A new passive transfemoral prosthesis mechanism based on 3R36 knee and ESAR foot providing walking and squatting

Researchers have proposed various linkage mechanisms to connect knee and ankle joints for above-knee prosthe-ses,but most of them only offer natural walking.However,studies have shown that people assume a squatting posture during daily activities.This paper introduces a novel mechanism that connects the knee joint with the foot-ankle joint to enable both squatting and walking.The prosthetic knee used is the well-known 3R36,while the energy storing and return(ESAR)prosthetic foot is used for the ankle-foot joint.To coordinate knee and ankle joint movements,a six-bar linkage mechanism structure is proposed.Simulation results demonstrate that the proposed modular transfemoral prosthesis accurately mimics the motion patterns of a natural human leg during walking and squatting.For instance,the prosthesis allows a total knee flexion of more than 140°during squatting.The new prosthesis design also incorporates energy-storing mechanisms to reduce energy expenditure during walking for amputees.

A comparative study on transradial vs transfemoral artery access for primary percutaneous coronary intervention in patients with acute myocardial infarction

Objective Comparative study on the feasibility,safety and outcome of transradial artery and transfemoral artery access for primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(AMI).Methods Two hundred and eight patients with AMI episoded within 12 hours, male 159, female 49, age 58.9 ±11.9 (34～88)years, were randomly divided into transradial artery access for primary PCI (TRA pPCI) group of 106 cases and transfemoral artery access for PCI (TFA pPCI) group of 102 cases during Sept, 2000 to Aug, 2002. The protocols of the manipulation duration and the effect for TRA pPCI and TFA pPCI procedures were respectively compared, including the time of transradial artery puncture and the rate of puncture success at first time ; the time of guiding catheter engaging into target coronary ostium; the rate of patence in infarct related artery (IRA); total duration of manipulation and the successful rate.The incidence of complications such as bleeding, vessel injury,thrombi and embolism as well as the average stay of hospitalization between two groups was compared. The status and the incidance of vessel spasm were observed and the effect of medicine administration to prevent from and relieve the vascular spasm was evaluated. The time of Allen’s test before and after TRA pPCI , the inner diameter and the peak of blood velocity of the right and left radial artery were investigated with color Doppler vessel echography as well as the complications of radial artery were followed up 1 month after TRA pPCI procedure. Results Two cases in every TRA pPCI and TFA pPCI groups were crossed over each other because procedure of the transradial or transfemoral access was failure. One handred and six vessels (48 vessels in LAD,22 vessels in LCX and 36 vessels in RCA) associated with 28 vessels of total occlusion in TRA pPCI group and 102 vessels (51 vessels in LAD,18 veesles in LCX and 33 vessels in RCA) with 24 vessels in total occlusion in TFA pPCI group were angioplasticized . The successful rates of the first time puncture in access artery, the re patence IRA and pPCI were similar in TRA pPCI and TFA pPCI groups ( 93.4% vs 96.1% ;100% vs 100%; 96.2% vs 97.1% , P >0.05 ). There were no significant diffierence in the average time of puncture time of access artery ,engaging in target vessels of guiding catheters and the total procedure of PCI between the two groups ( 1.3 ±0.3s vs 1.2 ±0.3s ; 6.0 ±1.6min vs 5.8 ±0.9min ; 49.2 ±24.1min vs 46.5 ± 26.4min , P >0.05 ). The access artery complications such as bleeding ,hematoma and embolism as well the veneous thrombosis in TFA pPCI group were much more than those in TRA pPCI group(p< 0.01 ). Although slight artery spasm of 4.7% cases in TRA pPCI group was happened during the procedure of PCI , the procedure had being continued after administration of medicine to release the spasm. The time of Allen’s test ,diameter and the systolic velocity of blood in daul radial arteries were no significant change before and after pPCI.Conclusions The duration and effect by TRA pPCI for AMI with stable hemodynamics was similar to TFA pPCI. The complications such as of bleeding,vessel injury, thrombi and embolism by TRA pPCI were few, and it was unnecessary to discontinue the anticoagulation medicine. TRA pPCI might be selected as a access vessel for pPCI in AMI patients with stable hemodynamics.

