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Seguel E. Cirugía cardíaca en ancianos: riesgo operatorio y alternativas de tratamiento. REVISTA MÉDICA CLÍNICA LAS CONDES 2022. [DOI: 10.1016/j.rmclc.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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A cirurgia de substituição valvular aórtica melhora a qualidade de vida dos octogenários com estenose aórtica severa. Rev Port Cardiol 2019; 38:251-258. [DOI: 10.1016/j.repc.2018.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 05/18/2018] [Accepted: 06/24/2018] [Indexed: 11/16/2022] Open
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Bento D, Coelho P, Lopes J, Fragata J. Aortic valve replacement surgery improves the quality of life of octogenarians with severe aortic stenosis. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2018.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Calle-Valda CM, Aguilar R, Benedicto A, Sarraj A, Monguio E, Munoz D, De Antonio N, Reyes G. Outcomes of Aortic Valve Replacement According to Surgical Approach in Intermediate and Low Risk Patients: A Propensity Score Analysis. Heart Lung Circ 2017; 27:885-892. [PMID: 28918980 DOI: 10.1016/j.hlc.2017.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 08/08/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Previous trials have shown that, among high-risk patients with aortic stenosis, survival rates are similar for transcatheter aortic-valve implantation (TAVI) and surgical aortic valve replacement. The study aimed to compare the outcomes of aortic valve replacement according to the adopted surgical approach in intermediate and low risk patients. METHODS This is a retrospective, observational, cohort study of prospectively collected data from 421 patients undergoing isolated aortic valve replacement between 2011 and 2015. A multinomial logit propensity score model based on preoperative risk factors was used to match patients 1:1:1 between conventional replacement (CAVR), minimally invasive (MIAVR) and TAVI groups, resulting in 50 matched three cohorts. RESULTS After multinomial logit propensity score, the three groups were comparable in terms of preoperative characteristics. Mean age and Logistic EuroSCORE I of CAVR, MIAVR and TAVI groups were (84.2±5.1 vs. 82.3±4.8 vs. 85.6±4.9 years; p=0.002) and (11.4±3.6% vs. 8.3±3.4% vs. 15.8±5.4%; p<0.001) respectively. Overall mortality rates were similar for the three patient cohorts at one year. There were no significant differences related to stroke to 30 days. In the TAVI cohort, pacemaker implantation for new-onset total atrioventricular block became necessary in 30% of patients (p<0.001) and 16% of patients had some degree of paravalvular aortic regurgitation, which was more than mild (p<0.001). Total length of stay was shorter in the TAVI group when compared with surgical groups (11.5±5.3 vs. 10.1±6.9 vs 8.5±3.7 days; p=0.023). After discharge, the survival rate follow-up (average follow up: 46.7 months) was 70%, 84% and 72% for three cohorts (log Rank x2=2.40, p=0.3). CONCLUSIONS In our experience, the three aortic valve replacement approaches offer very good results. Differences in the rate of complications were found between groups. Depending on patient's characteristics the Heart-Team group must offer the best surgical approach for each patient.
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Affiliation(s)
- Corazon M Calle-Valda
- Department of Cardiovascular Surgery, Hospital Universitario de La Princesa, Madrid, Spain.
| | - Rio Aguilar
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Amparo Benedicto
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Anas Sarraj
- Department of Cardiovascular Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | - Emilio Monguio
- Department of Cardiovascular Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | - Daniel Munoz
- Department of Cardiovascular Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | - Nieves De Antonio
- Department of Cardiovascular Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | - Guillermo Reyes
- Department of Cardiovascular Surgery, Hospital Universitario de La Princesa, Madrid, Spain
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Incidence, Severity, and Outcomes of Acute Kidney Injury in Octogenarians following Heart Valve Replacement Surgery. Int J Nephrol 2015; 2015:237951. [PMID: 26090225 PMCID: PMC4458288 DOI: 10.1155/2015/237951] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/05/2015] [Accepted: 04/23/2015] [Indexed: 01/16/2023] Open
Abstract
Background. The study investigates the occurrence, severity, and outcomes of acute kidney injury (AKI) in octogenarians following heart valve surgery. Methods. All patients, age >80 years, not on dialysis and without kidney transplant, undergoing heart valve replacement at Mayo Clinic, Rochester, in the years 2002-2003 were enrolled. AKI was diagnosed based on AKIN criteria. Results. 209 octogenarians (88.0% aortic valve, 6.2% mitral valve, 1.0% tricuspid valve, and 4.8% multivalve) with (58.4%) and without CABG were studied. 34 (16.3%) had preexisting CKD. After surgery, 98 (46.8%) developed AKI. 76.5% of the AKI were in Stage 1, 9.2% in Stage 2, and 14.3% in Stage 3. 76.5% CKD patients developed AKI. Length of hospital stay was longer for AKI patients. More AKI patients were discharged to care facilities. Patient survival at 30 days and 1 year for AKI versus non-AKI was 88.8 versus 98.7%, p = 0.003, and 76.5 versus 88.3%, p = 0.025, respectively. With follow-up of 3.94 ± 0.28 years, Kaplan-Meier analysis showed a reduced survival for AKI octogenarians. Preexisting CKD and large volume intraoperative
fluid administration were independent AKI predictors. Conclusions. Nearly half of the octogenarians developed AKI after valve replacement surgery. AKI was associated with significant functional impairment and reduced survival.
