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Rubens FD, Fremes SE, Grubic N, Fergusson D, Taljaard M, van Walraven C. Outcomes following coronary artery bypass grafting with multiple arterial grafting by pump status in men and women. J Thorac Cardiovasc Surg 2024; 167:1796-1807.e15. [PMID: 36935299 DOI: 10.1016/j.jtcvs.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/17/2023] [Accepted: 02/04/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Multiple arterial grafting (MAG) and off-pump surgery are strategies proposed to improve outcomes with coronary artery bypass grafting (CABG). This study was conducted to determine the impact of off-pump surgery on outcomes after CABG with MAG in men and women. METHODS This cohort study used population-based data to identify all Ontarians undergoing isolated CABG with MAG between October 2008 and September 2019. The primary outcome was all-cause mortality. Secondary outcomes included major adverse cardiac and cerebrovascular events (MACCE; hospitalization for stroke, myocardial infarction hospitalization or heart failure, or repeat revascularization). Analysis used propensity-score overlap-weighted cause-specific Cox proportional hazard regression. RESULTS A total of 2989 women (1188 off-pump, 1801 on-pump) and 16,209 men (6065 off-pump, 10,144 on-pump) underwent MAG with a median follow-up of 5.0 years (interquartile range, 2.7-8.0) years. Compared to the on-pump approach, all-cause mortality was not changed with off-pump status (hazard ratio [HR] in women: 1.25 [95% CI, 0.83-1.88]; in men: 1.08 [95% CI, 0.85-1.37]). In women, the risk of MACCE was significantly higher off-pump (HR, 1.45; 95% CI, 1.04-2.03), with nonsignificantly increased risk observed for all component outcomes. CONCLUSIONS In patients undergoing CABG with MAG, this population-based analysis found no association between pump status and survival in either men or women. However, it did suggest that off-pump MAG in women may be associated with an increased risk of MACCE.
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Nantsios A, Ahmadvand A, Burwash IG, Chan V, Guo MH, Mesana T, Messika-Zeitoun D, Ramsay T, Rubens FD. Edge-to-edge with partial band mitral valve repair compared to replacement and undersized restrictive annuloplasty for ischemic mitral regurgitation. JTCVS Tech 2024; 23:26-43. [PMID: 38351991 PMCID: PMC10859650 DOI: 10.1016/j.xjtc.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/01/2023] [Accepted: 10/10/2023] [Indexed: 02/16/2024] Open
Abstract
Objective Evidence supports replacement over repair for ischemic mitral regurgitation due to improved durability; however, the latter often involves an undersized ring annuloplasty that does not include edge-to-edge approximation. The objective of this study was to evaluate the outcomes of replacement, edge-to-edge leaflet approximation with mild-undersized annuloplasty and undersized ring annuloplasty for ischemic mitral regurgitation. Methods This is a single-center retrospective study of patients undergoing mitral surgery for moderate-severe or greater ischemic mitral regurgitation, between 2004 and 2020, with mild-undersized annuloplasty, mitral valve replacement, or undersized restrictive annuloplasty (undersized ring annuloplasty). The primary outcome was all-cause mortality. Secondary outcomes included first recurrence of mitral regurgitation, heart failure hospitalization, and composite of valve-related events (bleeding, thromboembolism, endocarditis, and mitral valve reoperation). Results There were 121, 93, and 78 patients in the mitral valve replacement, mild-undersized annuloplasty, and undersized restrictive annuloplasty groups, respectively, with a median follow-up of 3.1, 5.9, and 3.8 years, respectively. Both mitral valve replacement (hazard ratio, 1.87; 95% CI, 1.029-3.415) and undersized restrictive annuloplasty (hazard ratio, 2.73; 95% CI, 1.480-5.061) were associated with worse survival compared with mild-undersized annuloplasty. At 2 years, the rate of mild-moderate mitral regurgitation was greater in the mild-undersized annuloplasty group compared with the mitral valve replacement group (P = .001) but less than in the undersized restrictive annuloplasty group (P = .001). The rate of recurrent moderate or greater mitral regurgitation at 2 years was similar between mild-undersized annuloplasty and mitral valve replacement groups but significantly higher after undersized restrictive annuloplasty (P < .0001). Mitral valve replacement and undersized restrictive annuloplasty were associated with a significant increase in the incidence of first heart failure hospitalization compared with mild-undersized annuloplasty (P < .001 and P = .001, respectively). Mitral valve replacement was associated with an increased incidence of valve-related events compared with mild-undersized annuloplasty (P = .002). Conclusions Surgical edge-to-edge approximation in addition to a mild-undersizing annuloplasty offers similar durability compared with replacement, with a lower rate of hospitalization for heart failure, and may confer a survival advantage.
