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Wu KC. Phenomapping to Guide Treatment of Ischemic Cardiomyopathy With Secondary Mitral Regurgitation: One Size Does Not Fit All. Circ Cardiovasc Imaging 2024; 17:e016573. [PMID: 38626099 DOI: 10.1161/circimaging.124.016573] [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] [Indexed: 04/18/2024]
Affiliation(s)
- Katherine C Wu
- Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD
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2
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Khokhar AA, Curio J, Sticchi A, Hartley A, Demir OM, Ruparelia N. Transcatheter Aortic Valve Implantation to Treat Degenerated Aortic, Mitral and Tricuspid Bioprosthesis. J Clin Med 2024; 13:592. [PMID: 38276098 PMCID: PMC10816283 DOI: 10.3390/jcm13020592] [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: 12/22/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is now well established as the treatment of choice for patients with native aortic valve stenosis who are high or intermediate risk for surgical aortic valve replacement. Recent data has also supported the use of TAVI in patients at low surgical risk and also in anatomical subsets that were previously felt to be contra-indicated including bicuspid aortic valves and aortic regurgitation. With advancements and refinements in procedural techniques, the application of this technology has now been further expanded to include the management of degenerated bioprosthesis. After the demonstration of feasibility and safety in the management of degenerated aortic bioprosthetic valves, mitral and tricuspid bioprosthetic valve treatment is now also well-established and provides an attractive alternative to performing redo surgery. In this review, we appraise the latest clinical evidence and highlight procedural considerations when utilising TAVI technology in the management of degenerated aortic, mitral or tricuspid prosthesis.
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Affiliation(s)
- Arif A. Khokhar
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (A.A.K.); (A.H.)
| | - Jonathan Curio
- Department of Cardiology, Heart Center Cologne, Faculty of Medicine, University Hospital, University of Cologne, 50937 Cologne, Germany;
| | - Alessandro Sticchi
- Cardiac Catheterisation Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy;
- Università di Pisa, Lungarno Pacinotti 43, 56126 Pisa, Italy
| | - Adam Hartley
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (A.A.K.); (A.H.)
| | - Ozan M. Demir
- Department of Cardiology, Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon SS16 5NL, UK
| | - Neil Ruparelia
- Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK; (A.A.K.); (A.H.)
- Cardiology, Royal Berkshire Hospital, Reading RG1 5AN, UK
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3
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Baldus S, Bauersachs J, Beckmann A, Bleiziffer S, Böning A, Conradi L, Ensminger S, Falk V, Frerker C, Liebetrau C, Möllmann H, Rudolph V, Schächinger V, Schulze PC, Thiele H, Walther T, Beyersdorf F. Gemeinsamer Kommentar der Deutschen Gesellschaft für Kardiologie (DGK) und der Deutschen Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie (DGTHG) zu den Leitlinien (2021) der ESC/EACTS zum Management von Herzklappenerkrankungen. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2022. [DOI: 10.1007/s00398-022-00521-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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4
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Quality of Life and Social Functioning of Patients After Cardiosurgical Interventions. Fam Med 2022. [DOI: 10.30841/2307-5112.1-2.2022.260507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective: to study the quality of life (QOL) and social functioning of patients who underwent cardiosurgery intervention (CSI) with the use of artificial circulation (AR) in the postoperative period, to determine and improve the system for further medical, psychological and social rehabilitation.
Materials and methods. 700 patients who underwent CSI with the use of AR were treated at the Heart Institute of the Ministry of Health of Ukraine. 86 patients had cerebral infarction (CI), 217 patients with signs of postoperative encephalopathy, and 504 patients with signs of cognitive dysfunction. The level of QOL and social functioning in patients with this pathology was analyzed.
Statistical analysis of differences in the quantitative values of indicators was performed using the nonparametric Mann-Whitney test.
Results. It was found that patients after CSI had generally low levels of QOL in all fields, namely in the indicators of psychological (emotional) well-being, general perception of life, ability to work, physical well-being, personal realization, selfcare and independence; interpersonal interaction.
The presence of ischemic and neurological complications in patients after CSI significantly reduces the QOL indicators in all areas, with differences in the quantitative values of such patients statistically significant (p<0,01) compared to the groups of patients without such complications.