Transradial Versus Transfemoral Approach for Percutaneous Coronary Intervention in Elderly Patients in China： A Retrospective Analysis

Objective To compare hospital costs and clinical outcomes between transradial intervention （TRI） and transfemoral intervention （TFI） in elderly patients aged over 65 years. Methods We identified 1229 patients aged over 65 years who underwent percutaneous coronary intervention （PCI） in Fuwai Hospital, Beijing, China, between January 1 and December 31, 2010. Total hospital costs and in-hospital outcomes were compared between TRI and TFI. An inverse probability weighting （IPW） model was introduced to control potential biases. Results Patients who underwent TRI were younger, less often female, more likely to receive PCI for single-vessel lesions, and less likely to undergo the procedure for ostial lesions. TRI was associated with a cost saving of CNY7495 （95%CI： CNY4419-10 420）. Such differences were mainly driven by lower PCI-related costs. TRI patients had shorter length of stay （1.9 days, 95%CI： 1.1-2.7 days）, shorter post-procedural stay （0.7 days, 95%CI： 0.3-1.1 days）, and fewer major adverse cardiac events （adjusted odds ratio = 0.47, 95%CI： 0.31-0.73）. There was no statistical significance in the incidence of post-PCI bleeding between TRI and TFI （P〉0.05）. Such differences remained consistent in clinically relevant subgroups of acute myocardial infarction, acute coronary syndrome, and stable angina. Conclusion The use of TRI in patients aged over 65 years was associated with significantly reduced hospital costs and more favorable clinical outcomes.

Safety and efficacy of transfemoral intrahepatic portosystemic shunt for portal hypertension: A single-center retrospective study

BACKGROUND Transfemoral intrahepatic portosystemic shunt (TFIPS) can be performed to treat portal hypertension. However, few studies have evaluated the safety and efficacy of this technique. AIM To retrospectively evaluate the safety and clinical outcomes of TFIPS and compare them with those of typical transjugular intrahepatic portosystemic shunt (TIPS). METHODS This retrospective study was approved by our hospital ethics committee. From November 2012 to November 2015, 19 patients who underwent successful TFIPS placement were included. In addition, 21 patients treated with TIPS during the same period were selected as controls. Data collected included the success rate and complications of TIPS and TFIPS. Continuous data were expressed as the mean ± SD and were compared using the Student’s t test. All categorical data were expressed as count (percentage) and were compared using the χ2 test or Fisher’s exact test. The Kaplan–Meier method was used to calculate cumulative survival rate and survival curves. RESULTS Baseline characteristics were comparable between the two groups. The success rate of TFIPS and TIPS was 95%(19/20) and 100%(21/21), respectively. Effective portal decompression and free antegrade shunt flow was completed in all patients. The portal pressure gradient prior to TIPS and TFIPS placement was 23.91 ± 4.64 mmHg and 22.61 ± 5.39 mmHg, respectively, and it was significantly decreased to 10.85 ± 3.33 mmHg and 10.84 ± 3.33 mmHg after stent placement, respectively. Time–to-event calculated rates of shunt patency at one and two years in the TFIPS and TIPS groups were not statistically different (94.7% vs 95.2% and 94.7% vs 90.5%, respectively). De nova hepatic encephalopathy was 27.5%(11/40) with five patients in the TFIPS group (26.3%) and six patients (28.6%) in the TIPS group experiencing it (P = 0.873). The cumulative survival rates were similar between the two groups: 94.7% and 94.7% at 1 and 2 years, respectively, in the TFIPS group vs 100% and 95.2% at 1 and 2 years, respectively, in the TIPS group (P = 0.942). CONCLUSION TFIPS may be a valuable adjunct to traditional approaches in patients with portal hypertension.

