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Background: Recent case studies demonstrate resolution of rheumatologic symptoms following implant explantation, raising concern around breast implant illness and associated inflammatory symptomatology. In patients with connective tissue disorders (CTD) and breast implants, we quantified the number of anti-inflammatory medications as a proxy for inflammation and disease burden before and after implant removal. Methods: Using the Clinformatics Data Mart Database, adult female patients from 2003 to 2021 were queried. Current Procedural Terminology codes were used to identify patients who underwent implant-based reconstruction and subsequent implant removal. International Classification of Diseases, Ninth (ICD-9) and Tenth Revision (ICD-10) codes identified patients with CTD. Filled prescriptions of anti-inflammatory drugs were quantified for each patient during the preoperative, perioperative, and postoperative windows surrounding breast implant removal. Results: Of 1015 patients meeting criteria (mean age 56 ± 12 years), 821 (81%) filled prescriptions during the preoperative window, 753 (74%) filled during the perioperative window, and 735 (73%) filled during the postoperative window. Patients filled significantly fewer postoperative prescriptions than preoperative prescriptions (P < .001).Statistically significant predictors of the number of anti-inflammatory prescriptions filled in the postoperative window included additional anti-inflammatory prescriptions filled in the preoperative (P < .001) and perioperative (P < .001) windows. Experiencing a complication was not associated with the number of prescriptions filled in the postoperative window (P = .935). Conclusions: We found a significant decrease in filled anti-inflammatory prescriptions in patients with known CTD following implant removal, suggesting that breast implant removal may help diminish inflammatory symptomology in predisposed patients.
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INTRODUCTION: Silicone breast implants are widely prevalent. An increasing group of patients detail self-reported somatic and psychological symptoms that have been ascribed as breast implant illness (BII) and seek capsulectomy and implant removal. To guide consultations and shared decision making, more outcome data relating to this intervention are required. AIM: To present a multicentre study of patient-centred (nâ¯=â¯100) outcome data, following total capsulectomy with implant removal for BII. METHOD: A questionnaire survey was cross-referenced with medical records. Collected data included demographics, operation details, pre- and postoperative symptom scores, overall self-perceived percentage improvement in BII symptoms and breast shape satisfaction ratings after explantation. RESULTS: The 10 most frequently self-reported symptoms were fatigue (81%), pains/aches (72%), brain/memory fog (56%), mood disturbances (36%), neuropathic pain (28%), hair loss (28%), headaches (25%), gastric symptoms/intolerances (24%), eczema/rash (18%) and vision disturbance (17%). A high proportion of patients (98%) experienced a 62⯱â¯4% average symptom improvement; most self-reported symptoms (21/28) improved significantly after explantation with total capsulectomy (pâ¯<â¯0.05). Furthermore, patients had high overall self-perceived BII percentage improvement (76⯱â¯3%) and satisfaction with breast shape numerical rating score (8⯱â¯0.30) postoperatively. CONCLUSION: Despite BII not being a defined disease entity, symptom association with silicone breast implants continues for a growing number of patients. It is important to recognise that in this patient group, capsulectomy and implant removal may not be curative, however we have demonstrated that symptom improvement can occur. It is very difficult to prove a causal link between breast implants and BII; to do so will require extensive prospective data collection.
