RESUMEN
The COVID-19 pandemic exposed the vulnerabilities of global health care systems, underscoring the need for innovative solutions to meet the demands of an aging population, workforce shortages, and rising physician burnout. In recent years, wearable technology has helped segue various medical specialties into the digital era, yet its adoption in vascular surgery remains limited. This article explores the applications of wearable devices in vascular surgery and explores their potential outlets, such as enhancing primary and secondary prevention, optimizing perioperative care, and supporting surgical training. The integration of artificial intelligence and machine learning with wearable technology further expands its applications, enabling predictive analytics, personalized care, and remote monitoring. Despite the promising prospects, challenges such as regulatory complexities, data security, and interoperability must be addressed. As the digital health movement unfolds, wearable technology could play a pivotal role in reshaping vascular surgery while offering cost-effective, accessible, and patient-centered care.
Asunto(s)
COVID-19 , Procedimientos Quirúrgicos Vasculares , Dispositivos Electrónicos Vestibles , Humanos , Procedimientos Quirúrgicos Vasculares/instrumentación , Procedimientos Quirúrgicos Vasculares/efectos adversos , COVID-19/epidemiología , Telemedicina/instrumentaciónRESUMEN
Background: The COVID-19 pandemic has changed everyday life and work in many ways. As travelling to meetings and conferences was almost completely suppressed for most of healthcare professionals, e-Learning became increasingly prominent. The overall utility of e-Learning during the COVID-19 pandemic as well as its shortcomings in the international community of vascular surgery were assessed through the EL-COVID study. Regional variability was observed amongst participating nations, which is currently being addressed through several ongoing subgroup analyses. Our study completes the aforementioned efforts and aims to investigate the adherence and adoption of vascular e-Learning in Germany. Methods and participants: Using an online survey, EL-COVID gathered answers from 856 vascular surgeons, of whom 70 were located in Germany. We analyzed the answers of 62 German responders that attended at least one e-Learning activity and compared them with the remaining worldwide data. Results: Out of all European countries, Germany was best represented and ranked second worldwide after Mainland China (n=109). 30.6 percent of the German responders were female (vs. 20% worldwide; p=0.048) and 56.4% were vascular surgeons with >5 years of practice (vs. 56.3; p=0.975). The international cohort generally engaged in more e-Learning. Most German participants attended less than 4 online activities, while only 24.2% took part in more than 4 such events (vs. 56.3; p<0.0001). While the overall impression of e-Learning activities during the COVID-19 pandemic was positive, German employers were less supportive of participation during working hours (30.6% vs. 44%; p=0.042). The main reason for not attending was lack of time due to increased workload (56.5% vs. 50%; p=0.328). National and international societies played a lesser role in promoting such activities in Germany (22.6% vs. 39.2%; p=0.010), the same accounts for social media (16.1 vs. 30.3; p=0.017). Conclusions: E-Learning complements the classical training methods and has been embraced as a relevant alternative in the time of the COVID-19 pandemic. The results of this survey appeal to German employers and national societies to improve support and dissemination of e-Learning activities in the vascular medicine community.
Asunto(s)
COVID-19 , Instrucción por Computador , COVID-19/epidemiología , Femenino , Alemania/epidemiología , Humanos , Aprendizaje , Masculino , Pandemias , Encuestas y CuestionariosRESUMEN
We present the case of an adult male patient with an incomplete form of Shone's complex associated with bicuspid aortic valve and a double orifice mitral valve. Intraoperative inspection of the mitral valve showed double orifice configuration with a small, rudimentary left-sided mitral valve and a large, dominant, right-sided parachute mitral valve with Barlow-type of degeneration. The patient underwent reconstruction of both valves through a minimally invasive incision. At one year echocardiographic control both valves function normally.