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Aortic valve surgery in octogenarians: Risk factors and long-term impact. Rev Clin Esp 2015. [DOI: 10.1016/j.rceng.2014.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Carrascal Y, Valenzuela H, Laguna G, Pareja P, Blanco M, Ortega C. Aortic valve surgery in octogenarians: Risk factors and long-term impact. Rev Clin Esp 2014; 215:148-55. [PMID: 25278434 DOI: 10.1016/j.rce.2014.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/15/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES To understand the risk factors and long-term impact and results of aortic valve surgery in patients over age 80. PATIENTS AND METHODS We consecutively evaluated 255 octogenarians who were operated on between 2000 and 2013 and referred for aortic valve disease (isolated or combined with coronary artery disease), which, even when associated with other diseases, was the primary cause of the patient's functional limitation. RESULTS The mortality rate decreased from 14.08% (2000-2004) to 7.7% (isolated valve surgery, 4.4%; with coronary bypass, 3.3%) (2010-2013). The independent risk factors associated with mortality were urgent surgery, combined procedures, peripheral vascular disease, a postsurgery hematocrit level <24% and the need for transfusion. More than 50% of the patients experienced a postoperative complication. Blood product transfusions were associated with renal and respiratory failure, and preoperative anemia was associated with an increased rate of myocardial infarction and stroke. Survival at 1, 3, 5 and 10 years was 79.5, 74.3, 63.6 and 30.5%, respectively, with 91.5% of patients in NYHA functional class I-II. Long-term survival was lower for cases of preoperative left ventricular dysfunction. The EuroSCORE I logistics score was not useful for our population as a predictor of mortality or of medium to long-term survival. CONCLUSIONS The morbidity and mortality of aortic valve surgery for patients over age 80 has decreased in recent years, although it remains higher when valve surgery is combined with coronary surgery. The presence of preoperative left ventricular dysfunction decreases long-term survival.
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Affiliation(s)
- Y Carrascal
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - H Valenzuela
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - G Laguna
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - P Pareja
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M Blanco
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - C Ortega
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, España
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Grau JB, Mak AW, Ferrari G, Johnson CK, Shaw RE, Sperling J, Brizzio ME, Zapolanski A. Perioperative predictors of midterm survival after aortic valve replacement. Asian Cardiovasc Thorac Ann 2014; 22:566-73. [PMID: 24867031 DOI: 10.1177/0218492313501509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Elderly patients with aortic stenosis are under-referred for aortic valve replacement surgery. This study investigated the perioperative factors associated with midterm outcomes in a consecutive series of patients undergoing aortic valve replacement with or without coronary artery bypass graft surgery. METHODS From 2006 to 2010, 509 patients having aortic valve replacement or aortic valve replacement with coronary artery bypass were grouped according to age (<80 years and ≥80 years) and procedure (aortic valve replacement ± coronary artery bypass). Patient survival was followed up for 5 years (mean 2.6 years). Midterm survival was evaluated using Kaplan-Meier and Cox proportional hazards regression model statistics. RESULTS AND CONCLUSIONS 5-year survival among octogenarians was 59.2% with an observed 30-day mortality of 1% for aortic valve replacement and 3% for aortic valve replacement with coronary artery bypass. Kaplan-Meier survival analysis showed that age ≥80 years, New York Heart Association functional class III/IV, and left ventricular ejection fraction <35% were significantly associated with increased midterm mortality. Cox regression modeling demonstrated that age ≥80 years was the only significant independent factor associated with midterm mortality; older patients had a 3-fold increase in mortality (adjusted hazard ratio = 3.231, 95% confidence interval: 1.764-5.920, p < 0.0001). While hospital and 30-day mortality were not statistically different between age groups, age ≥80 years was the most powerful predictor of midterm death. These results support early aortic valve replacement with or without coronary artery bypass in aortic stenosis management.