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Moffatt-Bruce SD, Harris K, Rubens FD, Villeneuve PJ, Sundaresan RS. Competency-based training: Canadian cardiothoracic surgery. J Thorac Cardiovasc Surg 2024; 167:407-410. [PMID: 36702679 DOI: 10.1016/j.jtcvs.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/25/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
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Fehlmann CA, Bezzina K, Mazzola R, Visintini SM, Guo MH, Rubens FD, Wells GA, McGuinty C, Huang A, Khoury L, Boczar KE. Influence of preoperative frailty on quality of life after cardiac surgery: A systematic review and meta-analysis. J Am Geriatr Soc 2023; 71:3278-3286. [PMID: 37289174 DOI: 10.1111/jgs.18454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/04/2023] [Accepted: 05/13/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Frailty has emerged as an important prognostic marker of increased mortality after cardiac surgery, but its association with quality of life (QoL) and patient-centered outcomes is not fully understood. We sought to evaluate the association between frailty and such outcomes in older patients undergoing cardiac surgery. METHODS This systematic review included studies evaluating the effect of preoperative frailty on QoL outcomes after cardiac surgery amongst patients 65 years and older. The primary outcome was patient's perceived change in QoL following cardiac surgery. Secondary outcomes included residing in a long-term care facility for 1 year, readmission in the year following the intervention, and discharge destination. Screening, inclusion, data extraction, and quality assessment were performed independently by two reviewers. Meta-analyses based on the random-effects model were conducted. The evidential quality of findings was assessed with the GRADE profiler. RESULTS After the identification of 3105 studies, 10 observational studies were included (1580 patients) in the analysis. Two studies reported on the change in QoL following cardiac surgery, which was higher for patients with frailty than for patients without. Preoperative frailty was associated with both hospital readmission (pooled odds ratio [OR] 1.48 [0.80-2.74], low GRADE level) as well as non-home discharge (pooled OR 3.02 [1.57-5.82], moderate GRADE level). CONCLUSION While evidence in this field is limited by heterogeneity of frailty assessment and non-randomized data, we demonstrated that baseline frailty may possibly be associated with improved QoL, but with increased readmission as well as discharge to a non-home destination following cardiac surgery. These patient-centered outcomes are important factors when considering interventional options for older patients. STUDY REGISTRATION OSF registries (https://osf.io/vm2p8).
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Rahmouni K, Rubens FD. Commentary: The coronary Gordian knot. J Thorac Cardiovasc Surg 2023; 165:1414-1415. [PMID: 34154803 DOI: 10.1016/j.jtcvs.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022]
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Rubens FD, Clarke AE, Lee DS, Wells GA, Sun LY. Population study of sex-based outcomes after surgical aortic valve replacement. CJC Open 2022; 5:220-229. [PMID: 37013069 PMCID: PMC10066438 DOI: 10.1016/j.cjco.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Background Surgical aortic valve replacement (SAVR) is a key strategy for the treatment of aortic valve disease. However, studies have involved primarily male patients, and whether the benefits of this approach can be extrapolated to female patients is unclear. Methods Clinical and administrative datasets for 12,207 patients undergoing isolated SAVR in Ontario from 2008 to 2019 were linked. Male and female patients were balanced using inverse probability treatment weighting. Mortality, endocarditis, and major hemorrhagic and thrombotic events, as well as 2 composite outcomes-major adverse cerebral and cardiovascular events (MACCE) and patient-derived adverse cardiovascular and noncardiovascular events (PACE)-and their component events, were compared in the weighted groups with a stratified log-rank test. Results A total of 7485 male patients and 4722 female patients were included in the study. Median follow-up was 5.2 years in both sexes. All-cause mortality did not differ between sexes (hazard ratio [HR] 0.949 [95% confidence interval {CI} 0.851-1.059]). Male sex was associated with an increased risk of new-onset dialysis (HR 0.689 [95% CI 0.488-0.974]). Female sex was associated with a significantly increased risk of both new-onset heart failure (HR 1.211 [95% CI 1.051-1.394], P = 0.0081) and heart failure hospitalization (HR 1.200 [95% CI 1.036-1.390], P = 0.015). No statistically significant differences were seen in any of the other secondary outcomes between sexes. Conclusions This population health study demonstrated that survival did not differ between male and female patients undergoing SAVR. Significant sex-related differences were found in the risk of heart failure and new-onset dialysis, but these findings should be considered exploratory and require further study.
