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Bishawi M, Hattler B, Almassi GH, Quin JA, Grover FL, Collins JF, Ebrahimi R, Wolbrom DH, Shroyer AL. Health-related quality of life impacts upon 5-year survival after coronary artery bypass surgery. J Card Surg 2022; 37:4899-4905. [PMID: 36423254 DOI: 10.1111/jocs.17165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Poor preoperative health-related quality of life (HRQoL) has been associated with reduced short-term survival after coronary artery bypass graft (CABG) surgery; however, its impact on long-term mortality is unknown. This study's objective was to determine if baseline HRQoL status predicts 5-year post-CABG mortality. METHODS This prespecified, randomized on/off bypass follow-up study (ROOBY-FS) subanalysis compared baseline patient characteristics and HRQoL scores, obtained from the Seattle Angina Questionnaire (SAQ) and Veterans RAND Short Form-36 (VR-36), between 5-year post-CABG survivors and nonsurvivors. Standardized subscores were calculated for each questionnaire. Multivariable logistic regression assessed whether HRQoL survey subcomponents independently predicted 5-year mortality (p ≤ .05). RESULTS Of the 2203 ROOBY-FS enrollees, 2104 (95.5%) completed baseline surveys. Significant differences between 5-year post-CABG deaths (n = 286) and survivors (n = 1818) included age, history of chronic obstructive pulmonary disease, stroke, peripheral vascular disease, renal dysfunction, diabetes, lower left ventricular ejection fraction, atrial fibrillation, depression, non-White race/ethnicity, lower education status, and off-pump CABG. Adjusting for these factors, baseline VR-36 physical component summary score (p = .01), VR-36 mental component summary score (p < .001), and SAQ physical limitation score (p = .003) were all associated with 5-year all-cause mortality. CONCLUSIONS Pre-CABG HRQoL scores may provide clinically relevant prognostic information beyond traditional risk models and prove useful for patient-provider shared decision-making and enhancing pre-CABG informed consent.
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Affiliation(s)
- Muath Bishawi
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Brack Hattler
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA.,Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - G Hossein Almassi
- Department of Surgery, Clement J. Zablocki Veterans Affairs (VA) Medical Center, Milwaukee, Wisconsin, USA.,Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jacquelyn A Quin
- Department of Surgery, Division of Cardiac Surgery, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Frederick L Grover
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Joseph F Collins
- Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland, USA
| | - Ramin Ebrahimi
- Department of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Daniel H Wolbrom
- Northport Veterans Affairs Medical Center, Research and Development Office, Northport, New York, USA
| | - A Laurie Shroyer
- Northport Veterans Affairs Medical Center, Research and Development Office, Northport, New York, USA
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Quin JA, Wagner TH, Hattler B, Carr BM, Collins J, Almassi GH, Grover FL, Shroyer AL. Ten-Year Outcomes of Off-Pump vs On-Pump Coronary Artery Bypass Grafting in the Department of Veterans Affairs: A Randomized Clinical Trial. JAMA Surg 2022; 157:303-310. [PMID: 35171210 PMCID: PMC8851363 DOI: 10.1001/jamasurg.2021.7578] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE The long-term benefits of off-pump ("beating heart") vs on-pump coronary artery bypass grafting (CABG) remain controversial. OBJECTIVE To evaluate the 10-year outcomes and costs of off-pump vs on-pump CABG in the Department of Veterans Affairs (VA) Randomized On/Off Bypass (ROOBY) trial. DESIGN, SETTING, AND PARTICIPANTS From February 27, 2002, to May 7, 2007, 2203 veterans in the ROOBY trial were randomly assigned to off-pump or on-pump CABG procedures at 18 participating VA medical centers. Per protocol, the veterans were observed for 10 years; the 10-year, post-CABG clinical outcomes and costs were assessed via centralized abstraction of electronic medical records combined with merges to VA and non-VA databases. With the use of an intention-to-treat approach, analyses were performed from May 7, 2017, to December 9, 2021. INTERVENTIONS On-pump and off-pump CABG procedures. MAIN OUTCOMES AND MEASURES The 10-year coprimary end points included all-cause death and a composite end point identifying patients who had died or had undergone subsequent revascularization (ie, percutaneous coronary intervention [PCI] or repeated CABG); these 2 end points were measured dichotomously and as time-to-event variables (ie, time to death and time to composite end points). Secondary 10-year end points included PCIs, repeated CABG procedures, changes in cardiac symptoms, and 2018-adjusted VA estimated costs. Changes from baseline to 10 years in post-CABG, clinically relevant cardiac symptoms were evaluated for New York Heart Association functional class, Canadian Cardiovascular Society angina class, and atrial fibrillation. Outcome differences were adjudicated by an end points committee. Given that pre-CABG risks were balanced, the protocol-driven primary and secondary hypotheses directly compared 10-year treatment-related effects. RESULTS A total of 1104 patients (1097 men [99.4%]; mean [SD] age, 63.0 [8.5] years) were enrolled in the off-pump group, and 1099 patients (1092 men [99.5%]; mean [SD] age, 62.5 [8.5] years) were enrolled in the on-pump group. The 10-year death rates were 34.2% (n = 378) for the off-pump group and 31.1% (n = 342) for the on-pump group (relative risk, 1.05; 95% CI, 0.99-1.11; P = .12). The median time to composite end point for the off-pump group (4.6 years; IQR, 1.4-7.5 years) was approximately 4.3 months shorter than that for the on-pump group (5.0 years; IQR, 1.8-7.9 years; P = .03). No significant 10-year treatment-related differences were documented for any other primary or secondary end points. After the removal of conversions, sensitivity analyses reconfirmed these findings. CONCLUSIONS AND RELEVANCE No off-pump CABG advantages were found for 10-year death or revascularization end points; the time to composite end point was lower in the off-pump group than in the on-pump group. For veterans, in the absence of on-pump contraindications, a case cannot be made for supplanting the traditional on-pump CABG technique with an off-pump approach. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01924442.
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Affiliation(s)
- Jacquelyn A. Quin
- Department of Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts
| | - Todd H. Wagner
- Research Office, Veterans Affairs Health Economics and Research Center, Palo Alto, California,Department of Surgery, Stanford University, Palo Alto, California
| | - Brack Hattler
- Department of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado,Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Brendan M. Carr
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| | - Joseph Collins
- Research Office, Veterans Affairs Cooperative Studies Program, Perry Point, Maryland
| | - G. Hossein Almassi
- Department of Surgery, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin,Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Frederick L. Grover
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora,Department of Surgery, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - A. Laurie Shroyer
- Research and Development Office, Northport Veterans Affairs Medical Center, Northport, New York,Department of Surgery, Stony Brook University Renaissance School of Medicine, Stony Brook, New York
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Wagner BD, Grunwald GK, Hossein Almassi G, Li X, Grover FL, Shroyer ALW. Factors associated with long-term survival in patients with stroke after coronary artery bypass grafting. J Int Med Res 2021; 48:300060520920428. [PMID: 32723120 PMCID: PMC7391442 DOI: 10.1177/0300060520920428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective Occurrence of a stroke within 30 days following coronary artery bypass grafting (CABG) is an uncommon, but often devastating, complication. This study aimed to identify factors associated with long-term survival (beyond 30 days) in patients with stroke after CABG. Methods De-identified patients’ records from the Veterans Affairs Surgical Quality Improvement Program database were used to identify risk factors and perioperative complications associated with survival for up to 20 years in patients with post-CABG stroke. The multivariable Cox proportional hazards model was used for analyzing survival. Results The median survival time for patients with stroke (n = 1422) was 6.7 years. The mortality rate for these patients was highest in the first year post-CABG and was significantly elevated compared with non-stroke patients. Survival rates at 1, 5, and 10 years for stroke versus non-stroke patients were 79% vs. 96%, 58% vs. 83%, and 36% vs. 63%, respectively. High preoperative serum creatinine levels, postoperative occurrence of renal failure, prolonged ventilation, coma, and reoperation for bleeding were important predictors of 1-year mortality of patients with post-CABG stroke. Conclusions Veterans with post-CABG stroke have a considerably higher risk for mortality during the first year compared with patients without stroke.
