstantinos Kotis","doi":"10.3390/jcm14062120","DOIUrl":"10.3390/jcm14062120","url":null,"abstract":"<p><p><b>Background</b>: Freezing of gait (FoG) is a debilitating motor symptom of Parkinson's disease (PD), characterized by sudden episodes where patients struggle to initiate or sustain movement, often describing a sensation of their feet being \"glued to the ground.\" This study investigates the potential of machine-learning (ML) models to predict FoG severity in PD patients, focusing on the influence of dopaminergic medication by comparing gait parameters in ON and OFF medication states. <b>Methods</b>: Specifically, this study employed spatiotemporal gait features to develop a predictive model for FoG severity, leveraging a random forest regressor to identify the most influential gait parameters associated with this in each medication state. The results indicate that the model achieved higher predictive performance in the OFF-medication condition (R² = 0.82, MAE = 2.25, MSE = 15.23) compared to the ON-medication condition (R² = 0.52, MAE = 4.16, MSE = 42.00). <b>Results</b>: These findings suggest that dopaminergic treatment alters gait dynamics, potentially reducing the reliability of FoG predictions when patients are medicated. Feature importance analysis revealed distinct gait characteristics associated with FoG severity across medication states. In the OFF condition, step length parameters, particularly left step length mean, were the most dominant predictors, alongside swing time and stride width, indicating the role of spatial and temporal gait control in FoG severity without medication. In contrast, under the ON medication condition, stride width and gait speed emerged as the most influential predictors, followed by stepping frequency, reflecting how medication influences stability and movement rhythm. <b>Conclusions</b>: These findings highlight the need for predictive models that account for medication-induced gait variability, ensuring more reliable FoG detection. By integrating spatiotemporal gait analysis and ML-based prediction, this study contributes to the development of personalized intervention strategies for PD patients experiencing FoG episodes.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11942655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Accuracy of Restoration of the Individual Hip Anatomy Using Custom-Made Prostheses in Total Hip Arthroplasty.","authors":"Maximilian F Kasparek, Anna Jungwirth-Weinberger, Kirubakaran Pattabiraman, Marios Loucas, Devanand Hulmani, Maximilian Muellner, Tobias Scheidl, Oliver Haider, Thomas Muellner","doi":"10.3390/jcm14062115","DOIUrl":"10.3390/jcm14062115","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Femoral or acetabular deformities are important factors in development of early osteoarthritis. In particular, young patients benefit from individual anatomical restoration by decreasing the risk of early loosening and wear and achieving a good clinical outcome. <b>Methods</b>: This prospective study evaluates the use of a custom-made prosthesis in anterior approach total hip arthroplasty (THA). Pre- and postoperative imaging included conventional X-rays as well as computer tomography (CT) with a specialized protocol to analyze femoral diaphysis width, horizontal and vertical offset, caput-collum-diaphyseal (CCD) angle, leg length, femoral and acetabular anteversion angles, and the position of the center of rotation. <b>Results</b>: A total of 22 hips (11 female, 11 male) with a mean age of 55.8 years underwent THA with a custom-made prosthesis (Symbios^®). Accurate restoration has been shown for offset, leg length, and femoral anteversion. The custom stems showed a good fit within the femoral canal. <b>Conclusions</b>: This custom-made prosthesis has been shown to be a valuable option for the treatment of hip osteoarthritis in young patients, with adequate restoration of the preoperative anatomy.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer Is a Major Determinant of Postoperative Atrial Fibrillation After Cardiac Surgery.","authors":"Georgios P Georghiou, Andrew Xanthopoulos, George Kanellopoulos, Panos Georghiou, Amalia Georgiou, John Skoularigis, Grigorios Giamouzis, Konstantinos Lampropoulos, Ioannis Patrikios, Filippos Triposkiadis","doi":"10.3390/jcm14062117","DOIUrl":"10.3390/jcm14062117","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Postoperative atrial fibrillation (POAF) occurs frequently after cardiac surgery and is associated with increased morbidity and mortality. The pathogenesis of POAF in this setting is complex and not completely understood. Since cancer is a well-known risk factor for AF, the aim of this study was to identify potential predictors, including cancer, of POAF after cardiac