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Background The aim of this study is to see how the sutureless, stentless, Perceval S aortic valves behave when implanted in elderly patients with small aortic root and the comparison with a second group of patients with similar characteristics where a conventional stented bioprosthesis was implanted. This is a prospective randomized institutional study. Methods Our material is composed from 25 patients who underwent aortic valve replacement with sutureless self-anchoring Perceval S valve implantation (LivaNova), compared with 25 patients with conventional stented biological prosthesis implanted (soprano LivaNova group). The two groups of patients have similar demographic and medical characteristics with severe aortic stenosis. The study was conducted from January 2012 to June 2014. Preoperative, intraoperative and postoperative parameters were studied in order to investigate the utility of the Perceval S valves in this group of patients. Results The Perceval S valve implantation seems to be an interesting biological valve with good hemodynamic characteristics as compared with the typical biological prosthesis providing shorter ischemia time (40 ± 5.50 min vs 86 ± 15.86 min; p  < 0.001), shorter extracorporeal circulation time (73.75 ± 8.12 min vs 120.36 ± 28.31 min p  < 0.001), less operation time (149.38 ± 15.22 min vs 206.64 ± 42.85 min; p  < 0.001) and better postoperative recovery. The postoperative gradients were 23.5 ± 19.20 mmHg vs 24.5 ± 19.90 mmHg respectively. The postoperative effective orifice area in these two groups were respectively 1.5 =/-0.19 cm 2 vs 1.1=/-0.5 cm 2 (p 0.002). Among the 25 patients of the Soprano stented valve, 3 (12 %) came back in 6 months with New York Heart Association (NYHA) 3. The PPM of these patients was the cause of readmission in the Hospital required diuresis and supplementary treatment. Conclusions Aortic valve replacement with Perceval aortic valves in geriatric patients with comorbidities and small aortic annulus seems to be an alternative, safe and “fast” intervention with excellent short and mid-term results which provides a better effective orifice area.

Voice alteration is an important complication of thyroid surgery and is closely related to patients’ quality of life. There are no studies analyzing effect of energy-based devices (EBD) on voice quality (VQ). Aim of this prospective study is to evaluate impact of sutureless total thyroidectomy performed with EBDs on objective voice parameters of patients without recurrent laryngeal nerve (RLN) and/or external branch of superior laryngeal nerve (EBSLN) injury. Sixty patients underwent total thyroidectomy with meticulous dissection of EBSLN. Patients were assigned to Group L (Ligasure™), Group H (Harmonic), or Group C (Conventional) through random ballot. For analysis of alteration in VQ, digital videolaryngostroboscopy (VLS), voice handicap index (VHI), multidimensional voice program (MDVP), and electroglottography (EGG) were used. VLS was performed by 70°-angled indirect laryngoscopy and evaluation was standardized by VLS scale and laryngeal function scoring. This study is registered on clinicaltrials.gov with number NCT01865006. Forty eight patients were female. There was no difference on demographic data. On post-operative laryngoscopic examination, none of the patients had vocal fold palsy. When mean VHI scores at post-operative 1st week and 2nd month were compared to pre-operative values for each groups, groups L and H demonstrated a significant increase in VHI in the early post-operative evaluation, while there was no significant increase for group C. No significant increase was seen in late post-operative period compared to pre-operative period for any groups. In the early post-operative period, VQ is better with the conventional technique than EBDs; however, in late post-operative period, VQ is detected better in EBDs (especially in Group L) than the conventional technique, but no statistical difference was observed.

To evaluate the visual outcomes and complications after sutureless, flapless, and glueless intrascleral fixation of a posterior chamber intraocular lens (IOL) in patients between the ages of 5 and 20 years. Children with gross subluxated lenses and aphakia following intracapsular cataract extraction with inadequate posterior capsular support underwent intrascleral fixation of a standard three-piece posterior chamber IOL without sutures, flaps, or glue. A retrospective study of 15 eyes of 11 patients with a mean follow-up period of 6 months was performed. The main outcome measures were improvement in visual acuity (best corrected [BCVA] and uncorrected [UCVA]) and early and late postoperative complications. Preoperative to postoperative mean UCVA changed from 1.34 ± 0.35 to 0.36 ± 0.18 logarithm of the minimum angle of resolution (logMAR), respectively (P < .001). Preoperative to postoperative mean BCVA changed from 0.69 ± 0.37 to 0.19 ± 0.19 logMAR, respectively (P < .001). Two patients showed early postoperative complications within 1 week. One patient presented with vitreous hemorrhage and the other with hyphema on postoperative day 1. Both patients were treated conservatively and recovered by the first follow-up visit. None of the patients showed late postoperative complications during the 6-month follow-up period. The final visual outcome between the complication (n = 2) and no complication (n = 13) groups showed no statistically significant difference (P = .91). The final visual outcome between the eyes with primary and secondary implantation was similar with no statistically significant difference (P = .857). The technique of flapless, glueless, and sutureless scleral fixation of a three-piece IOL has shown significant improvement in visual acuity and does not cause significant complications postoperatively. [J Pediatr Ophthalmol Strabismus. 2017;54(6):381-386.].

