Scandinavian Journal of Surgery最新文献

{"title":"Challenges to preserve vascular access functioning after surgical correction for arteriovenous access ischemic steal in hemodialysis patients: A single-center study.","authors":"Eeva-Maija Weselius, Maria Söderström, Maarit Venermo","doi":"10.1177/14574969251319854","DOIUrl":"https://doi.org/10.1177/14574969251319854","url":null,"abstract":"<p><strong>Background and aims: </strong>Arteriovenous access ischemic steal (AVAIS) is a rare complication that causes morbidity and threatens hemodialysis access usability in patients with end-stage kidney disease (ESKD). This study aimed to determine the incidence of AVAIS over a 15-year period and assess the access usability after surgical correction.</p><p><strong>Methods: </strong>Access operations between January 2007 and August 2022 at Helsinki University Hospital were reviewed. Demographics, clinical, duplex, and contrast examinations with brachial artery volume flows, finger pressures, and delays to surgery were evaluated. Symptom relief, complications, access closures/re-interventions, primary, secondary, and functional patencies were assessed. Endpoints were permanent cessation of access use due to complication(s), transplantation, closure, definitive occlusion, or death.</p><p><strong>Results: </strong>Among 2914 access-related operations, the overall incidence of AVAIS was 2.2%. At the first vascular consultation 52% had ulcer(s) or gangrene(s) resulting in 28 direct closures, and 30 corrections as follows: 20 proximalization of arterial inflow (PAI), 6 flow reduction procedures, 2 distal revascularization with interval ligation (DRIL), 1 distal radial artery ligation (DRAL), and 1 venous bypass. The median time from consultation to surgery was 18 days (range: 0-348 days) for direct closures and 43 days (0-170 days) for corrective surgery. The functional patencies after correction were 60% at 1 year and 55% at 2 years; the primary patencies were 45% and 28% and secondary patencies 61% and 57%, respectively. The functional patencies after PAI were 41% and 31%, respectively.</p><p><strong>Conclusion: </strong>In AVAIS, access preservation is challenging in ESKD patients with multiple diseases. Attention should be paid to the original choice of vascular access by considering each patient's risks. Delay to vascular consultation and intervention should be minimized. PAI should be reserved for selected patients when no other option is preferable.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969251319854"},"PeriodicalIF":2.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical prediction model for gangrenous appendicitis: A retrospective single-center study.","authors":"Toshiyuki Suzuki, Akiyo Matsumoto, Daisuke Sugiki, Takahiko Akao, Hiroshi Matsumoto","doi":"10.1177/14574969251319853","DOIUrl":"https://doi.org/10.1177/14574969251319853","url":null,"abstract":"<p><strong>Background and aims: </strong>Gangrenous appendicitis, a type of complicated appendicitis, is an indication of emergency surgery due to a high risk of perforation. However, it can be challenging to diagnose preoperatively. This study aimed to validate the predictive factors of patients with gangrenous appendicitis and develop a novel scoring model based on objective parameters.</p><p><strong>Methods: </strong>This retrospective single-center study included 171 of 302 consecutive patients undergoing appendectomy between April 2014 and December 2023. Patients with perforation, chronic appendicitis, and appendicitis presenting with an abscess were excluded from the analysis. In other words, the study targeted Grades 1 and 2 on the American Association for the Surgery of Trauma (AAST) severity assessment scale. Computed tomography (CT) scan value was defined as the average value of fluid in the appendix lumen on plain CT scan. Univariate and multivariate analyses were performed to identify the independent objective predictors of gangrenous appendicitis. A new scoring model was developed based on the logistic regression coefficients of the independent predictors. The scores were then classified into three categories, and the probability of gangrenous appendicitis for each category was evaluated.</p><p><strong>Results: </strong>Overall, 46 (27%) and 125 (73%) patients presented with gangrenous appendicitis (=AAST Grade 2) and non-gangrenous (uncomplicated) appendicitis (=AAST Grade 1), respectively. The independent predictive factors of gangrenous appendicitis included a CT value of ≥24 HU, an appendiceal diameter of ≥12 mm, the presence of cecal mucosal edema, and a C-reactive protein level of ≥5.4 mg/dL. The scoring model, based on these four independent predictors, ranged from 0 to 4. The probability values of gangrenous appendicitis were 0%, 15%, and 97% in the low (0)-, moderate (1, 2)-, and high (3, 4)-risk categories, respectively.