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Aim Methods Results Conclusion In India, 85% of organ donations are from living donors and 15% are from deceased donors. One‐third of living donors were rejected because of ABO or HLA incompatibility. Kidney exchange transplantation (KET) is a cost‐effective and legal strategy to increase living donor kidney transplantation (LDKT) by 25%–35%.We report our experience with 539 KET cases and the evolution of a single‐centre program to increase the use of LDKT.Between January 2000 and 13 March, 2024, 1382 deceased donor kidney transplantations and 5346 LDKT were performed at our centre, including 10% (n = 539) from KET. Of the 539 KET, 80.9% (n = 436) were ABO incompatible pairs, 11.1% (n = 60) were compatible pairs, and 8% (n = 43) were sensitized pairs. There were 75% 2‐way (n = 2 × 202 = 404), 16.2% 3‐way (n = 3 × 29 = 87), 3% 4‐way (n = 4 × 4 = 16), 1.8% 5‐way (n = 5 × 2 = 10), 2.2% 6‐way (n = 6 × 2 = 12), and 1.8% 10‐way KET (n = 10 × 1 = 10). Of the recipients 81.2% (n = 438) were male and 18.8% (n = 101) were female, while of the donors, 78.5% (n = 423) were female and 21.5% (n = 116) were male. All donors were near relatives; wives (54%, n = 291) and mothers (20%, n = 108) were the most common donors. At a median follow‐up of 8.2 years, patient survival, death censored graft survival, acute rejection, and median serum creatinine levels of functioning grafts were 81.63% (n = 440), 91% (n = 494), 9.8% (n = 53) and 1.3 mg/dL respectively. We credited the success to maintaining a registry of incompatible pairs, high‐volume LDKT programs, non‐anonymous allocation and teamwork.This is the largest single‐centre KET program in Asia. We report the challenges and solutions to replicate our success in other KET programs. [ABSTRACT FROM AUTHOR]

Background: There is a scarcity of data comparing the consequences of first and second COVID‐19 waves on kidney transplant recipients (KTRs) in India. Methods: We conducted a single‐centre retrospective study of 259 KTRs with COVID‐19 to compare first wave (March 15–December 31 2020, n = 157) and second wave (April 1–May 31 2021, n = 102). Results: KTRs during second wave were younger (43 vs. 40 years; p‐value.04) and also included paediatric patients (0 vs. 5.9%; p‐value.003). Symptoms were milder during the second wave (45 vs. 62.7%; p‐value.007); COVID‐19 positive patients had less frequent cough (32 vs. 13.8%; p‐value.001), fever was less frequent (58 vs. 37%; p‐value.001), and we observed fewer co‐morbidities (11 vs. 20.6%; p‐value.04). The percentages of neutrophils (77 vs. 83%; p‐value.001) and serum ferritin (439 vs. 688; p‐value.0006) were higher during second wave, while lymphocyte counts were reduced (20 vs. 14%; p‐value.0001). Hydroxychloroquine (11 vs. 0%; p‐value.0001) and tocilizumab (7 vs. 0%; p‐value.004) were more frequently prescribed during first wave, while utilization of dexamethasone (6 vs. 27%; p‐value.0001) and remdesivir (47 vs. 65%; p‐value.03) increased during the second wave. Mucormycosis (1.3 vs. 10%; p‐value.01) and ICU admissions (20 vs. 37.2%; p‐value.002) were more frequent during second wave. The 28‐day mortality rate (9.6 vs. 10%; p‐value 1) was not different. Conclusions: There has been a different clinical spectrum of COVID‐19 amongst KTR with similar mortality between the two waves at a large Indian transplant centre. SUMMARY AT A GLANCE: A large single centre study from India reporting on the health outcomes of COVID‐19 infected kidney transplant recipients during the two waves of between 2020 and 2021. The rate of intensive care admission was more frequent during the second wave of infection although mortality rates were similar in both waves. [ABSTRACT FROM AUTHOR]