Percutaneous management of vascular access in transfemoral transcatheter aortic valve implantation

Transcatheter aortic valve implantation(TAVI) using stent-based bioprostheses has recently emerged as a promising alternative to surgical valve replacement in selected patients. The main route for TAVI is retrograde access from the femoral artery using large sheaths(16-24 F). Vascular access complications are a clinically relevant issue in TAVI procedures since they are reported to occur in up to one fourth of patients and are strongly associated with adverse outcomes. In the present paper, we review the different types of vascular access site complications associated with transfemoral TAVI. Moreover, we discuss the possible optimal management strategies with particular attention to the relevance of early diagnosis and prompt treatment using endovascular techniques.

Transradial versus transfemoral approach for cerebral angiography: A prospective comparison

Objectives: To evaluate the feasibility, efficiency, and safety of the transradial approach(TRA) for cerebral angiography versus the transfemoral approach(TFA) in patients.Methods: In this trial, 2314 patients underwent cerebral angiography, with 1085 patients undergoing the procedure via radial access and 1229 via transfemoral access. The arterial puncture time, operation success rate,oppression time on puncture points, local vascular complication incidence(including bleeding, hematoma, and pseudoaneurysm), deep venous thrombosis of lower limbs(DVT), and bradycardia/hypotension were observed and compared between the two groups.Results: Of the patients who underwent cerebral angiography via radial access, the procedure was successful in1070 patients;compared with 1219 patients with transfemoral access, there was no significant difference(P > 0.05) in the success rate or the arterial puncture time. Radial access patients were less likely to present with oppression time on puncture points, local vascular complications, DVT, and bradycardia/hypotension compared with femoral access patients.Conclusions: For patients undergoing cerebral angiography, radial and femoral approaches are both safe and effective. However, the lower rate of local vascular complications may be a reason to use the radial approach.

Multi-vessel percutaneous coronary intervention in a patient with a type B aortic dissection-transradial or transfemoral?

Patients with chronic aortic dissections are at high risk of catheter-induced complications. We report a 41-year-old patient with a type B aortic dissection (Stanford) who underwent successful three-vessel percutaneous coronary intervention via the right radial artery approach following a non-ST elevation myocardial infarction. The patient remained asymptomatic at 6 mo follow-up. Trans-radial approach for coronary interventions can be used safely in patients with Stanford type B aortic dissection without increasing the risk of procedure-related complications in this high-risk group of patients.

Nonlinear observer-based optimal control of an active transfemoral prosthesis

This paper designs a joint controller/observer framework using a state dependent Riccati equation(SDRE)approach for an active transfemoral prosthesis system.An integral state control technique is utilized to design a tracking controller for a robot/prosthesis system.This framework promises a systematic flexible design using which multiple design specifications such as robustness,state estimation,and control optimality are achieved without the need for model linearization.Performance of the proposed approach is demonstrated through simulation studies,which show improvements versus a robust adaptive impedance controller and an extended Kalman filter-based state estimation method.Numerical results confirm the benefits of our method over the above-mentioned approaches with regard to control optimality and state estimation.

Surgical apgar score predicts early complication in transfemoral amputees:Retrospective study of 170 major amputations