</p><p><strong>Conclusion: </strong>Our scoring model may assist in decision-making concerning emergency surgery and appendicitis management.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969251319853"},"PeriodicalIF":2.5,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduced length of stay and less systemic complications, implementation of the optimized DIEP recovery pathway.","authors":"Ina Korpiola, Päivi Merkkola-von Schantz, Elena Surcel, Susanna Kauhanen, Maiju Härmä","doi":"10.1177/14574969241312286","DOIUrl":"https://doi.org/10.1177/14574969241312286","url":null,"abstract":"<p><strong>Background and aims: </strong>The present study aimed to compare patients who underwent deep inferior epigastric perforator (DIEP) flap reconstruction with and without the implementation of the new optimized surgical recovery pathway. The new protocol aims to standardize and optimize perioperative management, shorten hospital stays, and lower complication rates for patients undergoing major surgical procedures.</p><p><strong>Methods: </strong>Consecutive patients who underwent immediate or delayed DIEP flap breast reconstruction were included in this study. Data regarding patient demographics, timing, laterality of reconstruction, hospital length of stay (LOS), and drain management were collected and compared for the pre-protocol group and the post-protocol group.</p><p><strong>Results: </strong>The pre-protocol group consisted of 65 patients, while the post-protocol group consisted of 68 patients. The two groups had similar total complication rates (pre-protocol 43.1% versus post-protocol 32.4%, <i>p</i> = 0.20). Between the two groups, there was a significantly lower rate of major surgical complications in the post-protocol group (pre-protocol 32.3% versus post-protocol 14.7%, <i>p</i> = 0.016). There were no significant differences between the groups regarding minor surgical complications (pre-protocol 7.7% versus post-protocol 17.6%, <i>p</i> = 0.086). In the pre-protocol group, the mean LOS was 6.1 days (range = 4-10, median = 6); in the post-protocol group, the mean LOS was 3.6 days (range = 3-10, median = 3; <i>p</i> < 0.00001). Majority of the post-protocol patients were discharged on postoperative day 3 (<i>n</i> = 47, 69.1%).</p><p><strong>Conclusion: </strong>Patients undergoing DIEP flap reconstruction can be discharged earlier without risking their safety by following the new protocol.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969241312286"},"PeriodicalIF":2.5,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of oncological outcomes of T1-3 N1 rectal cancer patients treated with neoadjuvant radiotherapy versus no radiotherapy: A retrospective cohort study.","authors":"Suvi Marjasuo, Laura Koskenvuo, Anna Lepistö","doi":"10.1177/14574969251319201","DOIUrl":"https://doi.org/10.1177/14574969251319201","url":null,"abstract":"<p><strong>Background and aims: </strong>Neoadjuvant short-course radiotherapy (SCRT) prior to surgery has been used to reduce local recurrences in moderately advanced rectal cancer (RC). Total mesorectal excision (TME) surgery by itself can reduce the local recurrence rate in these patients. The objective was to assess whether discontinuing neoadjuvant SCRT had a negative impact on survival and local recurrence rates of moderately advanced RC.</p><p><strong>Methods: </strong>This retrospective study examined 137 consecutive patients (67 neoadjuvant SCRT, 70 TME without neoadjuvant therapy) treated for rT1-3N1M0 RC without extramural venous invasion (EMVI) or a threatened surgical margin between January 2016 and March 2020 in a tertiary rectal surgery referral center. The primary objective was the impact of neoadjuvant therapy on overall, cancer-specific, and disease-free survival, and local recurrence rate. Secondary outcomes were risk factors affecting survival. The analyses were conducted on the total study cohort as well as a propensity score matched cohort of the same patient group, with the matching predicated upon age, gender, and histological T score.</p><p><strong>Results: </strong>The oncological outcomes were similar between the two different treatment groups. The 5-year cumulative overall survival rate, calculated using the Kaplan-Meier method, was 89.6% in the neoadjuvant SCRT group and 83.5% in the surgery-only group (<i>p</i> = 0.570), with the corresponding cancer-specific survival rates at 97.0% and 98.4% (<i>p</i> = 0.219) and disease-free survival rates at 97.0% and 91.9% (<i>p</i> = 0.438). No local recurrencies were detected in either group during the 5-year follow-up period.