This study evaluated the techno‐economic aspects of empty cotton boll valorization to liquid fuel (moisture free bio‐oil), potash fertilizer, and activated carbon. Three different plant capacities, in terms of feedstock handling capacities were considered: 50, 100, and 200 t day−1. For each plant capacity, three plant variants were considered: only fuel, fuel + potash fertilizer, and fuel + potash fertilizer + activated carbon. The net present value ranged from 7.73 M$ for a 50 t day−1 plant to 47.38 M$ for a 200 t day−1 plant, producing liquid fuel along with fertilizer and activated carbon. The overall profitability of the plant was improved by higher plant capacity. For a 200 t day−1 plant, equipment purchase cost related to the synthesis of fuel, potash fertilizer and activated carbon contributed 32.87, 25.77, and 41.36%, respectively to the total purchase equipment cost of the entire plant. Among the three products, activated carbon contributed 81.03% to the total revenue generated by the entire plant. The sensitivity of plant economics towards feedstock price, selling price of activated carbon, potassium hydroxide recovery, annual interest rates, and total capital investment was examined. The economic competitiveness for this kind of thermo‐chemical conversion was assessed in comparison with the solar gasification route. © 2021 Society of Chemical Industry and John Wiley & Sons, Ltd [ABSTRACT FROM AUTHOR]

Introduction: Follow‐up studies of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in kidney transplant recipients (KTR) are scarcely reported. Methods: We studied 142 hospitalized KTR for a median (interquartile range) follow‐up of 9 (8–11) months who recovered from SARS‐CoV‐2 during May 2020 to Dec 2020. The outcomes were to assess persistent symptoms post‐discharge; EuroQoL visual analogue score (EQ‐VAS); EuroQoL 5‐dimension score (E5‐QD‐5L) score and modified medical research dyspnea score (mMRC) at 1 month, 3‐month, and beyond 6 months. Graft outcome was also analyzed. Results: The age of the cohort was 43 (34–69) years and COVID‐19 severity ranged from asymptomatic (4%), mild (50%), moderate (35%) to severe (12%). The most common persistent symptom was fatigue which significantly decreased in the follow‐up (n = 45 [32.3] vs. 10 [7.4] vs. 4 [2.9]; p‐value = 0.001) at 1‐month, 3‐month, and beyond 6 months respectively. Decrement in the mean (standard deviation) EQ‐VAS score from baseline was also improved (28.6 [13] vs. 10.4 [12.5] vs. 7.5 [12.0]; p‐value = 0.012). There was significant improvement in all EQ‐5D‐5L scores in follow‐up. There was no deterioration in mMRC scores during the follow‐up (n = 4, 3% vs. 7, 5% vs. 3, 2%; p‐value = 0.86). Cases requiring oxygen had significantly poorer overall scores initially, but there was no difference at 6 months. All 10 graft losses had oxygen requirement and chronic graft dysfunction at baseline. Conclusion: Our initial assessment reports significant improvement in the quality of life in follow‐up. The majority recovered from allograft dysfunction. Further research is warranted to study the full spectrum of follow‐up. [ABSTRACT FROM AUTHOR]

Inpatient COVID-19 outcomes in solid organ transplant recipients compared to non-solid organ transplant patients: a retrospective cohort. A case report of successful kidney transplantation from a deceased donor with terminal COVID-19-related lung damage: Ongoing dilemma between discarding and accepting organs in COVID-19 era! With ongoing COVID-19 pandemic, the scenarios, dealing with donors and recipients recovered from COVID-19 would be a general norm. Dear Editors, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection is now emerging with a new challenge of transplantation from coronavirus disease (COVID-19)-recovered donors. [Extracted from the article]