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Affiliation(s)
- Brandie D Wagner
- Division of Cardiac Research, Eastern Colorado Health Care System, Department of Veterans Affairs Medical Center, Denver, CO, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gary K Grunwald
- Division of Cardiac Research, Eastern Colorado Health Care System, Department of Veterans Affairs Medical Center, Denver, CO, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - G Hossein Almassi
- Zablocki Veterans Affairs Medical Center and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Xinli Li
- Division of Cardiac Research, Eastern Colorado Health Care System, Department of Veterans Affairs Medical Center, Denver, CO, USA
| | - Frederick L Grover
- Division of Cardiac Research, Eastern Colorado Health Care System, Department of Veterans Affairs Medical Center, Denver, CO, USA.,Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - A Laurie W Shroyer
- Division of Cardiac Research, Eastern Colorado Health Care System, Department of Veterans Affairs Medical Center, Denver, CO, USA.,Research and Development Office, Northport Department of Veterans Affairs Medical Center, Northport, New York, USA
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Quin JA, Noubani M, Rove JY, Krstacic JE, Hattler B, Collins JF, Grover FL, Almassi GH, Shroyer AL. Coronary Artery Bypass Grafting Transit Time Flow Measurement: Graft Patency and Clinical Outcomes. Ann Thorac Surg 2020; 112:701-707. [PMID: 33359134 DOI: 10.1016/j.athoracsur.2020.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/15/2020] [Accepted: 12/07/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND This subanalysis of the Randomized On-Off Bypass (ROOBY) trial examined transit time flow measurement (TTFM) use and its impact on graft patency and long-term clinical outcomes after coronary artery bypass graft surgery. METHODS Use of TTFM for ROOBY centers and surgeons was assessed. Comparative patient outcomes based on TTFM use included 1-year graft patency and 1-year and 5-year major adverse cardiac events: all-cause mortality, nonfatal myocardial infarction, and revascularization (percutaneous coronary intervention or repeat coronary artery bypass graft surgery). RESULTS Transit time flow measurement was used in 1067 patients (TTFM group) and not used in 501 patients (non-TTFM group); of the TTFM group, median percentage TTFM use was 79% (interquartile range, 41% to 98%) among 18 Veterans Affairs Medical Centers, and 74% (interquartile range, 13% to 98%) among 48 surgeons. Patients were comparable in age (63 ± 8.5 years TTFM vs 62 ± 8 years non-TTFM, P = .30) and estimated 30-day mortality risk (1.8 ± 1.7 TTFM vs 1.9 non-TTFM, P = .53). One-year FitzGibbon A patency was 83% (1600 of 1988 grafts) for TTFM assessed grafts and 78% (629 of 803) for non-TTFM assessed grafts (P < .01). Fewer TTFM patients had an occluded graft (29%, vs 38% non-TTFM; P = .01). Comparing TTFM patients with non-TTFM patients, 5-year major adverse cardiac event rates were 30% vs 25% (P = .06). Individual component rates were 14% vs 11% for death (P = .06), 12% vs 8.8% for myocardial infarction (P = .07), and 13% vs 12% for revascularization (P = .62). CONCLUSIONS The association of TTFM use with graft patency and clinical outcome is uncertain. Future randomized studies that account for patient risk factors and practice variation would help address this knowledge gap.
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Affiliation(s)
- Jacquelyn A Quin
- VA Boston Healthcare System, West Roxbury, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Mohammad Noubani
- Northport VA Medical Center, Northport, New York; Stony Brook University, Stony Brook, New York
| | - Jessica Y Rove
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado; Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - John E Krstacic
- Northport VA Medical Center, Northport, New York; Stony Brook University, Stony Brook, New York
| | - Brack Hattler
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Frederick L Grover
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado; Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - G Hossein Almassi
- Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin; Medical College of Wisconsin, Milwaukee, Wisconsin
| | - A Laurie Shroyer
- Northport VA Medical Center, Northport, New York; Stony Brook University, Stony Brook, New York
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Hattler B, Grover FL, Wagner T, Hawkins RB, Quin JA, Collins JF, Bishawi M, Almassi H, Shroyer AL. Incidence and Prognostic Impact of Incomplete Revascularization Documented by Coronary Angiography 1 Year After Coronary Artery Bypass Grafting. Am J Cardiol 2020; 131:7-11. [PMID: 32718555 DOI: 10.1016/j.amjcard.2020.06.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 11/26/2022]
Abstract
Complete revascularization (CR) at the time of coronary artery bypass graft (CABG) surgery improves long-term cardiac outcomes. No studies have previously reported angiographically confirmed CR rates post-CABG. This study's aim was to assess the impact upon long-term outcomes of CR versus incomplete revascularization (IR), confirmed by coronary angiography 1 year after CABG. Randomized On/Off Bypass Study patients who returned for protocol-specified 1-year post-CABG coronary angiograms were included. Patients with a widely patent graft supplying the major diseased artery within each diseased coronary territory were considered to have CR. Outcomes were all-cause mortality and major adverse cardiovascular events (MACE; all-cause mortality, nonfatal myocardial infarction, repeat revascularization) over the 4 years after angiography. Of the 1,276 patients, 756 (59%) had CR and 520 (41%) had IR. MACE was 13% CR versus 26% IR, p <0.001. This difference was driven by fewer repeat revascularizations (5% CR vs 18% IR; p <0.001). There were no differences in mortality (7.1% CR vs 8.1% IR, p = 0.13) or myocardial infarction (4% in both). Adjusted multivariable models confirmed CR was associated with reduced MACE (odds ratio 0.44, 95% confidence interval 0.33 to 0.58, p <0.01), but had no impact on mortality. In conclusion, CR confirmed by post-CABG angiography was associated with improved MACE but not mortality. Repeat revascularization of patients with IR, driven by knowledge of the research angiography results, may have ameliorated potential mortality differences.
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Nawata K, D’Agostino RS, Habib RH, Kumamaru H, Hirahara N, Miyata H, Motomura N, Takamoto S, Shahian DM, Grover FL. First Database Comparison Between the United States and Japan: Coronary Artery Bypass Grafting. Ann Thorac Surg 2020; 109:1159-1164. [DOI: 10.1016/j.athoracsur.2019.07.095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/24/2019] [Accepted: 07/29/2019] [Indexed: 11/30/2022]
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Almassi GH, Hawkins RB, Bishawi M, Shroyer AL, Hattler B, Quin JA, Collins JF, Bakaeen FG, Ebrahimi R, Grover FL, Wagner TH. New-onset postoperative atrial fibrillation impact on 5-year clinical outcomes and costs. J Thorac Cardiovasc Surg 2019; 161:1803-1810.e3. [PMID: 31866082 DOI: 10.1016/j.jtcvs.2019.10.150] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/27/2019] [Accepted: 10/13/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The impact of new-onset postoperative atrial fibrillation (POAF) following coronary artery bypass grafting (CABG) surgery on long-term clinical outcomes and costs is not known. This subanalysis of the Veterans Affairs "Randomized On/Off Bypass Follow-up Study" compared 5-year outcomes and costs between patients with and without POAF. METHODS Of the 2203 veterans in the study, 100 with pre-CABG atrial fibrillation (93) or missing data (7) were excluded (4.8%). Unadjusted and risk-adjusted outcomes were compared between new-onset POAF (n = 551) and patients without POAF (n = 1552). Five-year clinical outcomes included mortality, major adverse cardiovascular events (MACE, comprising mortality, repeat revascularization, and myocardial infarction), MACE subcomponents, stroke, and costs. A stringent P value of ≤.01 was required to identify statistical significance. RESULTS Patients with POAF were older and had more complex comorbidities. Unadjusted 5-year all-cause mortality was 16.3% POAF versus 11.9% no-POAF, P = .008. Unadjusted cardiac-mortality was 7.4% versus 4.8%, P = .022. There were no differences between groups in any other unadjusted outcomes including MACE or stroke. After risk adjustment, there were no significant differences between groups in 5-year all-cause mortality (POAF odds ratio, 1.19; 99% confidence interval, 0.81-1.75) or cardiac mortality (odds ratio, 1.51, 99% confidence interval, 0.88-2.60). Adjusted first-year post-CABG costs were $15,300 greater for patients with POAF, but 2- through 5-year costs were similar. CONCLUSIONS No 5-year risk-adjusted outcome differences were found between patients with and without POAF after CABG. Although first-year costs were greater in patients with POAF, this difference did not persist in subsequent years.
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Affiliation(s)
- G Hossein Almassi
- Cardiothoracic Surgery, Zablocki Veterans Affairs Medical Center, Milwaukee, Wis; Department of Surgery, Medical College of Wisconsin, Milwaukee, Wis.
| | - Robert B Hawkins
- Department of Surgery, Salem Veterans Affairs Medical Center, Salem, Va; Department of Surgery, University of Virginia, Charlottesville, Va
| | - Muath Bishawi
- Research Office, Northport Veterans Affairs Medical Center, Northport, NY; Department of Surgery, Duke University Medical Center, Durham, NC
| | - A Laurie Shroyer
- Research Office, Northport Veterans Affairs Medical Center, Northport, NY; Research Office, Departments of Surgery and Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colo
| | - Brack Hattler
- Research Office, Departments of Surgery and Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colo; Departments of Surgery and Medicine, University of Colorado Anschutz School of Medicine, Aurora, Colo
| | - Jacquelyn A Quin
- Department of Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Mass; Harvard Medical School, Boston, Mass
| | - Joseph F Collins
- Cooperative Studies Program Coordinating Center, Perry Point Veterans Affairs Medical Center, Perry Point, Md
| | - Faisal G Bakaeen
- Department of Surgery, Pittsburgh Veterans Affairs Medical Center, Pittsburgh, Pa; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ramin Ebrahimi
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, Calif; Department of Medicine, University of California Los Angeles, Los Angeles, Calif
| | - Frederick L Grover
- Research Office, Departments of Surgery and Medicine, Rocky Mountain Regional VA Medical Center, Aurora, Colo; Departments of Surgery and Medicine, University of Colorado Anschutz School of Medicine, Aurora, Colo
| | - Todd H Wagner
- Health Economics Resource Center, Palo Alto Veterans Affairs Medical Center, Menlo Park, Calif; Department of Surgery, Stanford University, Stanford, Calif
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Grover FL. RESPONSE: Clinician-Educator Program for FITs: Filling a Gap in Training. J Am Coll Cardiol 2019; 73:2903. [PMID: 31171098 DOI: 10.1016/j.jacc.2019.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Frederick L Grover
- Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical School, Aurora, Colorado.