</p><p><strong>Conclusion: </strong>The omission of neoadjuvant SCRT in rT1-3N1M0 RC with no EMVI and no threatened resection margin caused no adverse effects on the survival of the patients. Based on this series, it appears that avoiding SCRT does not compromise the oncological outcome in these patients.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969251319201"},"PeriodicalIF":2.5,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of surgical specialization on long-term survival after emergent colon cancer resections.","authors":"Jenny Engdahl, Astrid Öberg, Sandra Bech-Larsen, Stefan Öberg","doi":"10.1177/14574969241312290","DOIUrl":"https://doi.org/10.1177/14574969241312290","url":null,"abstract":"<p><strong>Background: </strong>The impact of surgical specialization on long-term survival in patients undergoing emergent colon cancer resections remains unclear.</p><p><strong>Method: </strong>A retrospective analysis was conducted on all patients who underwent emergent colon cancer resections at a secondary care hospital between 2010 and 2020. The most senior surgeon performing the procedures was classified as colorectal surgeon (CS) or non-colorectal surgeon (NCS). NCS was further divided into acute care surgeons (ACSs) or general surgeons (GSs). Overall survival (OS) and cancer-free survival (CFS) were compared in patients operated by surgeons with different specializations.</p><p><strong>Results: </strong>A total of 235 emergent resections were performed during the study period, of which 99 (42%) were performed by CS and 136 (58%) by NCS. In adjusted Cox regression analyses, OS and CFS were similar in patients operated on by CS and NCS (hazard ratio (HR) for OS: 1.02 (0.72-1.496), <i>p</i> = 0.899 and HR for CFS: 0.91 (0.61-1.397), <i>p</i> = 0.660). Similarly, OS and CFS were equivalent in patients operated by ACS and CS (HR for OS: 1.10 (0.75-1.62), <i>p</i> = 0.629 and HR for CFS: 1.24 (0.80-1.92), <i>p</i> = 0.343). However, patients operated by GS had significantly shorter OS and CFS (HR for OS: 1.78 (1.05-3.00), <i>p</i> = 0.031 and HR for CFS: 1.83 (1.02-3.26), <i>p</i> = 0.041) compared with those operated by ACS and CS.</p><p><strong>Conclusion: </strong>Long-term survival after emergent colon cancer resections was similar in patients operated on by CS and NCS, and the subgroup of ACS, indicating equivalent comparable surgical quality. The less favorable poorer survival observed for patients operated on by GS may possibly be due to less frequent exposure to colorectal and emergent surgery.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969241312290"},"PeriodicalIF":2.5,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of reconstruction techniques after pancreatoduodenectomy: A single-center retrospective cohort study.","authors":"Iago Justo Alonso, Paola Peralta Fernández-Revuelta, Alberto Marcacuzco Quinto, Oscar Caso Maestro, Laura Alonso Murillo, Carlos Jiménez-Romero","doi":"10.1177/14574969241312287","DOIUrl":"https://doi.org/10.1177/14574969241312287","url":null,"abstract":"<p><strong>Background: </strong>There is controversy regarding which is the best reconstruction technique after the pancreatoduodenectomy. Currently, there are no studies comparing the three most frequent reconstruction techniques: Whipple + Roux-en-Y gastrojejunostomy (WRYGJ), pyloric-preserving + Billroth II (PPBII), and Whipple + BII (WBII).</p><p><strong>Methods: </strong>Between 2012 and March 2023, 246 patients underwent pancreaticoduodenectomy with the following type of reconstruction techniques: (1) WRYGJ: 40 patients; (2) PPBII: 118 patients; and (3) WBII: 88 patients. A retrospective comparative study among these groups was performed.</p><p><strong>Results: </strong>No significant differences were found among the groups regarding duration of the surgery, the blood volume transfused, or caliber of the Wirsung duct. The size and types of tumors, the degree of differentiation and tumor invasion of the peripancreatic tissue, vascular and neural structures, and lymph nodes were similar among the groups. The rate of R0 resection was lower in WBII (62.5% [55/88]) than in WRYGJ (75% [30/40]) and PPBII (72% [85/118]), but statistically insignificant among the groups (p = 0.232). The incidences of relevant B/C postoperative pancreatic fistula (POPF) were similar among the groups: 7.5% (7/40) in WRYGJ, 17% (20/118) in PPBI, and 26.2% (23/88) in WBII (p = 0.292). In addition, the incidence of B/C delayed gastric emptying (DGE) was higher in WBII (27.3% [24/88]) than in WRYGJ (20% [8/40]) and PPBII (19.5% [23/118]) but statistically insignificance among the groups (p = 0.381). The incidence of medical and surgical complications, intensive care unit and hospital stays, morbimortality at 90 days, and 5-year survival were similar among the groups. Multivariate analysis revealed that POPF grade B/C was a risk factor for DGE grade B/C (odds ratio (OR) = 9.903, 95% confidence interval (CI) = 4.829-20.310; p < 0.001), and a <3-mm Wirsung duct was a risk factor for POPF (OR = 3.604, 95% CI = 1.791-7.254; p < 0.001).