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Purpose: The Hydrus microstent was approved by the FDA in August 2018 for use with cataract surgery to reduce IOP in patients with mild to moderate primary open angle glaucoma (POAG). Pivotal clinical trials demonstrated its overall safety and efficacy in lowering IOP. However, malpositioning of the implant can result in uveitis-glaucoma-hyphema (UGH) syndrome necessitating device explantation. Here we report four such cases and their associated challenges. We also highlight the importance of early recognition of post-operative complications for ease of implant removal. Observations: Case 1: A 75-year-old female patient was referred for chronic granulomatous anterior uveitis with cystoid macular edema (CME) and uncontrolled IOP in the left eye after cataract extraction with Hydrus implantation. On gonioscopy, the implant was occluded and embedded in the iris. The patient underwent removal of the Hydrus implant 10 months after the initial surgery with canaloplasty to control IOP.Case 2: A 71-year-old male patient on dual anti-platelet developed intraoperative hyphema during cataract extraction with Hydrus microstent in the right eye. Post-operatively, clopidogrel was stopped, but hyphema persisted with uncontrolled IOP. The Hydrus was noted to be syneched against the iris face. The patient underwent anterior chamber washout with Hydrus explantation and Ahmed glaucoma valve implantation 16 days after the first surgery.Case 3: A 76-year-old patient developed persistent granulomatous anterior uveitis in the left eye after cataract extraction with Hydrus microstent. On gonioscopy, the Hydrus ostium was seen resting on the iris without occlusion, and the patient underwent Hydrus removal with nasal goniotomy 3 months after initial surgery.Case 4: A 63-year-old patient underwent cataract extraction with endoscopic cyclophotocoagulation and a complex Hydrus microstent implantation requiring multiple attempts. Eleven months later, the patient was found to have uveitis-glaucoma-hyphema syndrome and macular edema, and the Hydrus was noted to be insufficiently inserted and posteriorly rotated with contact against the iris. The Hydrus was explanted, and nasal goniotomy was performed. Conclusions and importance: Hydrus microstents that are malpositioned can result in persistent uveitis-glaucoma-hyphema syndrome. Explantation between 2 weeks and 11 months successfully resolved post-operative uveitis and hyphema, but all cases required additional glaucoma-hyphema syndrome. Early recognition is important since late removal was more challenging due to the implant becoming embedded in the iris.
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Background: This study aims to describe a prospective clinical cohort of patients with silicone breast implants and suspected Breast Implant Illness (BII). Methods: Women were included in a specialized silicone outpatient clinic at Amsterdam UMC, the Netherlands. Baseline characteristics were collected including medical history, implant details, and symptoms. Experienced physicians categorized BII suspicion as high, moderate, or low, based on symptoms and after exclusion of other probable causes. Additionally, participants completed questionnaires assessing symptoms and daily life impact at baseline, 6 months, 1, 2, and 5 years. For this initial analysis, the results from the first three years of inclusions were collected. Results: Data from 353 women were collected from December 2020-December 2023. At baseline, the most reported symptoms were fatigue, arthralgia, myalgia, and morning stiffness, accompanied by local symptoms in 83.3% of patients. At the clinic, 112 women were categorized as having high suspicion of BII, 147 women as moderate, and 94 women as low. At follow-up, 182 women (51.6%) opted for explantation. Following explantation, women with a high or moderate suspicion of BII experienced more significant symptom improvement, accompanied by a decrease in anxiety and a greater sense of control over their illness, compared to women with a low suspicion of BII. Conclusions: Our study highlights a distinct interplay of systemic and local symptoms among women with suspicion of BII. Women with a high or moderate BII suspicion benefit significantly more from explantation than women with low suspicion. Experienced physicians are pivotal in effectively assessing and guiding this patient group, highlighting the need for tailored clinical approaches.
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BACKGROUND: Implantable Cardioverter Defibrillator (ICD) implantation has significantly modified the natural history of patients at high risk of sudden cardiac death (SCD) in various types of heart diseases. However there is a high rate of psychological distress and reduced quality of life in patients with an ICD, more evident in younger individuals. The ICD removal upon patient request is a very rare event and causes many clinical and ethical issues. METHODS: The article discusses the case of a young patient affected by hypertrophic obstructive cardiomyopathy, who underwent implantable cardioverter defibrillator (ICD) implantation as a primary prevention of sudden cardiac death (SCD). Two years after the implantation, the patient repeatedly requested removal of the ICD due to of a significant and untreatable psychological device intolerance. RESULTS: Intervention became possible only after extensive psychological evaluation, which excluded specific pathology, and the ratification of Italian law 219/2017 on informed consent and advance directives, which guarantees the patient's independent decisions on current and future medical treatment. The explantation was performed 7 years after the implant. The patient is alive and in good health. CONCLUSIONS: The paper debates the issues related to establishing a patient-physician relationship based on respect for the patient's autonomy and experience of illness, in reference to principles such as beneficence and non-maleficence, and the conflicts that sometimes arise between them. If a paternalistic approach in the patient-physician relationship evolves into a patient-centered model, it is more certain that the patient's choice is realistically known and shared, and that it is consistent with the patient's values and life goals. The shared decision making (SDM) process and the use of pathology-specific decision aids are able to transform the informed consent tool, usually related to medical-legal issues, into an aid for true partnership between the patient and the medical care team.