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Hattler B, Carr BM, Messenger J, Spertus J, Ebrahimi R, Bishawi M, Quin JA, Almassi GH, Collins JF, Kozora E, Grover FL, Shroyer ALW. Clinical and Angiographic Predictors of Patient-Reported Angina 1 Year After Coronary Artery Bypass Graft Surgery. Circ Cardiovasc Qual Outcomes 2019; 12:e005119. [DOI: 10.1161/circoutcomes.118.005119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brack Hattler
- Rocky Mountain Regional VA Medical Center, Aurora, CO (B.H., F.L.G.)
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora CO (B.H., J.M., E.K., F.L.G.)
| | - Brendan M. Carr
- Northport Veterans Affairs Medical Center, Northport, NY (B.M.C., M.B., A.L.W.S.)
| | - John Messenger
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora CO (B.H., J.M., E.K., F.L.G.)
| | - John Spertus
- Saint Luke’s Mid America Heart Institute/University of Missouri at Kansas City, Kansas City, MO (J.S.)
| | - Ramin Ebrahimi
- Greater Los Angeles VA Medical Center, Los Angeles, CA (R.E.)
- University of California, Los Angeles (R.E.)
| | - Muath Bishawi
- Northport Veterans Affairs Medical Center, Northport, NY (B.M.C., M.B., A.L.W.S.)
- Duke University, Durham, NC (M.B.)
| | - Jacquelyn A. Quin
- VA Boston Healthcare System, West Roxbury, MA (J.A.Q.)
- Harvard Medical School, Boston, MA (J.A.Q.)
| | - G. Hossein Almassi
- Zablocki Veterans Affairs Medical Center, Milwaukee, WI (G.H.A.)
- Medical College of Wisconsin, Milwaukee (G.H.A.)
| | - Joseph F. Collins
- Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.)
| | - Elizabeth Kozora
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora CO (B.H., J.M., E.K., F.L.G.)
- National Jewish Health, Denver, CO (E.K.)
| | - Frederick L. Grover
- Rocky Mountain Regional VA Medical Center, Aurora, CO (B.H., F.L.G.)
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora CO (B.H., J.M., E.K., F.L.G.)
| | - A. Laurie W. Shroyer
- Northport Veterans Affairs Medical Center, Northport, NY (B.M.C., M.B., A.L.W.S.)
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Grover FL, Cleveland JC. Commentary: Doing what is right-We are all in this together. J Thorac Cardiovasc Surg 2019; 159:554-555. [PMID: 30853221 DOI: 10.1016/j.jtcvs.2019.01.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 01/23/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Frederick L Grover
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, Colo.
| | - Joseph C Cleveland
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, Colo; Cardiac Transplantation Program, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, Colo
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Thourani VH, O'Brien SM, Kelly JJ, Cohen DJ, Peterson ED, Mack MJ, Shahian DM, Grover FL, Carroll JD, Brennan JM, Forcillo J, Arnold SV, Vemulapalli S, Fitzgerald S, Holmes DR, Bavaria JE, Edwards FH. Development and Application of a Risk Prediction Model for In-Hospital Stroke After Transcatheter Aortic Valve Replacement: A Report From The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Ann Thorac Surg 2018; 107:1097-1103. [PMID: 30529671 DOI: 10.1016/j.athoracsur.2018.11.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 09/30/2018] [Accepted: 11/01/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stroke is a serious complication after transcatheter aortic valve replacement (TAVR), yet predictive models are not available. A new risk model for in-hospital stroke after TAVR was developed and used to estimate site-specific performance. METHODS We included 97,600 TAVR procedures from 521 sites in The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry from July 2014 to June 2017. Association between baseline covariates and in-hospital stroke was estimated by logistic regression. Discrimination was evaluated by C-statistic. Calibration was tested internally via cross-validation. Hierarchical modeling was used to estimate risk-adjusted site-specific performance. RESULTS Median age was 82 years, 44,926 (46.0%) were women, and 1,839 (1.9%) had in-hospital stroke. Covariates associated with stroke (odds ratio) included transapical access (1.44), access excluding transapical and transfemoral (1.77), prior stroke (1.57), prior transient ischemic attack (1.50), preprocedural shock, inotropes or mechanical assist device (1.48), smoking (1.28), porcelain aorta (1.23), peripheral arterial disease (1.21), age per 5 years (1.11), glomerular filtration rate per 5 mL/min (0.97), body surface area per m2 (0.55 male; 0.43 female), and prior aortic valve (0.78) and nonaortic valvular (0.42) procedures. The C-statistic was 0.622. Calibration curves demonstrated agreement between observed and expected stroke rates. Hierarchical modeling showed 10 (1.9%) centers with significantly higher odds ratios for in-hospital stroke than their peers. CONCLUSIONS A risk model for in-hospital stroke after TAVR was developed from The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry and used to estimate site-specific stroke performance. This model can serve as a valuable resource for quality improvement, clinical decision making, and patient counseling.
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Affiliation(s)
- Vinod H Thourani
- Department of Cardiac Surgery, Medstar Heart and Vascular Institute and Georgetown University, Washington, DC.
| | - Sean M O'Brien
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - John J Kelly
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J Cohen
- Division of Cardiology, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Michael J Mack
- Heart Hospital Baylor Plano, Baylor Healthcare System, Plano, Texas
| | - David M Shahian
- Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frederick L Grover
- Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - John D Carroll
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - J Matthew Brennan
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Jessica Forcillo
- Department of Cardiac Surgery, University of Montreal Hospital Centre, Montreal, Quebec, Canada
| | - Suzanne V Arnold
- Division of Cardiology, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
| | | | | | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Joseph E Bavaria
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fred H Edwards
- Division of Cardiothoracic Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida
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Shroyer ALW, Quin JA, Wagner TH, Carr BM, Collins JF, Almassi GH, Bishawi M, Grover FL, Hattler B. Off-Pump Versus On-Pump Impact: Diabetic Patient 5-Year Coronary Artery Bypass Clinical Outcomes. Ann Thorac Surg 2018; 107:92-98. [PMID: 30273568 DOI: 10.1016/j.athoracsur.2018.07.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/18/2018] [Accepted: 07/23/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND For diabetic patients who require coronary artery bypass graft (CABG) operation, controversy persists whether an off-pump or an on-pump approach may be advantageous. This US-based, multicenter, randomized, controlled trial, Department of Veterans Affairs Randomization On versus Off Bypass Follow-up Study, compared diabetic patients' 5-year clinical outcomes for off-pump versus on-pump procedures. METHODS From 2002 to 2008, 835 medically treated (ie, oral hypoglycemic agent or insulin) diabetic patients underwent either off-pump (n = 402) or on-pump (n = 433) CABG. Five-year primary end points included all-cause death and major adverse cardiovascular events (MACE; composite included all-cause death, myocardial infarction, or repeat revascularization). Secondary 5-year end points included cardiac death and MACE-related components. With baseline risk factors balanced, outcomes were evaluated by using a p value less than or equal to 0.01; nonsignificant trends were reported for p values greater than 0.01 and less than or equal to 0.15. RESULTS Five-year all-cause death rates were 20.2% off pump versus 14.1% on pump (p = 0.0198). No differences were seen in MACE (32.6% off-pump approach versus 28.6% on-pump approach, p = 0.216), repeat revascularization (12.4% off-pump approach versus 11.8% on-pump approach, p = 0.770), and nonfatal myocardial infarction (12.7% off-pump approach versus 10.4% on-pump approach, p = 0.299). Cardiac death trended worse with off-pump CABG (9.0%) than with on-pump CABG (6.25%, p = 0.137). Sensitivity analyses that removed conversions confirmed these findings. CONCLUSIONS With a 6.1% absolute difference, a strong trend toward improved 5-year survival was observed with on-pump CABG for medically treated diabetic patients. No off-pump advantage was found for any 5-year end points. A future clinical trial now appears warranted to rigorously compare off-pump versus on-pump longer term outcomes for diabetic patients.
