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Yeom R, Gorgone M, Malinovic M, Panzica P, Maslow A, Augoustides JG, Marchant BE, Fernando RJ, Nampi RG, Pospishil L, Neuburger PJ. Surgical Aortic Valve Replacement in a Patient with Very Severe Chronic Obstructive Pulmonary Disease. J Cardiothorac Vasc Anesth 2023; 37:2335-2349. [PMID: 37657996 DOI: 10.1053/j.jvca.2023.08.005] [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: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 09/03/2023]
Affiliation(s)
- Richard Yeom
- Department of Anesthesiology, Westchester Medical Center, Valhalla, NY
| | - Michelle Gorgone
- Department of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - Matea Malinovic
- Department of Anesthesiology, Westchester Medical Center, Valhalla, NY
| | - Peter Panzica
- Department of Anesthesiology, Westchester Medical Center, Valhalla, NY
| | - Andrew Maslow
- Department of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Bryan E Marchant
- Department of Anesthesiology, Cardiothoracic and Critical Care Sections, Wake Forest University School of Medicine, Winston Salem, NC
| | - Rohesh J Fernando
- Department of Anesthesiology, Cardiothoracic Section, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, NC.
| | - Robert G Nampi
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Liliya Pospishil
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
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Osman M, Khan MZ, Farjo PD, Khan MU, Khan SU, Benjamin MM, Munir MB, Balla S. In-hospital outcomes of percutaneous mitral valve repair in patients with chronic obstructive pulmonary disease: insights from the national inpatient sample database. Catheter Cardiovasc Interv 2021; 97:E104-E112. [PMID: 32374943 DOI: 10.1002/ccd.28913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/10/2020] [Accepted: 04/06/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We aimed to assess the in-hospital outcomes in patients with mitral regurgitation treated with percutaneous mitral valve repair (PMVR) among patients with chronic obstructive pulmonary disease (COPD). BACKGROUND There is lack of data on the outcomes of PMVR for mitral regurgitation in patients with COPD. METHODS We analyzed the national inpatient sample (NIS) database from January 2012 to December 2016. RESULTS A total of 9125 patients underwent PMVR in the period between January 2012 and December 2016, of whom 2,495 (27.3%) patients had concomitant COPD. Comparing COPD patients to non-COPD patients, COPD patients had higher proportion of females (48.3% vs. 46.6%, p = .16), were younger (75.8 ± 10.0 years vs. 76.4 ± 12.2 years; p = .04), had higher prevalence of peripheral vascular disease (17.4% vs. 13.5%; p < .01) and renal failure (39.3% vs. 37%; p < .01). After propensity matching, there was no significant difference in mortality among the COPD group versus non-COPD patients (2.6% vs. 2.9%; p = .6). Patients with COPD had higher proportion of in-hospital morbidities including St-segment elevation myocardial infarction (1.8% vs. 1.0%; p = .02), cardiogenic shock (1.4% vs. 0.4%; p < .01), vascular complications (2% vs. 0.8; p < .01), pneumothorax (1% vs. 0.4%; p < .01), and septic shock (1.2% vs. 0.4%; p < .01). Moreover, surrogates of severe disability (mechanical intubation and non-home discharges), cost of hospitalization, and length of stay were higher in the COPD group. CONCLUSIONS There was no difference in mortality between the COPD and non-COPD patients after PMVR. Moreover, we observed higher rates of in-hospital morbidities, surrogates of severe disability, and higher resources utilization by the COPD group.
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Affiliation(s)
- Mohammed Osman
- Division of Cardiovascular Medicine, Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Peter D Farjo
- Division of Cardiovascular Medicine, Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Muhammad U Khan
- Division of Cardiovascular Medicine, Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Mina M Benjamin
- Division of Cardiovascular Medicine, Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia, USA.,Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
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Yamauchi T, Takano H, Miyata H, Motomura N, Takamoto S. Risk Factors for Mortality and Morbidity of Surgical Aortic Valve Replacement for Aortic Stenosis - Risk Model From a Japan Cardiovascular Surgery Database. Circ Rep 2020; 1:131-136. [PMID: 33693127 PMCID: PMC7890290 DOI: 10.1253/circrep.cr-19-0010] [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] [Indexed: 11/13/2022] Open
Abstract
Background:
The aim of this study was to determine adequate indication for transcatheter aortic valve replacement (TAVR). We analyzed risk factors of surgical aortic valve replacement (SAVR) not only for mortality, but also for morbidity, including long hospital stay (≥90 days) and patient activity at discharge, in patients who underwent SAVR for aortic stenosis (AS). Methods and Results:
Using the Japan Adult Cardiovascular Surgery Database (JCVSD), 13,961 patients with or without coronary artery bypass grafting who underwent elective SAVR for AS were identified from January 2008 to December 2012. The hospital mortality rate was 3.1%. The percentage of patients who had long hospital stay (≥90 days) and who had moderately or severely decompressed activity at discharge (modified Rankin scale ≥4) was 2.9% and 6.5%, respectively. Eleven and 20 preoperative predictors of hospital mortality and morbidity, respectively, including long hospital stay and compromised status at discharge, were identified. Based on these risk factors, the risk model predicted hospital mortality (area under the curve [AUC], 0.732) and morbidity (AUC, 0.694). Conclusions:
Using JCVSD, a risk model of SAVR was developed for AS. This model can identify patients at high risk not only for mortality, but also for mortality and morbidity, including long hospital stay and status at discharge.