The most significant deterioration of QOL is found in patients with cerebral infarction in the postoperative period, slightly less significant – in patients with signs of postoperative encephalopathy, and the smallest changes – in patients with signs of cognitive dysfunction.
Conclusions. The main task of modern cardiac surgery is not only to save the patient from death, but also to improve the quality of life (QOL). At the same time, patients after cardiac surgery are at risk of developing ischemic, neurological complications that significantly reduce QOL in all areas of life. That is why it is necessary to take into account the findings of the study in the development of treatment and rehabilitation programs and preventive measures for such patients.
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5
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Pradegan N, D'Onofrio A, Longinotti L, Evangelista G, Mastro F, Fiocco A, Nadali M, Gerosa G. Feasibility of percutaneous coronary intervention before mitral NeoChord implantation: Single-center early results. J Card Surg 2021; 36:4205-4210. [PMID: 34462962 PMCID: PMC9291066 DOI: 10.1111/jocs.15953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Micro-invasive cardiac surgery identifies procedures performed off-pump, on beating heart. Aim of this single-center retrospective study was to assess early outcomes of a totally micro-invasive strategy (percutaneous coronary intervention-PCI-followed by transapical off-pump NeoChord mitral repair) in patients with concomitant coronary artery disease (CAD) and degenerative mitral regurgitation (MR). METHODS We analyzed early and 1-year follow-up data of patients who underwent a NeoChord procedure between November 2013 and May 2020, and preceded by PCI. Outcomes were defined according to Mitral Valve Academic Research Consortium (MVARC) definitions. RESULTS Among 220 patients who underwent NeoChord repair in the study period, 17 (7.7%) underwent PCI previously. CAD was an accidental finding during preoperative mitral evaluation in nine patients (52.9%; Group 1; with PCI occurring 2 months before NeoChord, interquartile range [IQR] = 1.0-2.7), while it was part of the past medical history in the remaining eight patients (47.1%; Group 2; with PCI occurring 30 months before NeoChord, IQR = 24.5-64.0). Twelve patients (70.6%) presented single-vessel disease, two patients (11.8%) triple-vessel disease. No surgical revisions for bleeding were required after NeoChord. At 1-year follow-up (n = 16), all patients were alive and did not experience major adverse events except for one reoperation due to late NeoChord failure. None required additional PCI. CONCLUSION In our experience, PCI before NeoChord seems safe and effective, and performing PCI before NeoChord might not affect outcomes. A totally micro-invasive strategy in selected patients suffering from MR and CAD should be considered as a reasonable alternative to conventional surgery.
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Affiliation(s)
- Nicola Pradegan
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Augusto D'Onofrio
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Lorenzo Longinotti
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giuseppe Evangelista
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Florinda Mastro
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alessandro Fiocco
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Matteo Nadali
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Shahian DM, Badhwar V, Kurlansky PA, Bowdish ME, Lobdell KW, Furnary AP, Thourani VH, Jacobs JP, Wyler von Ballmoos MC, Kim KM, Vassileva C, Antman MS, Grau-Sepulveda MV, O'Brien SM. The STS Participant-Level, Multi-Procedural Composite Measure for Adult Cardiac Surgery. Ann Thorac Surg 2021; 114:467-475. [PMID: 34370982 DOI: 10.1016/j.athoracsur.2021.06.084] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/25/2021] [Accepted: 06/28/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Composite performance measures for STS Adult Cardiac Surgery Database participants (typically hospital departments or practice groups) are currently available only for individual procedures. To assess overall participant performance, STS has developed a composite metric encompassing the most common adult cardiac procedures. METHODS Analyses included 1-year (July 1, 2018-June 30, 2019) and 3-year (July 1, 2016-June 30, 2019) time windows. Operations included isolated CABG, isolated AVR, isolated mitral valve repair (MVr) or replacement (MVR), AVR+CABG, MVr/MVR+CABG, AVR+MVr/MVR, and AVR+MVr/MVR+CABG. The composite was estimated using Bayesian hierarchical models with risk-adjusted mortality and morbidity endpoints. Star ratings were based on whether the 95% credible interval of a participant's score was entirely below (1-star), overlapped (2-star), or was above (3-star) the STS average composite score. RESULTS The North American procedural mix in the 3-year study cohort was 448,569 CABG, 72,067 AVR, 35,708 MVr, 29,953 MVR, 45,254 AVR+CABG, 12,247 MVr+CABG, 10,118 MVR+CABG, 3,743 AVR+MVr, 6,846 AVR+MVR, and 3,765 AVR+(MVr/MVR)+CABG. Mortality and morbidity weightings were similar for 1- and 3-year analyses (76% and 24%, [3-year]), as were composite score distributions (median 94.7%, IQR 93.6% to 95.6%, [3-year]). The 3-year timeframe was selected for operational use because of higher model reliability (0.81 [0.78 - 0.83]) and better outlier discrimination (26% 3-star, 16% 1-star). Risk-adjusted outcomes for 1-, 2-, and 3-star programs were 4.3%, 3.0%, and 1.8% mortality, and 18.4%, 13.4%, and 9.7% morbidity, respectively. CONCLUSIONS The STS participant-level, multi-procedural composite measure provides comprehensive, highly reliable, overall quality assessment of adult cardiac surgery practices.