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Affiliation(s)
- A Laurie W Shroyer
- Research and Development Office, Northport Veterans Affairs Medical Center, Northport, New York; Research and Development Office, Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado.
| | - Jacquelyn A Quin
- Department of Surgery, VA Boston Healthcare System, West Roxbury, Massachusetts
| | - Todd H Wagner
- Department of Veterans Affairs Health Economics Resource Center, Palo Alto, California; Department of Surgery, Stanford University, Palo Alto, California
| | - Brendan M Carr
- Research and Development Office, Northport Veterans Affairs Medical Center, Northport, New York; Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| | - Joseph F Collins
- Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, Maryland
| | - G Hossein Almassi
- Department of Surgery, Zablocki VA Medical Center, Milwaukee, Wisconsin; Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Muath Bishawi
- Research and Development Office, Northport Veterans Affairs Medical Center, Northport, New York; Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Frederick L Grover
- Research and Development Office, Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Brack Hattler
- Research and Development Office, Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado; Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
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Wagner TH, Hattler B, Bakaeen FG, Collins JF, Almassi GH, Quin JA, Grover FL, Bishawi M, Shroyer ALW. Costs Five Years After Off-Pump or On-Pump Coronary Artery Bypass Surgery. Ann Thorac Surg 2018; 107:99-105. [PMID: 30273569 DOI: 10.1016/j.athoracsur.2018.07.075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/28/2018] [Accepted: 07/23/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) is a common surgical treatment for ischemic heart disease. Little is known about the long-term costs of conducting the surgery on-pump or off-pump. METHODS As part of the Randomized On/Off Bypass follow-up study, we followed 2,203 participants randomized to on-pump (n = 1,099) and off-pump (n = 1,104) CABG for 5 years using Department of Veterans Affairs and Medicare administrative data. We examined annual costs through 5 years, standardized to 2016 dollars, using multivariate regression models, controlling for site and baseline patient factors. RESULTS In the first year, including the CABG surgery, annual average costs were $66,599 (SE, $1,946) for the on-pump group and $70,552 (SE, $1,954) for the off-pump group. In years 2 to 5, average costs ranged from $15,000 to $20,000 per year. There was no significant difference between on-pump and off-pump across the 5 years. We explored differences among high-risk subgroups (diabetes, chronic obstructive pulmonary disease, peripheral vascular disease, cerebrovascular disease, renal dysfunction, ejection fraction < 35%, over age 70 years), and found no treatment assignment by time interactions, except for a nonsignificant trend in patients with diabetes. CONCLUSIONS At 5 years, the average costs of off-pump and on-pump CABG patients did not statistically differ. Costs do not favor one approach and the decision should be based on clinical risks, especially in subgroups. Future research is warranted to examine post-CABG costs and outcomes for diabetic patients over time.
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Affiliation(s)
- Todd H Wagner
- VA Palo Alto Health Economics Resource Center, Menlo Park, California; Department of Surgery, Stanford University, Palo Alto, California.
| | - Brack Hattler
- Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado; University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colorado
| | - Faisal G Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Joseph F Collins
- Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland
| | - G Hossein Almassi
- Veterans Affairs Medical Center, Milwaukee, Wisconsin; Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Frederick L Grover
- Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado; University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colorado
| | - Muath Bishawi
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - A Laurie W Shroyer
- Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado; Northport VA Medical Center, Northport, New York
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Ebrahimi R, Gupta S, Carr BM, Bishawi M, Bakaeen FG, Almassi GH, Collins J, Grover FL, Quin JA, Wagner TH, Shroyer ALW, Hattler B. Comparison of Outcomes and Costs Associated With Aspirin ± Clopidogrel After Coronary Artery Bypass Grafting. Am J Cardiol 2018; 121:709-714. [PMID: 29402422 DOI: 10.1016/j.amjcard.2017.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 12/04/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
Abstract
Optimal antiplatelet therapy after coronary artery bypass graft (CABG) surgery remains controversial. This study evaluated the role of dual antiplatelet therapy using aspirin and clopidogrel (DAPT) versus antiplatelet therapy using aspirin only (ASA) on post-CABG clinical outcomes and costs. In the Department of Veterans Affairs Randomized On/Off Bypass (ROOBY) trial, clopidogrel use after CABG was prospectively collected beginning in year 2 of this study to include 1,525 of the 2,203 original ROOBY patients who received aspirin after CABG. Discretionarily, surgeons after CABG administered either DAPT or ASA treatments. The ROOBY trial's primary 30-day composite (mortality or perioperative morbidity), 1-year composite (all-cause death, repeat revascularization, or nonfatal myocardial infarction), and costs were compared for these 2 strategies. Of the 1,525 subjects, 511 received DAPT and 1,014 received ASA. DAPT subjects, compared with ASA subjects, had lower rates of preoperative left ventricular ejection fraction of ≥45% (78.8% vs 85.7%, p <0.001), on-pump CABG (36.6% vs 57.1%, p = 0.001), and endoscopic vein harvesting (30.0% vs 42.8%, p <0.001). ASA patients were more likely to have earlier aspirin administration and receive 325 versus 81 mg dosages. The 30-day composite outcome rate was significantly lower for DAPT patients compared with ASA patients (3.3% vs 7.1%, p = 0.003), but the 1-year composite outcome was equal between the 2 groups (12.0% vs12.0%, p = 1.0). At 1 year, there were no cost differences between the 2 groups. Propensity analyses did not significantly alter the results. In conclusion, DAPT appeared safe and was associated with fewer 30-day adverse outcomes than aspirin only and with no 1-year outcome or cost differences.
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Quin JA, Hattler B, Shroyer ALW, Kemp D, Almassi GH, Bakaeen FG, Carr BM, Bishawi M, Collins JF, Grover FL, Wagner TH. Concordance between administrative data and clinical review for mortality in the randomized on/off bypass follow-up study (ROOBY-FS). J Card Surg 2017; 32:751-756. [PMID: 29239024 DOI: 10.1111/jocs.13379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The optimal methodology to identify cardiac versus non-cardiac cause of death following cardiac surgery has not been determined. METHODS The Randomized On/Off Bypass Trial was a multicenter, randomized, controlled clinical trial of 2203 patients (February 2002-May 2008) comparing 1-year cardiac outcomes between off-pump and on-pump bypass surgery. In 2013, the Veterans Affairs (VA) Cooperative Studies Program funded a follow-up study to assess 5-year outcomes including mortality. Deaths were identified and confirmed using the National Death Index (NDI), VA Vital Status file, and medical records. An Endpoints Committee (EC) reviewed patient medical records and classified each cause of death as cardiac, non-cardiac, or unknown. Using pre-determined ICD-10 codes, NDI death certificates were independently used to classify deaths as cardiac or non-cardiac. Cause of death was compared between the NDI and EC classifications and concordance measured, using Kappa statistics. RESULTS Of the 297 5-year deaths identified by the NDI and/or VA vital status file and confirmed by the EC, 219 had adequate patient records for EC cause of death determination. The EC adjudicated 141 of these deaths as non-cardiac and 78 as cardiac, while the NDI classified 150 as non-cardiac and 69 as cardiac; agreement was 77.6% (kappa 0.500; P < 0.001). CONCLUSIONS Since concordance between EC and NDI cause of death classifications was only moderate, caution should be exercised in relying exclusively on NDI data to determine cause of death. A hybrid approach, integrating multiple information sources, may provide the most accurate approach to classifying cause of death.
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Affiliation(s)
- Jacquelyn A Quin
- Surgical Service, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Brack Hattler
- Department of Medicine, Division of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado.,School of Medicine at the Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Annie Laurie W Shroyer
- Research and Development Office, Northport Veterans Affair Medical Center, Northport, New York.,Research and Development Office, Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado
| | - Darlene Kemp
- Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland
| | - G Hossein Almassi
- Surgical Services, Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin.,Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Faisal G Bakaeen
- Pittsburgh VA Medical Center, Pittsburgh, Pennsylvania.,Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Brendan M Carr
- Research and Development Office, Northport Veterans Affairs Medical Center, Northport, New York.,Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota
| | - Muath Bishawi
- Research and Development Office, Northport Veterans Affairs Medical Center, Northport, New York.,Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Joseph F Collins
- Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland
| | - Frederick L Grover
- School of Medicine at the Anschutz Medical Campus, University of Colorado, Aurora, Colorado.,Department of Surgery, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado
| | - Todd H Wagner
- Veterans Affairs Palo Alto Health Economics Resource Center, Menlo Park, California.,Department of Surgery, Stanford University, Stanford, California
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Shroyer AL, Hattler B, Wagner TH, Collins JF, Baltz JH, Quin JA, Almassi GH, Kozora E, Bakaeen F, Cleveland JC, Bishawi M, Grover FL. Five-Year Outcomes after On-Pump and Off-Pump Coronary-Artery Bypass. N Engl J Med 2017; 377:623-632. [PMID: 28813218 DOI: 10.1056/nejmoa1614341] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Coronary-artery bypass grafting (CABG) surgery may be performed either with cardiopulmonary bypass (on pump) or without cardiopulmonary bypass (off pump). We report the 5-year clinical outcomes in patients who had been included in the Veterans Affairs trial of on-pump versus off-pump CABG. METHODS From February 2002 through June 2007, we randomly assigned 2203 patients at 18 medical centers to undergo either on-pump or off-pump CABG, with 1-year assessments completed by May 2008. The two primary 5-year outcomes were death from any cause and a composite outcome of major adverse cardiovascular events, defined as death from any cause, repeat revascularization (CABG or percutaneous coronary intervention), or nonfatal myocardial infarction. Secondary 5-year outcomes included death from cardiac causes, repeat revascularization, and nonfatal myocardial infarction. Primary outcomes were assessed at a P value of 0.05 or less, and secondary outcomes at a P value of 0.01 or less. RESULTS The rate of death at 5 years was 15.2% in the off-pump group versus 11.9% in the on-pump group (relative risk, 1.28; 95% confidence interval [CI], 1.03 to 1.58; P=0.02). The rate of major adverse cardiovascular events at 5 years was 31.0% in the off-pump group versus 27.1% in the on-pump group (relative risk, 1.14; 95% CI, 1.00 to 1.30; P=0.046). For the 5-year secondary outcomes, no significant differences were observed: for nonfatal myocardial infarction, the rate was 12.1% in the off-pump group and 9.6% in the on-pump group (P=0.05); for death from cardiac causes, the rate was 6.3% and 5.3%, respectively (P=0.29); for repeat revascularization, the rate was 13.1% and 11.9%, respectively (P=0.39); and for repeat CABG, the rate was 1.4% and 0.5%, respectively (P=0.02). CONCLUSIONS In this randomized trial, off-pump CABG led to lower rates of 5-year survival and event-free survival than on-pump CABG. (Funded by the Department of Veterans Affairs Office of Research and Development Cooperative Studies Program and others; ROOBY-FS ClinicalTrials.gov number, NCT01924442 .).