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As a consequence of the growing number of implanted transcatheter aortic valve prostheses, the increasing incidence of early and late complications of biological valves requires in several cases surgical explantation of the transcatheter valve and subsequent aortic root or surgical aortic valve replacement. In this video tutorial, we show how to avoid aortic root damage in the surgical explantation of a transcatheter aortic valve bioprosthesis in a patient with a dysfunctional transcatheter aortic valve prosthesis affected by endocarditis 15 months after implantation. The infected prosthesis and all foreign materials, concomitant to the calcified native valve, were excised en bloc in preparation for the extensive debridement of infected tissue in the abscess cavity. The defect on the aortic annulus was reconstructed using a pericardial patch, followed by a surgical valve implant.
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Válvula Aórtica , Bioprótesis , Prótesis Valvulares Cardíacas , Infecciones Relacionadas con Prótesis , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Válvula Aórtica/cirugía , Prótesis Valvulares Cardíacas/efectos adversos , Bioprótesis/efectos adversos , Infecciones Relacionadas con Prótesis/cirugía , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/diagnóstico , Endocarditis/cirugía , Endocarditis/etiología , Remoción de Dispositivos/métodos , Masculino , Estenosis de la Válvula Aórtica/cirugía , Reoperación , Anciano de 80 o más Años , Implantación de Prótesis de Válvulas Cardíacas/métodos , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Endocarditis Bacteriana/cirugía , Endocarditis Bacteriana/etiología , Endocarditis Bacteriana/diagnóstico , AncianoRESUMEN
BACKGROUND: Chronic pain after minimally invasive inguinal hernia repair with mesh can have debilitating effects on quality of life (QOL), limiting daily activities and ability to work. Many medical and surgical options for treatment have been proposed, however there is no consensus on the role of mesh explantation in the management of these patients. METHODS: We performed a retrospective review of all patients who underwent groin mesh removal by robotic or laparoscopic approach from July 2012 to July 2023 at our institution. Patients were interviewed post-operatively to determine their overall pain scores and QOL was assessed using the Carolinas Comfort Scale (CCS) Questionnaire. Patient characteristics, operative times, pre-operative imaging techniques and analgesia use was also recorded. RESULTS: Twenty-two patients underwent groin mesh removal for chronic pain, including 12 robotic and 10 laparoscopic operations. The mean pre-operative pain score in all patients was 7.6/10 compared to 4.0/10 post-operatively. The mean post-operative CCS score was 24, indicating moderate discomfort. Four patients demonstrated CCS scores <11 indicating no discomfort and no patients demonstrated CCS scores >90, indicating severe debilitating discomfort. The majority of patients had a reduction or total cessation of analgesia intake post-operatively. CONCLUSION: Both laparoscopic and robotic mesh explantation for treatment of chronic pain post-inguinal hernia repair is safe and effective in achieving a reduction in pain and reducing the need for long-term analgesia.