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV2) infection has drastically impacted the transplant communities. Remdesivir (RDV) has shown some promising results in coronavirus disease (COVID‐19) albeit with low certainty. Data in kidney transplant recipients (KTR) are still lacking. Methods: This was a retrospective cohort of 57 moderate to severe COVID‐19 positive KTR in a single center who received RDV as a part of COVID‐19 management. No dose adjustments were done. The outcomes were measured as acute kidney injury (AKI) recovery; liver function tests abnormalities; other side effects; graft loss and death. Results: The median (inter‐quartile range) age of presentation was 44 (31‐51) years. The duration from onset of symptoms to RDV initiation was 6 (5‐7) days. Thirty‐two (56%) cases received RDV on the day of admission. Forty‐six (81%) cases were on oxygen support upon initiation of RDV. Thirty‐eight (66.6%) cases had acute kidney injury on admission. The median baseline, admission, and 28‐day follow‐up serum creatinine of the cohort were 1.59 (1.1‐2.1), 2.13 (1.3‐3.1), and 1.58 (1.05‐2.1) mg/dl, respectively. A total of 8(14%) cases died in the study with 1 (1.7%) graft loss. All those cases that died were on oxygen therapy at the time of initiation of RDV. No liver function derangements or any other major adverse events with the drug were reported. Conclusion: RDV therapy is safe and clinically feasible in renal transplant recipients as seen in our cohort. Larger clinical registries and randomized clinical trials should be conducted to further explore the efficacy in transplant recipients. [ABSTRACT FROM AUTHOR]

Introduction: The literature on dengue infection in renal transplant recipients has shown wide diversity in clinical presentation and outcome. The objective of this study was to report the clinical profile, short‐term and long‐term outcomes of dengue among renal transplant recipients. Methods: A total of 59 post‐transplant dengue suspected cases were admitted from July 2019 to April 2020 of which 31 had confirmed dengue infection. The clinical and laboratory profile of the confirmed dengue cases (n = 31) were compared with non‐dengue cases (n = 28). Results: Among the clinical and laboratory features retro‐orbital pain, conjunctival redness, thrombocytopenia on admission, and absence of arthralgia were significantly associated with dengue compared to non‐dengue cases. No mortality was observed in the dengue cases. Allograft dysfunction, acute rejection and graft losses were identified in 64.5% (n = 20), 6.4% (n = 2) and 6.4% (n = 2) dengue cases respectively. No rejection or graft losses were observed in 1‐year follow‐up. Conclusions: We report a differential clinical profile for dengue in transplant settings which will aid in the diagnosis. We also report successful management of dengue infection in renal transplant recipients with the majority having allograft dysfunction. A long‐term follow‐up of the cohort was uneventful. [ABSTRACT FROM AUTHOR]

Objective: The objectives of this study were to: 1) characterize the distribution of noninterfering pain (defined as the pain intensity level at which individuals can function without interference) across different aspects of life among patients with rheumatoid arthritis (RA), and 2) identify clinical characteristics associated with differing levels of noninterfering pain.Methods: Patients with RA in FORWARD, The National Databank for Rheumatic Diseases completed 8 items from the Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference item bank that asked about interference with activities. If subjects reported pain interference, they were asked, "At what level would pain no longer interfere with this activity?" on a scale of 0 to 10. Subjects were also asked, "At what level of pain would you be able to do everything you want to do?" Multiple linear regression analyses examined associations between clinical characteristics and noninterfering pain.Results: A total of 3,949 patients with RA completed the questionnaires. Pain interference was most common for daily activities and least common for ability to concentrate. The mean ± SD level at which pain no longer interfered with activities ranged from 2.7 ± 2.1 for ability to fall/stay asleep to 3.1 ± 2.0 for social activities. Overall, the mean ± SD threshold for noninterfering pain was 2.8 ± 1.9. The mean ± SD level of pain at which patients could do everything they wanted to do was 2.3 ± 1.9. More severe pain intensity was associated with higher noninterfering pain.Conclusion: The mean pain level that did not interfere with activities was 3. High pain intensity was associated with high self-reported noninterfering pain. [ABSTRACT FROM AUTHOR]