AIM To assess whether the surgical apgar score(SAS) is a prognostic tool capable of identifying patients at risk of major complications following lower extremity amputations surgery.METHODS This was a single-center,retrospective observational cohort study conducted between January 2013 and April 2015. All patients who had either a primary transtibial amputation(TTA) or transfemoral amputation(TFA) conducted at our institution during the study period were assessed for inclusion. All TTA patients underwent a standardized one-stage operative procedure(ad modum Persson amputation) performed approximately 10 cm below the knee joint. All TTA procedures were performedwith sagittal flaps. TFA procedures were performed in one stage with amputation approximately 10 cm above the knee joint,performed with anterior/posterior flaps. Trained residents or senior consultants performed the surgical procedures. The SAS is based on intraoperative heart rate,blood pressure and blood loss. Intraoperative parameters of interest were collected by revising electronic health records. The first author of this study calculated the SAS. Data regarding major complications were not revealed to the author until after the calculation of SAS. The SAS results were arranged into four groups(SAS 0-4,SAS 5-6,SAS 7-8 and SAS 9-10). The cohort was then divided into two groups representing low-risk(SAS ≥ 7) and highrisk patients(SAS < 7) using a previously established threshold. The outcome of interest was the occurrence of major complications and death within 30-d of surgery.RESULTS A logistic regression model with SAS 9-10 as a reference showed a significant linear association between lower SAS and more postoperative complications [all patients: OR = 2.00(1.33-3.03),P = 0.001]. This effect was pronounced for TFA [OR = 2.61(1.52-4.47),P < 0.001]. A significant increase was observed for the high-risk group compared to the low-risk group for all patients [OR = 2.80(1.40-5.61),P = 0.004] and for the TFA sub-group [OR = 3.82(1.5-9.42),P = 0.004]. The AUC from the models were estimated as follows: All patients = [0.648(0.562-0.733),P = 0.001],for TFA patients = [0.710(0.606-0.813),P < 0.001] and for TTA patients = [0.472(0.383-0.672),P = 0.528]. This indicates moderate discriminatory power of the SAS in predicting postoperative complications among TFA patients.CONCLUSION SAS provides information regarding the potential development of complications following TFA. The SAS is especially useful when patients are divided into high- and low-risk groups.

Predictors of Complications after Sheath Removal Post Transfemoral Percutaneous Coronary Interventions

Background: Complications post percutaneous coronary interventions (PCI) are more threatening than it was previously thought so that necessary measures should be taken to minimize those risks. Objective: To identify the risk factors related to patient and procedure which could be used as predictors of complications after sheath removal post PCI. Methods: The study used a prospective non-experimental correlational descriptive. Design: The sample was chosen conveniently from three different hospitals and included 118 patients who were subjected to PCI. Results: Three models were used to predict complications. In the first model, none of the baseline variables were predictive of complications. In the second model, the only type of procedure (diagnostic, stent or balloon) was predictive of complications. In the third model, compression time was found to be a risk factor and a predictor of complications after sheath removal. Conclusion: Nurses and medical professionals are in a vital position to prevent, detect and manage PCI complications at the earliest possible opportunity. It is a must to assess and categorize patients in accordance with their risk level to develop post PCI and post sheath removal complications, in order to plan management strategies to decrease the health costs and the suffering.

Transradial versus transfemoral rotablation for heavily calcified coronary lesions in contemporary drug-eluting stent era

Background Although radial access for drug-eluting stent （DES） combined with rotational atherectomy （RA） in patients with calcified coronary lesions may be associated with a lower risk of major bleeding complications and obtain favorable clinical results compared with femoral access, the long-term outcome data of this approach were limited in contemporary DES era. Methods ＆ Results This retrospective study sought to compare in-hospital and long-term outcomes for patients undergoing RA via the transradial （TR） and transfemoral （TF） route in 126 consecutive patients （59 radial, 67 femoral） from 2009 to 2014. TR RA procedures were performed in 44/62 （71%） by the three TR operators, compared with 15/64 （23%） by the four TF operators in the present study. Significantly smaller diameter guide catheters and burrs （1.39 ± 0.16 mm vs. 1.53 ± 0.24 mm, P = 0.001） were used in the TR group. Procedural success rates were similar in both TR and TF groups. There was a significantly less major access site bleeding complications in favor of radial artery access （2% vs. 16%, P = 0.012）. The incidence of in-hospital death or myocardial infarction was low in both groups. Although a trend of lower adverse event rate was demonstrated in the TR group compared with the TF one, no statistical significance （21% vs. 27%, P = 0.135） was detected. Conclusions Radial access, a useful alternative to femoral access for RA and DES, can be safely and successfully performed on up to 71% of the patients with heavily calcified coronary lesions needing RA by experienced TR operators.

Comparison of transradial and transfemoral percutaneous coronary intervention in women:a propensity score matching-based analysis

Objective We conducted the present study in order to compare safety and efficacy of transradial intervention(TRI)and transfemoral intervention(TFI)in women undergoing percutaneous coronary intervention(PCI)in a large heart center in China.Methods The study population consisted of a consecutive cohort of 5,067 women undergoing PCI in Fuwai Hospital,Beijing,China between 2006 and 2011(TRI:n=4,105,TFI:n=962).