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Affiliation(s)
- A Laurie Shroyer
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Brack Hattler
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Todd H Wagner
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Joseph F Collins
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Janet H Baltz
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Jacquelyn A Quin
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - G Hossein Almassi
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Elizabeth Kozora
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Faisal Bakaeen
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Joseph C Cleveland
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Muath Bishawi
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
| | - Frederick L Grover
- From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.)
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Shapira OM, Blumenfeld O, Bolotin G, Grover FL, Shahian DM. International Participation in The Society of Thoracic Surgeons Adult Cardiac Surgery Database: From Institutional to National. Ann Thorac Surg 2017; 103:1683-1686. [DOI: 10.1016/j.athoracsur.2017.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/25/2016] [Accepted: 01/04/2017] [Indexed: 11/29/2022]
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Grover FL, Vemulapalli S, Carroll JD, Edwards FH, Mack MJ, Thourani VH, Brindis RG, Shahian DM, Ruiz CE, Jacobs JP, Hanzel G, Bavaria JE, Tuzcu EM, Peterson ED, Fitzgerald S, Kourtis M, Michaels J, Christensen B, Seward WF, Hewitt K, Holmes DR. 2016 Annual Report of The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Ann Thorac Surg 2017; 103:1021-1035. [DOI: 10.1016/j.athoracsur.2016.12.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Indexed: 11/28/2022]
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Grover FL, Vemulapalli S, Carroll JD, Edwards FH, Mack MJ, Thourani VH, Brindis RG, Shahian DM, Ruiz CE, Jacobs JP, Hanzel G, Bavaria JE, Tuzcu EM, Peterson ED, Fitzgerald S, Kourtis M, Michaels J, Christensen B, Seward WF, Hewitt K, Holmes DR. 2016 Annual Report of The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. J Am Coll Cardiol 2017; 69:1215-1230. [DOI: 10.1016/j.jacc.2016.11.033] [Citation(s) in RCA: 391] [Impact Index Per Article: 55.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/20/2016] [Accepted: 11/28/2016] [Indexed: 11/28/2022]
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Jacobs JP, Shahian DM, Prager RL, Edwards FH, McDonald D, Han JM, D'Agostino RS, Jacobs ML, Kozower BD, Badhwar V, Thourani VH, Gaissert HA, Fernandez FG, Wright CD, Paone G, Cleveland JC, Brennan JM, Dokholyan RS, Brothers L, Vemulapalli S, Habib RH, O’Brien SM, Peterson ED, Grover FL, Patterson GA, Bavaria JE. The Society of Thoracic Surgeons National Database 2016 Annual Report. Ann Thorac Surg 2016; 102:1790-1797. [DOI: 10.1016/j.athoracsur.2016.10.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
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Holmes DR, Nishimura RA, Grover FL, Brindis RG, Carroll JD, Edwards FH, Peterson ED, Rumsfeld JS, Shahian DM, Thourani VH, Tuzcu EM, Vemulapalli S, Hewitt K, Michaels J, Fitzgerald S, Mack MJ. Annual Outcomes With Transcatheter Valve Therapy: From the STS/ACC TVT Registry. Ann Thorac Surg 2016; 101:789-800. [PMID: 27175453 DOI: 10.1016/j.athoracsur.2015.10.049] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry has been a joint initiative of the STS and the ACC in concert with multiple stakeholders. The TVT Registry has important information regarding patient selection, delivery of care, science, education, and research in the field of structural valvular heart disease. OBJECTIVES This report provides an overview on current U.S. TVT practice and trends. The emphasis is on demographics, in-hospital procedural characteristics, and outcomes of patients having transcatheter aortic valve replacement (TAVR) performed at 348 U.S. centers. METHODS The TVT Registry captured 26,414 TAVR procedures as of December 31, 2014. Temporal trends between 2012 and 2013 versus 2014 were compared. RESULTS Comparison of the 2 time periods reveals that TAVR patients remain elderly (mean age 82 years), with multiple comorbidities, reflected by a high mean STS predicted risk of mortality (STS PROM) for surgical valve replacement (8.34%), were highly symptomatic (New York Heart Association functional class III/IV in 82.5%), frail (slow 5-m walk test in 81.6%), and have poor self-reported health status (median baseline Kansas City Cardiomyopathy Questionnaire score of 39.1). Procedure performance is changing, with an increased use of moderate sedation (from 1.6% to 5.1%) and increase in femoral access using percutaneous techniques (66.8% in 2014). Vascular complication rates are decreasing (from 5.6% to 4.2%), whereas site-reported stroke rates remain stable at 2.2%. CONCLUSIONS The TVT Registry provides important information on characteristics and outcomes of TAVR in contemporary U.S. clinical practice. It can be used to identify trends in practice and opportunities for quality improvement.
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Edwards FH, Cohen DJ, O’Brien SM, Peterson ED, Mack MJ, Shahian DM, Grover FL, Tuzcu EM, Thourani VH, Carroll J, Brennan JM, Brindis RG, Rumsfeld J, Holmes DR. Development and Validation of a Risk Prediction Model for In-Hospital Mortality After Transcatheter Aortic Valve Replacement. JAMA Cardiol 2016; 1:46-52. [DOI: 10.1001/jamacardio.2015.0326] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Fred H. Edwards
- Department of Surgery, University of Florida College of Medicine–Jacksonville
| | - David J. Cohen
- Department of Medicine, St Luke’s Mid America Heart Institute, Kansas City, Missouri
| | | | | | - Michael J. Mack
- Department of Cardiovascular Disease, Baylor Scott and White Health Care System, Plano, Texas
| | - David M. Shahian
- Department of Surgery, Center for Quality and Safety, Massachusetts General Hospital, Boston
| | | | - E. Murat Tuzcu
- Department of Cardiovascular Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Vinod H. Thourani
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - John Carroll
- Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | | | - Ralph G. Brindis
- Department of Medicine and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - John Rumsfeld
- Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
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Jacobs JP, Shahian DM, Prager RL, Edwards FH, McDonald D, Han JM, D'Agostino RS, Jacobs ML, Kozower BD, Badhwar V, Thourani VH, Gaissert HA, Fernandez FG, Wright C, Fann JI, Paone G, Sanchez JA, Cleveland JC, Brennan JM, Dokholyan RS, O’Brien SM, Peterson ED, Grover FL, Patterson GA. Introduction to the STS National Database Series. Ann Thorac Surg 2015; 100:1992-2000. [DOI: 10.1016/j.athoracsur.2015.10.060] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 10/14/2015] [Accepted: 10/15/2015] [Indexed: 11/30/2022]
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Almassi GH, Carr BM, Bishawi M, Shroyer AL, Quin JA, Hattler B, Wagner TH, Collins JF, Ravichandran P, Cleveland JC, Grover FL, Bakaeen FG. Resident versus attending surgeon graft patency and clinical outcomes in on- versus off-pump coronary artery bypass surgery. J Thorac Cardiovasc Surg 2015; 150:1428-35, 1437.e1; discussion 1435-7. [DOI: 10.1016/j.jtcvs.2015.08.124] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 08/06/2015] [Accepted: 08/26/2015] [Indexed: 10/23/2022]
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Holmes DR, Nishimura RA, Grover FL, Brindis RG, Carroll JD, Edwards FH, Peterson ED, Rumsfeld JS, Shahian DM, Thourani VH, Tuzcu EM, Vemulapalli S, Hewitt K, Michaels J, Fitzgerald S, Mack MJ. Annual Outcomes With Transcatheter Valve Therapy: From the STS/ACC TVT Registry. J Am Coll Cardiol 2015; 66:2813-2823. [PMID: 26652232 DOI: 10.1016/j.jacc.2015.10.021] [Citation(s) in RCA: 202] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/07/2015] [Accepted: 10/13/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry has been a joint initiative of the STS and the ACC in concert with multiple stakeholders. The TVT Registry has important information regarding patient selection, delivery of care, science, education, and research in the field of structural valvular heart disease. OBJECTIVES This report provides an overview on current U.S. TVT practice and trends. The emphasis is on demographics, in-hospital procedural characteristics, and outcomes of patients having transcatheter aortic valve replacement (TAVR) performed at 348 U.S. centers. METHODS The TVT Registry captured 26,414 TAVR procedures as of December 31, 2014. Temporal trends between 2012 and 2013 versus 2014 were compared. RESULTS Comparison of the 2 time periods reveals that TAVR patients remain elderly (mean age 82 years), with multiple comorbidities, reflected by a high mean STS predicted risk of mortality (STS PROM) for surgical valve replacement (8.34%), were highly symptomatic (New York Heart Association functional class III/IV in 82.5%), frail (slow 5-m walk test in 81.6%), and have poor self-reported health status (median baseline Kansas City Cardiomyopathy Questionnaire score of 39.1). Procedure performance is changing, with an increased use of moderate sedation (from 1.6% to 5.1%) and increase in femoral access using percutaneous techniques (66.8% in 2014). Vascular complication rates are decreasing (from 5.6% to 4.2%), whereas site-reported stroke rates remain stable at 2.2%. CONCLUSIONS The TVT Registry provides important information on characteristics and outcomes of TAVR in contemporary U.S. clinical practice. It can be used to identify trends in practice and opportunities for quality improvement.
