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Objectives: To describe imaging assessment, procedural and follow-up outcome of patients undergoing left atrial appendage (LAA) occlusion (LAAO) using a “sandwich” technique. Background: The presence of a LAA with chicken wing morphology constitutes a challenge that sometimes requires specific occlusion strategies like the “sandwich” technique. However, procedural and follow-up data focusing on this implanting strategy is scarce. Methods: This multicenter study collected individual data from eight centers between 2012 and 2019. Consecutive patients with chicken-wing LAAs defined as an early (<20 mm from the ostium) and severe bend (>90°) who underwent LAAO with Amplatzer devices and using the “sandwich” technique were included in the analysis. Results: Overall, 190 subjects were enrolled in the study. Procedures were done with the Amulet device (85%) and the Amplatzer Cardiac Plug (15%). Successful implantation was achieved in 99.5% with ≤1 partial recapture in 80% of cases. Single (46.2%) and dual antiplatelet therapy (39.4%) were the most used antithrombotic therapies after LAAO. In-hospital major adverse events rate was 1.5% with no deaths. One patient (0.5%) had cardiac tamponade requiring percutaneous drainage. With a mean follow-up of 19.6 ± 14.8 months, the mortality and stroke rates were 7.7%/year and 2.5%/year, respectively. Follow-up transesophageal echocardiography (TEE) at 2–3 months showed device-related thrombosis in 2.8% and peri-device leak ≥3 mm in 1.2% of patients. Conclusions: In a large series of patients with chicken wing LAA anatomies undergoing LAAO, the use of the “sandwich” technique was feasible and safe. Preprocedural imaging was a key-factor to determine specific measurements.

The study aimed to introduce a perspective of the essential reason behind why marginal microleakage develops regardless of the composite type, the technique, or the bonding system applied, especially in gingival floor of class II cavities. Materials and Methods: Three types of composite resin materials (CharmfilTM, ParaFillTM, and ProMedica®) were used to evaluate microleakage of class II restorations using two restorative approaches. Twenty four newly extracted bicuspid teeth were divided into two main groups (n=12 each) according to the restoration technique (open or closed sandwich techniques). Teeth of each group were then divided into 3 groups (n= 4 each) according to the type of the composite resin used. The restorations were then subjected to a thermocycling process and then were immersed into methylene blue solution for 12 hours. Mesiodistal sectional cuts were made along the central grooves and assessed under stereomicroscope for marginal microleakage. The data were statistically analyzed with a p-value <0.05 considered significant. Results: There were no statistically significant differences in marginal microleakage between the three examined groups using both techniques (p>0.05). Under the microscope, the marginal microleakage was more obvious at the cervical region than at the occlusal region. Conclusion: There was no effect of the composite type or the application technique used on the occurrence of marginal microleakage. The first portion of the material applied against the cavity floor is the primary factor involved in possibly minimizing marginal microleakage., El estudio tuvo como objetivo presentar una perspectiva de la razón esencial por la cual se desarrolla microfiltraciones independientemente del tipo de resina compuesta, el sistema de unión aplicado, especialmente en el piso gingival de cavidades de clase II. Materiales y Métodos: Se utilizaron tres tipos de resina compuesta (CharmfilTM, ParaFillTM y ProMedica®) para evaluar la microfiltración de restauraciones de clase II utilizando dos enfoques restaurativos. Veinticuatro dientes bicúspides recién extraídos se dividieron en dos grupos (n=12 cada uno) de acuerdo con la técnica de restauración (técnicas de sándwich abierto o cerrado). Los dientes de cada grupo se dividieron en 3 sub-grupos (n=4 cada uno) de acuerdo con el tipo de resina compuesta utilizada. Las restauraciones se sometieron después a un proceso de termociclado y finalmente se sumergieron en una solución de azul de metileno durante 12 horas. Se realizaron cortes en la sección mesiodistal a lo largo de los surcos centrales y se evaluaron bajo lupa para determinar la ocurrencia de microfiltración marginal. Los datos se analizaron estadísticamente con un valor de p<0,05 considerado significativo. Resultados: No hubo diferencias estadísticamente significativas en la microfiltración marginal entre los tres grupos examinados utilizando ambas técnicas (p>0.05). Bajo la lupa la microfiltración marginal fue más obvia en la región cervical que en la región oclusal. Conclusión: No hubo efecto del tipo compuesto o la técnica de aplicación utilizada en la aparición de microfiltración marginal. La primera porción del material aplicado el piso de la cavidad es el factor principal involucrado en la posibilidad de minimizar la microfiltración marginal.

Introduction: Open repair of the aorta carries a high risk for morbidity and mortality especially in the elderly population and in patients unfit for major surgery. Endovascular aortic repair is safe, durable and effective when there is adequate proximal and distal sealing zone for the aortic stent graft. Fenestrated and branched stent grafts have made the repair possible for complex but elective cases that do not have an adequate sealing zone. Urgent complex cases and patients with midaortic occlusive diseases do not have any therapeutic alternative if they are not fit for open repair. Chimney graft technique fills this gap and allows the sealing zones for aortic stent graft to be extended as required. The aim of the present thesis is to study the applicability, safety and durability of CG technique in urgent cases with complex lesions in the thoracic and abdominal aorta including the midaortic occlusive diseases. Patients and Methods: All patients who received CG were treated urgently or semi-urgently. The majority of the treated aortic lesions were aneurysms, dissections, pseudoaneurysms, infection, and accidental overstented vital aortic side branches. The median age of all patients was 75 years (IQR, 69-78), of them 32% were female except for the first study where all ten patients were female with midaortic occlusive diseases. The second study evaluated the mid to long-term efficacy and durability of the CG technique in 29 patients with urgent and complex lesions of the thoracic aorta. The third study examined the long-term results of CG in preserving the visceral flow of 51 patients with urgent complex aortic lesions. The fourth study evaluated the CTA images of 206 patients with ruptured abdominal aortic aneurysm. The study measured the applicability of CG in patients for whom standard EVAR was contraindicated because of a short aneurysmal neck. Results: The results showed that CG is applicable and safe for midaortic occlusive diseases with high technical suc