A body mass index (BMI) > 35 kg/m2 is a relative contraindication to heart transplantation in patients with end-stage heart failure. Bariatric surgery can be considered either concomitantly with continuous-flow left ventricular assist device (CF-LVAD) placement, or staged after CF-LVAD has been placed. We sought to evaluate the outcomes of these approaches. An electronic search was performed to identify all relevant studies. After assessment for inclusion and exclusion criteria, eight studies were pooled for systematic review and metaanalysis. Overall, of 59 patients, 22 (37%) underwent simultaneous sleeve gastrectomy with CF-LVAD implantation while 37 (63%) underwent staged sleeve gastrectomy after CF-LVAD. The mean age of patients was 46 years (95% CI: 39–53) with 40% females. Mean BMI at most recent follow-up (33.4 kg/m2, 95% CI: 30.2–36.6) was significantly lower compared with mean preoperative BMI (46.7 kg/m2, 95% CI: 42.9–50.6) (p < 0.01). There was no significant difference in total incidence of postoperative complications (simultaneous, 16% (95% CI: 1–87%) versus staged, 23% (95% CI: 7–53%)) or in overall survival (simultaneous, 93% (95% CI: 72–99%) versus staged, 79% (95% CI: 60–90%), p = 0.17) for average follow-up time of 12.7 months. Bariatric surgery resulted in 66% of patients (95% CI: 51–79) to be listed for heart transplantation, including 33% (95% CI: 22–47) who were transplanted. Both simultaneous and staged bariatric surgeries with CF-LVAD placement have comparable outcomes and significantly reduce BMI. This can allow previously ineligible patients to undergo heart transplantation.

Purpose This study aimed to determine the functional characteristics of various arthrodesis angles of the proximal interphalangeal (PIP) joints of the border fingers. Methods The dominant hands of 48 volunteers were tested using custom orthoses to simulate PIP joint arthrodesis. For the index finger (IF), orthoses were made in 25 degrees, 40 degrees, and 55 degrees of flexion (IF25, IF40, and IF55). For the little finger (LF), orthoses were made in 30 degrees, 55 degrees, and 70 degrees of flexion (LF30, LF55, and LF70). Twenty-three volunteers performed grip and pinch (key, tripod, and pulp) strength testing with and without simulated arthrodeses and 25 volunteers performed the Jebsen Hand Function Test (JHFT) with and without simulated arthrodeses. Simulated conditions of arthrodesis were compared with the unrestricted state and with each other within the same finger. Results For grip and pinch strength, there were no significant differences between simulated arthrodesis angles. Compared with baseline, grip was significantly weaker for all 6 simulated arthrodesis angles. Pinch was tested with simulated IF arthrodesis only; key pinch was significantly weaker for all tested angles and tripod pinch for IF25 and IF40. For JHFT, the 3 experimental angles for the index or ring finger did not show any statistically significant differences for any subtest. Volunteers were slower at completion times for all simulated arthrodesis angles compared to baseline times. This was significant in 5 of 7 tasks for IF25, 3 of 7 tasks for IF40, and 4 of 7 tasks for IF55. Index finger angle of flexion of 40 degrees was significantly faster than IF55 for writing and IF25 for lifting large, light objects. For the LF, LF30 was significantly slower than baseline for 6 of 7 tasks, LF55 for 3 of 7 tasks, and LF70 for 5 of 7 tasks. Index finger angle of flexion of 55 degrees was significantly faster than LF70 for simulated feeding and IF30 for lifting large, heavy objects. Conclusions No border digit PIP joint arthrodesis angle was superior for grip and pinch strength. Based on JHFT, IF40 and LF55 might be preferred arthrodesis angles. Copyright (C) 2020 by the American Society for Surgery of the Hand. All rights reserved.

BACKGROUND:Uterine myomas encountered at cesarean delivery increase the complexity and risk of the procedure. Preoperative planning of such deliveries may help optimize patient outcomes. The application of three-dimensional printing technology is rapidly expanding in many surgical specialties. We created a three-dimensional-printed model from the magnetic resonance images (MRIs) of a gravid uterus with multiple myomas for surgical planning of cesarean delivery.INSTRUMENT:A three-dimensional-printed uterine model from MRIs of a pregnant patient with multiple uterine myomas as a tool for planning cesarean delivery.EXPERIENCE:A 33-year-old woman with a myomectomy history presented to our institution for prenatal care. Initial ultrasound imaging revealed multiple uterine myomas. A three-dimensional-printed uterine model, based on subsequent MRI, was created for presentation at an obstetric multidisciplinary meeting. The model accurately represented the number, size, and locations of uterine myomas, aiding surgical planning, including skin and uterine incisions. At the time of cesarean delivery, the model was directly correlated with patient anatomy to further determine the optimal placement of uterine incision. Maternal and fetal outcomes were excellent.CONCLUSION:Three-dimensional-printed models, through improved surgical planning, could optimize outcomes for patients with uterine myomas undergoing cesarean delivery.

To date, 3D organ modeling has not reached widespread clinical use, despite showing promise in medical literature. The majority of anatomic modeling that is presented in the literature is performed with proprietary software, presenting certain barriers to use, such as price for usage rights. Open-source software not only circumvents this barrier, but also often provides greater customization offered by global communities. In this proof-of-concept experiment, a HeartMate II LVAD inflow cannula was "virtually fit" in a patient's left ventricle using only open-source software. Open-source programs provide a legitimate alternative to the proprietary software options.