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Affiliation(s)
- David M Shahian
- Division of Cardiac Surgery, Department of Surgery, and Center for Quality and Safety, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
| | - Paul A Kurlansky
- College of Physicians and Surgeons, Columbia University, New York, NY
| | - Michael E Bowdish
- Departments of Surgery and Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
| | - Kevin W Lobdell
- Atrium Health, Cardiovascular and Thoracic Surgery, Charlotte, NC
| | | | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA
| | - Jeffrey P Jacobs
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL
| | | | - Karen M Kim
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI
| | | | | | | | - Sean M O'Brien
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
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7
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Shahian DM, Bowdish ME, Bloom JP, Wyler von Ballmoos MC, Edgerton JR, Antman MS, Kurlansky PA, Lobdell KW, Cleveland JC, Gaudino MFL, Paone G, Vassileva C, Thourani VH, Furnary AP, Badhwar V, Jacobs JP, O'Brien SM. The STS CABG composite measure: 2021 methodology update. Ann Thorac Surg 2021; 113:1954-1961. [PMID: 34280375 DOI: 10.1016/j.athoracsur.2021.06.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The original STS CABG composite measure uses a 1-year analytic cohort and 98% credible intervals (CrI) to classify better (3-star) or worse (1-star) than expected performance. As CABG volumes per STS participant (e.g., hospital or practice group) have decreased, it has become more challenging to classify performance categories using this approach, especially for lower volume programs, and alternative approaches have been explored. METHODS Among 990 STS Adult Cardiac Surgery Database participants, performance classifications for the CABG composite were studied using various analytic cohorts: single year (current approach, 2017); 3 years (2015-2017); last 450 cases within 3 years; most recent year (2017) plus additional cases to 450 total. We also compared 98% CrI with 95% CrI (used in other STS composite measures). RESULTS Using 3 years of data and 95% CrI's, 113 of 990 participants (11.4%) were classified 1-star and 198 (20%) 3-star. Compared with 1-year analytic cohorts and 98% CrI, the absolute and relative increases in the proportion of 3-star participants were 14 percentage points and 233% (n=198[20%] versus n=59[6%]). Corresponding changes for 1-star participants were 6.5 percentage points and 133% (n=113[11.4%] versus n=48[4.9%]). These changes were particularly notable among lower volume (<199 CABG/year) participants. Measure reliability with the 3-year, 95% CrI modification is 0.78. CONCLUSIONS Compared with current STS CABG composite methodology, a 3-year analytic cohort and 95% CrI increases the number and proportion of better or worse than expected outliers, especially among lower-volume ACSD participants. This revised methodology is also now consistent with other STS procedure composites.
