Serupsigmon1754

Few reports about surgical outcomes in malignant pleural mesothelioma (MPM) were based on reliable nationwide databases. Here we analyzed the incidence, surgical outcome, and operative risk factors using Japanese nationwide database.

Characteristics and perioperative data from 622 patients who underwent curative-intent surgery for MPM between January 2014 and December 2017 were recorded from National Clinical Database of Japan. We analyzed the incidence, surgical outcomes, and risk factors for surgical complications after two surgical procedures (extrapleural pneumonectomy, EPP; and pleurectomy/decortication, P/D).

During 4 years, EPP was performed in 279 patients and P/D in 343. EPP was more frequently performed in less-MPM-experienced institutions, while P/D was more frequently performed in well-MPM-experienced institutions (P < .001), especially in high-volume centers with more than 10 cases during this period. P/D was more frequently performed, especially in high-volume centers. The morbidity rates were 45.2% in EPP and 35.9% in P/D. Heart failure and pneumonia were most frequent in EPP, while prolonged air leakage was most frequent in P/D. Thirty-day- and in-hospital mortality rates were 1.1% and 3.2% (EPP) and 1.2% and 3.2% (P/D), respectively. Regression analyses revealed that higher age (>65 years) was associated with operative complications in EPP (odds ratio, OR 3.56 [1.26-8.56]), whereas no risk factor was observed in P/D.

In Japanese nationwide annual database, P/D was more frequently performed, especially in high-volume centers. Morbidity was higher in EPP than P/D; however, the mortality rates were quite low in Japan regardless surgical procedures.

In Japanese nationwide annual database, P/D was more frequently performed, especially in high-volume centers. Morbidity was higher in EPP than P/D; however, the mortality rates were quite low in Japan regardless surgical procedures.Functional tricuspid valve regurgitation in the contest of mitral valve disease is a highly prevalent disease. We describe a ring-less technique that combines restrictive annuloplasty (De Vega) with posterior tricuspid leaflet obliteration (Kay) used for patients with less-than-severe functional tricuspid valve regurgitation undergoing mitral valve surgery. The technique has been in use at our centre since 2012, showing promising long-term echocardiographic results, with stable reduction of the annulus size and stable reduction of the degree of regurgitation.

Percutaneous coronary intervention (PCI) is being performed more frequently for left main coronary artery disease (LMCAD). This study evaluated a real-world propensity-matched analysis of surgical versus percutaneous revascularization for LMCAD.

Adults (≥18 years) at a single academic institution undergoing coronary artery bypass grafting (CABG) or PCI for left main stenosis ≥50% between 2010-2018 were examined. Greedy propensity-matching techniques were used to generate well-matched cohorts, and Kaplan-Meier analysis was used to compare survival. Multivariable Cox models were created for 5-year mortality and major adverse cardiac and cerebrovascular events (MACCE).

1091 with LMCAD were identified (898 CABG, 193 PCI). Patients undergoing PCI were significantly older (77 vs 68 years, p<0.001), more likely to have heart failure (26.94% vs 13.14%, p<0.001), and were less likely to have 3-vessel disease (42.49% vs 65.59%, p<0.001). Propensity-matching yielded 215 CABG and 134 PCI well-matched patients. In the matched analysis, 1-year (77.61% vs 88.37%) and 5-year (48.77% vs 75.62%) survival were lower with PCI. Rates of MACCE at 5-years were also higher with PCI (64.93% vs 32.56%, p<0.001). Rates of both myocardial infarction (19.40% vs 7.44%, p=0.001) and repeat revascularization (26.12% vs 7.91%, p<0.001) were higher with PCI. Following risk adjustment, CABG remained associated with reduced risk of mortality (HR 0.40, 95% CI 0.29-0.54; p<0.001) and MACCE (HR 0.37, 95% CI 0.28-0.48; p<0.001) at 5 years.

This real-world, propensity-matched analysis demonstrates substantial advantages in survival and MACCE with CABG for LMCAD, supporting surgical revascularization in this clinical setting in appropriate operative candidates.

This real-world, propensity-matched analysis demonstrates substantial advantages in survival and MACCE with CABG for LMCAD, supporting surgical revascularization in this clinical setting in appropriate operative candidates.

The decision to treat moderate ischemic mitral regurgitation (IMR) at the time of coronary artery bypass surgery (CABG) remains controversial. We previously conducted a prospective randomized trial that showed a benefit of adding restricted annuloplasty to bypass surgery (CABG-Ring group) in terms of ischemic mitral regurgitation (IMR) grade, NYHA classification, and left ventricle reverse remodeling. Here, we present the long-term (>10 years) follow-up data from this randomized trial.

The original trial arms accounted for 54 patients in the CABG-alone and 48 in the CABG-Ring group; patients were re-contacted for follow-up to obtain relevant clinical and echocardiographic information.

The mean follow-up was 160.4±45.5 months. Survival probabilities in the CABG-alone and CABG-Ring groups were 96% vs. 93% at 3 years, 85% vs. 89% at 6 years, 79% vs. 85% at 9 years, 77% vs. 83% at 12 years, and 72% vs. 80% at 15 years, respectively (p=0.18) Freedom from at least moderate IMR or re-intervention at last follow-up was also higher in the CABG-Ring group (p<0.001). Compared to the CABG-alone group, the CABG-Ring group had a higher degree of left ventricular reverse remodeling (54.7±6.9 mm vs. Trimethoprim 51.6±6 mm, respectively; p=0.03), lower NYHA class (p<0.001), and a lower rate of re-hospitalization (p=0.002).

Long-term follow-up data from our randomized trial further support the utility of performing restricted annuloplasty at the time of CABG to prevent further progression of IMR, mitral re-intervention, and left ventricle remodeling. Untreated IMR was associated with significantly higher NYHA class and re-hospitalization.

Long-term follow-up data from our randomized trial further support the utility of performing restricted annuloplasty at the time of CABG to prevent further progression of IMR, mitral re-intervention, and left ventricle remodeling. Untreated IMR was associated with significantly higher NYHA class and re-hospitalization.