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Article ; Online: Preparing the spinal cord - priming or preconditioning? A systematic review of experimental studies.

Herajärvi, Johanna / Juvonen, Tatu

Scandinavian cardiovascular journal : SCJ

2023 Volume 57, Issue 1, Page(s) 2166100

Abstract: Objectives. ...

Abstract	Objectives.
MeSH term(s)	Humans ; Aortic Aneurysm, Thoracic/surgery ; Spinal Cord Ischemia/etiology ; Spinal Cord Ischemia/prevention & control ; Paraplegia/etiology ; Paraplegia/prevention & control ; Ischemia ; Endovascular Procedures/adverse effects ; Aortic Aneurysm, Thoracoabdominal
Language	English
Publishing date	2023-01-19
Publishing country	England
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	1379906-x
ISSN	1651-2006 ; 1401-7431
ISSN (online)	1651-2006
ISSN	1401-7431
DOI	10.1080/14017431.2023.2166100
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Article ; Online: Access site complications in thoracic endovascular aortic repair.

Dahlbacka, Sebastian / Nykänen, Antti I / Juvonen, Tatu / Jormalainen, Mikko

Journal of vascular surgery

2023 Volume 79, Issue 4, Page(s) 740–747.e2

Abstract: Background: Percutaneous access and use of vascular closure devices facilitate thoracic endovascular aortic repair (TEVAR) procedures during local anesthesia and allow immediate detection of signs of spinal ischemia. However, the very large bore access ( ...

Abstract	Background: Percutaneous access and use of vascular closure devices facilitate thoracic endovascular aortic repair (TEVAR) procedures during local anesthesia and allow immediate detection of signs of spinal ischemia. However, the very large bore access (usually ≥22F sheath) associated with TEVAR increases the risk of vascular complications. In this study, we sought to define the safety and feasibility of two percutaneous femoral artery closure devices during TEVAR, in terms of access site vascular complications and major, life-threatening, or fatal bleeding (≥major) within 48 hours. Access site vascular complications were defined as technical failure of vascular closure or later formation of pseudoaneurysm. Methods: From March 2010 to December 2022, 199 transfemoral TEVAR were performed at Helsinki University Central Hospital, Finland. We retrospectively categorized these into three groups, based on surgeon preference for the access technique and femoral artery closure method: (1) surgical cut-down and vessel closure, n = 85 (42.7%), (2) percutaneous access and vascular closure with suture-based ProGlide, n = 56 (28.1%), or (3) percutaneous access and vascular closure with ultrasound-guided plug-based MANTA, n = 58 (29.1%). The primary outcome measure was technical success of vascular closure and access site vascular complications during index hospitalization. Secondary outcome measures were ≥major bleeding, early mortality, and hospital stay. Results: The technical success rate was 97.6% vs 91.1% vs 93.1% for surgical cut-down, ProGlide, and MANTA, respectively (P = .213). The rate of access site vascular complication was 3.5% vs 8.9% vs 10.3%, respectively (P = .290), with two pseudoaneurysms detected postoperatively and conservatively managed in the MANTA group. The vascular closure method was not associated with increased risk of ≥major bleeding, early mortality, or hospital stay on univariate analysis. Predictors for ≥major bleeding after TEVAR in multivariable analysis were urgent procedure (odds ratio: 2.8, 95% confidence interval: 1.4-5.5; P = .003) and simultaneous aortic branch revascularization (odds ratio: 2.7, 95% confidence interval: 1.3-5.4; P = .008). Conclusions: In this study, the technical success rates of the percutaneous techniques demonstrated their feasibility during TEVAR. However, the number of access site complications for percutaneous techniques was higher compared with open approach, although the difference was not statistically significant. In the lack of evidence, the safety of the new MANTA plug-based vascular closure for TEVAR warrants further investigation.
MeSH term(s)	Humans ; Endovascular Aneurysm Repair ; Endovascular Procedures ; Retrospective Studies ; Treatment Outcome ; Hemorrhage/etiology ; Hemorrhage/surgery ; Vascular Closure Devices ; Femoral Artery/diagnostic imaging ; Femoral Artery/surgery ; Hemostatic Techniques/adverse effects ; Catheterization, Peripheral/adverse effects
Language	English
Publishing date	2023-12-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2023.11.046
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Article ; Online: Use of Albumin Solution in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass-Reply.