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Affiliation(s)
- David M Shahian
- Division of Cardiac Surgery, Department of Surgery, and Center for Quality and Safety, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
| | - Michael E Bowdish
- Departments of Surgery and Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
| | - Jordan P Bloom
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | | | | | - Paul A Kurlansky
- College of Physicians and Surgeons, Columbia University, New York, NY
| | - Kevin W Lobdell
- Atrium Health, Cardiovascular and Thoracic Surgery, Charlotte, NC
| | - Joseph C Cleveland
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, CO
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Gaetano Paone
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA
| | | | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA
| | | | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown WV
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL
| | - Sean M O'Brien
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
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8
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Kurlansky PA, O'Brien SM, Vassileva CM, Lobdell KW, Edwards FH, Jacobs JP, von Ballmoos MW, Paone G, Edgerton JR, Thourani VH, Furnary AP, Ferraris VA, Cleveland JC, Bowdish ME, Likosky DS, Badhwar V, Shahian DM. Failure to Rescue: A New Society of Thoracic Surgeons Quality Metric for Cardiac Surgery. Ann Thorac Surg 2021; 113:1935-1942. [PMID: 34242640 DOI: 10.1016/j.athoracsur.2021.06.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/19/2021] [Accepted: 06/01/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Failure to rescue (FTR) focuses on the ability to prevent death among patients who experience postoperative complications. The Society of Thoracic Surgeons (STS) Quality Measurement Task Force has developed a new, risk- adjusted FTR quality metric for adult cardiac surgery. METHODS The study population was taken from 1118 STS Adult Cardiac Surgery Database participants including patients who underwent isolated CABG, aortic valve replacement +/- CABG, or mitral valve repair/replacement, +/- CABG between January, 2015 and June, 2019. The FTR analysis was derived from patients who experienced ≥ 1 of the following complications: prolonged ventilation, stroke, reoperation, and renal failure. Data were randomly split into 70% training (n=89,059) and 30% validation samples (n=38,242),Risk variables included STS predicted risk of mortality, operative procedures, and intraoperative variables (cardiopulmonary bypass and cross-clamp times, unplanned procedures, need for circulatory support, and massive transfusion). RESULTS Overall mortality for the for patients undergoing any of the index operations during the study period was 2.6% (27,045/1,058,138), with mortality of 0.9% (8,316/930,837), 8.0% (7,618/94,918), 30.6% (8,247/26,934), 51.9%(2,661/5,123), and 62.3% (203/326) among patients suffering none, one, two, three or four complications. FTR risk model calibration was excellent, as were model discrimination (c-statistic 0.806) and the Brier score (0.102). Using 95% Bayesian credible intervals, 62 (5.6%) participants performed worse and 53 (4.7%) participants performed better than expected. CONCLUSIONS A new risk-adjusted FTR metric has been developed which complements existing STS performance measures. The metric specifically assesses institutional effectiveness of postoperative care, allowing hospitals to target quality improvement efforts.
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Affiliation(s)
- Paul A Kurlansky
- Columbia University, Department of Surgery, Division of Cardiac Surgery, New York, New York.
| | - Sean M O'Brien
- Duke Clinical Research Institute, Durham, North Carolina
| | | | | | - Fred H Edwards
- University of Florida College of Medicine, Department of Surgery, Jacksonville, Florida
| | - Jeffrey P Jacobs
- University of Florida, Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Gainesville, Florida
| | | | - Gaetano Paone
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Vinod H Thourani
- Piedmont Heart Institute and Piedmont Healthcare, Atlanta, Georgia
| | - Anthony P Furnary
- Providence Health Systems, Starr-Wood Cardiac Group, Anchorage, Alaska
| | | | - Joseph C Cleveland
- University of Colorado, Division of Cardiothoracic Surgery, Aurora, Colorado
| | - Michael E Bowdish
- University of Southern California, Department of Surgery, Los Angeles, California
| | - Donald S Likosky
- Michigan Medicine, Department of Cardiac Surgery, Health Services Research and Quality, Ann Arbor, Michigan
| | - Vinay Badhwar
- West Virginia University, Department of Cardiovascular and Thoracic Surgery, Morgantown, West Virginia
| | - David M Shahian
- Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
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Sharma V, Glotzbach JP, Ryan J, Selzman CH. Evaluating Quality in Adult Cardiac Surgery. Tex Heart Inst J 2021; 48:464663. [PMID: 33946105 DOI: 10.14503/thij-19-7136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
National and institutional quality initiatives provide benchmarks for evaluating the effectiveness of medical care. However, the dramatic growth in the number and type of medical and organizational quality-improvement standards creates a challenge to identify and understand those that most accurately determine quality in cardiac surgery. It is important that surgeons have knowledge and insight into valid, useful indicators for comparison and improvement. We therefore reviewed the medical literature and have identified improvement initiatives focused on cardiac surgery. We discuss the benefits and drawbacks of existing methodologies, such as comprehensive regional and national databases that aid self-evaluation and feedback, volume-based standards as structural indicators, process measurements arising from evidence-based research, and risk-adjusted outcomes. In addition, we discuss the potential of newer methods, such as patient-reported outcomes and composite measurements that combine data from multiple sources.