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Muller Moran HR, Alakhtar AM, Al-Atassi T, Rubens FD, Arora RC, Lachapelle KJ. Cardiac Surgery Training in the Transcatheter Era. Can J Cardiol 2022; 38:1736-1738. [PMID: 35940455 DOI: 10.1016/j.cjca.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 12/24/2022] Open
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Vo TX, Rubens FD. Commentary: Good things come to those who wait. JTCVS Tech 2022; 12:131. [PMID: 35403015 PMCID: PMC8987316 DOI: 10.1016/j.xjtc.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 12/05/2022] Open
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Rubens FD. Reply: Rose-colored glasses. JTCVS OPEN 2022; 9:88. [PMID: 36003467 PMCID: PMC9390178 DOI: 10.1016/j.xjon.2021.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Rahmouni K, Rubens FD. Commentary: No-Touch Saphenous Vein: Adding More Fuel to the Flame? Semin Thorac Cardiovasc Surg 2021; 35:237-238. [PMID: 34965476 DOI: 10.1053/j.semtcvs.2021.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 11/11/2022]
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Rubens FD. Reply: Implications of innovations on clinical outcomes. JTCVS OPEN 2021; 8:381. [PMID: 36004112 PMCID: PMC9390576 DOI: 10.1016/j.xjon.2021.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Rahmouni K, Rubens FD. Commentary: One cannot fix what one cannot see. J Thorac Cardiovasc Surg 2021; 165:2074-2075. [PMID: 34281704 DOI: 10.1016/j.jtcvs.2021.06.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
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Rubens FD, Virani A, Coylewright M, Sathananthan J, Wood D. Balancing patient-centered care and evidence-based medicine in patients needing coronary revascularization. J Thorac Cardiovasc Surg 2021; 164:1903-1906. [PMID: 33965224 DOI: 10.1016/j.jtcvs.2021.03.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 12/25/2022]
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Elmistekawy E, Nair V, Rubens FD. Skin cancer at median sternotomy scar. Asian Cardiovasc Thorac Ann 2021; 29:970. [PMID: 33818155 PMCID: PMC8564238 DOI: 10.1177/02184923211006864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nantsios A, Rubens FD. Unexplained fever following DeBakey type I aortic dissection repair with woven Dacron grafts. J Card Surg 2021; 36:2175-2178. [PMID: 33768595 DOI: 10.1111/jocs.15497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/03/2021] [Accepted: 03/01/2021] [Indexed: 11/29/2022]
Abstract
Transient fever is not uncommon postcardiac surgery, usually related to underlying clinical process such as inflammation related to the physiological insult or infection. Here, we present a case series of two patients who underwent repair for type A aortic dissection with Gelweave graft prosthesis who had persistent fevers, leukocytosis, and raised inflammatory markers persisting months after surgery. Both patients were found to have sterile perigraft fluid collections. Comprehensive investigations excluded common causes of postoperative inflammation, as well as rarer causes of fever of unknown origin. The presence of this idiopathic inflammatory state lead to extended hospitalization and resource utilization, prompting need for further characterization of its mechanism and proper management.
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Guo MH, Rubens FD. Commentary: Never let semantics get in the way of a good idea. JTCVS Tech 2021; 8:88-89. [PMID: 34401822 PMCID: PMC8350609 DOI: 10.1016/j.xjtc.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 02/17/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022] Open
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Rahmouni K, Rubens FD. Commentary: Multi-Arterial Grafting in Atrial Fibrillation: Pushing the Envelope of Practicality? Semin Thorac Cardiovasc Surg 2021; 33:984-985. [PMID: 33600970 DOI: 10.1053/j.semtcvs.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/05/2021] [Indexed: 11/11/2022]
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Sun LY, Rodger J, Duffett L, Tulloch H, Crean AM, Chong AY, Rubens FD, MacPhee E, Mesana TG, Lee DS, van Diepen S, Beanlands RS, Ruel M, Julien AM, Bilodeau J. Derivation of Patient-Defined Adverse Cardiovascular and Noncardiovascular Events Through a Modified Delphi Process. JAMA Netw Open 2021; 4:e2032095. [PMID: 33394003 PMCID: PMC7783543 DOI: 10.1001/jamanetworkopen.2020.32095] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
IMPORTANCE There is little evidence to support patient-centered outcomes in patients with cardiovascular disease. OBJECTIVE To derive patient-defined adverse cardiovascular and noncardiovascular events (PACE) through a consensus-based process. DESIGN, SETTING, AND PARTICIPANTS This pan-Canadian, consensus-based, qualitative study used an iterative Delphi method to achieve consensus within a 35-member panel consisting of patients with cardiovascular diseases and their caregivers and clinicians. The process included 4 rounds of online questionnaires, followed by an in-person final consensus meeting. Data analysis was performed in September 2019. MAIN OUTCOMES AND MEASURES Defining PACE as a 5-item composite outcome. RESULTS Thirty-five potential panelists consented to participate, including 11 clinicians (8 men [73%]) and 24 patients and caregivers (13 men [54%]). Twenty-nine (83%), 28 (80%), 26 (74%), and 23 (66%) of the panelists participated in each of respective the online rounds. A shortlist of 11 patient-defined items was further refined at the in-person meeting, which 20 of the panelists attended. The PACE definition that was decided through the consensus process was a composite of severe stroke necessitating hospitalization for 14 days or longer or inpatient rehabilitation, ventilator dependence, new onset or worsening heart failure, nursing home admission, or new onset dialysis. CONCLUSIONS AND RELEVANCE This study defined PACE as a versatile, patient-centered outcome through a consensus process with input from patients, caregivers, and clinicians. Given the paucity of patient-centered outcomes in cardiovascular research, PACE may be considered as a potential outcome after methodological evaluation of its reliability.