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Jacobs JP, Shahian DM, He X, O'Brien SM, Badhwar V, Cleveland JC, Furnary AP, Magee MJ, Kurlansky PA, Rankin JS, Welke KF, Filardo G, Dokholyan RS, Peterson ED, Brennan JM, Han JM, McDonald D, Schmitz D, Edwards FH, Prager RL, Grover FL. Penetration, Completeness, and Representativeness of The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg 2015; 101:33-41; discussion 41. [PMID: 26542437 DOI: 10.1016/j.athoracsur.2015.08.055] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/17/2015] [Accepted: 08/24/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) has been successfully linked to the Centers for Medicare and Medicaid (CMS) Medicare database, thereby facilitating comparative effectiveness research and providing information about long-term follow-up and cost. The present study uses this link to determine contemporary completeness, penetration, and representativeness of the STS ACSD. METHODS Using variables common to both STS and CMS databases, STS operations were linked to CMS data for all CMS coronary artery bypass graft (CABG) surgery hospitalizations discharged between 2000 and 2012, inclusive. For each CMS CABG hospitalization, it was determined whether a matching STS record existed. RESULTS Center-level penetration (number of CMS sites with at least one matched STS participant divided by the total number of CMS CABG sites) increased from 45% in 2000 to 90% in 2012. In 2012, 973 of 1,081 CMS CABG sites (90%) were linked to an STS site. Patient-level penetration (number of CMS CABG hospitalizations done at STS sites divided by the total number of CMS CABG hospitalizations) increased from 51% in 2000 to 94% in 2012. In 2012, 71,634 of 76,072 CMS CABG hospitalizations (94%) occurred at an STS site. Completeness of case inclusion at STS sites (number of CMS CABG cases at STS sites linked to STS records divided by the total number of CMS CABG cases at STS sites) increased from 88% in 2000 to 98% in 2012. In 2012, 69,213 of 70,932 CMS CABG hospitalizations at STS sites (98%) were linked to an STS record. CONCLUSIONS Linkage of STS and CMS databases demonstrates high and increasing penetration and completeness of the STS database. Linking STS and CMS data facilitates studying long-term outcomes and costs of cardiothoracic surgery.
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Affiliation(s)
- Jeffrey P Jacobs
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, Florida.
| | - David M Shahian
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Xia He
- Duke Clinical Research Institute (DCRI), Duke University, Durham, North Carolina
| | - Sean M O'Brien
- Duke Clinical Research Institute (DCRI), Duke University, Durham, North Carolina
| | - Vinay Badhwar
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | - Mitchell J Magee
- Medical City Dallas Hospital, Baylor University Medical Center Dallas, Dallas, Texas
| | | | | | - Karl F Welke
- Section of Congenital Cardiovascular Surgery, University of Illinois College of Medicine at Peoria, Children's Hospital of Illinois, Peoria, Illinois
| | - Giovanni Filardo
- Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas
| | - Rachel S Dokholyan
- Duke Clinical Research Institute (DCRI), Duke University, Durham, North Carolina
| | - Eric D Peterson
- Duke Clinical Research Institute (DCRI), Duke University, Durham, North Carolina
| | - J Matthew Brennan
- Duke Clinical Research Institute (DCRI), Duke University, Durham, North Carolina
| | - Jane M Han
- The Society of Thoracic Surgeons (STS), Chicago, Illinois
| | - Donna McDonald
- The Society of Thoracic Surgeons (STS), Chicago, Illinois
| | | | - Fred H Edwards
- University of Florida College of Medicine, Jacksonville, Florida
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Thourani VH, Jensen HA, Babaliaros V, Suri R, Vemulapalli S, Dai D, Brennan JM, Rumsfeld J, Edwards F, Tuzcu EM, Svensson L, Szeto WY, Herrmann H, Kirtane AJ, Kodali S, Cohen DJ, Lerakis S, Devireddy C, Sarin E, Carroll J, Holmes D, Grover FL, Williams M, Maniar H, Shahian D, Mack M. Transapical and Transaortic Transcatheter Aortic Valve Replacement in the United States. Ann Thorac Surg 2015; 100:1718-26; discussion 1726-7. [DOI: 10.1016/j.athoracsur.2015.05.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/24/2015] [Accepted: 05/01/2015] [Indexed: 10/23/2022]
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Jacobs JP, O'Brien SM, Pasquali SK, Gaynor JW, Mayer JE, Karamlou T, Welke KF, Filardo G, Han JM, Kim S, Quintessenza JA, Pizarro C, Tchervenkov CI, Lacour-Gayet F, Mavroudis C, Backer CL, Austin EH, Fraser CD, Tweddell JS, Jonas RA, Edwards FH, Grover FL, Prager RL, Shahian DM, Jacobs ML. The Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model: Part 2-Clinical Application. Ann Thorac Surg 2015; 100:1063-8; discussion 1068-70. [PMID: 26245504 DOI: 10.1016/j.athoracsur.2015.07.011] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 04/24/2015] [Accepted: 07/02/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The empirically derived 2014 Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model incorporates adjustment for procedure type and patient-specific factors. The purpose of this report is to describe this model and its application in the assessment of variation in outcomes across centers. METHODS All index cardiac operations in The Society of Thoracic Surgeons Congenital Heart Surgery Database (January 1, 2010, to December 31, 2013) were eligible for inclusion. Isolated patent ductus arteriosus closures in patients weighing less than or equal to 2.5 kg were excluded, as were centers with more than 10% missing data and patients with missing data for key variables. The model includes the following covariates: primary procedure, age, any prior cardiovascular operation, any noncardiac abnormality, any chromosomal abnormality or syndrome, important preoperative factors (mechanical circulatory support, shock persisting at time of operation, mechanical ventilation, renal failure requiring dialysis or renal dysfunction (or both), and neurological deficit), any other preoperative factor, prematurity (neonates and infants), and weight (neonates and infants). Variation across centers was assessed. Centers for which the 95% confidence interval for the observed-to-expected mortality ratio does not include unity are identified as lower-performing or higher-performing programs with respect to operative mortality. RESULTS Included were 52,224 operations from 86 centers. Overall discharge mortality was 3.7% (1,931 of 52,224). Discharge mortality by age category was neonates, 10.1% (1,129 of 11,144); infants, 3.0% (564 of 18,554), children, 0.9% (167 of 18,407), and adults, 1.7% (71 of 4,119). For all patients, 12 of 86 centers (14%) were lower-performing programs, 67 (78%) were not outliers, and 7 (8%) were higher-performing programs. CONCLUSIONS The 2014 Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model facilitates description of outcomes (mortality) adjusted for procedural and for patient-level factors. Identification of low-performing and high-performing programs may be useful in facilitating quality improvement efforts.