Pesonen, Eero / Juvonen, Tatu / Pettilä, Ville

JAMA

2022 Volume 328, Issue 20, Page(s) 2067–2068

MeSH term(s)	Humans ; Albumins/administration & dosage ; Albumins/therapeutic use ; Cardiac Surgical Procedures ; Cardiopulmonary Bypass ; Hematologic Agents/administration & dosage ; Hematologic Agents/therapeutic use ; Solutions/administration & dosage ; Solutions/therapeutic use
Chemical Substances	Albumins ; Hematologic Agents ; Solutions
Language	English
Publishing date	2022-11-20
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.2022.17491
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Article ; Online: Impact of high-risk features on outcome of acute type B aortic dissection.

Herajärvi, Johanna / Mustonen, Caius / Kesävuori, Risto / Raivio, Peter / Biancari, Fausto / Jormalainen, Mikko / Juvonen, Tatu

JTCVS open

2023 Volume 13, Page(s) 20–31

Abstract: Background: Acute type B aortic dissection (TBAD) is a severe condition associated with significant morbidity and mortality. The optimal classification and treatment strategy of TBAD remain controversial and inconsistent.: Methods: This analysis ... ...

Abstract	Background: Acute type B aortic dissection (TBAD) is a severe condition associated with significant morbidity and mortality. The optimal classification and treatment strategy of TBAD remain controversial and inconsistent. Methods: This analysis includes patients treated for acute TBAD at the Helsinki University Hospital, Finland between 2007 and 2019. The endpoints were early and late mortality, intervention of the aorta, and a composite of death and aortic intervention in uncomplicated patients and high-risk patients. Results: This study included 162 consecutive TBAD patients (27.8% females), 114 in the high-risk group and 48 in the uncomplicated group, with a mean age of 67.6 ± 13.9 years. Intramural hematoma was reported in 63 cases (38.9%). The mean follow-up was 5.1 ± 3.9 years. In-hospital/30-day mortality (n = 4; 3.5%) occurred solely in the high-risk group ( Conclusions: Recognition of risk factors underlying adverse events related to TBAD is essential because the disease progression impacts both early and late outcomes. Early aortic repair in high-risk TBAD may reduce long-term morbidity and mortality.
Language	English
Publishing date	2023-01-16
Publishing country	Netherlands
Document type	Journal Article
ISSN	2666-2736
ISSN (online)	2666-2736
DOI	10.1016/j.xjon.2023.01.005
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Article ; Online: Commentary: Cooling the brain for elective aortic hemiarch repair.

Biancari, Fausto / Juvonen, Tatu / Speziale, Giuseppe

The Journal of thoracic and cardiovascular surgery

2021 Volume 165, Issue 5, Page(s) 1774–1775

MeSH term(s)	Humans ; Aortic Aneurysm, Thoracic/diagnostic imaging ; Aortic Aneurysm, Thoracic/surgery ; Brain
Language	English
Publishing date	2021-10-11
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2021.10.007
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Article ; Online: Outcomes of surgery for extensive infective endocarditis.

Huuskonen, Antti / Kaarne, Markku / Vento, Antti / Juvonen, Tatu / Raivio, Peter

Journal of cardiac surgery

2021 Volume 36, Issue 12, Page(s) 4675–4681

Abstract: Objective: Extensive infective endocarditis (EIE) involving the valve annulus or the intervalvular fibrous body (IFB) is a treatment challenge. We sought to clarify the outcomes of patients undergoing surgery for EIE.: Methods: We retrospectively ... ...