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Affiliation(s)
- Juan B Grau
- The Valley Columbia Heart Center, Columbia University College of Physicians and Surgeons, Ridgewood NJ, USA University of Pennsylvania School of Medicine, Glenolden, PA, USA
| | - Andrew Wc Mak
- The Valley Columbia Heart Center, Columbia University College of Physicians and Surgeons, Ridgewood NJ, USA
| | - Giovanni Ferrari
- The Valley Columbia Heart Center, Columbia University College of Physicians and Surgeons, Ridgewood NJ, USA University of Pennsylvania School of Medicine, Glenolden, PA, USA
| | - Christopher K Johnson
- The Valley Columbia Heart Center, Columbia University College of Physicians and Surgeons, Ridgewood NJ, USA
| | - Richard E Shaw
- The Valley Columbia Heart Center, Columbia University College of Physicians and Surgeons, Ridgewood NJ, USA
| | - Jason Sperling
- The Valley Columbia Heart Center, Columbia University College of Physicians and Surgeons, Ridgewood NJ, USA
| | - Mariano E Brizzio
- The Valley Columbia Heart Center, Columbia University College of Physicians and Surgeons, Ridgewood NJ, USA
| | - Alex Zapolanski
- The Valley Columbia Heart Center, Columbia University College of Physicians and Surgeons, Ridgewood NJ, USA
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Zapolanski A, Mak AWC, Ferrari G, Johnson C, Shaw RE, Brizzio ME, Sperling JS, Grau JB. Impact of New York Heart Association classification, advanced age and patient-prosthesis mismatch on outcomes in aortic valve replacement surgery. Interact Cardiovasc Thorac Surg 2012; 15:371-6. [PMID: 22665381 DOI: 10.1093/icvts/ivs231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES More elderly patients (>80 years of age) are being referred for aortic valve replacement (AVR) with or without CABG. Current risk stratification models may not accurately predict the preoperative risk in these patients. We sought to determine which perioperative variables were relevant in determining short-term (30-day to in-hospital) outcomes in our intuition's series of consecutive AVR and AVR+CABG surgeries. We constructed a novel variable, patient-prosthesis mismatch (PPM) in the presence of diminished functional status (NYHA) classification, and studied its role as a predictor of mortality risk. METHODS From 2006 to 2010, 509 patients undergoing AVR or AVR+CABG were evaluated. We created four groups based on the age and procedure (AVR >80, AVR+CABG >80, AVR <80 and AVR+CABG <80). PPM was defined as a calculated effective orifice area index value of ≤ 0.85, and it was calculated from manufacturer-generated charts. In-hospital and 30-day outcomes were assessed using the Chi-square and logistic regression analyses. RESULTS Overall observed 30-day mortality for all groups was lower (n = 8, 1.6%) than the STS-predicted mortality. Reoperation and PPM+NYHA class III-IV were associated with short-term mortality, but age >80 years was not. Octogenarians referred for surgery often had advanced heart failure. CONCLUSIONS Overall, short-term outcomes after AVR with or without CABG were excellent and lower than predicted by the STS model. The low risk of AVR with CABG supports the consideration for earlier surgical referral and intervention for patients with a high likelihood of aortic stenosis progression before the onset of advanced heart failure ensues, regardless of the age. This should help further decrease the already very low mortality observed in these series. Efforts to avoid PPM in the setting of advanced heart failure may improve short-term results in this subset of patients.
