Background: The frozen elephant trunk (FET) procedure remains an increasingly popular approach to address complex multi-segmental aortic pathologies, owing to their ability to promote false lumen thrombosis and reduce the need for second-stage operations. While the short-term outcomes of such procedures have been shown to be acceptable, much less is known regarding long-term outcomes. This systematic review evaluates long-term outcomes of the FET procedure.Methods: Studies with at least 12 months follow-up data on FETs were identified in four electronic databases. All studies were reviewed by two independent researchers and relevant data extracted. Long-term outcomes, including overall survival, freedom from reintervention, and freedom from aortic events, were evaluated using patient data recreated from digitized Kaplan-Meier curves.Results: Thirty-seven studies with 4,178 patients were identified. The majority of the studies focused solely on acute dissections. Average follow-up was 3.2 years. Overall survival at 1-, 3-, and 5-year was 89.6%, 85.2%, and 82.0%, respectively. Freedom from reintervention at the same timepoints were 93.9%, 89.3%, and 86.8%, respectively. Mortality, permanent neurological deficit and spinal cord injury were 10.2%, 7.7%, and 6.5%, respectively.Conclusions: Survival after the FET procedure is favorable, though ongoing close serial monitoring is essential to assess for the need for further reintervention. Larger multi-institutional registries are required to provide more robust evidence to better elucidate the patient cohort that would most benefit from the FET.
The present systematic review demonstrated that short-term AVR with this prosthesis provided excellent early safety and hemodynamic outcomes with acceptable mean gradients and EOA. Long-term follow-up and randomized controlled trials are warranted to confirm the early results.
Background: The number of elderly patients undergoing hepatic resection for surgical treatment of benign and malignant cancers is increasing. However, there is limited clinical data on the complications and long-term survival rates associated with liver surgery in the elderly patients (≥70 years) versus younger patients for malignant liver conditions. Methods: Six electronic databases were searched for original published studies comparing elderly (≥70) versus younger (<70) cohorts for malignant liver tumours. Data were extracted and analysed according to predefined clinical endpoints. Results: Twenty-seven comparative studies were identified, including 4769 elderly patients versus 15 855 younger patients (n = 20 624). There was significantly higher 30-day mortality in the elderly colorectal liver metastasis group (P < 0.00002) and significant difference between elderly and young in terms of overall survival (hazard ration (HR), 1.10; P = 0.02). However, there was no difference in disease-free survival (HR, 1.05; P = 0.27). Post-operative pneumonia, renal failure and infection were more frequent in the elderly group. Conclusions: Liver resection for malignant hepatic tumours in the elderly is associated with a greater 30-day mortality and overall mortality when compared with younger cohorts, but similar disease-free survival. Length of stay and transfusions were not significantly different while pneumonia, renal failure and infections were more frequent in the elderly group.
This systematic review of contemporary data suggests a modest average effect of DFT, if any, in terms of mortality, shock efficacy, or safety. Therefore, DFT testing should no longer be compulsory during de novo implantation. However, DFT testing may still be clinically relevant in specific patient populations.
Although preliminary meta-analysis of pooled data suggested the highest efficacy with PRF, this was not replicated when analysis was limited to randomized data. Therefore, there was insufficient evidence to suggest that one ablation modality is more efficacious than another. However, there was a consistent reduction in procedural duration associated with PRF in all analyses. The present meta-analysis highlights the critical need for further randomized studies comparing available ablation technologies in terms of efficacy and safety.
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