As low‐molecular‐weight hydrogelators, dipeptide hydrogel materials are suited for embedding multiple organic molecules and inorganic nanoparticles. Herein, a simple but precisely controllable method is presented that enables the fabrication of dipeptide‐based hydrogels by supramolecular assembly inside microfluidic channels. Water‐soluble quantum dots (QDs) as well as premixed porphyrins and a dipeptide in dimethyl sulfoxide (DMSO) were injected into a Y‐shaped microfluidic junction. At the DMSO/water interface, the confined fabrication of a dipeptide‐based hydrogel was initiated. Thereafter, the as‐formed hydrogel flowed along a meandering microchannel in a continuous fashion, gradually completing gelation and QD entrapment. In contrast to hydrogelation in conventional test tubes, microfluidically controlled hydrogelation led to a tailored dipeptide hydrogel regarding material morphology and nanoparticle distribution. [ABSTRACT FROM AUTHOR]

In India, the deceased kidney transplant program is still in its preliminary stage, and accepting deceased donors with snakebite is just a forward step to expand the donor pool. We report here the outcome of 8 successful renal transplantations from brain‐dead donors who died from a neurotoxic snakebite. We accepted them as donors as they had no evidence of hemotoxic snakebite. 7 recipients did well. 1 died due to sepsis with a functioning graft. 1 required renal biopsy that showed acute tubular necrosis. 1 required re‐exploration due to graft collection due to a surgical issue. Patient and graft survival in follow‐up were similar to other matched deceased donors in our center. According to our experience, utilizing brain‐dead donors who died from a neurotoxic snakebite is safe and may dramatically expand the donor pool especially in countries where death due to snakebite is high in numbers. [ABSTRACT FROM AUTHOR]

Objective: Despite strong recommendations for routine measurement of rheumatoid arthritis (RA) disease activity and associated treatment changes to attain remission/low disease activity, the measurement tools that clinicians use to evaluate RA patients' disease activity and frequency of treatment change have not been well characterized. Therefore, we evaluated different measurement tools that physicians used to assess RA disease activity and associated RA treatment changes.Methods: Using data from the Rheumatology Informatics System for Effectiveness (RISE) registry from January 2016 through June 2017, and using the following criteria: age ≥18 years, diagnosis of RA (International Classification of Diseases, Ninth and Tenth Revision, codes), ≥2 RISE visits, and ≥1 RA disease activity measure scored in 2016, we classified eligible patients' drug use at the index visit as monotherapy or combination therapy with conventional synthetic (cs) and biologic disease-modifying antirheumatic drugs (bDMARDs). Outcomes include change in treatment over 12 months. Mixed models identified factors associated with treatment change.Results: Among 50,996 eligible patients, 27,274 had longitudinal data. The most commonly used measures were RAPID3 (78.9%) and the Clinical Disease Activity Index (CDAI) (34.2%). The frequency of treatment change during follow-up was relatively low (35.6-54.6%), even for patients with moderate/high disease activity according to RAPID3 or CDAI scores. Older patients (age ≥75 years; adjusted odds ratio [ORadj ] 0.63 [95% confidence interval (95% CI) 0.50-0.78]) and those already receiving combination therapy with csDMARDs (ORadj 0.45 [95% CI 0.33-0.61]) or combination therapy with bDMARDs (ORadj 0.30 [95% CI 0.24-0.38]) were less likely to change RA treatment even after multivariable adjustment.Conclusion: Using the American College of Rheumatology's national RISE registry, one- to two-thirds of RA patients failed to change their treatment, even when experiencing moderate/high disease activity. Multimodal interventions directed at both patients and providers are needed to encourage shared decision-making, goal-directed care, and to overcome barriers to treatment escalation. [ABSTRACT FROM AUTHOR]

