XENOGENEIC DERMAL MATRIX VERSUS AUTOLOGOUS CONNECTIVE TISSUE GRAFT VERSUS NO GRAFT AT ABUTMENT CONNECTION FOR IMPROVING AESTHETICS: 6-MONTH OUTCOMES OF A RANDOMISED CONTROLLED TRIAL

OBJECTIVES. The aim of this multicentre randomised controlled trial was to evaluate the efficacy of a xenogeneic dermal matrix in widening keratinised peri-implant tissues du-ring second-stage surgery, and to compare it to both autologous connective tissue graft and a control group with no augmentation. MATERIAL AND METHODS. Patients requiring an increase in keratinised gingiva width were enrolled by four university/dental practices and randomised into three different groups for grafting procedures at the implant uncovering stage: either xenogeneic dermal matrix (Group X), autologous connective tissue graft (Group A) or no graft (control, Group C). The primary outcomes were width of keratinised tissue and facial soft tissue levels, evaluated at three different time points (T0, implant uncovering stage; T1 and T2, six weeks and six months after surgery, respectively). Secondary outcomes were: implant failure, complications, marginal bone loss, papilla index, facial soft tissue level, pink esthetic score, and aesthetic assessment by patients. RESULTS. Thirty-six patients, with one implant per patient, were enrolled at two centres (18 at each centre): 12 for control, 12 for xenogeneic dermal matrix and 12 for autologous tissue graft. Three patients dropped out and two patients from the autologous group had implant failures. No complications were recorded. After six months, the width of keratini-sed tissue increased by 0.16 ± 1.01 (P = 0.79), 1.05 ± 0.76 (P = 0.01) and 0.80 ± 1.73 mm (P = 0.28), and facial soft tissue level was-0.95 ± 0.85 (P = 0.04), 0.32 ± 0.57 (P = 0.15) and 0.35 ± 0.79 mm (P = 0.30) respectively in Groups C, X and A groups. Between-group analysis showed that, with respect to control, only facial soft tissue level (1.31 mm, P = 0.01) and width of keratinised mucosa (2.43 mm, P = 0.01) outcomes in the autologous graft group were statistically significant at T2. Mean marginal bone loss between T0-T2 was-0.4 ± 0.4mm, with no differences between groups. Pink aesthetic score showed no significant differences between groups, being 0.89 for A-C (P = 0.41), 0.88 for A–X (P = 0.63) and 0.72 for X-C (P = 0.88). Patient’s aesthetic satisfaction (Visual Analogue Scale) was 92.2 ± 8.4, 93.8 ± 7.7, 97.2 ± 3.0, for Groups C, X and A, respectively. Between the two dental centres, only facial soft tissue level at T0–T2 was significantly different, by 0.67 ± 0.62 mm (P = 0.03). CONCLUSIONS. After six months, autologous connective tissue graft yielded a significant gain in facial soft tissue levels and width of keratinised mucosa, as compared to the control group (no graft)

Normothermic frozen elephant trunk: our experience and literature review

none6Background and Objective: The frozen elephant trunk (FET) technique has undoubtable advantages in treating complex and extensive disease of the aortic arch and the thoracic descending aorta. Despite several improvements in cardiopulmonary bypass conduction and surgical strategy, operative times and the institution of systemic circulatory arrest remain the main determinants of early mortality, cerebral/spinal cord injury and visceral organs dysfunction. We have conducted this review to highlight the recent technical advances in arch and FET surgery aiming at the reduction/avoidance of systemic circulatory arrest, and their impact on early outcomes. Methods: A literature search (from origin to January 2022), limited to publications in English, was performed on online platforms and database (PubMed, Google, ResearchGate). After a further review of associated or similar papers, we found 4 experiences, described by 11 peer-reviewed published papers, which focused on minimising or avoiding systemic circulatory arrest during total arch replacement plus stenting of the descending thoracic aorta. Key Content and Findings: Recent experiences reported the use of an antegrade endoaortic balloon, advanced and inflated into the stent graft, to provide an early systemic reperfusion soon after the deployment of the stented portion of the FET prosthesis and minimize the circulatory arrest time (down to a mean of 5 minutes), thus avoiding the need of moderate or deep hypothermia (mean systemic temperature 28-30 ???) while allowing a complete arch and FET repair. Our approach, based on off-pump retrograde vascular stent graft deployment in distal arch/descending thoracic aorta, and the use of a retrograde endoballoon, allows the repair of extensive aortic pathologies during uninterrupted normothermic cerebral and lower body perfusion. Conclusions: The use of endoballoon occlusion has emerged in recent years as a safe and effective strategy to allow distal perfusion during FET repair. This technique minimizes or avoids the detrimental effects of hypothermia and systemic circulatory arrest and significantly reduces the operative times.Malvindi, PG; Alfonsi, J; Berretta, P; Cefarelli, M; Gatta, E; Di Eusanio, MMalvindi, Pg; Alfonsi, J; Berretta, P; Cefarelli, M; Gatta, E; Di Eusanio,

