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Kim KM, Arghami A, Habib R, Daneshmand MA, Parsons N, Elhalabi Z, Krohn C, Thourani V, Bowdish ME. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2022 Update on Outcomes and Research. Ann Thorac Surg 2023; 115:566-574. [PMID: 36623634 DOI: 10.1016/j.athoracsur.2022.12.033] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/05/2022] [Accepted: 12/10/2022] [Indexed: 01/08/2023]
Abstract
The Society of Thoracic Surgeons Adult Cardiac Surgery Database is the most mature and comprehensive cardiac surgery database. It is one of the most respected clinical data registries in health care, providing accurate risk-adjusted benchmarks, a foundation for quality measurement and improvement activities, and the ability to perform novel research. This report encompasses data from the years 2020 and 2021 and is the seventh in a series of reports that provide updated volumes, outcomes, database-related developments, and research summaries using the Adult Cardiac Surgery Database.
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Affiliation(s)
- Karen M Kim
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Robert Habib
- The Society of Thoracic Surgeons, Chicago, Illinois
| | - Mani A Daneshmand
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Carole Krohn
- The Society of Thoracic Surgeons, Chicago, Illinois
| | - Vinod Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Michael E Bowdish
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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Mehaffey JH, Hawkins RB, Wegermann ZK, Grau-Sepulveda MV, Fallon JM, Brennan JM, Thourani VH, Badhwar V, Ailawadi G. Aortic Annular Enlargement in the Elderly: Short and Long-Term Outcomes in the United States. Ann Thorac Surg 2021; 112:1160-1166. [PMID: 33421392 DOI: 10.1016/j.athoracsur.2020.12.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/08/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patient prosthesis mismatch is associated with significant long-term morbidity and mortality after aortic valve replacement, but the role and outcomes of annular enlargement (AE) remain poorly defined. We hypothesized that increasing rates of AE may lead to improved outcomes for patients at risk for severe patient prosthesis mismatch. METHODS Patients over age 65 years undergoing surgical aortic valve replacement with or without coronary artery bypass grafting from 2008-2016 in The Society of Thoracic Surgeons Adult Cardiac Surgery Database with matching Centers for Medicare & Medicaid Services data were included (n=189,268). Univariate, multivariate, and time-to-event analysis was used to evaluate the association between AE and early and late outcomes. Patients were stratified by projected degree of patient prosthesis mismatch based on calculated effective orifice area index. RESULTS A total of 5412 (2.9%) patients underwent AE. The Society of Thoracic Surgeons Adult Cardiac Surgery Database-predicted mortality was similar between AE and non-AE groups (2.97% vs 2.99%, P = .052). Patients undergoing AE had higher risk-adjusted rates of 30-day complications and death (5.4% vs 3.4%, P < .0001), but no differences in long-term rates of stroke, heart failure re-hospitalization,s or aortic valve reoperation. Survival analysis demonstrated a higher risk of mortality with AE during the first 3 years, after which the survival curves cross, favoring AE. CONCLUSIONS These data suggest that annular enlargement during surgical aortic valve replacement is associated with increased short-term risk in a Medicare population. Survival curves crossed after 3 years, which may portend a benefit in select patients. However, annular enlargement is still only performed in the minority of patients who are at risk for patient prosthesis mismatch.
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Affiliation(s)
- J Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.
| | - Robert B Hawkins
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | | | | | - John M Fallon
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - J Matthew Brennan
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Piedmont Heart Institute, Atlanta, Georgia
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
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Massias SA, Pittams A, Mohamed M, Ahmed S, Younas H, Harky A. Aortic root enlargement: When and how. J Card Surg 2020; 36:229-235. [PMID: 33124077 DOI: 10.1111/jocs.15175] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/18/2020] [Indexed: 02/05/2023]
Abstract
Aortic valve replacement is the definitive management for severe aortic stenosis. Intraoperatively, an aortic root enlargement (ARE) may be used to facilitate the implementation of a suitably sized prosthetic valve. This is to prevent patient prosthesis mismatch (PPM), a condition that causes a left ventricular outflow obstruction. There are four main techniques that are used to perform ARE, namely, Nicks, Manouguian, Nunez (modified Manouguian), and Kanno-Rastan procedures. They each involve incisions through different anatomical structures and allow a variety of valve sizes to be implanted. Studies prove that ARE effectively reduces the incidence of PPM. In addition, they show that there is no definitive link between ARE and perioperative mortality or other complications. There is a scarcity of literature exploring the comparative outcomes of each surgical technique. Therefore, further research is warranted for these procedures to be compared adequately. This review aims to summarise the available literature surrounding ARE with respect to three main questions. (1) What are the indications for ARE, (2) what surgical techniques exist to facilitate ARE, and (3) are there significant differences in patient outcomes when these surgical techniques are employed?