Purpose To compare refractive outcomes of the foldable intraocular lens sutureless scleral fixated sutureless (Carlevale® FIL-SSF) with the iris-claw lens (Artisan®). Methods This retrospective study included consecutive patients who underwent a FIL-SSF implantation or an iris-claw implantation between January 2020 and November 2022 in the ophthalmology departments of Hospices Civils de Lyon (France). Results A total of 271 eyes from 265 patients were included: 96 eyes in the FIL-SSF group and 175 eyes in the iris-claw group. At 6 months, the mean (SD) surgically induced astigmatism (SIA) was significantly lower in the FIL-SSF group with 0.3 (1.8) diopters against 0.8 (2.1) diopters in the iris-claw group ( p  = 0.01). The mean (SD) refractive error was also lower for the FIL-SSF group with 0.1 (1.2) diopters versus 0.5 (1.6) diopters in the iris-claw group ( p  < 0.001). The mean best corrected visual acuity at 6 months was not significantly different between FIL-SSF and iris-claw lens with 0.47 (0.58) logMAR and 0.39 (0.55) logMAR, respectively ( p  = 0.12). However, the mean (SD) operative time was longer for FIL-SSF implantation in comparison to iris-claw implantation (59.8 (21.1) minutes versus 41.9 (24.4) minutes, respectively ( p  < 0.001)). The rate of postoperative complications was similar between the two techniques. Conclusion This study shows that FIL-SSF achieves better refractive results than iris-claw lens, with a similar rate of postoperative complications. As a relatively new implantation technique, there is a learning curve required to reduce operating time. Key messages What is known? Multiple surgical options for correcting aphakia in the absence of capsular support can be used. Currently, foldable intraocular lens sutureless scleral fixated sutureless (FIL-SSF, Carlevale®) and iris-claw (Artisan®) implants are the two preferred options, but there is no consensus on the best technique to adopt. What is new? We showed that FIL-SSF has a significantly lower surgically induced astigmatism compared to the iris-claw implant. Similar rate of postoperative complications was found between these two techniques. Future studies with a longer follow-up period are needed to ascertain its tolerance.

ObjectiveThis study aimed to assess renal cell carcinoma (RCC) complexity using the R.E.N.A.L. nephrometry score and evaluate the feasibility and safety of the non-clamping sutureless technique combined with a radiofrequency ultrasound scalpel (RFUS) for low-complexity RCC.MethodsThis retrospective, multi-center cohort study categorized patients into three groups: Group I (suture laparoscopic partial nephrectomy [LPN] with clamping renal artery), Group II (sutureless LPN without renal artery clamping, combined with monopolar electrocoagulation), and Group Ⅲ (sutureless laparoscopic nephron-sparing surgery [LNSS] without renal artery clamping combined with RFUS). Key outcomes included operative time, intraoperative blood loss, postoperative hospital stays, serum creatinine (Scr) levels, and the estimated glomerular filtration rate (eGFR) of the affected kidney. Post hoc power analysis was used to evaluate eGFR variation across groups, and a multiple linear regression model was employed to analyze factors influencing postoperative eGFR alterations.ResultsThe study included 60 patients with exophytic and low-complexity RCC. Blood loss in Group III was comparable to that in Group I but less than that in Group II (  = 0.035). Operative time and postoperative hospital stays were significantly shorter in Group III than in the other groups (  < 0.01). A statistically significant increase in Scr levels was observed during the early postoperative period, continuing through the 6-month follow-up assessment compared with preoperative levels (  < 0.01). The 6-month postoperative eGFR of the affected kidney in Group III was significantly higher than that in the other groups (  < 0.01). The decrease in preoperative and 6-month postoperative eGFR values was greatest in Group I (  < 0.01), followed closely by Group II (  < 0.01), while no significant reduction was observed in Group III. The post hoc power analysis revealed high detection power (0.912 or 1.0). Warm ischemia time emerged as the sole significant eGFR predictor (  = 0.814,  < 0.05).ConclusionThe non-clamping sutureless technique combined with RFUS for RCC effectively alleviates renal ischemia-reperfusion injury, offering superior renal function protection while achieving comparable oncological outcomes.

An important limitation of the pivotal randomized controlled trials that compared transcatheter aortic valve replacement (TAVR) to surgical aortic valve replacement (SAVR) is that the SAVR arm scarcely included sutureless bioprosthetic valves. We identified 13 retrospective propensity-matched studies in low ( n  = 2), intermediate ( n  = 8), and high-risk ( n  = 3) patients, using EuroSCORE and STS score to assess perioperative risk. One large registry drove the outcome in low-risk patients, showing better early survival with TAVR, lower rates of stroke and acute kidney injury. Intermediate-risk patients showed improved early and medium-term survival with SU-AVR, whilst in high-risk patients, no significant differences were seen between treatment options. Overall, across all risk categories, the rates of moderate and severe aortic regurgitation and permanent pacemaker implantation were significantly lower with SU-AVR, while transprosthetic gradients and duration of hospital stay were higher compared to TAVR. The differences in survival in the intermediate risk group are not in line with conclusions of pivotal randomized trials comparing TAVR with SAVR. Specific features of SU-AVR may account for these survival differences, positioning SU-AVR as a valid and safe alternative for patients at intermediate risk. Awaiting confirmation in randomized trials, careful patient selection and consideration of either of the AVR options in the heart team remain crucial.

