Little is known on the pulmonary gradients of oxyhemoglobin, carboxyhemoglobin and methemoglobin in pulmonary arterial hypertension (PAH). We sought to determine these gradients in group 1 PAH and assess their association with disease severity and survival. During right heart catheterization (RHC) we obtained blood from pulmonary artery (PA) and pulmonary artery wedge (PAW) positions and used co-oximetry to test their gasometric differences. We included a total of 130 patients, 65 had group 1 PAH, 40 had pulmonary hypertension (PH) from groups 2–5 and 25 had no PH during RHC. In all groups, PAW blood had higher pH, carboxyhemoglobin and lactate as well as lower pCO2 than PA blood. In group 1 PAH (age 58 ± 15 years, 72% females), methemoglobin in the PAW was lower than in the PA blood (0.83% ± 0.43 vs 0.95% ± 0.50, p = 0.03) and was directly associated with the degree of change in pulmonary vascular resistance (R = 0.35, p = 0.02) during inhaled nitric oxide test. Oxyhemoglobin in PA (HR (95%CI): 0.90 (0.82–0.99), p = 0.04) and PAW (HR (95%CI): 0.91 (0.84–0.98), p = 0.003) blood was associated with adjusted survival in PAH. Marked differences were observed in the gasometric determinations between PAW and PA blood. The pulmonary gradient of methemoglobin was lower in PAH patients compared to controls and a higher PAW blood methemoglobin was associated with a more pronounced pulmonary vascular response to inhaled nitric oxide. Pulmonary artery and PAW oxyhemoglobin tracked with disease severity and survival in PAH.

Aim The aim was to evaluate 120-day complete wound healing rates in negative pressure wound therapy (NPWT) versus conventional dressings in anatomically challenging areas (the heel and ankle regions). Patients and methods A retrospective, cohort study that included diabetic patients having acute (30 days) challenging wounds at the area of the heel and ankle after surgical debridement and achieved complete wound healing or 120-day follow-up whichever occurs first. Forty-four patients were identified and were divided into two groups according to the method of wound therapy. Group A (NPWT, n=18) and group B (conventional moist daily dressings, n=26). The primary end point was complete wound healing rates within 120 days. Distribution of characteristics between study groups and healing rates among different risk groups were reported. Kaplan–Meier curve on the basis of time-to-event strategy followed by a log rank test to measure difference among study groups were performed. Results Complete wound healing within a 120-day assessment period was achieved in 72.3% (group A) and 30.8% in group B (P=0.019). There was no overall significant difference in the distribution of characteristics among two groups except for BMI (P=0.03) and albumin level (0.02). However, HgA1c levels (P=0.01) and wound treatment method (P=0.007) were only factors that significantly affected the healing rate. Conclusion On the basis of current data analysis, the use of NPWT should be recommended for acute diabetic foot wounds in the heel and ankle regions to obtain faster complete healing and desired wound closure in such critical areas.

Aim The aim was to evaluate 120-day complete wound healing rates in negative pressure wound therapy (NPWT) versus conventional dressings in anatomically challenging areas (the heel and ankle regions). Patients and methods A retrospective, cohort study that included diabetic patients having acute (30 days) challenging wounds at the area of the heel and ankle after surgical debridement and achieved complete wound healing or 120-day follow-up whichever occurs first. Forty-four patients were identified and were divided into two groups according to the method of wound therapy. Group A (NPWT, n=18) and group B (conventional moist daily dressings, n=26). The primary end point was complete wound healing rates within 120 days. Distribution of characteristics between study groups and healing rates among different risk groups were reported. Kaplan–Meier curve on the basis of time-to-event strategy followed by a log rank test to measure difference among study groups were performed. Results Complete wound healing within a 120-day assessment period was achieved in 72.3% (group A) and 30.8% in group B (P=0.019). There was no overall significant difference in the distribution of characteristics among two groups except for BMI (P=0.03) and albumin level (0.02). However, HgA1c levels (P=0.01) and wound treatment method (P=0.007) were only factors that significantly affected the healing rate. Conclusion On the basis of current data analysis, the use of NPWT should be recommended for acute diabetic foot wounds in the heel and ankle regions to obtain faster complete healing and desired wound closure in such critical areas.

