An Experimental Study of the Sleeve Technique in Graft Anastomosis

The effects of a sleeve anastomotic technique (SL), which was designed to avoid intimal injury, on the healing characteristics of a polytetrafluoro-ethylene (PTFE) graft were compared with the effects of the conventional end-to-end anastomotic technique (ETE). A segment of canine abdominal aorta was replaced with a PTFE graft. The grafts were explanted after 4 months and the anastomotic portion was examined macroscopically and by light microscopy. The animals were divided into 4 groups (A to D) according to the combination of the anastomotic methods (ETE or SL) used for the proximal and distal anastomosis. No substantial difference was found between the proximal and distal anastomosis for either ETE or SL. The pulling tests between the PTFE graft and the excised segment of the abdominal aorta revealed no significant difference in the breaking loads between ETE and SL. Macroscopic and microscopic examination revealed that SL resulted in better and more regular neointimal extension on the luminal surface of the PTFE graft. The results suggest that SL is less traumatic to the endothelium of the host artery and may be effective in preventing postoperative intimal hyperplasia

Long-Term Results of Open Mitral Commissurotomy : Effects of Pathologic Features and Surgical Techniques

Of the 174 patients with mitral stenosis (MS) who underwent open mitral commissurotomy (OMC) at Nagasaki University Hospital between 1971 and 1988, the cases of the 50 pure MS patients who underwent OMC alone as the first operation were retrospectively investigated, and the indications for OMC in these MS patients were evaluated. According to the pathological features of the mitral valve (Types I-III) and operative methods used (r: radical OMC, c : conservative OMC), the patients were classified into 4 groups, groups I, IIr, IIc, and III, and we compared the changes in the mitral valve area before and after the operation and the cardiac functions and clinical status in the late postoperative period in these groups. In all groups, the mitral valve area was significantly increased in the early postoperative period, then gradually decreased, but on average it remained larger in the late postoperative period than before the operation. However, significantly larger mitral valve areas were maintained in the late postoperative period than those before the operation only in groups I and IIr. Group IIr showed the highest % increase of the valve areas in the late postoperative period. Furthermore, group IIr maintained the best NYHA cardiac function classes and the highest percentage of normal sinus rhythm on electrocardiograms in the same period. These results suggested that OMC was effective in the Types I and II MS patients, and the complete removal of subvalvular fusions with debridement of calcified foci was considered to be particularly effective for Type II patients to maintain the favorable operative effects and high quality of life for a long period

Ulceration of Leg Associated with Therapeutic Femoral Arteriovenous Fistula

We treated a rare case of stasis ulceration of the leg due to surgically induced femoral arteriovenous fistula. The patient is a 24-year-old Japanese man who had poliomyelitis in his infancy and had a sequela of short left lower limb. At ten years of age he underwent surgical creation of a femoral arteriovenous fistula at another hospital to accelerate the bone growth. Although the operation was effective on the growth of the impaired extremity, stasis signs progressed in the left leg and an ulceration developed 14 years after operation. We closed the fistula restoring the arterial and venous continuities, which was followed by a rapid healing of the ulcer

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Long-Term Results of Open Mitral Commissurotomy : Effects of Pathologic Features and Surgical Techniques

Of the 174 patients with mitral stenosis (MS) who underwent open mitral commissurotomy (OMC) at Nagasaki University Hospital between 1971 and 1988, the cases of the 50 pure MS patients who underwent OMC alone as the first operation were retrospectively investigated, and the indications for OMC in these MS patients were evaluated. According to the pathological features of the mitral valve (Types I-III) and operative methods used (r: radical OMC, c : conservative OMC), the patients were classified into 4 groups, groups I, IIr, IIc, and III, and we compared the changes in the mitral valve area before and after the operation and the cardiac functions and clinical status in the late postoperative period in these groups. In all groups, the mitral valve area was significantly increased in the early postoperative period, then gradually decreased, but on average it remained larger in the late postoperative period than before the operation. However, significantly larger mitral valve areas were maintained in the late postoperative period than those before the operation only in groups I and IIr. Group IIr showed the highest % increase of the valve areas in the late postoperative period. Furthermore, group IIr maintained the best NYHA cardiac function classes and the highest percentage of normal sinus rhythm on electrocardiograms in the same period. These results suggested that OMC was effective in the Types I and II MS patients, and the complete removal of subvalvular fusions with debridement of calcified foci was considered to be particularly effective for Type II patients to maintain the favorable operative effects and high quality of life for a long period