Asunto(s)
Anomalías Múltiples , Cardiopatías Congénitas/diagnóstico , Estenosis de la Válvula Mitral/diagnóstico , Válvula Mitral/cirugía , Procedimientos Quirúrgicos Cardíacos/métodos , Ecocardiografía , Cardiopatías Congénitas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Estenosis de la Válvula Mitral/cirugíaRESUMEN
BACKGROUND: Our retrospective single-center study aimed to evaluate the safety of the carotid endarterectomy (CEA) in comparison to patients with untreated asymptomatic carotid stenosis ≥60% before CABG. METHODS: This single-center retrospective study included 174 patients with asymptomatic unilateral carotid stenosis treated between 2004 and 2017 with CABG. Thereof 106 patients had CEA before cardiac surgery either by a simultaneous (n = 62) or staged (n = 44) approach. Patients with untreated carotid stenosis served as control (no-CEA group; n = 68). RESULTS: The mean stenosis grade was higher in the CEA group (CEA 83% (±1), no-CEA 71% (±1) p < 0.0001). The overall stroke rate was 5/174 (3%) and was due to a high incidence of stroke in the no-CEA group (CEA: 0/106 (0%); No-CEA 5/68 (7%) p = 0.0083). The overall mortality was 1% and comparable between the groups (CEA: 2/106 (2%); No-CEA 0/68 (0%) p = 0.5211). Stroke related mortality was not observed. The groups were similar regarding the incidence of myocardial infarction (p = 1.0), atrial fibrillation (p = 0.1931), delirium (p = 0.2106) and IMC/ICU stay (p = 0.1542). No significant difference in the subgroup analysis was found between the simultaneous and staged approach regarding the myocardial infarction (simultaneous: 1/62 (1%); staged: 1/44 (1%); p = 1.0). CONCLUSIONS: CEA performed as a staged procedure in local anesthesia or a simultaneous procedure in general anesthesia, may reduce the stroke risk prior to CABG.
Asunto(s)
Estenosis Carotídea/terapia , Tratamiento Conservador , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Endarterectomía Carotidea , Anciano , Enfermedades Asintomáticas , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/mortalidad , Tratamiento Conservador/efectos adversos , Tratamiento Conservador/mortalidad , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/mortalidad , Endarterectomía Carotidea/efectos adversos , Endarterectomía Carotidea/mortalidad , Femenino , Humanos , Masculino , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: We investigated the mid-term results of carotid-axillary bypass (CAB) in the setting of zone II thoracic endovascular aortic repair as an alternative method for the left subclavian artery (LSA) revascularization. METHODS: Our retrospective, single cohort study included all 69 patients from March 2015 to December 2018 with zone II thoracic endovascular aortic repair and CAB for the revascularization of the LSA. Demographics and clinical data were collected. We assessed several clinical outcomes: local complications (hematoma, injury of the brachial plexus, vagus and sympathetic chain nerve palsies, chyle leakage), subclavian steal, arm ischemia, paraplegia, mortality, and stroke. Follow-up computed tomography scans were analyzed for CAB and vertebral artery (VA) patency and the extent of thrombus formation in the LSA. RESULTS: The in-hospital mortality was 3% and the perioperative stroke rate was 4%. Permanent paraplegia occurred in 3%. Perioperative morbidity included irritation of the brachial plexus (1%), sympathetic chain nerve palsy (1%), and wound hematoma in 3% of the cases. Phrenic and vagus nerve lesions and chyle leakage were not observed. Bypass patency was 97% at mean follow-up of 333 ± 39 days. VA occlusion was found in 6% of all cases. Strokes did not occur during the follow-up. Morbidity at follow-up included arm claudication (3%) in two patients with bypass thrombosis. Subclavian steal was observed in 3%. The LSA ostium was ligated (44%), plugged (22%), or left open (35%) in patients without a type II endoleak. Subgroup analysis of LSA thrombosis to the level of the VA was more prevalent after surgical ligature (P = .02), but had no negative effects on CAB or VA patency or stroke. CONCLUSIONS: CAB is a safe alternative to classic debranching procedures, with distinctive advantages regarding local complication rates described in the literature.
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Enfermedades de la Aorta/cirugía , Arteria Axilar/cirugía , Arteria Carótida Común/cirugía , Procedimientos Endovasculares/métodos , Complicaciones Posoperatorias/epidemiología , Anciano , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Arteria Axilar/diagnóstico por imagen , Arteria Carótida Común/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Procedimientos Endovasculares/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Stents , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Arteria Subclavia/cirugía , Síndrome del Robo de la Subclavia/epidemiología , Síndrome del Robo de la Subclavia/etiología , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
OBJECTIVES: Our aim was to compare aortic remodelling in type B dissections after thoracic endovascular aortic repair (TEVAR) or conservative treatment. METHODS: We conducted a retrospective analysis of computed tomography (CT) data sets at dissection onset and at the last follow-up in a group with conservative (group A) and TEVAR treatment (group B). An additional analysis of the preoperative CT images was performed in patients from group A, who were converted to TEVAR during follow-up. Diameters and lengths of all aortic segments were measured and growth rates were calculated. RESULTS: We included 74 patients: 50 patients in group A (follow-up time: 1625 ± 209 days) and 24 patients in group B (follow-up time: 554 ± 129 days). The mean aortic diameter growth rate was significantly higher in group A than in group B in the mid-descending aorta (A: +7 mm/year; B: -4 mm/year; P = 0.003). Length growth difference was only present in the abdominal aortic segment and was more pronounced in group A (+2 vs ±0 mm/year; P = 0.009). The conversion rate from conservative treatment to TEVAR was 36% (n = 18). A false lumen diameter of >22 mm at baseline was associated with a higher rate of conversion (P = 0.036). After conversion, the mean growth rate in the proximal descending and mid-descending aorta decreased from preoperative +11 and +18 mm/year to postoperative -9 and -14 mm/year, respectively (P < 0.001). CONCLUSIONS: In acute type B dissections, TEVAR stops aortic enlargement in the thoracic aorta, but promotes distal dilatation compared to the conservative treatment group. After conversion to TEVAR in conservatively pretreated chronic type B dissections, a more pronounced diameter decrease in the descending aorta was observed than in patients treated in the acute phase.