Abstract	Objective: Extensive infective endocarditis (EIE) involving the valve annulus or the intervalvular fibrous body (IFB) is a treatment challenge. We sought to clarify the outcomes of patients undergoing surgery for EIE. Methods: We retrospectively reviewed all 197 consecutive patients who underwent an operation for infective endocarditis (IE) between 2005 and 2016 in the Helsinki University Hospital. Thirty-five (18%) patients had EIE, of which 17 (9%) infection extended to IFB. Results: Patients with EIE had higher EuroSCORE II (24.4% vs. 12.4% p < .001), higher frequency of diabetes (29% vs. 13% p = .017), more often NYHA Class IV (83% vs. 56% p = .02), aortic (97% vs. 45% p < .001), multivalve (40% vs. 11% p < .001), and prosthetic valve IE (37% vs. 9% p < .001), and underwent more often emergency surgery (46% vs. 29% p = .042). Thirty-day mortality was 9% in the EIE group and 7% in the non-EIE group (p = .720). Survival of patients with EIE at 5 years was 60% and with non-EIE 71% (p = .029). The frequency of complications was higher in EIE (54%) than in non-EIE patients (25%) (p < .001), due to the higher need for permanent pacemaker implantations (34% vs. 4% p < .001). Freedom from re-operations at 5 years was 91% in the EIE group and 97% in the non-EIE group (p = .203). Conclusions: Early mortality of surgery for EIE was comparable with non-EIE. Midterm survival was lower after surgery for EIE than after surgery for non-EIE but there was no difference in survival of patients with IE limited to the valve annulus amenable to patch repair and patients with endocarditis requiring IFB reconstruction.
MeSH term(s)	Aortic Valve/surgery ; Endocarditis/surgery ; Endocarditis, Bacterial/surgery ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation ; Humans ; Reoperation ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2021-09-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	639059-6
ISSN	1540-8191 ; 0886-0440
ISSN (online)	1540-8191
ISSN	0886-0440
DOI	10.1111/jocs.16005
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Article ; Online: 13-year single-center experience with the treatment of acute type B aortic dissection.

Herajärvi, Johanna / Jormalainen, Mikko / Mustonen, Caius / Kesävuori, Risto / Raivio, Peter / Biancari, Fausto / Juvonen, Tatu

Scandinavian cardiovascular journal : SCJ

2022 Volume 56, Issue 1, Page(s) 360–367

Abstract: ... Background ... Acute type B aortic dissection (TBAD) is catastrophic event associated with significant mortality and lifelong morbidity. The optimal treatment strategy of TBAD is still controversial. ... Methods ... This analysis includes patients ... ...

Abstract	Background. Acute type B aortic dissection (TBAD) is catastrophic event associated with significant mortality and lifelong morbidity. The optimal treatment strategy of TBAD is still controversial. Methods. This analysis includes patients treated for TBAD at the Helsinki University Hospital, Finland in 2007-2019. The endpoints were early and late mortality, and intervention of the aorta. Results. There were 205 consecutive TBAD patients, 59 complicated and 146 uncomplicated patients (mean age of 66 ± 14, females 27.8%). In-hospital and 30-day mortality rates were higher in complicated patients compared with uncomplicated patients with a statistically significant difference (p = 0.035 and p = 0.015, respectively). After a mean follow-up of 4.9 ± 3.8 years, 36 (25.0%) and 22 (37.9%) TBAD -related adverse events occurred in the uncomplicated and complicated groups, respectively (p = 0.066). Freedom from composite outcome was 83 ± 3% and 69 ± 6% at 1 year, 75 ± 4% and 63 ± 7% at 5 years, 70 ± 5% and 59 ± 7% at 10 years in the uncomplicated group and in the complicated group, respectively (p = 0.052). There were 25 (39.1%) TBAD-related deaths in the overall series and prior aortic aneurysm was the only risk factor for adverse aortic-related events in multivariate analysis (HR 3.46, 95% CI 1.72-6.96, p < 0.001). Conclusion. TBAD is associated with a significant risk of early and late adverse events. Such a risk tends to be lower among patients with uncomplicated dissection, still one fourth of them experience TBAD-related event. Recognition of risk factors in the uncomplicated group who may benefit from early aortic repair would be beneficial.
MeSH term(s)	Aged ; Aged, 80 and over ; Aneurysm, Dissecting/diagnostic imaging ; Aneurysm, Dissecting/surgery ; Aortic Aneurysm, Thoracic/diagnostic imaging ; Aortic Aneurysm, Thoracic/surgery ; Blood Vessel Prosthesis Implantation/adverse effects ; Endovascular Procedures/adverse effects ; Female ; Humans ; Middle Aged ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2022-10-02
Publishing country	England
Document type	Journal Article
ZDB-ID	1379906-x
ISSN	1651-2006 ; 1401-7431
ISSN (online)	1651-2006
ISSN	1401-7431
DOI	10.1080/14017431.2022.2127873
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Article ; Online: Ultrasound-guided closure of the femoral artery during venoarterial decannulation using a large-bore closure device.