Background: Heart block requiring a pacemaker is common after self‐expandable transcatheter aortic valve replacement (SE‐TAVR); however, conduction abnormalities may improve over time. Optimal device management in these patients is unknown. Objective: To evaluate the long‐term, natural history of conduction disturbances in patients undergoing pacemaker implantation following SE‐TAVR. Methods: All patients who underwent new cardiac implantable electronic device (CIED) implantation at Michigan Medicine following SE‐TAVR placement between January 1, 2012 and September 25, 2017 were identified. Electrocardiogram and device interrogation data were examined during follow‐up to identify patients with recovery of conduction. Logistic regression analysis was used to compare clinical and procedural variables to predict conduction recovery. Results: Following SE‐TAVR, 17.5% of patients underwent device placement for new atrioventricular (AV) block. Among 40 patients with an average follow‐up time of 17.1 ± 8.1 months, 20 (50%) patients had durable recovery of AV conduction. Among 20 patients without long‐term recovery, four (20%) had transient recovery. The time to transient conduction recovery was 2.2 ± 0.2 months with repeat loss of conduction at 8.2 ± 0.9 months. On multivariate analysis, larger aortic annular size (odds ratio: 0.53 [0.28–0.86]/mm, P = 0.02) predicted lack of conduction recovery. Conclusions: Half of the patients undergoing CIED placement for heart block following SE‐TAVR recovered AV conduction within several months and maintained this over an extended follow‐up period. Some patients demonstrated transient recovery of conduction before recurrence of conduction loss. Larger aortic annulus diameter was negatively associated with conduction recovery. [ABSTRACT FROM AUTHOR]

The other report with Oxford vaccine in SOT was reported by a national registry of UK,4 in which around 350 KTR were tested for antibody response. Of a total of 48 KTR receiving vaccine, 31 completed the second dose schedule of vaccine and were analysed for antibody response. The efficacy of coronavirus (COVID-19) vaccine in solid organ transplantation (SOT) has not remained encouraging.1,2 Additionally, the data about Oxford/AstraZeneca (ChAdOx1 nCoV-19 vaccine) is understudied in SOT.3 We intended to measure the antibody response and safety of this vaccine in kidney transplant recipients (KTR) in this prospective observational study conducted at the Department of Nephrology, IKDRC-ITS, Ahmedabad, India. [Extracted from the article]

Reactivation of SARS-CoV-2 infection following recovery from COVID-19. At this second admission, he tested again positive for SARS-CoV2 RT-PCR, and his illness progressed from mild to severe COVID-19 in his 10-day hospital course, during which he also developed bacterial/fungal super-infections. Reactivation and reinfection of COVID-19 is a rare and threatening complication with relevance for organ transplantation.1-4 We have recently observed a reinfection documented by severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) reverse transcriptase-polymerase chain reaction (RT-PCR) following a previous two negative RT-PCR tests and clinical convalescence in a kidney transplant recipient (KTR) which resulted in mortality (Figure 1). [Extracted from the article]

According to the Indian chronic kidney disease registry, in 2010 only 2% of end stage kidney disease patients were managed with kidney transplantation, 37% were managed with dialysis and 61% were treated conservatively without renal replacement therapy. In countries like India, where a well-organized deceased donor kidney transplantation program is not available, living donor kidney transplantation is the major source of organs for kidney transplantation. The most common reason to decline a donor for directed living donation is ABO incompatibility, which eliminates up to one third of the potential living donor pool. Because access to transplantation with human leukocyte antigen ( HLA)-desensitization protocols and ABO incompatible transplantation is very limited due to high costs and increased risk of infections from more intense immunosuppression, kidney paired donation ( KPD) promises hope to a growing number of end stage kidney disease patients. KPD is a rapidly growing and cost-effective living donor kidney transplantation strategy for patients who are incompatible with their healthy, willing living donor. In principle, KPD is feasible for any centre that performs living donor kidney transplantation. In transplant centres with a large living donor kidney transplantation program KPD does not require extra infrastructure, decreases waiting time, avoids transplant tourism and prevents commercial trafficking. Although KPD is still underutilized in India, it has been performed more frequently in recent times. To substantially increase donor pool and transplant rates, transplant centres should work together towards a national KPD program and frame a uniform acceptable allocation policy. [ABSTRACT FROM AUTHOR]