Asunto(s)
Aneurisma de la Aorta/terapia , Disección Aórtica/terapia , Tratamiento Conservador , Procedimientos Endovasculares , Remodelación Vascular , Adulto , Anciano , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/patología , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/patología , Implantación de Prótesis Vascular , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: Pulmonary hypertension (PH) is a frequent occurrence and a negative prognostic indicator in patients with mitral regurgitation. Preoperative PH causes higher early and late mortality rates after heart surgery, adverse cardiac events, and postoperative systolic dysfunction in the left ventricle (LV). METHODS: The research consisted of a retrospective study of a group of 171 consecutive patients with mitral regurgitation and preoperative PH who had undergone mitral valve surgery between January 2008 and October 2011. The PH diagnosis was based on echocardiographic evidence (systolic pulmonary artery pressure [sPAP] >35 mm Hg). The echocardiographic examination included assessment of the following: LV volume, LV ejection fraction (LVEF), sPAP, right ventricular end-diastolic diameter, right atrium area indexed to the body surface area, the ratio of the pulmonary acceleration time to the pulmonary ejection time (PAT/PET), tricuspid annular plane systolic excursion (TAPSE), determination of the severity of the associated tricuspid regurgitation, and presence of pericardial fluid. Surgical procedures consisted of mitral valve repair in 55% of the cases and mitral valve replacement in the remaining 45%. Concomitant coronary artery bypass grafting (CABG) surgery was carried out in 52 patients (30.41%), and De Vega tricuspid annuloplasty was performed in 29 patients (16.95%). The primary end point was perioperative mortality. The secondary end points included the following: pericardial, pleural, hepatic, or renal complications; the need for a new surgical procedure; postoperative mechanical ventilation >24 hours; length of stay in the intensive care unit; duration of postoperative inotropic support; need for an intra-aortic balloon pump; and need for pulmonary vasodilator drugs. RESULTS: The mortality rate was 2.34%. In the univariate analysis, the clinical and echocardiographic parameters associated with mortality were preoperative New York Heart Association (NYHA) class IV, the PAT/PET ratio, TAPSE, the indexed area of the right atrium, and concomitant CABG surgery. In the multivariate analysis, the indexed area of the right atrium and concomitant CABG surgery remained statistically significant. The multivariate analysis also showed the indexed area of the right atrium, LVEF, presence of pericardial fluid, preoperative NYHA class, and concomitant CABG surgery as statistically significant for the secondary end point. The receiver operating characteristic (ROC) curves identified an sPAP value >65 mm Hg to have the highest specificity and sensitivity for the risk of perioperative death in mitral regurgitation patients (area under the ROC curve [AUC], 0.782; P < .001) and identified an sPAP value of 60 mm Hg as the secondary end point (AUC, 0.82; P < .001). Severe PH (sPAP >60 mm Hg) is associated with a significant increase in the mortality rate; a longer stay in the intensive care unit; a mechanical ventilation duration >24 hours; lengthy inotropic support; renal, hepatic, and pericardial complications; and a need for endothelin receptor antagonists, phosphodiesterase type 5 inhibitors, and/or prostanoids, both in the general group and in patients with preserved systolic functioning of the left ventricle. CONCLUSIONS: PH is a strong short-term negative prognostic factor for patients with mitral regurgitation. The surgical procedure should be performed in the early stages of PH. Echocardiographic examination has useful, simple, and reproducible tools for classifying operative risks. An ischemic etiology and a need for concomitant CABG surgery are additional risk factors for patients with mitral regurgitation and PH.