Rahman, Tasnia / Herajärvi, Johanna / Ahonen, Henri / Jormalainen, Mikko / Syrjälä, Simo / Järvinen, Tommi / Juvonen, Tatu / Dahlbacka, Sebastian

Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society

2023 Volume 112, Issue 4, Page(s) 256–264

Abstract: Background: Peripheral femoro-femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) is viable for fast hemodynamic assistance during cardiogenic shock. Ultrasound-guided closure with a large-bore device (MANTA: Methods: This ... ...

Abstract	Background: Peripheral femoro-femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) is viable for fast hemodynamic assistance during cardiogenic shock. Ultrasound-guided closure with a large-bore device (MANTA Methods: This retrospective study included patients weaning from percutaneously inserted femoro-femoral VA-ECMO at the Helsinki University Hospital, Finland in 2012-2020. The primary endpoints were access-site complications, a composite of hematomas/seromas/surgical site infections (SSIs), and the safety endpoint of vascular complications (VCs). Results: A total of 100 consecutive percutaneously implanted and weaned VA-ECMO patients were stratified into two groups by decannulation strategy: percutaneous ultrasound-guided MANTA device ( Conclusions: Percutaneous ultrasound-guided MANTA closure of the femoral artery after VA-ECMO decannulation was associated with high technical success rate and low incidence of VCs. Compared to surgical closure, access-site complications were significantly less frequent, along with access-site complications necessitating interventions.
MeSH term(s)	Female ; Humans ; Adult ; Middle Aged ; Femoral Artery/diagnostic imaging ; Femoral Artery/surgery ; Retrospective Studies ; Seroma ; Catheterization, Peripheral/methods ; Hematoma/etiology ; Surgical Wound Infection ; Ultrasonography, Interventional ; Treatment Outcome
Language	English
Publishing date	2023-07-10
Publishing country	England
Document type	Journal Article
ZDB-ID	2077691-3
ISSN	1799-7267 ; 1457-4969
ISSN (online)	1799-7267
ISSN	1457-4969
DOI	10.1177/14574969231181232
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Article ; Online: Commentary: Age is just an element of the quality of life puzzle following aortic valve replacement.

Mariscalco, Giovanni / Juvonen, Tatu / Biancari, Fausto

The Journal of thoracic and cardiovascular surgery

2019 Volume 161, Issue 4, Page(s) 1213–1214

MeSH term(s)	Aortic Valve/diagnostic imaging ; Aortic Valve/surgery ; Aortic Valve Stenosis/surgery ; Heart Valve Prosthesis ; Humans ; Quality of Life
Language	English
Publishing date	2019-11-27
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2019.11.021
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Article ; Online: Reliability of Bioreactance and Pulse-Power Analysis in Measuring Cardiac Index During Open Abdominal Aortic Surgery.

Ronkainen, Heikki Pekka Oskari / Ylikauma, Laura Anneli / Pohjola, Mari Johanna / Ohtonen, Pasi Petteri / Erkinaro, Tiina Maria / Vakkala, Merja Annika / Liisanantti, Janne Henrik / Juvonen, Tatu Sakari / Kaakinen, Timo Ilari

Journal of cardiothoracic and vascular anesthesia

2024

Abstract: Objective: To investigate the accuracy, precision, and trending ability of noninvasive bioreactance-based Starling SV and the mini invasive pulse-power device LiDCOrapid as compared to thermodilution cardiac output (TDCO) as measured by pulmonary artery ...

Abstract	Objective: To investigate the accuracy, precision, and trending ability of noninvasive bioreactance-based Starling SV and the mini invasive pulse-power device LiDCOrapid as compared to thermodilution cardiac output (TDCO) as measured by pulmonary artery catheter when assessing cardiac index (CIx) in the setting of elective open abdominal aortic (AA) surgery. Design: A prospective method-comparison study. Setting: Oulu University Hospital, Finland. Participants: Forty patients undergoing elective open abdominal aortic surgery. Interventions: Intraoperative CI measurements were obtained simultaneously with TDCO and the study monitors, resulting in 627 measurement pairs with Starling SV and 497 with LiDCOrapid. Measurements and main results: The Bland-Altman method was used to investigate the agreement among the devices, and four-quadrant plots with error grids were used to assess trending ability. The agreement between TDCO and Starling SV was associated with a bias of 0.18 L/min/m Conclusion: The CI measurements achieved with Starling SV and LiDCOrapid were not interchangeable with TDCO, and the ability to track changes in CI was poor. These results do not support the use of either study device in monitoring CI during open AA surgery.
Language	English
Publishing date	2024-02-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2024.02.005
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