Extracorporeal Membrane Oxygenation Support as Treatment for Early Graft Failure After Heart Transplantation

Early graft failure (EGF) is a major risk factor for death after heart transplantation (Htx) accounting for >40% of deaths within 30 days postoperatively. According to the last International Society for Heart and Lung Transplantation (ISHLT) consensus statement, the graft dysfunction (GD) is to be classified into primary (PGD), in case of an unknown triggering factor or secondary (SGD) where there is a discernible cause such as acute rejection, pulmonary hypertension, or known surgical complications. The diagnosis of GD is to be made within 24 h after completion of Htx surgery and a severity scale for GD should include mild, moderate, or severe grades based on specified criteria. Mechanical circulatory support (MCS) for GD should be considered when medical management is not sufficient to support the newly transplanted graft. Currently, extra‐corporeal membrane oxygenation (ECMO) is widely accepted as treatment of severe EGF, given its easy and quick setup, the system versatility, the optimal end‐organ perfusion provided, and the possibility of both biventricular and lung assistance by usage of a low‐cost single pump

Minimally Invasive Trans-Axillary versus Full Sternotomy Mitral Valve Repair: A Propensity Score-Matched Analysis on Mid-Term Outcomes

Background and Objectives: Minimally invasive cardiac surgery is an established approach for the treatment of heart valve pathologies and is associated with excellent technical and early postoperative outcomes. Data from medium- and long-term longitudinal evaluation of patients who underwent mitral valve repair (MVr) through transaxillary approach (TAxA) are still lacking. The aim of this study is to investigate mid-term results in patients who underwent TAxA MVr. Materials and Methods: Prospectively collected data of patients who underwent first-time MVr for MV regurgitation between 2017 and 2022, were reviewed. A total of 308 patients received TAxA, while in 220 cases, traditional full sternotomy (FS) was performed. Concomitant aortic and coronary artery bypass grafting (CABG) procedures, infective endocarditis or urgent operations were excluded. A propensity match (PS) analysis was used to overcome preoperative differences between the populations. Follow-up data were retrieved from outpatients' clinic, telephone calls and municipal administration records. Results: After PS-matching, two well-balanced cohorts of 171 patients were analysed. The overall 30-day mortality rate was 0.6% in both cohorts. No statistical difference in postoperative complications was reported. TAxA cohort experienced earlier postoperative extubation (p < 0.001) with a higher rate of extubation performed in the operating theatre (p < 0.001), shorter intensive care unit (ICU) stay (p < 0.001), and reduced hospitalization with 51% of patients discharged home (p < 0.001). Estimated survival at 5 years was 98.8% in TAxA vs. 93.6% in FS cohort (Log rank p = 0.15). The cumulative incidence of reoperation was 2.6% and 4.4% at 5 years, respectively, in TAxA and FS cohorts (Gray test p = 0.49). Conclusions: TAxA approach for MVr was associated with low rates of in-hospital mortality and major postoperative complications being furthermore associated with shorter mechanical ventilation time, shorter ICU stay and reduced hospitalization with a higher rate of patients able to be discharged home. At mid-term, TAxA was associated with excellent survival and low rate of MV reoperatio

Aortic Root Replacement With Biological Valved Conduits

none9The execution of Bentall procedures using biological valved conduits is expanding owing to the increased incidence of aortic valve and root diseases in the aging population. To review the available data, a systematic search identified 29 studies with a total of 3,298 patients. Although evidence on short-term results suggested favorable outcomes after biological Bentall operations, data beyond 5 years are limited and highlight the urgent need for further investigations with longer follow-up.openCastrovinci, Sebastiano; Tian, David H; Murana, Giacomo; Cefarelli, Mariano; Berretta, Paolo; Alfonsi, Jacopo; Yan, Tristan D; Di Bartolomeo, Roberto; Di Eusanio, MarcoCastrovinci, Sebastiano; Tian, David H; Murana, Giacomo; Cefarelli, Mariano; Berretta, Paolo; Alfonsi, Jacopo; Yan, Tristan D; Di Bartolomeo, Roberto; Di Eusanio, Marc

Sampling of one-dimensional probability measures in the convex order and computation of robust option price bounds

This paper is an updated version of a part of the paper https://hal.archives-ouvertes.fr/hal-01589581 (or https://arxiv.org/pdf/1709.05287.pdf )International audienceFor µ and ν two probability measures on the real line such that µ is smaller than ν in the convex order, this property is in general not preserved at the level of the empirical measures µI = 1 I I i=1 δX i and νJ = 1 J J j=1 δY j , where (Xi) 1≤i≤I (resp. (Yj) 1≤j≤J) are independent and identically distributed according to µ (resp. ν). We investigate modifications of µI (resp. νJ) smaller than νJ (resp. greater than µI) in the convex order and weakly converging to µ (resp. ν) as I, J → ∞. According to Kertz and Rösler (1992), the set of probability measures on the real line with a finite first order moment is a complete lattice for the increasing and the decreasing convex orders. For µ and ν in this set, this enables us to define a probability measure µ ∨ ν (resp. µ ∧ ν) greater than µ (resp. smaller than ν) in the convex order. We give efficient algorithms permitting to compute µ ∨ ν and µ ∧ ν (and therefore µI ∨ νJ and µI ∧ νJ) when µ and ν have finite supports. Last, we illustrate by numerical experiments the resulting sampling methods that preserve the convex order and their application to approximate martingale optimal transport problems and in particular to calculate robust option price bounds

Evolution of the Wasserstein distance between the marginals of two Markov processes

International audienceIn this paper, we are interested in the time derivative of the Wasserstein distance between the marginals of two Markov processes. As recalled in the introduction, the Kantorovich duality leads to a natural candidate for this derivative. Up to the sign, it is the sum of the integrals with respect to each of the two marginals of the corresponding generator applied to the corresponding Kantorovich potential. For pure jump processes with bounded intensity of jumps, we prove that the evolution of the Wasserstein distance is actually given by this candidate. In dimension one, we show that this remains true for Piecewise Deterministic Markov Processes

Sampling of probability measures in the convex order by Wasserstein projection

International audienceMotivated by the approximation of Martingale Optimal Transport problems, westudy sampling methods preserving the convex order for two probability measures$\mu$ and $\nu$ on $\mathbb{R}^d$, with $\nu$ dominating $\mu$. When$(X_i)_{1\le i\le I}$ (resp. $(Y_j)_{1\le j\le J}$) are i.i.d. according $\mu$(resp. $\nu$), the empirical measures $\mu_I$ and $\nu_J$ are not in the convexorder. We investigate modifications of $\mu_I$ (resp. $\nu_J$) smaller than$\nu_J$ (resp. greater than $\mu_I$) in the convex order and weakly convergingto $\mu$ (resp. $\nu$) as $I,J\to\infty$. In dimension 1, according to Kertzand R\"osler (1992), the set of probability measures with a finite first ordermoment is a lattice for the increasing and the decreasing convex orders. Fromthis result, we can define $\mu\vee\nu$ (resp. $\mu\wedge\nu$) that is greaterthan $\mu$ (resp. smaller than $\nu$) in the convex order. We give efficientalgorithms permitting to compute $\mu\vee\nu$ and $\mu\wedge\nu$ when $\mu$ and$\nu$ are convex combinations of Dirac masses. In general dimension, when $\mu$and $\nu$ have finite moments of order $\rho\ge 1$, we define the projection$\mu\curlywedge_\rho \nu$ (resp. $\mu\curlyvee_\rho\nu$) of $\mu$ (resp. $\nu$)on the set of probability measures dominated by $\nu$ (resp. larger than $\mu$)in the convex order for the Wasserstein distance with index $\rho$. When$\rho=2$, $\mu_I\curlywedge_2 \nu_J$ can be computed efficiently by solving aquadratic optimization problem with linear constraints. It turns out that, indimension 1, the projections do not depend on $\rho$ and their quantilefunctions are explicit, which leads to efficient algorithms for convexcombinations of Dirac masses. Last, we illustrate by numerical experiments theresulting sampling methods that preserve the convex order and their applicationto approximate Martingale Optimal Transport problems

Open thoracoabdominal aortic aneurysm repair in expert hands: “all roads lead to Rome”

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