surgery. <b>Methods</b>: This prospective study included 400 consecutive patients in sinus rhythm who underwent elective cardiac surgery in Aretaeio Hospital (Nicosia, Cyprus) from January 2020 till January 2023. The primary outcome was the development of POAF during hospitalization, defined as any documented AF episode lasting >30 s. Predictors of the primary outcome were studied using univariable and multivariable logistic regression analysis. <b>Results</b>: Of the 400 patients (68 [61-73] years, 64 [16%] females) studied, 66 (16.5%) developed POAF. Among the variables examined, the only predictors of POAF were cardiopulmonary bypass time (odds ratio [OR] = 1.001, 95% confidence interval = [95% CI, 1.000-1.001], <i>p</i> = -0.031) and cancer (OR = 3.852, 95% CI = [1.535-9.664], <i>p</i> = 0.004). Cancer was present in 13 (4%) and in 10 (15%) of patients without and with POAF, respectively (<i>p</i> < 0.001). <b>Conclusions</b>: Cancer was associated with a dramatic increase in POAF risk early after elective cardiac surgery in this study. Whether patients developing POAF after cardiac surgery should be searched for cancer deserves further investigation.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy and Safety of Direct Oral Anticoagulants Compared to Warfarin for Left Ventricular Thrombus Resolution.","authors":"Mariana Sousa Paiva, Francisco Gama, Samuel Azevedo, Pedro M Lopes, Francisco Albuquerque, Carla Reis, Pedro Freitas, Sara Guerreiro, João Abecasis, Marisa Trabulo, António M Ferreira, Regina Ribeiras, Jorge Ferreira, Pedro Pulido Adragão","doi":"10.3390/jcm14062129","DOIUrl":"10.3390/jcm14062129","url":null,"abstract":"<p><p><b>Background and Aim:</b> Left ventricular thrombus (LVT) is a common complication of myocardial infarction (MI) and heart failure with reduced ejection fraction (HFrEF), typically managed with vitamin K antagonists (VKAs) for up to six months. However, data on direct oral anticoagulants (DOACs) for LVT treatment remain limited and conflicting. This study evaluates the effectiveness and safety of DOACs compared to warfarin for LVT resolution. <b>Methods</b>: We conducted a single-center retrospective cohort study of consecutive patients diagnosed with LVT from January 2010 to May 2024. The primary outcome was LVT resolution at 24 months. Safety outcomes included major bleeding and thromboembolic events. Diagnosis and follow-up were performed via echocardiography, with cardiac magnetic resonance and computed tomography as needed. Anticoagulant type, dose, duration, and concurrent antiplatelet therapy were at the treating physician's discretion. <b>Results</b>: Among 171 patients (82.5% male, mean age 59.8 ± 14.7 years), 99 received DOACs and 72 received warfarin. LVT resolution was higher with DOACs (66.7% vs. 50%, HR 2.0, 95% CI 1.07-3.73, <i>p</i> = 0.029), with a trend toward faster thrombus resolution (185 vs. 220 days, <i>p</i> = 0.214) though statistically not significant. DOAC use remained an independent predictor of LVT resolution, regardless of antiplatelet use. Major bleeding (2.9%), thromboembolic events (5.3%), and mortality (5.3%) were similar between groups. <b>Conclusions</b>: DOAC therapy was associated with higher LVT resolution rates and a comparable safety profile to warfarin. Further randomized clinical trials are warranted to validate these findings.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11942919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Radiation Shields to Minimize Operator Dose in the Bronchoscopy Suite: A Phantom Study and Clinical Application.","authors":"Hosang Jeon, Dong Woon Kim, Ji Hyeon Joo, Yongkan Ki, Suk-Woong Kang, Won Chul Shin, Seong Hoon Yoon, Yun Seong Kim, Seung Hyun Yong, Hyun Sung Chung, Taehoon Lee, Hee Yun Seol","doi":"10.3390/jcm14062114","DOIUrl":"10.3390/jcm14062114","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Fluoroscopy has been widely adopted in interventional pulmonology, as it facilitates real-time visualization of the bronchoscope, endobronchial ultrasound, and biopsy tools during procedures. The purpose of this study was to evaluate the effectiveness of radiation shields in minimizing scattered X-ray dose to the bronchoscopist in a phantom study and to determine the dose of scattered X-ray dose to medical staff with radiation shields in clinical application. <b>Methods</b>: An anthropomorphic torso phantom was positioned on the fluoroscopic table between the C-arm X-ray tube and the image detector to mimic bronchoscopic operations. Upper and lower body lead shields were used to examine the effectiveness of radiation shielding. Scatter radiation rates were assessed at a first operator location using real-time dosimeters with and without protective devices. In clinical application, the