Redo aortic valve replacement versus valve-in-valve trans-catheter aortic valve implantation: a UK propensity-matched analysis.

This study sought to compare the morbidity and mortality of redo aortic valve replacement (redo-AVR) versus valve-in-valve trans-catheter aortic valve implantation (valve-in-valve TAVI) for patients with a failing bioprosthetic valve. A multicenter UK retrospective study of redo-AVR or valve-in-valve TAVI for patients referred for redo aortic valve intervention due to a degenerated aortic bioprosthesis. Propensity score matching was performed for confounding factors. From July 2005 to April 2021, 911 patients underwent redo-AVR and 411 patients underwent valve-in-valve TAVI. There were 125 pairs for analysis after propensity score matching. The mean age was 75.2±8.5 years. In-hospital mortality was 7.2% (n=9) for redo-AVR versus 0 for valve-in-valve TAVI, p=0.002. Surgical patients suffered more post-operative complications, including intra-aortic balloon pump support (p=0.02), early re-operation (p<0.001), arrhythmias (p<0.001), respiratory and neurological complications (p=0.02 and p=0.03) and multi-organ failure (p=0.01). The valve-in-valve TAVI group had a shorter intensive care unit and hospital stay (p<0.001 for both). However, moderate aortic regurgitation at discharge and higher post-procedural gradients were more common after valve-in-valve TAVI (p<0.001 for both). Survival probabilities in patients who were successfully discharged from the hospital were similar after valve-in-valve TAVI and redo-AVR over the 6-year follow-up (log-rank p=0.26). In elderly patients with a degenerated aortic bioprosthesis, valve-in-valve TAVI provides better early outcomes as opposed to redo-AVR, although there was no difference in mid-term survival in patients successfully discharged from the hospital.

Systematic review of the role of thoracoscopic splanchnicectomy in palliating the pain of patients with chronic pancreatitis.

BACKGROUND: The management of opiate-dependent intractable abdominal pain caused by chronic pancreatitis remains challenging. The published series on the role, safety, feasibility, and efficacy of thoracoscopic splanchnicectomy are reviewed. METHODS: The MEDLINE, EMBASE, and PREMEDLINE databases were searched, and relevant English language publications were systematically retrieved. Data were pooled by two independent reviewers. RESULTS: Between 1994 and 2006, 302 patients were featured in 16 reports. The reports described 202 procedures as bilateral and 100 as unilateral. These procedures were associated with rates of 16.6% for morbidity, 1.3% for conversion to thoracotomy, 1.3% for reoperation to manage complications, and 0% for mortality. The mean postoperative hospital stay was 2.7 days. The mean success rate was 90% up to 6 months of follow-up evaluation, 75% at >6 to 15 months of follow-up evaluation, and 49% at >15 months to 5.7 years of follow-up evaluation. Further intervention for pain relief was required for 12.9% of the patients. CONCLUSION: Splanchnicectomy reduces pain and improves quality of life for patients with chronic pancreatitis. Patient selection determines success rates, but the early good results achieved decline with time elapsed after thoracoscopic splanchnicectomy.

Minimally invasive pancreatic surgery: the new frontier?

Recent advances in minimally invasive pancreatic surgery encompass laparoscopic, retroperitoneoscopic, endoscopic, thoracoscopic, and percutaneous approaches. Applications of endoscopic pancreatic surgery include laparoscopic resection, necrosectomy, drainage of pseudocysts, gastric and biliary bypass, and thoracoscopic splanchnotomy. This review provides an update on laparoscopic pancreatic resections. Over 400 cases of laparoscopic distal pancreatectomy (LDP) and enucleation (LEn) have been reported in the English literature, largely for benign disease. LDP and LEn have been associated with reductions in blood loss, morbidity, and hospital stay and a greater rate of splenic preservation compared with open surgery. Laparoscopic ultrasound is essential for intraoperative localization of insulinomas because failure of localization is the most common cause for conversion to laparotomy. The role of LDP with en bloc splenectomy and laparoscopic pancreaticoduodenectomy (LPD) for malignancy remains controversial. The majority of LPDs have been performed for malignancy. The short-term results of the limited world experience of 34 reported LPDs appear favorable.