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Affiliation(s)
- Takashi Yamauchi
- Department of Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center Koshigaya Japan
| | - Hiroshi Takano
- Department of Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center Koshigaya Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, The University of Tokyo Tokyo Japan
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Toho University, Sakura Medical Center Sakura Japan
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Calderon-Rojas R, Greason KL, King KS, Oh JK, Stulak JM, Daly RC, Dearani JA, Schaff HV. Tricuspid Valve Regurgitation in Patients Undergoing Pericardiectomy for Constrictive Pericarditis. Semin Thorac Cardiovasc Surg 2020; 32:721-728. [DOI: 10.1053/j.semtcvs.2020.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 11/11/2022]
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Hirji SA, Ramirez-Del Val F, Ejiofor JI, Lee J, Norman AV, McGurk S, Pelletier MP, Aranki S, Rawn J, Shekar PS, Hunninghake GM, Kaneko T. Significance of Interstitial Lung Disease on Outcomes Following Cardiac Surgery. Am J Cardiol 2019; 124:1133-1139. [PMID: 31405546 DOI: 10.1016/j.amjcard.2019.06.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022]
Abstract
Interstitial lung disease (ILD) is a known risk factor for noncardiac surgery due to acute pulmonary exacerbations but its impact after cardiac surgery is not known. We examined perioperative outcomes and risk factors for long-term survival in ILD patients who underwent cardiac surgery. From January 2002 to June 2017, 294 cardiac surgery patients with a previous ILD diagnosis, including 75 patients with idiopathic pulmonary fibrosis (IPF), were identified. A comparison cohort of 1,481 non-ILD patients was selected based on a priori variables. Long-term survival was evaluated using Cox proportional hazard modeling. Median follow-up was 6.4 years. ILD patients had higher postoperative mortality, reintubation rates, longer intensive care unit stay, and higher 30-day readmission rates (all p <0.05). Kaplan-Meier estimates of survival at 1, 5, and 10 years were 89%, 62%, and 37% for the non-IPF ILD cohort, 89%, 50%, and 13% for the IPF cohort, and 95%, 82%, and 67% for the comparison cohort, respectively (overall p <0.001). These significant differences in survival persisted in our risk-adjusted survival analysis. Adjusted survival analysis identified IPF (hazard ratio 3.04) and ILD (non-IPF; hazard ratio 1.78) as significant contributors to all-cause mortality. However, there were no changes in pulmonary function tests after 48 months postprocedure. In conclusion, ILD patients who underwent cardiac surgery have increased operative mortality, reintubation rates, longer intensive care unit, and higher 30-day readmissions compared with non-ILD patients. Moreover, severity of ILD, especially in IPF, appears to be associated with shorter long-term survival. In these patients, pulmonary risk stratification and multidisciplinary team approach are crucial.
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Lomivorotov VV, Shmyrev VA, Nepomniashchikh VA. Regional Versus General Anesthesia for Carotid Endarterectomy: Do We Need Another Randomized Trial? J Cardiothorac Vasc Anesth 2018; 33:943-944. [PMID: 30293828 DOI: 10.1053/j.jvca.2018.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Vladimir V Lomivorotov
- Department of Anaesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Vladimir A Shmyrev
- Department of Anaesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Valery A Nepomniashchikh
- Department of Anaesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
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Ponomarev D, Kamenskaya O, Klinkova A, Loginova I, Vedernikov P, Kornilov I, Shmyrev V, Lomivorotov V, Chernavskiy A, Karaskov A. Response: "Outcomes of Patients With COPD Undergoing Cardiac Surgery: Don't Hold Your Breath". J Cardiothorac Vasc Anesth 2018; 32:e1-e2. [PMID: 29673762 DOI: 10.1053/j.jvca.2018.03.021] [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: 03/12/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Dmitry Ponomarev
- Department of Anesthesia and Intensive Care, Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Oksana Kamenskaya
- Department of Physiology, Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Asya Klinkova
- Department of Physiology, Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Irina Loginova
- Department of Physiology, Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Pavel Vedernikov
- Department of Anesthesia and Intensive Care, Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Igor Kornilov
- Department of Anesthesia and Intensive Care, Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Vladimir Shmyrev
- Department of Anesthesia and Intensive Care, Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Vladimir Lomivorotov
- Department of Anesthesia and Intensive Care, Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Aleksander Chernavskiy
- Department of Cardiac Surgery, Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Aleksander Karaskov
- Department of Cardiac Surgery, Meshalkin National Medical Research Centre, Novosibirsk, Russia
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