scattered X-ray dose of the first operator and main assistant was measured using wearable radiation dosimeters during 20 procedures. <b>Results</b>: In the phantom study, scattered radiation without shielding was 266.34 ± 8.86 μSv/h (glabella), 483.90 ± 8.01 μSv/h (upper thorax), 143.97 ± 8.20 μSv/h (hypogastrium), and 7.22 ± 0.28 μSv/h (ankle). The combination of upper and lower body lead shields reduced the scattered X-ray dose by 98.7%, 98.3%, 66.2%, and 79.9% at these levels, respectively. In clinical application, mean scattered X-ray dose rates were 0.14 ± 0.05 μSv/procedure (eye), 0.46 ± 0.51 μSv/procedure (chest), 0.67 ± 0.50 μSv/procedure (hypogastrium), and 1.57 ± 2.84 μSv/procedure (assistant's wrist). <b>Conclusions</b>: The combination of radiation shields significantly reduced the scattered X-ray dose at the operator site in the phantom study. The scattered X-ray dose to medical staff during bronchoscopy can be kept at a low level with the aid of a shielding system.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting the Hamstring Graft Size for ACL Reconstruction Using a 3D Tendon Model in Preoperative MRI.","authors":"Andreas Frodl, Moritz Mayr, Markus Siegel, Hans Meine, Elham Taghizadeh, Sebastian Bendak, Hagen Schmal, Kaywan Izadpanah","doi":"10.3390/jcm14062128","DOIUrl":"10.3390/jcm14062128","url":null,"abstract":"<p><p><b>Background:</b> Rupture of the ACL is a common injury among men and women athletes. While planning the surgical ACL reconstruction procedure, the eventual graft's diameter is extremely important. Many parameters are therefore evaluated pre-surgery to ensure access to reliable data for estimating the graft diameter. Considering this, magnetic resonance imaging (MRI), particularly qualitative analyses of the hamstring tendons, offers a promising approach. <b>Methods:</b> In a retrospective analysis, we carried out 3D segmentation of the gracilis (GT) and semitendinosus tendon (ST) utilizing MRI with varying slice thicknesses and field strengths. The cross-sectional area (CSA) was calculated on different levels (by relying on the models we had thus created) to generate a mean of CSA with six specific segments. We then correlated the mean CSA with the diameter of the graft measured during surgery. <b>Results:</b> A total of 32 patients were included (12 female, 20 male) in this retrospective analysis. We observed the largest CSA in segment 10 mm-0 (16.8 ± 6.1) with differences between men and women. The graft size and tendon diameter correlated significantly in all segments throughout our study cohort. The strongest correlation was apparent in the segment 10 mm-0 (r = 0.552). <b>Conclusions:</b> MRI-based 3D segmentation and the STGT CSA represent a reliable method for estimating preoperatively a quadrupled hamstring graft diameter. The 10 mm-0 mm segment above the joint line showed a strong correlation, making it an ideal reference for graft planning.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Cardiovascular Risk Among Polish Soldiers: Insights Using the POL SCORE Tool.","authors":"Magdalena Zawadzka, Justyna Marszałkowska-Jakubik, Ewelina Ejchman-Pac, Beata Pająk-Tarnacka, Paweł Szymański","doi":"10.3390/jcm14062130","DOIUrl":"10.3390/jcm14062130","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Maintaining the health and operational readiness of military personnel is a strategic priority, particularly in the context of cardiovascular diseases (CVDs), which remain a significant public health challenge in Poland. Despite a decline in mortality rates between 2006 and 2012, Poland continues to report higher premature mortality rates compared to the OECD average. This study highlights the importance of effective risk assessment and management strategies, employing the POL SCORE scale, an adaptation of the European Society of Cardiology's Systematic Coronary Risk Evaluation (SCORE) project. <b>Methods</b>: This study included 196 participants, comprising soldiers and civilian employees of the Ministry of National Defense, to assess their 10-year cardiovascular mortality risk. Data were collected using clinical evaluations and self-reported questionnaires. <b>Results</b>: Findings revealed that 66.3% of participants were at moderate risk, with significant differences observed based on gender and education level. Notably, the average triglyceride level was 219.3 ± 114.31 mg/dL in the very high-risk group, compared to 97.4 ± 41.31 mg/dL in the low-risk group. Stress, reported by 88.2% of participants, emerged as the most prevalent work-related risk factor. Alarmingly, a lack of awareness regarding cardiovascular risk factors was observed, particularly among high-risk individuals. <b>Conclusions</b>: This study underscores the need for targeted health education, regular preventive screenings, and psychological support, particularly among military personnel. These interventions are crucial to mitigating the burden of CVDs and ensuring the operational readiness of armed forces.