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BACKGROUND: The number of women seeking explantation of their breast implants has increased in recent years. Anxiety due to potential health problems has been one of the major catalysts. Mastopexy with or without autoaugmentation and fat grafting are the main techniques used in breast implant removal surgery. OBJECTIVES: To analyse the aesthetic and satisfactory outcomes after simple breast implant removal assisted by targeted compression. METHODS: Twenty-eight patients were included in the series. Targeted compression of the breast after implant removal was performed during the 1st month. A satisfaction survey using a Likert scale was used before and after the final visit. The patients were followed up for 1 year. RESULTS: The mean age of the patients was 41 years old, and the mean time between implantation and removal was 10 years. Subjective reasons for removal (46.4% of the patients) were more frequent in women with less time since implantation (5 years) versus 15 years for implant-related problems. A total of 57.14% of the women were satisfied with the aesthetic result, and 42.86% were very satisfied. Only 17.8% of the total would consider an aesthetic refinement. CONCLUSIONS: Simple breast implant removal yields good aesthetic outcomes, and patients are satisfied with the results. Good management of compression of the breast and close follow-up to treat any collection in the pocket provides good adhesion and allows for effective management of the process of deflation and setting of the breast mound. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Histoplasma vascular graft infection (VGI) is rarely reported, with only a handful of instances documented in the existing literature. Reporting Histoplasma VGI cases is important as they demonstrate previous treatment strategies and their outcomes. In this paper, we report a case of disseminated histoplasmosis with ascending aortic graft infection. Conservative therapy was attempted initially but failed, and our patient eventually required surgical graft explantation. Our case demonstrates the challenges in diagnosing and managing VGI caused by Histoplasma capsulatum.
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BACKGROUND: The path and interaction of leads within the cardiovascular system are influenced by various factors, including the implantation technique. Furthermore, the multifaceted composition of these leads, often comprising multiple materials, can contribute to their potential degradation and wear over time. OBJECTIVES: Our aim was to investigate the wear of lead insulation following the removal of transvenous leads and pinpoint the regions of the lead most vulnerable to damage. MATERIAL AND METHODS: We undertook a prospective analysis of patients from a single tertiary center who underwent transvenous lead explantation (TLE) between October 1, 2013, and July 31, 2015. Specifically, our examination focused on endocardial leads removed using simple screw-out and gentle traction techniques. Subsequent lead evaluations were conducted utilizing scanning electron and optical microscopes. RESULTS: Among the 86 patients who underwent the TLE procedure, 26 patients (30%) required the removal of 39 leads through simple traction. Inspection using scanning electron microscopy consistently indicated insulation damage across all leads. A total of 347 damaged sites were identified: 261 without lead unsealing and 86 exhibiting unsealing. Notably, the sections of the leads located within the intra-pocket area demonstrated the highest vulnerability to damage (odds ratio (OR): = 9.112, 95% confidence interval (95% CI): 3.326-24.960), whereas the intravenous regions displayed the lowest susceptibility (OR: 0.323, 95% CI: 0.151-0.694). CONCLUSIONS: Our study reveals that all evaluated leads exhibited insulation damage, with the intra-pocket segments manifesting a notably higher prevalence of damage than the intravenous segments.
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PURPOSE: To clarify the characteristics of intraocular lens (IOL) dislocation requiring IOL suture or intraocular scleral fixation. METHODS: This retrospective consecutive case series included 21 eyes (21 patients) who required sutured or sutureless intrascleral IOL fixation following IOL extraction owing to IOL dislocation at the outpatient clinic in the Department of Ophthalmology, Saitama Red Cross Hospital, Japan, between January and December 2019. Medical records were retrospectively reviewed for background diseases, location of the dislocated IOL (intracapsular/extracapsular), insertion of a capsular tension ring (CTR), and the period from IOL insertion to dislocation. RESULTS: We included 21 eyes of 21 patients who required IOL suture or intrascleral fixation for IOL dislocation at our clinic from January to December 2019 were included. The most common background disease was pseudoexfoliation syndrome (four cases), followed by atopic dermatitis, dysplasia/dehiscence of the zonule, post-retinal detachment surgery, high myopia, and uveitis (three cases each). At the time of dislocation, the IOLs were either intracapsular (16 cases, including 3 cases with CTR insertion) or extracapsular (5 cases). The time from IOL insertion to IOL dislocation was 13.7 ± 8.1 years (maximum: 31.3 years, minimum: 1.7 years). CONCLUSIONS: In this study, all 21 cases represented late IOL dislocations occurring after 3 months postoperatively. Among these late IOL dislocation cases, IOL dislocation occurred in a short-medium period of time, especially in those with CTR insertion and weakness/dehiscence of the zonule, with an average of 3 to 5 years postoperatively. We propose referring to these cases as intermediate-term IOL dislocation.