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Affiliation(s)
- Jeffrey P Jacobs
- Johns Hopkins All Children's Heart Institute, Saint Petersburg, Tampa, and Orlando, Florida; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Florida Hospital for Children, Orlando, Florida.
| | - Sean M O'Brien
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Sara K Pasquali
- Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - J William Gaynor
- Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - John E Mayer
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tara Karamlou
- Division of Pediatric Cardiac Surgery, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Karl F Welke
- Section of Congenital Cardiovascular Surgery, University of Illinois College of Medicine at Peoria, Children's Hospital of Illinois, Peoria, Illinois
| | - Giovanni Filardo
- Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas
| | - Jane M Han
- The Society of Thoracic Surgeons, Chicago, Illinois
| | - Sunghee Kim
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - James A Quintessenza
- Johns Hopkins All Children's Heart Institute, Saint Petersburg, Tampa, and Orlando, Florida; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Florida Hospital for Children, Orlando, Florida
| | | | | | | | - Constantine Mavroudis
- Johns Hopkins All Children's Heart Institute, Saint Petersburg, Tampa, and Orlando, Florida; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Florida Hospital for Children, Orlando, Florida
| | - Carl L Backer
- Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Erle H Austin
- Kosair Children's Hospital, University of Louisville, Louisville, Kentucky
| | - Charles D Fraser
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | | | | | - Fred H Edwards
- University of Florida, College of Medicine-Jacksonville, Jacksonville, Florida
| | | | | | - David M Shahian
- Massachusetts General Hospital Department of Surgery and Center for Quality and Safety, and Harvard Medical School, Boston, Massachusetts
| | - Marshall L Jacobs
- Johns Hopkins All Children's Heart Institute, Saint Petersburg, Tampa, and Orlando, Florida; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Florida Hospital for Children, Orlando, Florida
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Winkley Shroyer AL, Bakaeen F, Shahian DM, Carr BM, Prager RL, Jacobs JP, Ferraris V, Edwards F, Grover FL. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: The Driving Force for Improvement in Cardiac Surgery. Semin Thorac Cardiovasc Surg 2015; 27:144-51. [PMID: 26686440 DOI: 10.1053/j.semtcvs.2015.07.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2015] [Indexed: 11/11/2022]
Abstract
Initiated in 1989, the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) includes more than 1085 participating centers, representing 90%-95% of current US-based adult cardiac surgery hospitals. Since its inception, the primary goal of the STS ACSD has been to use clinical data to track and improve cardiac surgical outcomes. Patients' preoperative risk characteristics, procedure-related processes of care, and clinical outcomes data have been captured and analyzed, with timely risk-adjusted feedback reports to participating providers. In 2006, STS initiated an external audit process to evaluate STS ACSD completeness and accuracy. Given the extremely high inter-rater reliability and completeness rates of STS ACSD, it is widely regarded as the "gold standard" for benchmarking cardiac surgery risk-adjusted outcomes. Over time, STS ACSD has expanded its quality horizons beyond the traditional focus on isolated, risk-adjusted short-term outcomes such as perioperative morbidity and mortality. New quality indicators have evolved including composite measures of key processes of care and outcomes (risk-adjusted morbidity and risk-adjusted mortality), longer-term outcomes, and readmissions. Resource use and patient-reported outcomes would be added in the future. These additional metrics provide a more comprehensive perspective on quality as well as additional end points. Widespread acceptance and use of STS ACSD has led to a cultural transformation within cardiac surgery by providing nationally benchmarked data for internal quality assessment, aiding data-driven quality improvement activities, serving as the basis for a voluntary public reporting program, advancing cardiac surgery care through STS ACSD-based research, and facilitating data-driven informed consent dialogues and alternative treatment-related discussions.
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Affiliation(s)
- Annie Laurie Winkley Shroyer
- Research and Development Service, Northport Veterans Affairs Medical Center, Northport, New York; Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York.
| | - Faisal Bakaeen
- Department of Surgery, Baylor College of Medicine and Michael E. DeBakey VAMC, Houston, Texas
| | - David M Shahian
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brendan M Carr
- Research and Development Service, Northport Veterans Affairs Medical Center, Northport, New York; Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York
| | - Richard L Prager
- Department of Cardiac Surgery, University of Michigan Health Care System, Ann Arbor, Michigan
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, Johns Hopkins All Children׳s Heart Institute, Johns Hopkins University, Saint Petersburg and Tampa, Florida
| | - Victor Ferraris
- Department of Surgery, University of Kentucky School of Medicine, Lexington, Kentucky
| | - Fred Edwards
- Department of Surgery, University of Florida School of Medicine, Jacksonville, Florida
| | - Frederick L Grover
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado; Department of Surgery, Denver Veterans Affairs Medical Center, Denver, Colorado
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Grover FL. 50th Anniversary Landmark Commentary on Oldham HN Jr, Ebert PA, Young WG, Sabiston DC Jr. Surgical Management of Congenital Coronary Artery Fistula. Ann Thorac Surg 1971;12:503-13. Ann Thorac Surg 2015; 99:1875. [PMID: 26046853 DOI: 10.1016/j.athoracsur.2015.04.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 04/16/2015] [Accepted: 04/16/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Frederick L Grover
- Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Anschutz Medical Campus and Denver Department of Veterans Affairs Medical Center, Academic Office One, Bldg L15, Rm 6602, 12631 E 17th Ave, Aurora, CO80045.
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Zhang Z, Kolm P, Grau-Sepulveda MV, Ponirakis A, O'Brien SM, Klein LW, Shaw RE, McKay C, Shahian DM, Grover FL, Mayer JE, Garratt KN, Hlatky M, Edwards FH, Weintraub WS. Cost-effectiveness of revascularization strategies: the ASCERT study. J Am Coll Cardiol 2015; 65:1-11. [PMID: 25572503 DOI: 10.1016/j.jacc.2014.09.078] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/29/2014] [Accepted: 09/03/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND ASCERT (American College of Cardiology Foundation and the Society of Thoracic Surgeons Collaboration on the Comparative Effectiveness of Revascularization Strategies) was a large observational study designed to compare the long-term effectiveness of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) to treat coronary artery disease (CAD) over 4 to 5 years. OBJECTIVES This study examined the cost-effectiveness of CABG versus PCI for stable ischemic heart disease. METHODS The Society of Thoracic Surgeons and American College of Cardiology Foundation databases were linked to the Centers for Medicare and Medicaid Services claims data. Costs for the index and observation period (2004 to 2008) hospitalizations were assessed by diagnosis-related group Medicare reimbursement rates; costs beyond the observation period were estimated from average Medicare participant per capita expenditure. Effectiveness was measured via mortality and life-expectancy data. Cost and effectiveness comparisons were adjusted using propensity score matching with the incremental cost-effectiveness ratio expressed as cost per quality-adjusted life-year gained. RESULTS CABG patients (n = 86,244) and PCI patients (n = 103,549) were at least 65 years old with 2- or 3-vessel coronary artery disease. Adjusted costs were higher for CABG for the index hospitalization, study period, and lifetime by $10,670, $8,145, and $11,575, respectively. Patients undergoing CABG gained an adjusted average of 0.2525 and 0.3801 life-years relative to PCI over the observation period and lifetime, respectively. The life-time incremental cost-effectiveness ratio of CABG compared to PCI was $30,454/QALY gained. CONCLUSIONS Over a period of 4 years or longer, patients undergoing CABG had better outcomes but at higher costs than those undergoing PCI.
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Affiliation(s)
- Zugui Zhang
- Value Institute, Christiana Care Health System, Newark, Delaware.