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Cryoballoon and Ablation Index-Guided Radiofrequency Ablation in Paroxysmal Atrial Fibrillation.","authors":"Botond Bocz, Dorottya Debreceni, Kristof-Ferenc Jánosi, Dalma Torma, Peter Kupo","doi":"10.3390/jcm14062119","DOIUrl":"10.3390/jcm14062119","url":null,"abstract":"<p><p><b>Background</b>: Atrial fibrillation is the most common sustained arrhythmia worldwide. Pulmonary vein isolation (PVI) is the most effective catheter ablation technique for treating paroxysmal atrial fibrillation (pAF). Common ablation methods include point-by-point radiofrequency (RF) ablation and single-shot techniques such as cryoballoon ablation (CB). This single-center, prospective study aimed to compare the efficacy of ablation index-guided RF ablation (AI-RF) and CB in patients with symptomatic, antiarrhythmic-resistant pAF. <b>Methods</b>: A total of 154 patients undergoing initial PVI were divided into two groups (CB: 51, AI-RF: 103), based on the operators' decision. Procedural data (total procedure time, fluoroscopy time, radiation dose, complication rate) and recurrence rates were analyzed over a 12-month follow-up period. <b>Results</b>: The CB group had a significantly shorter total procedure time compared to the AI-RF group (64 [57; 74.8] minutes vs. 92 [76; 119] minutes; <i>p</i> < 0.001). However, the CB group experienced higher fluoroscopy times (559 [395; 868] seconds vs. 167 [126; 224] seconds; <i>p</i> < 0.001) and a greater fluoroscopy dose (21.8 [11.7; 40.1] mGy vs. 7.65 [5.21; 14.5] mGy; <i>p</i> < 0.001). Recurrence rates were similar during both the blanking period (11.7% vs. 10.7%; <i>p</i> = 0.84) and the 12-month follow-up period (22.7% vs. 13.4%; <i>p</i> = 0.22). No major complications were reported during this study. <b>Conclusions</b>: In this single-center study, there were no significant differences in long-term recurrence or complication rates between the CB and AI-RF groups for patients with antiarrhythmic-refractory, symptomatic pAF. While the CB group benefited from a significantly shorter procedure time, it required a higher fluoroscopy dose and a longer fluoroscopy time.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innominate Artery Graft Cannulation for Selective Antegrade Cerebral Perfusion in Aortic Surgery: Clinical Findings and Feasibility.","authors":"Ufuk Turkmen, Kudret Atakan Tekin, Gorkem Yigit, Ayla Ece Celikten, Ertekin Utku Unal","doi":"10.3390/jcm14062126","DOIUrl":"10.3390/jcm14062126","url":null,"abstract":"<p><p><b>Background</b>: Cerebral protection during aortic surgery is crucial for improving surgical outcomes and reducing neurological complications. Selective antegrade cerebral perfusion (SACP) is increasingly used, and innominate artery (IA) side graft cannulation presents an innovative alternative to conventional axillary artery cannulation, with the potential to reduce complications associated with the latter. <b>Methods</b>: In this retrospective study, 196 patients who underwent proximal aortic surgery with IA graft cannulation for SACP between January 2021 and June 2024 were analyzed. Demographic data, intraoperative parameters, and postoperative outcomes were evaluated. Complications such as new stroke, postoperative delirium, mortality, and acute renal failure (ARF) were assessed. <b>Results</b>: The median age of the patients was 63 years, and 18.37% underwent emergency surgery for Type A acute aortic dissection (TAAAD). The most frequently performed surgical procedure was ascending aorta and hemiarch replacement (36.74%). The median cardiopulmonary bypass, cross-clamp, and SACP durations were 120.5, 93, and 23 min, respectively. The postoperative mortality rate was 3.06%, stroke rate was 2.04%, delirium rate was 9.18%, and ARF rate was 3.06%. All cases of delirium resolved spontaneously within 2-3 days. The mortality rate among Marfan syndrome (MFS) patients was 4.35%, with no reported stroke cases in this group. <b>Conclusions</b>: IA graft cannulation is a safe and effective method for providing SACP in aortic surgery, particularly in high-risk patient groups such as those with TAAAD and MFS. This technique ensures optimal cerebral perfusion, minimizes neurological and systemic complications, and enhances surgical efficiency by reducing operative duration. However, large-scale, multicenter, and prospective studies are needed to evaluate its long-term efficacy and safety.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11942680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}