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Migracion de Implante de Lente Artificial , Lentes Intraoculares , Humanos , Estudios Retrospectivos , Femenino , Masculino , Anciano , Persona de Mediana Edad , Migracion de Implante de Lente Artificial/cirugía , Migracion de Implante de Lente Artificial/etiología , Migracion de Implante de Lente Artificial/diagnóstico , Lentes Intraoculares/efectos adversos , Anciano de 80 o más Años , Factores de Tiempo , Agudeza Visual , Adulto , Esclerótica/cirugía , Técnicas de Sutura , Estudios de Seguimiento , Implantación de Lentes Intraoculares/métodos , Implantación de Lentes Intraoculares/efectos adversos , Complicaciones PosoperatoriasRESUMEN
Von Willebrand disease is an inherited disorder characterized by deficiency of von Willebrand factor, which contributes to platelet adhesion to the endothelium. Patients with coagulation disorders present a challenge at the time of surgery due to the high risk of presenting heavy bleeding within the procedure or postoperative hematomas. We present a case of a 56-year-old woman with Type 1 von Willebrand's disease who was scheduled for breast explantation with autologous reconstruction, due to the presence of long-standing breast implants. The case was satisfactorily managed by a multidisciplinary team formed by plastic surgery, hematology, and anesthesiology, individualizing the management for the patient's case, obtaining good results and a safe procedure.
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BACKGROUND: The etiology of transcatheter aortic valve (TAV) degeneration is poorly understood, particularly noncalcific mechanisms. OBJECTIVES: The authors sought to investigate noncalcific and calcific mechanisms of TAV degeneration and evaluate their impact on leaflet function by bench testing, imaging, and histology. METHODS: TAV explants were obtained from the EXPLANT THV registry and clinical institutions. Hydrodynamic assessment was performed using a heart valve pulse duplicator system under physiological conditions. Micro-computed tomography, high-resolution photography, high speed video, and hematoxylin and eosin staining were used to evaluate the morphological appearance, leaflet kinematics, and calcium burden of TAVs. RESULTS: A total of 14 explants were evaluated: 10 self-expanding CoreValve/Evolut TAVs (Medtronic), 3 balloon-expandable SAPIEN 3 TAVs (Edwards Lifesciences), and 1 mechanically expandable Lotus TAV (Boston Scientific). The median patient age at explantation was 73.0 years (Q1-Q3: 64.5-80.0 years), with a time to explantation of 4 years 1 month (1 year 5 months to 4 years 11 months). Six TAV explants were found to have leaflet calcification (162.4 mm3; 58.8-603.0 mm3), and 8 had no calcification detectable by micro-computed tomography and histology. All samples had impaired leaflet kinematics. There was no significant difference in the hydrodynamic mean gradient between calcified (47.2 mm Hg; 26.6-74.1 mm Hg) and noncalcified (27.6 mm Hg; 15.2-36.7 mm Hg; P = 0.28) TAVs. Leaflet calcification had a weak but nonsignificant association with the hydrodynamic mean gradient (r = 0.42; P = 0.14). CONCLUSIONS: TAV function can be severely impacted by noncalcific and calcific mechanisms of tissue degeneration. Importantly, functional stenosis can occur in TAVs in the absence of obvious and significant calcification.