Kute VB, Trivedi HL, Vanikar AV, Shah PR, Gumber MR, Patel HV, Munjappa BC, Modi PR, Gera DN. Long-term outcome of deceased donor renal transplantation in pediatric recipients: A single-center experience from a developing country Abstract: RTx is best treatment for children with ESRD. Data scarcity on DDRTx outcome in children prompted us to review our experience. This study was undertaken to evaluate patient/graft survival, function vis-a-vis SCr, rejection episodes, and mortality in DDRTx performed in 37 children between 1998 and 2011. The most common recipient diseases leading to ESRD were congenital anomalies of kidney and urinary tract (48.6%) and chronic glomerulonephritis (18.9%). Mean recipient age was 13.8 ± 3.1 yr; 67.5% (n = 25) were men. Mean donor age was 38.8 ± 18.6 yr; 48.5% (n = 18) were men. Mean dialysis duration pre-transplantation was 15.5 ± 3.5 months. All recipients received r-ATG, and triple immunosuppression. Over a mean follow-up of 3.93 ± 3.5 yr, patient and graft survival rates were 72.9% (n = 27) and 83.7% (n = 31), respectively, with a mean SCr of 1.1 mg/dL; 21.6% (n = 8) of patients had acute rejection episodes; 24.3% (n = 9) of patients had DGF. A total of 27% (n = 10) patients died, mainly owing to infections (n = 6) and cardiovascular disease (n = 3). DDRTx is a viable option for children and achieves acceptable graft function with patient/graft survival over long-term follow-up, encouraging use of this approach. [ABSTRACT FROM AUTHOR]

The intention of this study was to explore the efficacy and feasibility for Acid Yellow 17 adsorption onto fixed bed column of Tamarind Seed Powder. The effect of various parameters like flow rate, initial concentration of dye, bed height, and pH were exploited in this study. The Thomas, Yoon-Nelson, Bed Depth Service Time (BDST), and Adams and Bohart model were analysed to evaluate the column adsorption performance. The adsorption capacity, rate constant and correlation coefficient associated to each model for column adsorption was calculated and mentioned. The adsorption capacity increases with increasing initial dye concentration and bed height and decreasing flow rate. The maximum adsorption capacity related to Adams and Bohart model was found to be 978.5 mg/g at initial concentration of 50 ppm at constant flow rate of 15 mL/min, bed height of 15 cm, and pH 7. Le but de cette étude était d'explorer l'efficacité et la faisabilité de l'Acid Yellow 17 adsorption sur colonne à lit fixe de Tamarind Seed Powder. L'effet de différents paramètres comme le débit, la concentration initiale de colorant, la hauteur du lit et le pH ont été exploitées dans cette étude. Le Thomas, Yoon-Nelson, BDST et Adams et le modèle Bohart ont été analysées pour évaluer les performances d'adsorption colonne. La capacité d'adsorption, constante de vitesse et coefficient de corrélation associé à chaque modèle de la colonne d'adsorption a été calculé et mentionné. Les augmentations de capacité d'adsorption avec une concentration croissante de colorant initial et un lit en hauteur et le débit diminue. La capacité maximale d'adsorption liées au modèle Adams et Bohart a été trouvé à 978,5 mg/g à la concentration initiale de 50 ppm à débit constant de 15 ml/min, la hauteur du lit de 15 cm et un pH de 7. [ABSTRACT FROM AUTHOR]

The article presents a case study of an iatrogenic complication following internal jugular vein catheterization for hemodialysis access. The diabetic end-stage renal disease patient was diagnosed with pulsating mass with a palpable thrill and a bruit in the right subclavicular region. This study demonstrated the importance of thorough physical examination, emphasizing checking for neck swellings, thrill, and bruit, along with standard use of vascular doppler for securing dialysis access.

A letter to the editor is presented in response to an article related to the kidney donation programs in India, that was published in previous issue.

A letter to the editor is presented in response to the article regarding the improvement in the standards of retinopathy of prematurity (ROP) in the 2014 issue.

The article presents a case study of a 54-year-old woman with diabetic chronic kidney disease that needs renal replacement therapy. It discusses results of her post-procedure posteroanterior chest X-ray and computerized tomography (CT). It suggests the routine use of Doppler to secure the access along with fluoroscopic-guided permcatheter placement to minimize the complications.