Aim The aim was to evaluate 120-day complete wound healing rates in negative pressure wound therapy (NPWT) versus conventional dressings in anatomically challenging areas (the heel and ankle regions). Patients and methods A retrospective, cohort study that included diabetic patients having acute (30 days) challenging wounds at the area of the heel and ankle after surgical debridement and achieved complete wound healing or 120-day follow-up whichever occurs first. Forty-four patients were identified and were divided into two groups according to the method of wound therapy. Group A (NPWT, n=18) and group B (conventional moist daily dressings, n=26). The primary end point was complete wound healing rates within 120 days. Distribution of characteristics between study groups and healing rates among different risk groups were reported. Kaplan–Meier curve on the basis of time-to-event strategy followed by a log rank test to measure difference among study groups were performed. Results Complete wound healing within a 120-day assessment period was achieved in 72.3% (group A) and 30.8% in group B (P=0.019). There was no overall significant difference in the distribution of characteristics among two groups except for BMI (P=0.03) and albumin level (0.02). However, HgA1c levels (P=0.01) and wound treatment method (P=0.007) were only factors that significantly affected the healing rate. Conclusion On the basis of current data analysis, the use of NPWT should be recommended for acute diabetic foot wounds in the heel and ankle regions to obtain faster complete healing and desired wound closure in such critical areas.

We compared outcomes of single-stage hybrid aortic arch replacement (frozen elephant trunk) versus 2-stage hybrid repairs with primary open arch procedures followed by thoracic endovascular stenting. Methods This study reports a single-center retrospective review (2003 to 2016) of 118 patients undergoing hybrid repair of the aortic arch including 48 single-stage repairs versus 70 two-stage repairs. Results Single-stage repair was performed in 48 patients, including 31 (64.6%) men and 17 (35.4%) women with a mean age of 64 ± 11 years and a 2-stage procedure was performed in 70 patients, including 42 (60%) men and 28 (40%) women with a mean age of 65.67 ± 13.3 years (p = 0.46). More emergent single-stage procedures were performed in 23 of 48 (47.9%) patients versus 2-stage procedures in 8 of 70 (11.43%) patients (p 0.001). Between the single- and 2-stage groups, there was no difference in stroke (6.25% [3 of 48] versus 14.28% [10 of 70]; p = 0.23), spinal cord ischemia (4.16% [2 of 48] versus 5.7% [4 of 70]; p = 1.0), or 30-day mortality rate: 8 of 48 (16.7%) patients versus a combined 30-day mortality rate of the 2-stage procedure of 14.8% (4 of 70 [5.7%] at the first stage and 5 of 55 [9.1%] at the second stage; p = 0.56), respectively. After exclusion of the 30-day mortality, midterm survival was 86% at 1 to 2 years for single-stage patients versus 80% at 1 year and 46% at 2 years for the 2-stage patients (p = 0.0019). Conclusions Both single-stage and 2-stage hybrid arch replacements are effective approaches for treating complex aortic arch diseases. Early deaths and neurological outcomes in the single-stage group are comparable to those in the combined 2-stage group. Furthermore, in this series, patients who had a single-stage hybrid procedure had a higher survival rate at 2 years.

We compared outcomes of single-stage hybrid aortic arch replacement (frozen elephant trunk) versus 2-stage hybrid repairs with primary open arch procedures followed by thoracic endovascular stenting. Methods This study reports a single-center retrospective review (2003 to 2016) of 118 patients undergoing hybrid repair of the aortic arch including 48 single-stage repairs versus 70 two-stage repairs. Results Single-stage repair was performed in 48 patients, including 31 (64.6%) men and 17 (35.4%) women with a mean age of 64 ± 11 years and a 2-stage procedure was performed in 70 patients, including 42 (60%) men and 28 (40%) women with a mean age of 65.67 ± 13.3 years (p = 0.46). More emergent single-stage procedures were performed in 23 of 48 (47.9%) patients versus 2-stage procedures in 8 of 70 (11.43%) patients (p 0.001). Between the single- and 2-stage groups, there was no difference in stroke (6.25% [3 of 48] versus 14.28% [10 of 70]; p = 0.23), spinal cord ischemia (4.16% [2 of 48] versus 5.7% [4 of 70]; p = 1.0), or 30-day mortality rate: 8 of 48 (16.7%) patients versus a combined 30-day mortality rate of the 2-stage procedure of 14.8% (4 of 70 [5.7%] at the first stage and 5 of 55 [9.1%] at the second stage; p = 0.56), respectively. After exclusion of the 30-day mortality, midterm survival was 86% at 1 to 2 years for single-stage patients versus 80% at 1 year and 46% at 2 years for the 2-stage patients (p = 0.0019). Conclusions Both single-stage and 2-stage hybrid arch replacements are effective approaches for treating complex aortic arch diseases. Early deaths and neurological outcomes in the single-stage group are comparable to those in the combined 2-stage group. Furthermore, in this series, patients who had a single-stage hybrid procedure had a higher survival rate at 2 years.