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Válvula Aórtica , Calcinosis , Prótesis Valvulares Cardíacas , Hidrodinámica , Diseño de Prótesis , Falla de Prótesis , Sistema de Registros , Reemplazo de la Válvula Aórtica Transcatéter , Microtomografía por Rayos X , Humanos , Anciano , Válvula Aórtica/fisiopatología , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Válvula Aórtica/patología , Calcinosis/fisiopatología , Calcinosis/diagnóstico por imagen , Calcinosis/patología , Calcinosis/cirugía , Femenino , Anciano de 80 o más Años , Masculino , Reemplazo de la Válvula Aórtica Transcatéter/instrumentación , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Persona de Mediana Edad , Factores de Tiempo , Remoción de Dispositivos , Estenosis de la Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Hemodinámica , Fenómenos Biomecánicos , Ensayo de Materiales , Grabación en VideoRESUMEN
(1) Background: Medical devices, especially neuromodulation devices, are often explanted for a variety of reasons. The removal process imparts significant forces on these devices, which may result in device fracture and tissue trauma. We hypothesized that a device's form factor interfacing with tissue is a major driver of the force required to remove a device, and we isolated helical and linear electrode structures as a means to study atraumatic removal. (2) Methods: Ductile linear and helical microwire structure electrodes were fabricated from either Gold (Au) or Platinum-Iridium (Pt-Ir, 90-10). Removal forces were captured from synthetic gel models and following chronic implantation in rodent and porcine models. Devices were fully implanted in the animal models, requiring a small incision (<10 mm) and removal via tissue forceps. (3) Results: Helical devices were shown to result in significantly lower maximal removal forces in both synthetic gel and rodent studies compared to their linear counterparts. Chronically (1 yr.), the maximal removal force of helical devices remained under 7.30 N, for which the Platinum-Iridium device's tensile failure force was 32.90 ± 2.09 N, resulting in a safety factor of 4.50. (4) Conclusions: An open-core helical structure that can freely elongate was shown to result in reduced removal forces both acutely and chronically.
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BACKGROUND: Magnetic sphincter augmentation (MSA) explantation is an uncommon occurrence, and there are limited studies characterizing factors predictive of MSA explantation. This study aimed to create a nomogram to aid in determining the probability of explantation in patients before MSA implantation. METHODS: An institutional review board-approved, prospectively maintained database was retrospectively reviewed for all patients undergoing antireflux surgery between February 2015 and May 2023. All patients who underwent MSA-related procedures were included. Patients were divided into 2 groups, explant group and nonexplant group, and differences were analyzed. A multivariable logistic regression model was fitted to identify independent risk factors for predicting MSA explantation, and a nomogram-based scoring tool was developed. RESULTS: There were 227 patients (134 females and 93 males) with a mean age of 51.4 years. The explant group included 28 patients (12.3%), whereas the nonexplant group included 199 patients (87.7%). Patient sociodemographic characteristics, medical comorbidities, preoperative testing results, and surgical history were included in the analysis. The multivariable regression model resulted in 4 significant variables that were included in the nomogram. These included preoperative DeMeester score, preoperative gastroesophageal reflux disease health-related quality of life score, preoperative distal contractile integral value on manometry, and body mass index. Based on these variables, a scoring nomogram was developed with values ranging from 0 to 18. CONCLUSION: Our data were used to develop a scoring calculator capable of predicting the probability of MSA explantation. This scoring tool can guide preoperative patient selection and treatment decisions.
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Remoción de Dispositivos , Esfínter Esofágico Inferior , Reflujo Gastroesofágico , Nomogramas , Humanos , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Reflujo Gastroesofágico/cirugía , Adulto , Esfínter Esofágico Inferior/cirugía , Factores de Riesgo , Imanes , Manometría , Modelos Logísticos , Anciano , Calidad de VidaRESUMEN
71-year-old male with history of obstructive sleep apnea presented with persistent drainage from the surgical incision site over the recently implanted hypoglossal nerve stimulator. Wound cultures from device pocket identified the pathogen as Turicella otitidis. Clinical course included treatment with broad-spectrum intravenous antibiotics and device explantation. This case is the first known T. otitidis device associated infection.
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PURPOSE: To manage patient dissatisfaction following multifocal intraocular lens (MF-IOL) implantation by IOL exchange with either a monofocal or an alternative MF-IOL, and to compare outcomes in these two groups. METHODS: MF-IOL exchange was performed in 32 patients (64 eyes) with neuroadaptation failure. The MF-to-MF group involved patients who had a MF-IOL exchanged with another MF-IOL of a different optical profile and the MF-to-MO group involved patients who had a MF-IOL exchanged to a monofocal IOL. Visual outcomes and complications were analysed. The Quality of Vision (QoV) questionnaire, Visual Function Index (VF-14) and its Rasch-revised version (VF-8R) were also used to assess outcomes. RESULTS: There were no significant differences (p > 0.05) in the QoV scores between the two groups, both preoperatively and postoperatively. Preoperatively, there were no significant differences in VF-14 scores between both groups (p > 0.05). Postoperatively, there were statistically significant differences in VF-14 (total score, intermediate vision and near vision) in favour of the MF-to-MF group (p < 0.05). The postoperative VF-8R score in the MF-to-MF group was significantly better than the MF-to-MO group (p ≤ 0.001). Uncorrected and corrected near as well as corrected distance visual acuities were significantly better (p < 0.05) in the MF-to-MF group compared to the MF-to-MO group at 3 months. CONCLUSION: Patient dissatisfaction and neuroadaptation failure following MF-IOL implantation can be managed by an IOL exchange with an alternative optical design of MF-IOL or a monofocal IOL. Although, in the current study, the MF-to-MF group showed some better postoperative results, both options are feasible solutions.
