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Giannis D, Geropoulos G, Ziogas IA, Gitlin J, Oropallo A. The anti-adhesive effect of anti-VEGF agents in experimental models: A systematic review. Wound Repair Regen 2020; 29:168-182. [PMID: 33316850 DOI: 10.1111/wrr.12879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/04/2020] [Accepted: 11/25/2020] [Indexed: 02/01/2023]
Abstract
Adhesions constitute a major problem in abdominal-pelvic and thoracic surgery with significant impact in the postoperative quality of life and healthcare services utilization. Adhesiogenesis is the result of increased fibrin formation, impaired fibrinolysis, angiogenesis, and fibrosis. Despite the recent advancements, the ideal anti-adhesive agent remains to be determined. To this end, we performed a comprehensive literature search in PubMed, EMBASE, and Scopus databases to identify studies investigating the antiadhesive role of anti-VEGF agents in peritoneal, pleural, and pericardial experimental adhesion models. Fifteen studies were eligible for inclusion with a total population of 602 animals (334 rats, 180 rabbits, and 88 mice). The majority of included studies (11/15) used bevacizumab, while three studies used other anti-VEGF antibodies and one study used an anti-VEGFR-antibody. A rat model was used in nine studies, while rabbit (n = 3) or mouse (n = 3) models were used less frequently. Eleven studies used peritoneal models, three studies used pleural models, and one study used a pericardial model. The scales (n = 12) and interval (Range: 1-42 days) used for the evaluation of adhesions varied between the studies. All studies demonstrated a significant decrease in adhesion scores between the anti-VEGF and control groups up to 42 days postprocedure. VEGF blockade resulted in decreased fibrosis in four out of five studies that used peritoneal models, while the effect on pleural models depended on the pleurodesis agent and was significant between 7 and 28 days. The effect of anti-VEGF agents on anastomosis integrity depends on the dose and the model that is used (inconclusive results).Current data support the anti-adhesive role of Anti-VEGF agents in all three serosal surfaces up to 6 weeks postprocedure. Further studies are needed to confirm the anti-adhesive role of anti-VEGF agents in pleural and pericardial adhesion experimental models and investigate any effect on anastomosis integrity in peritoneal models.
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Affiliation(s)
- Dimitrios Giannis
- Institute of Health Innovations and Outcomes Research, The Feinstein Institutes for Medical Research, Manhasset, New York, USA.,Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Georgios Geropoulos
- Surgery Working Group, Society of Junior Doctors, Athens, Greece.,Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London, UK
| | - Ioannis A Ziogas
- Surgery Working Group, Society of Junior Doctors, Athens, Greece.,Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Jordan Gitlin
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
| | - Alisha Oropallo
- Department of Vascular Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA
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Khalil F, Siontis K, Bagameri G, Killu AM. Hybrid Catheter-Based and Surgical Techniques for Ablation of Ventricular Arrhythmias. Arrhythm Electrophysiol Rev 2020; 9:97-103. [PMID: 32983531 PMCID: PMC7491053 DOI: 10.15420/aer.2020.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Catheter ablation is a rapidly expanding and evolving field. The advent of interventional techniques and advances in technology have allowed catheter ablation to supplant antiarrhythmic surgery for ventricular arrhythmia treatment. However, issues related to access and energy delivery limit the use of catheter ablation in some cases. Hybrid catheter-based and surgical techniques represent a novel approach to overcome these limitations. The hybrid technique combines the strengths and minimises the limitations of either catheter or surgical ablation alone. There is a growing body of evidence in the literature supporting the safety and efficacy of the hybrid surgical technique. This review aims to provide an overview of hybrid surgical-catheter ablation for ventricular arrhythmia.
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Affiliation(s)
- Fouad Khalil
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, US
| | - Konstantinos Siontis
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, US
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, US
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, US
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Karki R, Friedman PA, Killu AM. The Future of Percutaneous Epicardial Interventions. Card Electrophysiol Clin 2020; 12:419-430. [PMID: 32771195 DOI: 10.1016/j.ccep.2020.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The pericardial space provides a unique vantage point to access different cardiac structures for diagnosis and treatment of arrhythmias and other nonelectrophysiologic conditions, such as heart failure. There have been notable innovations to improve safety of percutaneous pericardial access and its use for various procedures. Percutaneous pericardial device therapies for pacing and defibrillation have been in development, success of which will be a significant advance in treatment of bradyarrhythmias, cardiac resynchronization therapy, and prevention of arrhythmic deaths. There is need for continued efforts in development and expansion of this technique and a systematic approach to monitor efficacy and safety outcomes.
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Affiliation(s)
- Roshan Karki
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 1st Street, Rochester, MN 55905, USA. https://twitter.com/roshankarkimd
| | - Paul A Friedman
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 1st Street, Rochester, MN 55905, USA. https://twitter.com/drpaulfriedman
| | - Ammar M Killu
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 1st Street, Rochester, MN 55905, USA.