Hybrid arch repair improved surgical outcomes in aneurysmal disease. Sutureless anastomosis using an intraluminal ringed graft and stent graft bridging has been reported. We incorporate the vascular ring connector, angiography-assisted sutureless telescoping anastomosis technique, and thoracic endovascular aortic repair, rendering the hybrid arch repair for acute type A aortic dissection sutureless. Herein, we presented our sutureless procedure for acute type A aortic dissection. Between January 2022 and April 2023, 19 patients who underwent sutureless type II hybrid arch repair were enrolled. The surgical procedures were described. The preoperative demographics, operative details, postoperative outcomes and follow-up results were retrospectively collected. Nineteen patients with a median age of 62 (interquartile range [IQR]: 10.5) and male dominant in 73.7% were recorded. The sutureless type II hybrid arch repair was performed in a median operative time of 397 min (IQR: 111.5), with a cardiopulmonary bypass time of 184 min (IQR: 52.5). The fully sutureless type II hybrid arch repair further reduced the abovementioned times. In-hospital death was two in 10.5%. Seventeen discharged patients had regular follow-ups in a median of 553 days (IQR: 129). The serial computed tomography scan revealed all reconstructed arch vessels were patent, and positive aortic remodelling was observed at the arch and thoracic endoprosthesis levels at 100% and 94.2%, respectively. Sutureless type II hybrid arch repair is feasible, demonstrating complete procedural success and favourable postoperative outcomes in mid-term follow-up. Long-term monitoring is necessary to assess this procedure's durability and potential complications.

PurposeTo compare the effectiveness and efficiency of a glued (sutureless) technique for amniotic membrane transplantation (AMT) with a traditional sutured one in the setting of acute Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN).MethodsThis retrospective cohort study evaluated all patients diagnosed with SJS/TEN between 2008 and 2020 within our hospital network who received AMT in the acute phase according to our protocol and had at least one ophthalmic follow-up in the chronic phase. Primary outcomes included best-corrected visual acuity (BCVA) at the most recent visit, presence of a severe ocular complication (SOC) via predefined criteria, time to procedure and duration of procedure. Random effects model analysis was used to evaluate the impact of potential covariates on outcome measures.ResultsA total of 23 patients (45 eyes) were included: 14 patients (27 eyes) in the AMT suture group and 9 patients (18 eyes) in the AMT glue group. There was no difference between the two groups in BCVA at the most recent visit (p=0.5112) or development of a SOC (p=1.000). The glue method was shorter in duration than the suture method (p<0.001). Random effects model additionally indicated that there was no difference in BCVA at most recent follow-up between patients who had received glued versus sutured AMT (p=0.1460).ConclusionsOur glued technique for AMT is as effective as our sutured technique in stabilising the ocular surface and mitigating chronic ocular complications in SJS/TEN. The glued technique is also shorter in duration and performed more expediently than the sutured technique.

Purpose: To report the surgical and refractive outcomes over a 5-year follow-up period in patients who underwent sutureless scleral fixation of a one-piece intraocular lens (IOL). Methods: A retrospective study was conducted at one single center involving consecutive patients undergoing sutureless scleral fixation of one-piece IOL implantation, between September 2016 and May 2020. Visual acuity, refractive outcomes, and complications were assessed over a minimum 60-month follow-up period. Results: The study included 28 eyes of 28 patients (7 women and 21 men; mean age 61.0 ± 19.4 years [95% CI: 53.4 to 68.5]). Five years after surgery, mean corrected distance visual acuity significantly improved from 1.1 ± 0.6 logarithm of the minimum angle of resolution (95% CI: 0.9 to 1.3) to 0.5 ± 0.6 (95% CI: 0.3 to 0.8 logarithm of the minimum angle of resolution) (P < .001) with a mean refractive prediction error of −0.04 ± 1.30 diopters (95% CI: −0.53 to +0.45 diopters). After surgery mean endothelial cell count significantly decreased from 2,037 ± 455 cells/mm2 (95% CI: 1,861 to 2,213 cells/mm2) to 1,704 ± 483 cells/mm2 (95% CI: 1,517 to 1,891 cells/mm2) (P < .001), with a mean loss of 16.9%. A mean IOL tilting of 2.7 ± 0.9 degrees (95% CI: 2.3 to 3 degrees) was found at 60 months postoperatively. The most common postoperative complication were corneal edema in the early course (2 eyes, 7.2%) and localized scleral thinning over the haptic in the late course (9 eyes, 32.1%). At 5 years postoperatively, anterior segment optical coherence tomography showed preserved scleral thickness 199.3 ± 72.7 μm (95% CI: 172.4 to 226.2 μm). Conclusions: Sutureless intrascleral fixation of the one-piece IOL demonstrated satisfactory long-term outcomes with good visual acuity and a low rate of complications.