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Jabagi H, Tran D, Glineur D, Rubens FD. Optimal Configuration for Bypass of the Left Anterior Descending Artery During Bilateral Internal Thoracic Artery Grafting. Ann Thorac Surg 2020; 110:1917-1925. [DOI: 10.1016/j.athoracsur.2020.03.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
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Rubens FD. Commentary: Expertise in fitting square pegs in round holes. JTCVS Tech 2020; 5:19. [PMID: 34318095 PMCID: PMC8300007 DOI: 10.1016/j.xjtc.2020.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/01/2020] [Accepted: 11/06/2020] [Indexed: 11/25/2022] Open
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Rubens FD. Commentary: Lung recruitment: Why is this not on my radar? J Thorac Cardiovasc Surg 2020; 164:183-184. [PMID: 33309094 DOI: 10.1016/j.jtcvs.2020.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 10/23/2022]
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Guo MH, Rubens FD. Commentary: Necessity is the Mother of Reinventions. Semin Thorac Cardiovasc Surg 2020; 33:452-453. [PMID: 33181289 DOI: 10.1053/j.semtcvs.2020.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/27/2020] [Indexed: 11/11/2022]
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Vo TX, Rubens FD. Commentary: The Fog of War - The Impact of Missing Data in Database Analyses. Semin Thorac Cardiovasc Surg 2020; 33:395-396. [PMID: 33181290 DOI: 10.1053/j.semtcvs.2020.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/27/2020] [Indexed: 11/11/2022]
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Rubens FD. Commentary: All we like iSheep: Reflections of an early adopter. J Thorac Cardiovasc Surg 2020; 162:1554-1555. [PMID: 33097215 DOI: 10.1016/j.jtcvs.2020.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 11/30/2022]
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Rubens FD, Ngu J, Malvea A, Samuels SJ, Burwash IG. Early Midterm Results After Valve Replacement With Contemporary Pericardial Prostheses for Severe Aortic Stenosis. Ann Thorac Surg 2020; 112:99-107. [PMID: 33080239 DOI: 10.1016/j.athoracsur.2020.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/07/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Clinical studies have demonstrated improved gradients after aortic valve replacement with the Trifecta (TR) valve (Abbott Cardiovascular, St Paul, MN) as compared with the Carpentier-Edwards Magna Ease (ME) valve (Edwards Lifesciences, Irvine, CA). Clinical benefits of this strategy have not been demonstrated. METHODS Patients undergoing aortic valve replacement for severe aortic stenosis with either valve were included. Patients were excluded if they underwent concomitant procedures other than coronary artery bypass grafting. Inverse proportion treatment weighting was used in the analysis. The primary outcome was a composite of cardiac mortality, need for reintervention, and freedom from first congestive heart failure (CHF). Secondary outcomes were all-cause mortality, the composite components, and cumulative CHF admission. Follow-up echocardiograms were assessed in a cohort of patients to assess structural valve degeneration. RESULTS There were 331 patients in the TR group and 360 patients in the ME group. The TR group had more women (48% vs 32%, P < .001) with smaller roots (left ventricular outflow tract diameter: TR, 2.11 cm; ME, 2.17 cm; P < .001). After weighting there was no significant difference in the composite measure between groups (P > .05). There was no difference in all-cause mortality (hazard ratio, 0.82; 95% confidence interval, 0.42-1.59; P = .56), and 5-year survival was 91.9% in the ME group and 93.4% in the TR group. There was no difference in cardiac death, reintervention, or first onset of CHF or incidence of structural valve degeneration between groups. There was no difference in the rate of admissions for CHF per 100 patients between the 2 valve types (P = .19). CONCLUSIONS Early hemodynamic benefits have not translated into differences in medium-term clinical outcomes between these 2 valves. Long-term follow-up is necessary.
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