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Mathew S, Feickert S, Fink T, Rillig A, Reissmann B, Rottner L, Hashiguchi N, Wohlmuth P, Maurer T, Lemes C, Metzner A, Kuck KH, Ouyang F. Epicardial access for VT ablation: analysis of two different puncture techniques, incidence of adhesions and complication management. Clin Res Cardiol 2020; 110:810-821. [PMID: 32719917 PMCID: PMC8166684 DOI: 10.1007/s00392-020-01711-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022]
Abstract
Introduction Pericardial access for ablation of ventricular arrhythmias (VA) can be gained either by an anterior-oriented or inferior-oriented epicardial puncture under fluoroscopical guidance. We retrospectively sought to assess the safety of these two puncture techniques and the incidence of epicardial adhesions and introduce our algorithm for management of pericardial tamponade. Methods and results In 211 patients (61.4 ± 15.6 years, 179 males; 84.8%) 271 epicardial ablation procedures of VA were performed using either an anterior- or inferior-oriented approach for epicardial access. Puncture-related complications were systematically analyzed. Furthermore, the incidence of adhesions was evaluated during first and repeated procedures. A total of 34/271 (12.5%) major complications occurred and 23/271 (8.5%) were directly related to epicardial puncture. The incidence of puncture-related major complications in the anterior and inferior group was 4/82 (4.9%) and 19/189 (10.1%), respectively. Pericardial tamponade was the most common major complication (15/271; 5.5%). Collateral damages of adjacent structures such as liver, colon, gastric vessels and coronary arteries occurred in 6/189 (3.2%) patients and only within the inferior epicardial access group. Adhesions were documented in 19/211 (9%) patients during the first procedure and in 47.1% if patients had 2 or more procedures involving epicardial access. Conclusion Anterior-oriented epicardial puncture shows an observed association to a reduced incidence of pericardial tamponades and overall puncture-related complications in epicardial ablation of VA. In cases of repeated epicardial access adhesions increase significantly and may lead to ablation failure.
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Affiliation(s)
- Shibu Mathew
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
- Department of Cardiology, University Hospital of Giessen, Klinikstrasse 33, 35392, Giessen, Germany.
| | | | - Thomas Fink
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- University Heart Center Lübeck, Medical Clinic II, University Hospital Schleswig Holstein, Lübeck, Germany
| | - Andreas Rillig
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- University Heart Center Hamburg, Department of Electrophysiology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Bruno Reissmann
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- University Heart Center Hamburg, Department of Electrophysiology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Laura Rottner
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- University Heart Center Hamburg, Department of Electrophysiology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | | | | | - Tilman Maurer
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christine Lemes
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Andreas Metzner
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- University Heart Center Hamburg, Department of Electrophysiology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Feifan Ouyang
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- Fuwai Hospital/National Centers of Cardiovascular Diseases, The Chinese Academy of Medical Sciences and National Center of Cardiovascular Diseases, Beijing, China
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John M, Post A, Burkland DA, Greet BD, Chaisson J, Heberton GA, Saeed M, Rasekh A, Razavi M. Confirming pericardial access by using impedance measurements from a micropuncture needle. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:593-601. [PMID: 32333406 DOI: 10.1111/pace.13927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/03/2020] [Accepted: 04/19/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pericardial access is complicated by two difficulties: confirming when the needle tip is in the pericardial space, and avoiding complications during access, such as inadvertently puncturing other organs. Conventional imaging tools are inadequate for addressing these difficulties, as they lack soft-tissue markers that could be used as guidance during access. A system that can both confirm access and avoid inadvertent organ injury is needed. METHODS A 21G micropuncture needle was modified to include two small electrodes at the needle tip. With continuous bioimpedance monitoring from the electrodes, the needle was used to access the pericardium in porcine models (n = 4). The needle was also visualized in vivo by using an electroanatomical map (n = 2). Bioimpedance data from different tissues were analyzed retrospectively. RESULTS Bioimpedance data collected from the subcutaneous space (992.8 ± 13.1 Ω), anterior mediastinum (972.2 ± 14.2 Ω), pericardial space (323.2 ± 17.1 Ω), mid-myocardium (349.7 ± 87.6 Ω), right ventricular cavity (235.0 ± 9.7 Ω), lung (1142.0 ± 172.0 Ω), liver (575.0 ± 52.6 Ω), and blood (177.5 ± 1.9 Ω) differed significantly by tissue type (P < .01). Phase data in the frequency domain correlated well with the needle being in the pericardial space. A simple threshold analysis effectively separated lung (threshold = 1120.0 Ω) and blood (threshold = 305.9 Ω) tissues from the other tissue types. CONCLUSIONS Continuous bioimpedance monitoring from a modified micropuncture needle during pericardial access can be used to clearly differentiate tissues. Combined with traditional imaging modalities, this system allows for confirming access to the pericardial space while avoiding inadvertent puncture of other organs, creating a safer and more efficient needle-access procedure.
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Affiliation(s)
- Mathews John
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
| | - Allison Post
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
| | - David A Burkland
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Brian D Greet
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Jordan Chaisson
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - George A Heberton
- Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Mohammad Saeed
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Abdi Rasekh
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Mehdi Razavi
- Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
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Vaidya VR, Asirvatham SJ. Epicardial access: Adjusting the approach as we discover complications. J Cardiovasc Electrophysiol 2019; 30:1341-1344. [DOI: 10.1111/jce.14036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Vaibhav R. Vaidya
- Department of Cardiovascular DiseasesMayo Clinic Rochester Minnesota
| | - Samuel J. Asirvatham
- Department of Cardiovascular DiseasesMayo Clinic Rochester Minnesota
- Department of Pediatrics and Adolescent MedicineMayo Clinic Rochester Minnesota
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