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Affiliation(s)
- Vikas Sharma
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Jason P Glotzbach
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - John Ryan
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
| | - Craig H Selzman
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
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Elhenawy AM, Algarni K, Rao V, Yau TM. Predictors of hospital mortality after surgery for ischemic mitral regurgitation: the Toronto General Hospital experience. J Card Surg 2020; 35:3334-3339. [PMID: 32985733 DOI: 10.1111/jocs.15064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The benefit of mitral valve repair (MVr) over replacement in patients with severe ischemic mitral regurgitation (IMR) is still controversial. We report our early postoperative outcomes of repair versus replacement. METHODS Data were collected for patients undergoing first-time mitral valve surgery for severe IMR between 1990 and 2009 (n = 393). Patients who underwent combined procedures for papillary muscle rupture, post-infarction ventricular septal defect, endocarditis, or any previous cardiac surgery were excluded. Preoperative demographics, operative variables, and hospital outcomes were analyzed, and multivariable regression analysis was employed to identify independent predictors of hospital mortality. RESULTS Valve repair was performed in 42% (n = 164) of patients and replacement in 58% (n = 229). Patients who underwent replacement were older and had a higher prevalence of unstable angina, New York Heart Association Class IV symptoms, preoperative cardiogenic shock, preoperative myocardial infarction, peripheral vascular disease, renal failure, and urgent or emergency surgery (all p < .05). Unadjusted hospital mortality was higher in patients undergoing valve replacement (13% vs. 5%; p = .01). Valve repair was associated with a lower prevalence of postoperative low cardiac output syndrome. Multivariable analysis revealed that age, urgency of operation, and preoperative left ventricular (LV) function were independent predictors of hospital mortality. Importantly, MVr versus replacement was not an independent predictor of hospital mortality. CONCLUSION Our data did not suggest an early survival benefit to MVr over replacement for IMR. However, age, LV dysfunction, and the need for urgent surgery were independently associated with hospital mortality.
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Affiliation(s)
- Abdelsalam M Elhenawy
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.,Division of Cardiothoracic Surgery, Al Azhar University, Cairo, Egypt
| | - Khaled Algarni
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.,Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Vivek Rao
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Terrence M Yau
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
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11
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Commentary: Safety in numbers. J Thorac Cardiovasc Surg 2020; 161:1043-1045. [PMID: 32863033 DOI: 10.1016/j.jtcvs.2020.07.058] [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: 07/17/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 11/20/2022]
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12
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Shahian DM, Kozower BD, Fernandez FG, Badhwar V, O’Brien SM. The Use and Misuse of Indirectly Standardized, Risk-Adjusted Outcomes and Star Ratings. Ann Thorac Surg 2020; 109:1319-1322. [DOI: 10.1016/j.athoracsur.2019.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 09/01/2019] [Indexed: 01/14/2023]
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13
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Gatti G, Fiore A, Zilio C, Michelotti S, Ecarnot F, Taffarello P, Perniciaro V, Priolo L, Castaldi G, Currò P, Benussi B, Pappalardo A, Chocron S, Folliguet T, Perrotti A. Bilateral Internal Thoracic Artery Grafting Concomitant With Other Cardiac Operations ― Insights From a European Multicenter Retrospective Study on 1,123 Consecutive Patients ―. Circ J 2019; 83:2466-2478. [DOI: 10.1253/circj.cj-19-0696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Giuseppe Gatti
- Cardio-Thoracic and Vascular Department, Trieste University Hospital
| | - Antonio Fiore
- Department of Cardio-Thoracic Surgery, University Hospital Henri-Mondor
| | - Chiara Zilio
- Cardio-Thoracic and Vascular Department, Trieste University Hospital
| | - Sara Michelotti
- Cardio-Thoracic and Vascular Department, Trieste University Hospital
| | - Fiona Ecarnot