</p><p><strong>Conclusion: </strong>No technique was superior to the others. Only relevant POPF B/C was a risk factor for DGE B/C, and <3 mm Wirsung for a POPF.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969241312287"},"PeriodicalIF":2.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stent stoma: Endoscopic stent insertion for refractory small intestine fistulas.","authors":"Marcus Kantowski, Peter Sauer, Michael Ardelt, Nathaniel Melling, Thomas Roesch, Chengcheng Christine Zhang","doi":"10.1177/14574969241310051","DOIUrl":"https://doi.org/10.1177/14574969241310051","url":null,"abstract":"<p><strong>Background and aims: </strong>The therapeutic management of fistulas presents significant challenges, often involving both conservative and surgical approaches. Despite these interventions, recurrence and postoperative mortality rates remain high. Endoscopic stent insertion into the fistula, along with the creation of a stent stoma, may offer a promising alternative for patients who fail surgical or conservative therapies. This study aimed to evaluate the feasibility, effectiveness, and safety of endoscopic stent insertion in the treatment of refractory small intestinal fistulas.</p><p><strong>Methods: </strong>Patients with refractory small intestine fistulas who underwent endoscopic stent insertion were included. The primary endpoint was defined as successful fistula treatment, which included an improvement in clinical symptoms related to the fistula, successful bridging to subsequent surgical revision, and the restoration of enteral nutrition. Secondary endpoints comprised the feasibility of the endoscopic procedure, complications, procedure-related complications, and in-hospital mortality.</p><p><strong>Results: </strong>Eight patients were included, with a median follow-up period of 2.7 months. The implantation of a self-expanding metal stent was successfully performed in all patients (technical success rate, 100%; <i>n</i> = 8/8). The clinical success rate was 87.5% (<i>n</i> = 7/8), indicating clinical improvement in fistula-related symptoms, wound care, and enteral nutrition. Procedure-related complications occurred in one patient (12.5%; <i>n</i> = 1/8), involving stent dislocation leading to small intestine perforation, which was managed endoscopically. No procedure-related mortality was observed.</p><p><strong>Conclusions: </strong>Endoscopic stent insertion is a feasible, effective, and safe option for the management of therapy-refractory small intestinal fistulas. The creation of a stent stoma improves patient quality of life.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969241310051"},"PeriodicalIF":2.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modern surgical treatments for lymphedema.","authors":"Marie Kearns, Susanna Kauhanen, Maria Mani","doi":"10.1177/14574969241300101","DOIUrl":"https://doi.org/10.1177/14574969241300101","url":null,"abstract":"<p><p>Lymphedema occurs when the lymphatic system is malformed, leaking or is damaged by infection or cancer treatment. Enlarged extremities due to extensive fluid retention and adipose tissue deposition, recurrent cellulitis, and the requirement for hard-to-wear compression garments lead to impaired limb function and decreased quality of life. This narrative review aims to elucidate classification, diagnostic tools, and conservative management strategies leading the path to patient selection for microsurgical reconstructive procedures or volume reduction procedures. The surgical approaches include reconstructive procedures such as lymphaticovenous anastomosis (LVA) and lymph node transfer and reductive procedures, mainly liposuction and occasionally excisional surgery. Comparing the efficacy of lymphedema surgeries is fully dependent on standardized and reproducible outcome measures. A growing body of knowledge has evolved pointing to the benefits of reconstructive microsurgery of the lymphatic system with or without surgical volume reduction. Tissue engineering and stem cell research leads the way for new approaches. However, several questions remain emphasizing the research needs. Ongoing multicentre trials aiming to elucidate the efficacy and accessibility of surgical treatments for this condition are on their way.