We compared outcomes of single-stage hybrid aortic arch replacement (frozen elephant trunk) versus 2-stage hybrid repairs with primary open arch procedures followed by thoracic endovascular stenting. Methods This study reports a single-center retrospective review (2003 to 2016) of 118 patients undergoing hybrid repair of the aortic arch including 48 single-stage repairs versus 70 two-stage repairs. Results Single-stage repair was performed in 48 patients, including 31 (64.6%) men and 17 (35.4%) women with a mean age of 64 ± 11 years and a 2-stage procedure was performed in 70 patients, including 42 (60%) men and 28 (40%) women with a mean age of 65.67 ± 13.3 years (p = 0.46). More emergent single-stage procedures were performed in 23 of 48 (47.9%) patients versus 2-stage procedures in 8 of 70 (11.43%) patients (p 0.001). Between the single- and 2-stage groups, there was no difference in stroke (6.25% [3 of 48] versus 14.28% [10 of 70]; p = 0.23), spinal cord ischemia (4.16% [2 of 48] versus 5.7% [4 of 70]; p = 1.0), or 30-day mortality rate: 8 of 48 (16.7%) patients versus a combined 30-day mortality rate of the 2-stage procedure of 14.8% (4 of 70 [5.7%] at the first stage and 5 of 55 [9.1%] at the second stage; p = 0.56), respectively. After exclusion of the 30-day mortality, midterm survival was 86% at 1 to 2 years for single-stage patients versus 80% at 1 year and 46% at 2 years for the 2-stage patients (p = 0.0019). Conclusions Both single-stage and 2-stage hybrid arch replacements are effective approaches for treating complex aortic arch diseases. Early deaths and neurological outcomes in the single-stage group are comparable to those in the combined 2-stage group. Furthermore, in this series, patients who had a single-stage hybrid procedure had a higher survival rate at 2 years.

We compared outcomes of single-stage hybrid aortic arch replacement (frozen elephant trunk) versus 2-stage hybrid repairs with primary open arch procedures followed by thoracic endovascular stenting. Methods This study reports a single-center retrospective review (2003 to 2016) of 118 patients undergoing hybrid repair of the aortic arch including 48 single-stage repairs versus 70 two-stage repairs. Results Single-stage repair was performed in 48 patients, including 31 (64.6%) men and 17 (35.4%) women with a mean age of 64 ± 11 years and a 2-stage procedure was performed in 70 patients, including 42 (60%) men and 28 (40%) women with a mean age of 65.67 ± 13.3 years (p = 0.46). More emergent single-stage procedures were performed in 23 of 48 (47.9%) patients versus 2-stage procedures in 8 of 70 (11.43%) patients (p 0.001). Between the single- and 2-stage groups, there was no difference in stroke (6.25% [3 of 48] versus 14.28% [10 of 70]; p = 0.23), spinal cord ischemia (4.16% [2 of 48] versus 5.7% [4 of 70]; p = 1.0), or 30-day mortality rate: 8 of 48 (16.7%) patients versus a combined 30-day mortality rate of the 2-stage procedure of 14.8% (4 of 70 [5.7%] at the first stage and 5 of 55 [9.1%] at the second stage; p = 0.56), respectively. After exclusion of the 30-day mortality, midterm survival was 86% at 1 to 2 years for single-stage patients versus 80% at 1 year and 46% at 2 years for the 2-stage patients (p = 0.0019). Conclusions Both single-stage and 2-stage hybrid arch replacements are effective approaches for treating complex aortic arch diseases. Early deaths and neurological outcomes in the single-stage group are comparable to those in the combined 2-stage group. Furthermore, in this series, patients who had a single-stage hybrid procedure had a higher survival rate at 2 years.

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