- Department of Thoracic and Cardiovascular Surgery, University Hospital Jean-Minjoz
| | | | - Vera Perniciaro
- Cardio-Thoracic and Vascular Department, Trieste University Hospital
| | - Luigi Priolo
- Cardio-Thoracic and Vascular Department, Trieste University Hospital
| | - Gianluca Castaldi
- Cardio-Thoracic and Vascular Department, Trieste University Hospital
| | - Placido Currò
- Cardio-Thoracic and Vascular Department, Trieste University Hospital
| | - Bernardo Benussi
- Cardio-Thoracic and Vascular Department, Trieste University Hospital
| | | | - Sidney Chocron
- Department of Thoracic and Cardiovascular Surgery, University Hospital Jean-Minjoz
| | - Thierry Folliguet
- Department of Cardio-Thoracic Surgery, University Hospital Henri-Mondor
| | - Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, University Hospital Jean-Minjoz
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14
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Fernandez FG, Shahian DM, Kormos R, Jacobs JP, D'Agostino RS, Mayer JE, Kozower BD, Higgins RSD, Badhwar V. The Society of Thoracic Surgeons National Database 2019 Annual Report. Ann Thorac Surg 2019; 108:1625-1632. [PMID: 31654621 DOI: 10.1016/j.athoracsur.2019.09.034] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/18/2019] [Indexed: 02/07/2023]
Abstract
The Society of Thoracic Surgeons (STS) National Database was established in 1989 as an initiative for quality improvement and patient safety for cardiothoracic surgery. The STS National Database has 4 components, each focusing on a distinct discipline-Adult Cardiac Surgery, General Thoracic Surgery, Congenital Heart Surgery, and mechanical circulatory support with the STS Interagency Registry for Mechanical Circulatory Support (Intermacs)/Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) Database. In December 2015, The Annals of Thoracic Surgery began publishing a monthly series of scholarly articles on outcomes analysis, quality improvement, and patient safety. This article provides the fourth annual summary of the status of the STS National Database.
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Affiliation(s)
- Felix G Fernandez
- Department of General Thoracic Surgery, Emory University, Atlanta, Georgia.
| | - David M Shahian
- Division of Cardiac Surgery and Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert Kormos
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Richard S D'Agostino
- Lahey Hospital and Medical Center, Burlington, Massachusetts and Tufts University School of Medicine, Boston, Massachusetts
| | - John E Mayer
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Robert S D Higgins
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
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15
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Shahian DM. Professional Society Leadership in Health Care Quality: The Society of Thoracic Surgeons Experience. Jt Comm J Qual Patient Saf 2019; 45:466-479. [DOI: 10.1016/j.jcjq.2019.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Nishimura RA, O’Gara PT, Bavaria JE, Brindis RG, Carroll JD, Kavinsky CJ, Lindman BR, Linderbaum JA, Little SH, Mack MJ, Mauri L, Miranda WR, Shahian DM, Sundt TM. 2019 AATS/ACC/ASE/SCAI/STS Expert Consensus Systems of Care Document: A Proposal to Optimize Care for Patients With Valvular Heart Disease. Ann Thorac Surg 2019; 107:1884-1910. [DOI: 10.1016/j.athoracsur.2019.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/08/2019] [Indexed: 10/27/2022]
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17
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2019 AATS/ACC/ASE/SCAI/STS Expert Consensus Systems of Care Document: A Proposal to Optimize Care for Patients With Valvular Heart Disease. J Am Coll Cardiol 2019; 73:2609-2635. [DOI: 10.1016/j.jacc.2018.10.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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18
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Nishimura RA, O'Gara PT, Bavaria JE, Brindis RG, Carroll JD, Kavinsky CJ, Lindman BR, Linderbaum JA, Little SH, Mack MJ, Mauri L, Miranda WR, Shahian DM, Sundt TM. 2019 AATS/ACC/ASE/SCAI/STS Expert Consensus Systems of Care Document: A Proposal to Optimize Care for Patients With Valvular Heart Disease: A Joint Report of the American Association for Thoracic Surgery, American College of Cardiology, American Society of Echocardiography, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Soc Echocardiogr 2019; 32:683-707. [PMID: 31010608 DOI: 10.1016/j.echo.2019.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Laura Mauri
- American College of Cardiology representative
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19
