Lankenau Medical Center, part of Main Line Health, is a 370-bed acute care, teaching hospital in Wynnewood, Lower Merion Township, Pennsylvania. Lankenau Medical Center has been named as one of the top 5 hospitals in the Philadelphia region by U.S. News & World Report and received the Gold Seal of Approval from the Joint Commission. Lankenau Medical Center’s clinical areas include the Lankenau Heart Institute, the gastrointestinal and GI endoscopy program, cancer care services, pulmonology, orthopaedics, obstetrics and maternity, including and a level III neonatal intensive care unit, as well as minimally invasive and robotic surgery. The campus is also home to the Lankenau Institute for Medical Research and the Annenberg Center for Medical Education.
BACKGROUND AND AIMS:The TRISCEND II trial demonstrated superior clinical benefits for patients with ≥severe tricuspid regurgitation (TR) treated with the EVOQUE transcatheter tricuspid valve replacement (TTVR) system plus medical therapy vs medical therapy alone. This work reports 1-year and 18-month outcomes in patients stratified by baseline TR severity. METHODS:The multicentre, prospective TRISCEND II trial enrolled 400 patients with symptomatic, ≥severe TR, and randomized 2:1 to TTVR (n = 267) or control (n = 133). In a post hoc analysis, patients were stratified into severe TR (n = 172) and massive/torrential TR (n = 220) cohorts. Clinical and quality-of-life outcomes were reported at 1 year, with Kaplan-Meier estimates for all-cause mortality and heart failure (HF) hospitalization assessed at 18 months. Study oversight included an independent echocardiographic core laboratory, clinical events committee, and data safety monitoring board. RESULTS:One year after TTVR, TR was ≤mild in 95.2% of severe TR and 95.3% of massive/torrential TR patients. The primary safety and effectiveness endpoint (win ratio) favoured TTVR over control regardless of baseline TR severity: severe {1.64 [95% confidence interval (CI): 1.11, 2.43]} and massive/torrential [2.20 (1.55, 3.14)]. At 18 months, TTVR patients had similar mortality to controls [rate difference: severe 0.2% (-11.6, 11.9), massive/torrential -5.8% (-17.6, 6.0)], whereas HF hospitalization rates favoured TTVR in the massive/torrential cohort [vs control, severe 9.8% (-3.0, 22.7), massive/torrential -15.2% (-28.9, -1.5)]. CONCLUSIONS:Patients with ≥severe TR benefit from TTVR, experiencing improvements in TR severity, functional capacity, and quality of life regardless of baseline TR severity, with a signal for greater benefit in patients with more advanced disease.
Cryoablation is emerging as a minimally invasive alternative to lumpectomy for select women with early-stage breast cancer. The FROST trial (NCT01992250) was a prospective, phase 2 multicenter study evaluating the outcome of cryoablation in the management of stage I, hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, node-negative invasive ductal carcinoma. Women 50 years old or older with unifocal, ultrasound-visible tumors were stratified by age: stratum 1 (age ≥70 years, endocrine therapy only) and stratum 2 (age 50–69 years, endocrine therapy + radiotherapy + optional sentinel node biopsy). Cryoablation was performed using a single cryoprobe under ultrasound guidance. Core biopsy 6 months after ablation was performed to confirm complete ablation. Patients were followed with clinical exams and imaging. The study included 83 completed cryoablations and follow-up evaluations. The median tumor size was 9 mm. More than 85
BACKGROUND:Transcatheter tricuspid valve replacement (TTVR) is a novel therapy for severe tricuspid regurgitation. However, conduction disturbances requiring pacemaker implantation occur in up to 24.7% of patients. Left bundle branch area pacing (LBBAP) has not been systematically evaluated post-TTVR, where lead passage across the prosthesis may compromise valve integrity. The objective of this paper was to report the feasibility, safety, and performance of LBBAP after TTVR. CASE SUMMARY:Two pacemaker-naïve patients requiring pacing post-TTVR were retrospectively analyzed. DISCUSSION:Both patients underwent TTVR and developed high-grade atrioventricular block within 72 hours. LBBAP was successful in both cases with no procedural-related complications. At 30 days, pacing parameters remained unchanged with no device-related adverse events. Echocardiography at 1 and 30 days demonstrated ≤ mild tricuspid regurgitation, no lead-valve interaction, and stable right ventricular function. TAKE-HOME MESSAGES:LBBAP post-TTVR is feasible with excellent short-term safety and performance while maintaining valve integrity. Our series reinforces its safety and adds systematic echocardiographic follow-up.
BACKGROUND:Transanal total mesorectal excision (taTME) facilitates sphincter preservation in low rectal cancer. Preliminary results and functional outcomes from the North American multicenter phase II taTME trial (NCT03144765) have been published. Three-year outcomes are reported. METHODS:Patients with stage I to III rectal adenocarcinoma were enrolled across 11 centers (2017-2022). Endpoints included TME grade, 3-year overall survival, disease-free survival, cancer-specific survival, recurrence, late (beyond 90 d) complications, and stoma-free survival. Surveillance followed National Comprehensive Cancer Network guidelines, with pelvic magnetic resonance imaging (MRI) at 3 years to assess for pelvic sidewall recurrence when possible. Kaplan-Meier analysis assessed oncologic outcomes. RESULTS:One hundred patients underwent taTME for tumors at a median of 5.8 cm from the anal verge, with intersphincteric resection in 36% and handsewn anastomosis in 54%. Median follow-up was 50.9 months. Late complications occurred in 32 patients, including 21 severe (Clavien-Dindo ≥3). Late anastomotic complications occurred in 5 patients; one required surgical revision. Estimated 3-year overall survival, cancer-specific survival, and disease-free survival were 93.7%, 96.6%, and 84.6%, respectively. Distant recurrence occurred in 15 patients (median: 17.6 months), most commonly in the lung and liver. Locoregional recurrence occurred in 2 patients. Preoperative N stage, lymph node yield, tumor deposits, and perineural invasion were associated with recurrence. Among 100 patients diverted at taTME, 97% were stoma-free at 3 years; 4 patients later underwent secondary diversion. CONCLUSIONS:Three-year outcomes of this multicenter trial support the safety and efficacy of taTME in resectable mid and low rectal tumors, with outcomes comparable to contemporary studies. Longer-term oncologic and functional outcomes are needed.
Transanal excision of rectal lesions remains challenging due to limitations in visualization and access to the cephalad margin, often resulting in high rates of piecemeal excision and positive margins. Transanal Minimally Invasive Surgery (TAMIS), developed using laparoscopic instruments, aimed to improve transanal exposure and reach. We present our experience with single-port robotic TAMIS (SP rTAMIS) to assess its safety and efficacy. A prospectively maintained database of SP robotic colorectal resections performed between October 2018 to September 2024 was retrospectively reviewed to identify all SP rTAMIS operations performed. Cases were analyzed regarding peri-operative outcomes to determine the efficiency and safety of this operation. A total of 81 SP rTAMIS operations were performed. Men comprised 59