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"14574969241300101"},"PeriodicalIF":2.5,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of oral administration of calcitriol to prevent symptomatic hypocalcemia after total thyroidectomy: Systematic review and meta-analysis.","authors":"Parisa A Dadkhah, Amirali Farshid, Reza Khademi, Shayan Yaghoubi, Ailin Asadzadeh, Nima Moharamnejad, Faezeh Jadidian, Seyed A Ziaei, Sepehr Haghshoar, Omid Salimi, Seyyed-Ghavam Shafagh, Negin Rabiei, Saleh Shahsavari, Samin Shokravi, Zahra Maroufi, Niloofar Deravi, Gisou Erabi, Mahdyieh Naziri","doi":"10.1177/14574969241251899","DOIUrl":"10.1177/14574969241251899","url":null,"abstract":"<p><strong>Background: </strong>One of the most common complications of total thyroidectomy is post-operative transient or persistent hypoparathyroidism that can cause symptomatic hypocalcaemia. To prevent this complication, shorten the period of hospitalization and reduce morbidity, routine supplementation of oral vitamin D and calcium has been suggested. This systematic review and meta-analysis aims to critically assess the association between pre-operative calcitriol supplementation and post-operative hypocalcaemia.</p><p><strong>Methods: </strong>Randomized controlled trial studies were identified by searching PubMed, Scopus, and Google Scholar databases up to 30 March 2023. Screening of titles, abstracts, and full texts of articles were performed, and data were extracted for a meta-analysis.</p><p><strong>Results: </strong>This meta-analysis includes data from nine randomized controlled trials with a total of 1259 patients but with significant heterogeneity. The results demonstrate that calcium levels were higher in patients who had pre-operative calcitriol supplementation, with a weighted mean difference (WMD) 0.18 (95% confidence interval (CI) = 0.00, 0.37). Pre-operative calcitriol supplementation did not lead to significant changes in parathyroid hormone (PTH) levels, with WMD -0.49 (95% CI: -1.91, 0.94).</p><p><strong>Conclusion: </strong>Pre-operative calcitriol supplementation leads to higher calcium levels, but the high heterogeneity of the included studies (79% to 98.7%) could affect the results.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"263-272"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141089188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The cardioprotective effects of adenosine-induced cardioplegic arrest versus saline in aortic valve replacement patients: A randomized controlled trial.","authors":"Mikko S Mattila, Kati M Järvelä, Markku J Rantanen, Suvi Tuohinen, Kjell C Nikus, Jari O Laurikka","doi":"10.1177/14574969241266716","DOIUrl":"10.1177/14574969241266716","url":null,"abstract":"<p><strong>Background and aims: </strong>Adenosine is a widely used potent cardioprotective drug, but the effect of an adenosine bolus in initial cardioplegia on cardioprotection in aortic valve replacement (AVR) patients has not been demonstrated. The aim of this double-blind randomized clinical trial was to compare intra-aortic adenosine bolus with saline on the postoperative myocardial function in patients undergoing AVR.</p><p><strong>Methods: </strong>Aortic valve stenosis patients scheduled for elective or urgent AVR surgery were randomized to receive either a 20 mg (4 mL) single dose of adenosine or a saline into the ascending aorta during the first cardioplegia infusion. The primary outcome was cardiac index (CI (L/min/m²) at four timepoints (before incision, after weaning from cardiopulmonary bypass (CPB), at 7 p.m. on the operation day, and at 6 a.m. the next morning). Secondary outcomes included left ventricular stroke work index, right ventricular stroke work index, and myocardial biomarkers at the same timepoints.</p><p><strong>Results: </strong>Between November 2015 and March 2018, 45 patients were recruited, 23 in the adenosine group and 22 in the placebo group. The last follow-up date was 17 March 2018. There were no statistically significant differences in CI (mean differences with 95% confidence interval (95% CI): 0.09 L/min/m² at baseline (-0.20 to 0.38), -1.39 L/min/m² (-3.47 to 0.70) at post-CPB, -0.39 L/min/m² (-0.78 to 0.004) at 7 p.m., and -0.32 L/min/m² (-0.68 to 0.05) at 6 a.m., (<i>p</i> = 0.066)), right ventricular stroke work index, (<i>p</i> = 0.24), or cardiac biomarkers between the groups. Left ventricular stroke work index was lower in the adenosine group (-3.66 gm/m² (-11.13 to 3.81) at baseline, -17.42 gm/m² (-37.81 to 2.98) at post-CPB, -3.36 gm/m² (-11.10 to 4.38) at 7 p.m., and -3.77 gm/m² (-10.19 to 2.66) at 6 a.m. (<i>p</i> = 0.021)).</p><p><strong>Conclusions: </strong>There were no differences between 20 mg adenosine bolus and saline in the first cardioplegia infusion in CI improvement in AVR surgery for aortic valve stenosis.EudraCT number: 2014-001382-26.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":"273-281"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}