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BACKGROUND: Explantation is the proposed treatment for breast implant illness (BII). Little is known about which medical specialists are visited and what diagnoses are made before explantation is provided as the treatment. OBJECTIVES: This study investigated medical specialist care utilization in women with cosmetic breast implants who underwent explantation compared to women who chose breast implant replacement surgery and to women without breast implants. METHODS: Retrospective cohort study using data linkage with the Dutch Breast Implant Registry and the Dutch health insurance claims database. Visits to medical specialists were examined over the 3 years before explantation. A total of 832 explantation patients were matched and compared to 1463 breast implant replacement patients and 1664 women without breast implants. RESULTS: Explantation patients were more likely to have visited > 5 different medical specialties compared to both replacement patients (12.3% vs. 5.7%; p < 0.001) and women without breast implants (12.3% vs. 3.7%; p < 0.001). Among explantation patients, women who underwent explantation because of BII were more likely to have visited > 5 different medical specialties compared to women who underwent explantation because of other reasons (25.0% vs. 11.0%; p < 0.001). CONCLUSIONS: Women who underwent explantation of breast implants had higher utilization of medical specialist care in the years before explantation compared to women who underwent breast implant replacement surgery and women without breast implants. Medical specialist care use was especially high among women for whom BII was the registered reason for explantation. These findings suggest further research is needed into the link between BII and the use of medical specialist care. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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BACKGROUND AND AIMS: Surgical explantation of transcatheter heart valves (THVs) is rapidly increasing, but there are limited data on patients with THV-associated infective endocarditis (IE). This study aims to assess the outcomes of patients undergoing THV explant for IE. METHODS: All patients who underwent THV explant between 2011 and 2022 from 44 sites in the EXPLANT-TAVR registry were identified. Patients with IE as the reason for THV explant were compared to those with other mechanisms of bioprosthetic valve dysfunction (BVD). RESULTS: A total of 372 patients from the EXPLANT-TAVR registry were included. Among them, 184 (49.5%) patients underwent THV explant due to IE and 188 (50.5%) patients due to BVD. At the index transcatheter aortic valve replacement, patients undergoing THV explant for IE were older (74.3 ± 8.6 vs. 71 ± 10.6 years) and had a lower Society of Thoracic Surgeons risk score [2.6% (1.8-5.0) vs. 3.3% (2.1-5.6), P = .029] compared to patients with BVD. Compared to BVD, IE patients had longer intensive care unit and hospital stays (P < .05) and higher stroke rates at 30 days (8.6% vs. 2.9%, P = .032) and 1 year (16.2% vs. 5.2%, P = .010). Adjusted in-hospital, 30-day, and 1-year mortality was 12.1%, 16.1%, and 33.8%, respectively, for the entire cohort, with no significant differences between groups. Although mortality was numerically higher in IE patients 3 years postsurgery (29.6% for BVD vs. 43.9% for IE), Kaplan-Meier analysis showed no significant differences between groups (P = .16). CONCLUSIONS: In the EXPLANT-TAVR registry, patients undergoing THV explant for IE had higher 30-day and 1-year stroke rates and longer intensive care unit and hospital stays. Moreover, patients undergoing THV explant for IE had a higher 3-year mortality rate, which did not reach statistical significance given the relatively small sample size of this unique cohort and the reduced number of events.