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Affiliation(s)
- Samuel A Massias
- St George's School of Medicine, University of London, London, UK
| | | | | | | | - Hiba Younas
- St George's School of Medicine, University of London, London, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Cardiac Surgery, Alder Hey NHS Foundation Trust Hospital, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, UK
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Yamamoto M, Watanabe Y, Tada N, Naganuma T, Araki M, Yamanaka F, Mizutani K, Tabata M, Ueno H, Takagi K, Higashimori A, Shirai S, Hayashida K. Transcatheter aortic valve replacement outcomes in Japan: Optimized CathEter vAlvular iNtervention (OCEAN) Japanese multicenter registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:843-851. [DOI: 10.1016/j.carrev.2018.11.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/06/2018] [Accepted: 11/27/2018] [Indexed: 12/20/2022]
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Simonato M, Dvir D. Transcatheter aortic valve replacement in failed surgical valves. Heart 2019; 105:s38-s43. [DOI: 10.1136/heartjnl-2018-313517] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 11/22/2018] [Accepted: 11/28/2018] [Indexed: 11/03/2022] Open
Abstract
Aortic valve-in-valve is a less invasive alternative to surgical redo in the treatment of failed bioprosthetic valves. While only inoperable patients underwent the procedure before, operators currently offer it to those at lower risk and worldwide experience is in the thousands. Early mortality has diminished in recent analyses and improvements in symptoms and quality of life have been documented. Main considerations with aortic valve-in-valve include elevated postprocedural gradients, coronary obstruction and leaflet thrombosis. Risk factors for each of these adverse events have been described at length. Aortic valve-in-valve offers a safe and effective option in the management of failed bioprosthetic valves.
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Tobita R, Iwata K, Kamisaka K, Yuguchi S, Tahara M, Oura K, Morisawa T, Ohhashi S, Kumamaru M, Hanafusa Y, Kato M, Saitoh M, Sakurada K, Takahashi T. Clinical characteristics of functional recovery after coronary artery bypass graft surgery in Japanese octogenarians. J Phys Ther Sci 2016; 28:621-5. [PMID: 27065553 PMCID: PMC4793021 DOI: 10.1589/jpts.28.621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/17/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to elucidate characteristics of postoperative physical
functional recovery in octogenarians undergoing coronary artery bypass graft surgery.
[Subjects and Methods] This was a multi-center, retrospective study. Nine hundred and
twenty-seven elective isolated coronary artery bypass graft surgeries were evaluated (746
males and 181 females, mean age: 68.6 years, range: 31–86 years). Participants were
stratified according to age < 80 years (n = 840; mean age, 67.1; range, 31–79) or >
80 years (n = 87; mean age, 82.2; range, 80–86). Patient characteristics and postoperative
physical functional recovery outcomes were compared between groups. [Results] There was no
significant difference between groups when considering the postoperative day at which
patients could sit on the edge of the bed, stand at bedside, or walk around the bed. The
postoperative day at which patients could walk 100 m independently was later in
octogenarians, when compared with non-octogenarians (6.1 ± 3.2 days vs. 4.9 ± 3.9 days).
In octogenarians, the percentage of patients who could walk 100 m independently within 8
days after surgery was 79.5%. [Conclusion] A postoperative target time in octogenarians
for independent walking, following coronary artery bypass grafting, can be set at
approximately 6 days.
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Affiliation(s)
- Ryo Tobita
- Department of Rehabilitation, Shiga University of Medical Science Hospital, Japan
| | - Kentaro Iwata
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Japan
| | - Kenta Kamisaka
- Rehabilitation Center, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Japan
| | - Satoshi Yuguchi
- Department of Rehabilitation, The Sakakibara Heart Institute of Okayama, Japan
| | - Masayuki Tahara
- Department of Rehabilitation, Higashi Takarazuka Satoh Hospital, Japan
| | - Keisuke Oura
- Division of Rehabilitation, Fukuyama Cardiovascular Hospital, Japan
| | - Tomoyuki Morisawa
- Department of Physical therapy, Faculty of Rehabilitation, Hyogo University of Health Sciences, Japan
| | - Satoko Ohhashi
- Department of Rehabilitation, Kasukabe Chuo General Hospital, Japan
| | - Megumi Kumamaru
- Department of Rehabilitation, Gunma Children's Medical Center, Japan
| | - Yusuke Hanafusa
- Department of Rehabilitation, Saitama Medical University International Medical Center, Japan
| | - Michitaka Kato
- Department of Rehabilitation, Shizuoka Medical Center, Japan
| | - Masakazu Saitoh
- Department of Physiotherapy, Sakakibara Heart Institute, Japan
| | - Koji Sakurada
- Department of Rehabilitation, The Cardiovascular Institute, Japan
| | - Tetsuya Takahashi
- Department of Physical Therapy, School of Health Science, Tokyo University of Technology, Japan
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