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2019 AATS/ACC/ASE/SCAI/STS expert consensus systems of care document: A proposal to optimize care for patients with valvular heart disease: A joint report of the American Association for Thoracic Surgery, American College of Cardiology, American Society of Echocardiography, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Thorac Cardiovasc Surg 2019; 157:e327-e354. [PMID: 31010585 DOI: 10.1016/j.jtcvs.2019.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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20
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Nishimura RA, O'Gara PT, Bavaria JE, Brindis RG, Carroll JD, Kavinsky CJ, Lindman BR, Linderbaum JA, Little SH, Mack MJ, Mauri L, Miranda WR, Shahian DM, Sundt TM. 2019 AATS/ACC/ASE/SCAI/STS expert consensus systems of care document: A proposal to optimize care for patients with valvular heart disease. Catheter Cardiovasc Interv 2019; 94:3-26. [DOI: 10.1002/ccd.28196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Laura Mauri
- American College of Cardiology Representative
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21
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Shahian DM, Fernandez FG, Badhwar V. The Society of Thoracic Surgeons National Database at 30: Honoring Our Heritage, Celebrating the Present, Evolving for the Future. Ann Thorac Surg 2019; 107:1259-1266. [DOI: 10.1016/j.athoracsur.2019.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/19/2019] [Indexed: 12/01/2022]
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22
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Gokalp O, Eygi B, Gurbuz A. Factors Affecting Postoperative Mortality in Coronary Bypass Surgery. Ann Thorac Surg 2019; 108:1266. [PMID: 30905585 DOI: 10.1016/j.athoracsur.2019.02.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/10/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Orhan Gokalp
- Department of Cardiovascular Surgery, Faculty of Medicine, Izmir Katip Celebi University, Altınvadi Cd No 85 D:10, 35320 Karabaglar, Izmir, Turkey.
| | - Börtecin Eygi
- Department of Cardiovascular Surgery, Ataturk Education and Research Hospital, Izmir Katip Celebi University, Karabaglar, Izmir, Turkey
| | - Ali Gurbuz
- Department of Cardiovascular Surgery, Faculty of Medicine, Izmir Katip Celebi University, Karabaglar, Izmir, Turkey
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23
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D’Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW, Shahian DM. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2019 Update on Outcomes and Quality. Ann Thorac Surg 2019; 107:24-32. [DOI: 10.1016/j.athoracsur.2018.10.004] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/17/2018] [Indexed: 12/12/2022]
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24
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Jacobs JP, Shahian DM, D'Agostino RS, Mayer JE, Kozower BD, Badhwar V, Thourani VH, Jacobs ML, Gaissert HA, Fernandez FG, Naunheim KS. The Society of Thoracic Surgeons National Database 2018 Annual Report. Ann Thorac Surg 2018; 106:1603-1611. [DOI: 10.1016/j.athoracsur.2018.10.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/02/2018] [Indexed: 11/15/2022]
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25
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Rankin JS, Grau-Sepulveda M, Shahian DM, Gillinov AM, Suri R, Gammie JS, Bolling SF, McCarthy PM, Thourani VH, Ad N, O’Brien SM, Jacobs JP, Badhwar V. The Impact of Mitral Disease Etiology on Operative Mortality After Mitral Valve Operations. Ann Thorac Surg 2018; 106:1406-1413. [DOI: 10.1016/j.athoracsur.2018.04.053] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 03/30/2018] [Accepted: 04/17/2018] [Indexed: 10/16/2022]
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26
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Bavaria JE, Fukuhara S, Desai ND. Thoracic aortic surgery enters the era of big data. Eur J Cardiothorac Surg 2018; 52:499-500. [PMID: 28874033 DOI: 10.1093/ejcts/ezx225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Joseph E Bavaria
- Department of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Shinichi Fukuhara
- Department of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Nimesh D Desai
- Department of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
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27
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Badhwar V, Rankin JS, Thourani VH, D’Agostino RS, Habib RH, Shahian DM, Jacobs JP. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2018 Update on Research: Outcomes Analysis, Quality Improvement, and Patient Safety. Ann Thorac Surg 2018; 106:8-13. [DOI: 10.1016/j.athoracsur.2018.04.052] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 04/17/2018] [Indexed: 11/27/2022]