Background: To compare perioperative and midterm outcomes in thoracic and thoraco-abdominal aortic aneurysm (TAA and TAAA) repair using hypothermic circulatory arrest (HCA) or aortic clamping (AC) with mild hypothermia., Methods: From 2012 to 2021 there were 180 open repairs of a TAA or TAAA, of which 90 (50%) were done with HCA and 90 (50%) with aortic clamping with mild hypothermia. The indications for HCA were arch aneurysm, TAA from chronic aortic dissection, and inability to clamp the aorta for proximal anastomosis., Results: Compared to AC, the HCA group had less prior descending aorta replacement/repair (9.1% vs. 32%, p = 0.0001). Intraoperatively, the HCA group had more TAAs (70% vs. 20%, p < 0.0001) while the AC group had more TAAAs (80% vs. 30%, p < 0.0001). HCA group had longer cardiopulmonary bypass times (242 vs. 181 min, p < 0.0001) but shorter cross-clamp time (39 vs. 120 min, p < 0.0001) and lower temperatures (18°C vs. 34°C, p < 0.0001). Postoperatively, the HCA group had longer intubation times (31 vs. 26 h, p = 0.002), but all other postoperative outcomes including paralysis (2.2% vs. 8.9%, p = 0.08), and operative mortality (4.4% vs. 2.2%, p = 0.68) were similar between HCA and AC groups. Patient age was an independent risk factor for postoperative paralysis (OR 1.07, p = 0.03) while HCA was not significant (OR 0.37, p = 0.21). Five-year survival was similar between HCA and AC groups (85% vs. 80%, p = 0.36)., Conclusions: Postoperative outcomes and midterm survival were acceptable in thoracic and thoracoabdominal aneurysm patients after HCA or AC. Both HCA and AC with mild hypothermia were valid approaches in TAA/A repair., (© 2022 Wiley Periodicals LLC.)

Background: To determine the progression of aortic root in acute type A aortic dissection (ATAAD) patients after aortic root repair (ARr) or replacement (ARR) based on long-term follow-up imaging studies., Methods: From 1996 to 2019, 732 patients had ATAAD repair at our institution. Six hundred and seven of these patients had either ARr, (n = 383) or ARR (n = 224). Eighty-one patients were excluded due to a lack of postoperative imaging. Three hundred and thirty-two patients were included in the repair group and 194 patients in the replacement group for long-term follow-up imaging study., Results: Compared to the ARR group, the ARr group was significantly older (60 years vs. 55 years) and had more patients with hypertension (79% vs. 63%) but less male patients (63% vs. 79%) and connective tissue disorder (1.8% vs 8%). The ARr group had more zone two arch replacement (22% vs. 11%), similar HCA time (35 min vs. 31 min), shorter cardiopulmonary bypass time (203 min vs. 266 min), aortic cross-clamp time (128 min vs. 214 min), and fewer concomitant coronary artery bypass (3.9% vs. 8.9%). The root growth rate over 12 years was similar between the repair and replacement group (0.20 mm/year vs. 0.18 mm/year, p = .75). Both the repair and replacement group had similar 15-year cumulative incidence of reoperation (6.9% vs. 5.9%; p = .67), operative mortality (7.8% vs. 8.5%; p = .78), and 15-year survival (51% vs. 52%; p = .40)., Conclusions: There was minimal growth of the aortic root after root repair or replacement for ATAAD patients. Both aortic root repair and replacement were acceptable techniques for ATAAD surgery in select patients., (© 2022 Wiley Periodicals LLC.)