The Systemic Inflammation on Transradial vs Transfemoral Approach for Coronary Angiography in Patients with Chronic Coronary Syndrome <br/>—Does Transradial Coronary Angiography Trigger More Inflammation?

Background: Most of the institutions accept the Transradial Access (TRA) as the first approach for patients undergoing Coronary Angiography (CAG) and Percutaneous Coronary Interventions (PCI). Several studies clearly revealed endothelial injury of coronary arteries triggers inflammatory response. In this study, we aimed to evaluate inflammatory respond to CAG and to compare the inflammatory response of TRA and Transfemoral Access (TFA). Methods: In this single-center prospective study 140 consecutive patients presenting with (Chronical Coronary Syndrome) CCS and underwent transradial or transfemoral CAG between December 2017 and December 2018 were included. After exclusions, left 92 patients were divided into two equal groups as TRA and TFA. The primary endpoints were 2nd hour Tumor Necrosis Factor alpha (TNFα), 48th hour high-sensitivity C-Reactive Protein (hs-CRP), complication rates, amount of contrast medium, procedure time and fluoroscopy time. Results: Basal characteristics of TRA and TFA groups were similar. A comparison of variables demonstrated that there was no statistical significance in increase in inflammatory markers (TNFα, hs-CRP), complication rates, amount of contrast media and procedure time. In contrast, TRA was associated longer fluoroscopy time and higher X-ray dosage, although statistically insignificant. CAG caused a similar increase in hs-CRP in both groups, insignificantly. Conclusion: In contrast to previous studies reporting a higher inflammatory response with TRA, this study demonstrates that inflammatory response caused by CAG is unrelated to access site and similar in TRA and TFA. Longer fluoroscopy time, higher X-ray dosage and longer procedure time in the TRA group indicate the importance of carefully selecting the angiographic route especially in patients with chronic heart failure, chronic renal impairment and malignancy risk. Also, these parameters place importance for physicians own health and woman planning pregnancy.

A New Implant for Transfemoral Amputation: Improved Gait and Comfort

Introduction: Transfemoral amputation results in a prosthesis which bears weight on the ischium. Gait disturbance, lack of an end-bearing stump and discomfort in the groin from the socket even while sitting, are important issues. Methods: This is a pilot report of an ongoing randomized blind clinical trial of a new intramedullary implant post transfemoral amputation. Here, we describe a single case illustrating the surgical technique and clinical outcome of a dysfunctional post-traumatic transfemoral amputation addressed with this implant. Clinical gait analysis, SF-12 and VAS were assessed pre- and post-intervention at 6 months of follow-up. Results: An improved stump control is accomplished by means of myoplasty and myodesis through an end-cap. Stride width improved from 0.21 m pre-op to 0.13 m post-op, and more symmetrical stride length (△0.21 m pre-op vs. △0.06 m post-op) was noted, indicating improved gait quality and stability. Gait velocity increased (0.51 ± 0.04 m/s pre-op vs. 0.64 ± 0.02 m/s post-op). Conclusion: This technique reveals improvements in gait parameters in a transfemoral amputee treated with a new procedure. Improved prosthesis control, sitting comfort, greater hip range of motion, better gait stability, and enhanced walking abilities were noted.

Comparison of immediate and followup results between transradial and transfemoral approach for percutaneous coronary intervention in true bifurcational lesions