| | - Paul Kolm
- Value Institute, Christiana Care Health System, Newark, Delaware
| | - Maria V Grau-Sepulveda
- Department of Outcomes, Health Economics, and Quality of Life, Duke Clinical Research Institute, Durham, North Carolina
| | - Angelo Ponirakis
- Department of Research Study, American College of Cardiology, Washington, DC
| | - Sean M O'Brien
- Department of Outcomes, Health Economics, and Quality of Life, Duke Clinical Research Institute, Durham, North Carolina
| | - Lloyd W Klein
- Section of Cardiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois
| | - Richard E Shaw
- Department of Clinical Informatics, California Pacific Medical Center, San Francisco, California
| | - Charles McKay
- Section of Cardiology, Harbor-UCLA Medical Center, Torrance, California
| | - David M Shahian
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Frederick L Grover
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado; Section of Cardiology, Denver Department of Veterans Affairs Medical Center, Denver, Colorado
| | - John E Mayer
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Kirk N Garratt
- Department of Interventional Cardiovascular Research, Lenox Hill Heart and Vascular Institute of New York, New York, New York
| | - Mark Hlatky
- Department of Health Research and Policy, Stanford University, Palo Alto, California
| | - Fred H Edwards
- Department of Surgery, University of Florida Shands Jacksonville, Jacksonville, Florida
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Quin J, Lucke J, Hattler B, Gupta S, Baltz J, Bishawi M, Almassi GH, Grover FL, Collins J, Shroyer AL. Surgeon judgment and utility of transit time flow probes in coronary artery bypass grafting surgery. JAMA Surg 2015; 149:1182-7. [PMID: 25251332 DOI: 10.1001/jamasurg.2014.1891] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Transit time flow (TTF) probes may be useful for predicting long-term graft patency and assessing grafts intraoperatively in patients undergoing coronary artery bypass grafting (CABG); however, studies of TTF probe use are limited. OBJECTIVE To examine 1-year graft patency and intraoperative revision rates in patients undergoing CABG based on intraoperative TTF assessment. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of a multicenter randomized clinical trial conducted at 18 Veterans Affairs hospitals using the Randomized On/Off Bypass (ROOBY) Trial data set. Of the original 2203 patients undergoing CABG surgery with or without cardiopulmonary bypass from February 1, 2002, through May 31, 2008, we studied a subset of 1607 who underwent TTF probe analysis of 1 or more grafts during surgery. EXPOSURES Use of TTF probes to assess graft flow and pulsatility index (PI) values. The decision to revise a graft was based on the judgment of the attending surgeon. MAIN OUTCOMES AND MEASURES Rates of 1-year FitzGibbon grade A patency and intraoperative revision were compared based on TTF measurements (<20 [low flow] vs ≥20 mL/min [normal flow]) and PI values (<3, 3-5, and >5). RESULTS We measured TTF and/or PI in 2738 grafts, and 1-year patency was determined in 1710 (62.5%) of these grafts. FitzGibbon grade A patency occurred significantly less often in grafts with a TTF with low flow (259 of 363 [71.3%]) than in those with normal flow (1174 of 1347 [87.2%]; P < .01). FitzGibbon grade A patency was also inversely correlated with increasing PI values, as found in 936 of 1093 grafts (85.6%) with a PI less than 3, 136 of 182 grafts (74.7%) with a PI of 3 to 5, and 91 of 134 grafts (67.9%) with a PI greater than 5 (P ≤ .01). Intraoperative graft revision was more frequent in grafts with low flow (44 of 568 [7.7%]) than in those with normal flow (8 of 2170 [0.4%]; P < .01). Graft revision was also more frequent as PI increased (12 of 1827 [0.7%] with a PI <3, 9 of 307 [2.9%] with a PI 3-5, and 9 of 155 [5.8%] with a PI >5; P < .01). CONCLUSIONS AND RELEVANCE Intraoperative TTF probe data may be helpful in predicting long-term patency and in the decision of whether to revise a questionable graft for patients undergoing CABG surgery.
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Affiliation(s)
- Jacquelyn Quin
- Surgery Service, Veterans Affairs (VA) Boston Healthcare System, West Roxbury, Massachusetts
| | - John Lucke
- Surgery Service, Charles George VA Medical Center, Asheville, North Carolina
| | - Brack Hattler
- Medicine Service, Department of VA Eastern Colorado Health Care System, Denver4Department of Medicine, University of Colorado School of Medicine-Anschutz Medical Campus, Aurora
| | - Sandeep Gupta
- Surgery Service, Northport VA Medical Center and Stony Brook University, Stony Brook, New York
| | - Janet Baltz
- Surgery Service, Department of VA Eastern Colorado Health Care System, Denver
| | - Muath Bishawi
- Surgery Service, Northport VA Medical Center and Stony Brook University, Stony Brook, New York6currently with Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, North Carolina
| | | | - Frederick L Grover
- Surgery Service, Department of VA Eastern Colorado Health Care System, Denver9Department of Surgery, University of Colorado School of Medicine-Anschutz Medical Campus, Aurora
| | - Joseph Collins
- Cooperative Studies Program Coordinating Center and VA Medical Center, Perry Point, Maryland
| | - A Laurie Shroyer
- Surgery Service, Northport VA Medical Center and Stony Brook University, Stony Brook, New York7Surgery Service, Department of VA Eastern Colorado Health Care System, Denver
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Affiliation(s)
- G Hossein Almassi
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA
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Almassi GH, Wagner TH, Carr B, Hattler B, Collins JF, Quin JA, Ebrahimi R, Grover FL, Bishawi M, Shroyer ALW. Postoperative atrial fibrillation impacts on costs and one-year clinical outcomes: the Veterans Affairs Randomized On/Off Bypass Trial. Ann Thorac Surg 2014; 99:109-14. [PMID: 25442992 DOI: 10.1016/j.athoracsur.2014.07.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/14/2014] [Accepted: 07/17/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND New-onset postoperative atrial fibrillation (POAF) after coronary artery bypass graft surgery (CABG) is associated with worse in-hospital morbidity and mortality, extended hospital stays, and higher costs. Beyond the initial hospital discharge, the cost and outcomes of POAF have not been well studied. METHODS For CABG patients with and without new-onset POAF, a retrospective propensity-matched, multivariable regression analysis was performed to compare 1-year outcomes (including health-related quality of life [HRQoL] scores and mortality rates) and costs (standardized to 2010 dollars). Regression models controlled for site and patient factors, with propensity matching used to adjust for differences in POAF versus no-POAF patients' risk profiles. RESULTS Using the existing CABG trial database, 2,096 patient records were analyzed, including POAF patients (n = 549) versus no-POAF patients (n = 1,547). For the index CABG hospitalization, POAF patients had longer postoperative length of stay (+3.9 days) and higher discharge costs (+$13,993) than no-POAF patients. At 1 year, POAF patients had more than twice the adjusted odds of dying (p < 0.01), with higher 1-year total cumulative costs. This 1-year cost difference (+$15,593) was largely attributable to hospital-based costs during the index surgery hospitalization. There was no difference in 1-year HRQoL scores (or HRQoL score changes) between POAF patients and no-POAF patients. CONCLUSIONS Compared with no-POAF patients, POAF patients had higher discharge and 1-year costs along with higher 1-year mortality rates, but no differences were observed in 1-year HRQoL scores. Additional research appears warranted to improve the longer-term survival rates for POAF CABG patients, targeting future POAF-specific postdischarge interventions.
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Affiliation(s)
- G Hossein Almassi
- Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin; Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Todd H Wagner
- Veterans Affairs Palo Alto Health Economics Resource Center, Menlo Park, California; Department of Health Research and Policy, Stanford University, Stanford, California
| | - Brendan Carr
- Northport Veterans Affair Medical Center, Northport, New York
| | - Brack Hattler
- Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado; University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colorado
| | - Joseph F Collins
- Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland
| | | | - Ramin Ebrahimi
- Greater Los Angeles VA Medical Center, Los Angeles, California
| | - Frederick L Grover
- Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado; University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colorado
| | - Muath Bishawi
- Northport Veterans Affair Medical Center, Northport, New York
| | - A Laurie W Shroyer
- Northport Veterans Affair Medical Center, Northport, New York; Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado
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Jacobs JP, O'Brien SM, Pasquali SK, Kim S, Gaynor JW, Tchervenkov CI, Karamlou T, Welke KF, Lacour-Gayet F, Mavroudis C, Mayer JE, Jonas RA, Edwards FH, Grover FL, Shahian DM, Jacobs ML. The importance of patient-specific preoperative factors: an analysis of the society of thoracic surgeons congenital heart surgery database. Ann Thorac Surg 2014; 98:1653-8; discussion 1658-9. [PMID: 25262395 DOI: 10.1016/j.athoracsur.2014.07.029] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 07/04/2014] [Accepted: 07/09/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The most common forms of risk adjustment for pediatric and congenital heart surgery used today are based mainly on the estimated risk of mortality of the primary procedure of the operation. The goals of this analysis were to assess the association of patient-specific preoperative factors with mortality and to determine which of these preoperative factors to include in future pediatric and congenital cardiac surgical risk models. METHODS All index cardiac operations in The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) during 2010 through 2012 were eligible for inclusion. Patients weighing less than 2.5 kg undergoing patent ductus arteriosus closure were excluded. Centers with more than 10% missing data and patients with missing data for discharge mortality or other key variables were excluded. Rates of discharge mortality for patients with or without specific preoperative factors were assessed across age groups and were compared using Fisher's exact test. RESULTS In all, 25,476 operations were included (overall discharge mortality 3.7%, n=943). The prevalence of common preoperative factors and their associations with discharge mortality were determined. Associations of the following preoperative factors with discharge mortality were all highly significant (p<0.0001) for neonates, infants, and children: mechanical circulatory support, renal dysfunction, shock, and mechanical ventilation. CONCLUSIONS Current STS-CHSD risk adjustment is based on estimated risk of mortality of the primary procedure of the operation as well as age, weight, and prematurity. The inclusion of additional patient-specific preoperative factors in risk models for pediatric and congenital cardiac surgery could lead to increased precision in predicting risk of operative mortality and comparison of observed to expected outcomes.
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Affiliation(s)
- Jeffrey Phillip Jacobs
- Johns Hopkins All Children's Heart Institute, Saint Petersburg, Florida; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Sean M O'Brien
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Sara K Pasquali
- Department of Pediatrics and Communicable Diseases, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Sunghee Kim
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | - Christo Ivanov Tchervenkov
- Division of Pediatric Cardiac Surgery, Benioff Children's Hospital, University of California San Francisco, San Francisco, California
| | - Tara Karamlou
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Karl F Welke
- Children's Hospital of Illinois, Peoria, Illinois
| | | | - Constantine Mavroudis
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John E Mayer
- Children's Hospital Boston, Harvard University Medical School, Boston, Massachusetts
| | - Richard A Jonas
- Children's National Heart Institute, Children's National Medical Center, