Analysis of complications following implant-based breast reconstruction in breast cancer patients

Background: The complications associated with implant-based breast reconstruction are well recognized. While it is crucial to understand the risk factors associated to specific complications, the existing literature lacks standardized definitions and comprehensive characterization of complications, resulting in significantly heterogenous and non-comparative data. Further in-depth analysis of complications with standardized definition of complications and stratification of risk factors is useful to guide patient selection, support patients to make informed choices, and optimize post-operative care.Methods: A retrospective study of three surgeons’ experience was performed between 2015 and 2019 at a tertiary hospital. The complications were assessed in accordance with the immediate breast reconstruction and adjuvant therapy audit (iBRA2). Multiple logistic regression analysis was used to determine prognostic impact of different risk factors associated with complications.Results: A total of 184 patients who underwent breast reconstruction were included. One or more minor and major complications occurred in 75 patients (40.7%). Most common complications were seroma formation requiring aspiration (15.8%), capsular contracture (15.8%), and infection (12.0%). Implant-based breast reconstruction using the latissimus dorsi flap is an important predictor for seroma formation requiring aspiration (OR = 41.27, 95% confidence interval (CI) 11.53–147.66, and p Conclusions: Age, post-mastectomy radiotherapy, and use of the latissimus dorsi flap have a significant prognostic value in complications following implant-based breast reconstruction. Our findings are useful in counseling patients to make informed decisions and also in optimizing post-operative care.</p

Prevalence and clinical significance of conduction disease in patients with idiopathic pulmonary arterial hypertension.

Anatomical and physiological changes in the right heart as a direct consequence of the upstream pressure overload characteristic of idiopathic pulmonary hypertension (IPAH) are likely to lead to conduction disease in these patients. However, the prevalence and clinical implications of atrioventricular conduction disease in IPAH patients are not well-characterized. In this observational cohort study, we show that conduction disease is far more prevalent in a cohort of 175 IPAH patients than a group of matched comparators (37.1% vs 10.8%), and is associated with older age, male sex and more severe right heart dilatation. However, conduction disease is independently associated with worse functionality and higher mortality in this patient group. Prospective study is required to substantiate this, and whether intervention such as prophylactic pacing could restore prognosis

Natural history of chronic thromboembolic pulmonary disease with no or mild pulmonary hypertension.

BACKGROUND: We describe baseline characteristics, disease progression and mortality in chronic thromboembolic pulmonary disease patients as a function of mean pulmonary artery pressure (mPAP) according to new and previous definitions of pulmonary hypertension. METHODS: All patients diagnosed with chronic thromboembolic pulmonary disease between January, 2015 and December, 2019 were dichotomized according to initial mPAP: ≤ 20 mmHg ('normal') vs 21-24 mmHg ('mildly-elevated'). Baseline features were compared between the groups, and pairwise analysis performed to determine changes in clinical endpoints at 1-year, excluding those who underwent pulmonary endarterectomy or did not attend follow-up. Mortality was assessed for the whole cohort over the entire study period. RESULTS: One hundred thirteen patients were included; 57 had mPAP ≤ 20 mmHg and 56 had mPAP 21-24 mmHg. Normal mPAP patients had lower pulmonary vascular resistance (1.6 vs 2.5WU, p < 0.01) and right ventricular end-diastolic pressure (5.9 vs 7.8 mmHg, p < 0.01) at presentation. At 3 years, no major deterioration was seen in either group. No patients were treated with pulmonary artery vasodilators. Eight had undergone pulmonary endarterectomy. Over 37 months median follow-up, mortality was 7.0% in the normal mPAP group and 8.9% in the mildly-elevated mPAP group. Cause of death was malignancy in 62.5% of cases. CONCLUSIONS: Chronic thromboembolic pulmonary disease patients with mild pulmonary hypertension have statistically higher right ventricular end-diastolic pressure and pulmonary vascular resistance than those with mPAP ≤ 20 mmHg. Baseline characteristics were otherwise similar. Neither group displayed disease progression on non-invasive tests up to 3 years. Mortality over 37 months follow-up is 8%, and mainly attributable to malignancy. Further prospective study is required to validate these findings