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Affiliation(s)
- Alex Zapolanski
- Columbia University College of Physicians and Surgeons, The Valley Columbia Heart Center, Ridgewood, NJ, USA
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Stroke Associated With Surgical and Transcatheter Treatment of Aortic Stenosis. J Am Coll Cardiol 2011; 58:2143-50. [DOI: 10.1016/j.jacc.2011.08.024] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 08/02/2011] [Accepted: 08/02/2011] [Indexed: 11/19/2022]
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Sustitución valvular aórtica: ¿es una solución a la epidemia de estenosis aórtica en el anciano? Respuesta. Med Clin (Barc) 2011; 136:272-3. [DOI: 10.1016/j.medcli.2010.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 02/09/2010] [Accepted: 02/11/2010] [Indexed: 11/22/2022]
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Lozano I, Calvo D, Rondan J. Letter by Lozano et al regarding articles, "transcatheter valve-in-valve implantation for failed bioprosthetic heart valves" and "percutaneous therapy for valvular heart disease: a huge advance and a huge challenge to do it right". Circulation 2011; 123:e15. [PMID: 21263002 DOI: 10.1161/circulationaha.110.964148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ribera Casado JM. [Cardiac surgery in octogenarians]. Med Clin (Barc) 2009; 133:77. [PMID: 19368943 DOI: 10.1016/j.medcli.2008.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 10/24/2008] [Indexed: 10/20/2022]
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Leontyev S, Walther T, Borger MA, Lehmann S, Funkat AK, Rastan A, Kempfert J, Falk V, Mohr FW. Aortic valve replacement in octogenarians: utility of risk stratification with EuroSCORE. Ann Thorac Surg 2009; 87:1440-5. [PMID: 19379882 DOI: 10.1016/j.athoracsur.2009.01.057] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 01/21/2009] [Accepted: 01/22/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND With the advent of percutaneous valve implantation, an increasing amount of interest is being expressed in outcomes of conventional aortic valve replacement (AVR) in elderly patients. We evaluated characteristics and outcomes of elderly patients undergoing isolated AVR with a particular focus on the European System for Cardiac Operative Risk Evaluation (EuroSCORE) risk stratification. METHODS All patients aged 80 years or older (n = 282) undergoing isolated AVR between November 1995 and June 2006 at our institution were reviewed according to logistic EuroSCORE (ES(log)) risk stratification. Surgical risk was defined as low risk (ES(log) < or = 10% [n = 107]), moderate risk (10% < ES(log) < 20% [n = 103]), and high risk (ES(log) > or = 20% [n = 72]). Patient age was 82 +/- 2 years (low risk), 82.7 +/- 2.7 years (moderate risk), and 83.6 +/- 3.1 years (high risk), respectively (p < 0.05). Mean ES(log) predicted risk of mortality was 7.3% +/- 1.4% (low risk), 13.7% +/- 2.5% (moderate risk), and 33.0% +/- 11.5% (high risk; p < 0.05). Follow-up was 99.7% complete. RESULTS In-hospital mortality was 7.5% (low risk), 12.6% (moderate risk), and 12.5% (high risk; p = 0.4). One-year survival was 90%, 78%, and 69% (p = 0.002); 5-year survival was 70%, 53%, and 38% (p = 0.05); and 8-year survival was 38%, 33%, and 21% (p = 0.017), for low-, moderate-, and high-risk patients, respectively. Independent predictors for in-hospital mortality were pulmonary hypertension and urgent indication for surgery. Cox regression predictors of medium-term survival were congestive heart failure, urgent timing, previous stroke or transient ischemic attack, and EuroSCORE stratum. CONCLUSIONS Aortic valve replacement can be performed in the elderly population with acceptable outcomes. EuroSCORE risk stratification is imprecise for prediction of perioperative mortality among octogenarian AVR patients, but may be useful for predicting mortality during medium-term follow-up.
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Affiliation(s)
- Sergey Leontyev
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
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Abstract
The article by Sack and co-workers published in this issue presents the results of a retrospective study on the treatment of severe calcified aortic stenosis (AS) by means of balloon aortic valvuloplasty (BAV) in the elderly patient. While arguing that BAV should be used in patients unfit for surgical aortic valve replacement (AVR) due to relative contraindications their results reveal widely unfavourable outcomes particularly with regard to survival and mortality rates. In contrast, surgical AVR yields excellent results in the mid- and long-term follow-up even in a high-risk patient population. In the rare case of real contraindications to surgical AVR transcatheter valve implantation techniques seem to be the more adequate alternative today.
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Viana-Tejedor A, Domínguez FJ, Moreno Yangüela M, Moreno R, López de Sá E, Mesa JM, López-Sendón J. Cirugía cardíaca en pacientes octogenarios. Factores predictores de mortalidad y evaluación de la supervivencia y la calidad de vida a largo plazo. Med Clin (Barc) 2008; 131:412-5. [DOI: 10.1157/13126216] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Javier López-Rodríguez F, González-Santos JM, José Dalmau M, Bueno M. Cirugía cardiaca en el anciano: comparación de resultados a medio plazo entre octogenarios y ancianos de 75 a 79 años. Rev Esp Cardiol 2008. [DOI: 10.1157/13123063] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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