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28
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Bouma HR, Mungroop HE, de Geus AF, Huisman DD, Nijsten MW, Mariani MA, Scheeren TW, Burgerhof JG, Henning RH, Epema AH. Acute Kidney Injury Classification Underestimates Long-Term Mortality After Cardiac Valve Operations. Ann Thorac Surg 2018; 106:92-98. [DOI: 10.1016/j.athoracsur.2018.01.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 12/19/2017] [Accepted: 01/22/2018] [Indexed: 10/17/2022]
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29
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Rankin JS, Grau-Sepulveda MV, Ad N, Damiano RJ, Gillinov AM, Brennan JM, McCarthy PM, Thourani VH, Jacobs JP, Shahian DM, Badhwar V. Associations Between Surgical Ablation and Operative Mortality After Mitral Valve Procedures. Ann Thorac Surg 2018; 105:1790-1796. [DOI: 10.1016/j.athoracsur.2017.12.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 11/25/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
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30
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Kamioka N, Babaliaros V, Morse MA, Frisoli T, Lerakis S, Iturbe JM, Binongo J, Corrigan F, Yousef A, Gleason P, Wells JA, Caughron H, Dong A, Rodriguez E, Leshnower B, O’Neill W, Paone G, Eng M, Guyton R, Block PC, Greenbaum A. Comparison of Clinical and Echocardiographic Outcomes After Surgical Redo Mitral Valve Replacement and Transcatheter Mitral Valve-in-Valve Therapy. JACC Cardiovasc Interv 2018; 11:1131-1138. [DOI: 10.1016/j.jcin.2018.03.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/05/2018] [Accepted: 03/05/2018] [Indexed: 12/15/2022]
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31
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The Society of Thoracic Surgeons 2018 Adult Cardiac Surgery Risk Models: Part 1—Background, Design Considerations, and Model Development. Ann Thorac Surg 2018; 105:1411-1418. [DOI: 10.1016/j.athoracsur.2018.03.002] [Citation(s) in RCA: 190] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/09/2018] [Indexed: 01/26/2023]
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32
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Role of Echocardiography in Transcatheter Mitral Valve Replacement in Native Mitral Valves and Mitral Rings. J Am Soc Echocardiogr 2018; 31:475-490. [DOI: 10.1016/j.echo.2018.01.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Indexed: 02/06/2023]
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33
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The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2018 Update on Outcomes and Quality. Ann Thorac Surg 2018; 105:15-23. [DOI: 10.1016/j.athoracsur.2017.10.035] [Citation(s) in RCA: 238] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 10/21/2017] [Indexed: 11/22/2022]
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34
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Shahian DM, Jacobs JP, Badhwar V, D’Agostino RS, Bavaria JE, Prager RL. Risk Aversion and Public Reporting. Part 2: Mitigation Strategies. Ann Thorac Surg 2017; 104:2102-2110. [DOI: 10.1016/j.athoracsur.2017.06.076] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 06/25/2017] [Indexed: 01/25/2023]
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35
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Jacobs JP, Shahian DM, D’Agostino RS, Jacobs ML, Kozower BD, Badhwar V, Thourani VH, Gaissert HA, Fernandez FG, Prager RL. The Society of Thoracic Surgeons National Database 2017 Annual Report. Ann Thorac Surg 2017; 104:1774-1781. [DOI: 10.1016/j.athoracsur.2017.10.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 01/15/2023]
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36
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The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2017 Update on Research. Ann Thorac Surg 2017; 104:22-28. [DOI: 10.1016/j.athoracsur.2017.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 05/03/2017] [Indexed: 01/13/2023]
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37
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D'Agostino RS, Jacobs JP, Badhwar V, Paone G, Rankin JS, Han JM, McDonald D, Edwards FH, Shahian DM. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2017 Update on Outcomes and Quality. Ann Thorac Surg 2017; 103:18-24. [DOI: 10.1016/j.athoracsur.2016.11.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 11/17/2022]
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