Background A comparison of efficacy and safety between transradial and transfemoral approach for percutaneous coronary intervention （PCI） in bifurcations has not been done. This study evaluated feasibility of transradial PCI （TRI） and compared the immediate and followup results with transfemoral PCI （TFI） in bifurcations. Methods One hundred and thirty-four consecutive patients with bifurcations were treated with PCI in our hospital from April 2004 to October 2005. Of these, there were 60 patients （88 lesions） in TRI group and 74 patients （101 lesions） in TFI group. Bifurcations type was classified according to the Institut Cardiovasculaire Paris Sud Classification. Results TRI group had smaller stent diameter （（3.06±0.37） mm vs （3.18±0.35） mm, P=0.023） and postprocedural in-stent minimum lumen diameter （（2.62±0.37） mm vs （2.74±0.41） mm, P=0.029） than TFI, but there were not significant differences in in-stent subacute thrombosis rate （0% vs 1.0%, P=0.349）, target lesion revascularization （TLR） （0% vs 1.0%, P=0.349） following procedure and thrombosis （2.3% vs 1.0%, P=0.482）, in-stent restenosis （12.5% vs 10.9%, P=0.731）, in-segment restenosis （17.0% vs 14.9%, P=0.681）, TLR （10.2% vs 13.9%, P=0.446） and TLR-free cumulative survival rate （89.8% vs 86.1%, P=0.787） at seven months followup. No death was reported in the two groups. Conclusion Transradial intervention is feasible and appears to be as effective and safe as transfemoral PCI in treatment of true bifurcational lesions.

A Comparison of the Transradial and Transfemoral Approaches for the Angiography and Intervention in Patients with a History of Coronary Artery Bypass Surgery： In-hospital and 1-year Follow-up Results

Background:Percutaneous coronary intervention (PCI) through transradial approach (TRA) has shown to be safe and effective as transfemoral approach (TFA) among unselected patients.However,very few studies have compared the outcomes between TRA and TFA specifically in patients with a history of coronary artery bypass grafting surgery (CABG).Methods:A total of 404 post-CABG patients who had undergone angiography or PCI were included in the study.The primary endpoint was defined as angiographic success and procedure success.The secondary endpoint was defined as in-hospital net adverse clinical events (NACEs),which included all cause of death,myocardial infarction (MI),stroke,repeat revascularization,and major bleeding.Patients were followed-up for 1-year.Major adverse cardiovascular events (MACEs),which included death,MI,and repeat revascularization,at 1-year follow-up were also compared.Results:The angiographic success was reached by 97.4％ in the TRA group compared with 100％ in the TFA group (P =0.02).The procedure success was achieved in 99.1％ in the TRA group and 97.9％ in the TFA group (P =0.68).The incidence rates of in-hospital NACE (2.7％ vs.2.7％,P =1.00) and 1-year MACE (11.5％ vs.12.0％,P =0.88) were similar between TRA and TFA.Meanwhile,TRA was associated with a lower rate of Bleeding Academic Research Consortium ≥2 bleeding (P =0.02).In patients undergoing graft PCI,the procedure success was similar between TRA and TFA (100.0％ vs.98.7％,P =1.00).The procedure time (25.0 min vs.27.5 min,P =0.53) was also similar.No significant difference was detected between TRA and TFA in terms of in-hospital NACE (0 vs.0,P =1.00)and 1-year MACE (21.4％ vs.10.3％,P =0.19).Conclusions:Compared with TFA,TRA had lower angiographic success but had a similar procedure success in post-CABG patients.TRA was also associated with decreased bleeding and shortened hospital stay.

Design method and verification of a hybrid prosthetic mechanism with energy-damper clutchable device for transfemoral amputees

Transfemoral amputees(TAs)have difficulty in mobility during walking,such as restricted movement of lower extremity and body instability,yet few transfemoral prostheses have explored human-like multiple motion characteristics by simple structures to fit the kinesiology,biomechanics,and stability of human lower extremity.In this work,the configurations of transfemoral prosthetic mechanism are synthesized in terms of human lower-extremity kinesiology.A hybrid transfemoral prosthetic(HTP)mechanism with multigait functions is proposed to recover the gait functions of TAs.The kinematic and mechanical performances of the designed parallel mechanism are analyzed to verify their feasibility in transfemoral prosthetic mechanism.Inspired by motion-energy coupling relationship of the knee,a wearable energy-damper clutched device that can provide energy in knee stance flexion to facilitate the leg off from the ground and can impede the leg’s swing velocity for the next stance phase is proposed.Its co-operation with the springs in the prismatic pairs enables the prosthetic mechanism to have the energy recycling ability under the gait rhythm of the knee joint.Results demonstrate that the designed HTP mechanism can replace the motion functions of the knee and ankle to realize its multimode gait and effectively decrease the peak power of actuators from 94.74 to 137.05 W while maintaining a good mechanical adaptive stability.