Purpose: Up to 10% of acute type A aortic dissection (TAAD) patients are deemed unfit for open surgical repair, exposing these patients to high mortality rates. In recent years, thoracic endovascular aortic repair has proven to be a promising alternative treatment modality in specific cases. This study presents a comprehensive overview of the current state of catheter-based interventions in the setting of primary TAAD., Methods: A literature search was conducted, using MEDLINE and PubMed databases according to PRISMA guidelines, updated until January 2020. Articles were selected if they reported on the endovascular repair of DeBakey Type I and II aortic dissections. The exclusion criteria were retrograde type A dissection, hybrid procedures, and combined outcome reporting of mixed aortic pathologies (e.g., pseudoaneurysm and intramural hematoma)., Results: A total of 31 articles, out of which 19 were case reports and 12 case series, describing a total of 92 patients, were included. The median follow-up was 6 months for case reports and the average follow-up was 14 months for case series. Overall technical success was 95.6% and 30-day mortality of 9%. Stroke and early endoleak rates were 6% and 18%, respectively. Reintervention was required in 14 patients (15%)., Conclusion: This review not only demonstrates that endovascular repair in the setting of isolated TAAD is feasible with acceptable outcomes at short-term follow-up, but also underlines a lack of mid-late outcomes and reporting consistency. Studies with longer follow-up and careful consideration of patient selection are required before endovascular interventions can be widely introduced., (© 2020 Wiley Periodicals LLC.)

Introduction: To identify patients with aneurysmal degeneration of the native aorta following type A aortic dissection (TAAD), reproducible serial measurements of aortic dimensions are critical. We used a systematic workflow for measuring aortic geometry following TAAD, using computed tomography angiography data, and test its reproducibility., Methods: The workflow for aortic measurements included centerline generation, luminal diameter, and area measurement at six anatomically defined locations along the aorta and luminal volumetric measurements in the descending aorta. Two independent observers measured the aortic geometry in 20 surgically repaired TAAD patients, preoperatively and at 3 months follow-up. To test reproducibility, intraobserver and interobserver agreement scores were analyzed using a concordance correlation coefficient (CCC)., Results: The interobserver agreement scores of the diameter, area, and volumetric measurements in the descending aorta were acceptable. The agreement scores of the area measurements were highest, with CCCs ranging from 0.909 to 0.984. Luminal diameter measurements scored lower than luminal area measurements and were least reproducible at the mid aortic arch (CCC < 0.886). Overall, intraobserver agreement scores were better than interobserver agreement scores (SD of mean difference was 1.89 vs 1.94 for intraobserver vs interobserver diameter measurements, and 0.61 vs 0.66 for area measurements)., Conclusion: Although overall reproducibility was acceptable in descending aortic measurements, our results show that it remains challenging to reliably measure luminal diameters, compared with areas. To aid identification of early adverse remodeling following acute TAAD, novel two- and three-dimensional measurement techniques are needed that capture locoregional changes in the false lumen and true lumen morphology more accurately., (© 2020 The Authors. Journal of Cardiac Surgery published by Wiley Periodicals, Inc.)

Background: Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for the treatment of aortic stenosis in patients at intermediate, high, and extreme risk for mortality from SAVR. We examined recent trends in aortic valve replacement (AVR) in Michigan., Methods: The Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC) database was used to determine the number of SAVR and TAVR cases performed from January 2012 through June 2017. Patients were divided into low, intermediate, high, and extreme risk groups based on STS predicted risk of mortality (PROM). TAVR patients in the MSTCVS-QC database were also matched with those in the Transcatheter Valve Therapy Registry to determine their Heart Team-designated risk category., Results: During the study period 9517 SAVR and 4470 TAVR cases were performed. Total annual AVR volume increased by 40.0% (from 2086 to 2920), with a 13.3% decrease in number of SAVR cases (from 1892 to 1640) and a 560% increase in number of TAVR cases (from 194 to 1280). Greater than 90% of SAVR patients had PROM ≤8%. While >70% of TAVR patients had PROM ≤ 8%, they were mostly designated as high or extreme risk by a Heart Team., Conclusions: During the study period, SAVR volume gradually declined and TAVR volume dramatically increased. This was mostly due to a new group of patients with lower STS PROM who were designated as higher risk by a Heart Team due to characteristics not completely captured by the STS PROM score., (© 2018 Wiley Periodicals, Inc.)