Chinese expert consensus on transradial access in percutaneous peripheral interventions

Transradial access(TRA)is a safe and comfortable approach and the preferred access for percutaneous coronary intervention.However,TRA is not widely used for peripheral interventions.Currently,there is a lack of data on patient selection,appropriate medical devices,complication prevention,and TRA adoption.Therefore,the Chinese Society of Interventional Oncology of the China Anti-Cancer Association organized nationwide experts to establish a Working Group of China Expert Consensus on TRA in percutaneous peripheral interventions in 2022,and jointly formulated this consensus to better promote the application of TRA in peripheral interventions to guide clinicians on patient selection,technical recommendations,and physician training.This consensus mainly focuses on the current situation,advantages and limitations of TRA in peripheral interventions,anatomical characteristics of the radial artery,patient selection,technical aspects,prevention and management of complications,radiation dose,and learning curve.A consensus was reached through a literature evaluation and by referring to the opinions of the expert group.

Hand dysfunction after transradial artery catheterization for coronary procedures

AIM To sythesize the available literature on hand dysfunction after transradial catheterization.METHODS We searched MEDLINE and EMBASE. The search results were reviewed by two independent judicators for studies that met the inclusion criteria and relevant reviews. We included studies that evaluated any transradial procedure and evaluated hand function outcomes post transradial procedure. There were no restrictions based on sample size. There was no restriction on method of assessing hand function which included disability, nerve damage, motor or sensory loss. There was no restriction based on language of study. Data was extracted, these results were narratively synthesized.RESULTS Out of 555 total studies 13 studies were finally included in review. A total of 3815 participants with mean age of 62.5 years were included in this review. A variety of methods were used to assess sensory and motor dysfunction of hand. Out of 13 studies included, only 3 studies reported nerve damage with a combined incidence of 0.16%, 5 studies reported sensory loss, tingling and numbness with a pooled incidence of 1.52%. Pain after transradial access was the most common form of hand dysfunction(6.67%) reported in 3 studies. The incidence of hand dysfunction defined as disability, grip strength change, power loss or any other hand complication was incredibly low at 0.26%. Although radial artery occlusion was not our primary end point for this review, it was observed in 2.41% of the participants in total of five studies included.CONCLUSION Hand dysfunction may occur post transradial catheterisation and majority of symptoms resolve without any clinical sequel.

Risk scoring model for prediction of non-home discharge after transcatheter aortic valve replacement

Background Patients undergoing transcatheter aortic valve replacement(TAVR) are likely to be discharged to a location other than home. We aimed to determine the association between preoperative risk factors and non-home discharge after TAVR. Methods Patients discharged alive after TAVR at three centers were identified from a prospectively maintained database randomly divided into 80% derivation and 20% validation cohorts. Logistic regression models were fit to identify preoperative factors associated with non-home discharge in the derivation cohort. Multivariable models were developed and a nomogram based risk-scoring system was developed for use in preoperative counseling. Results Between June 2012 and December 2018, a total of 1,163 patients had TAVR at three centers. Thirty-seven patients who died before discharge were excluded. Of the remaining 1,126 patients(97%) who were discharged alive, the incidence of non-home discharge was 25.6%(n = 289). The patient population was randomly divided into the 80%(n = 900) derivation cohort and 20%(n = 226) validation cohort. Mean ± SD age of the study population was 83 ± 8 years. In multivariable analysis, factors that were significantly associated with non-home discharge were extreme age, female sex, higher STS scores, use of general anesthesia, elective procedures, chronic liver disease, non-transfemoral approach and postoperative complications. The unbiased estimate of the C-index was 0.81 and the model had excellent calibration. Conclusions One out of every four patients undergoing TAVR is discharged to a location other than home. Identification of preoperative factors associated with non-home discharge can assist patient counseling and postoperative disposition planning.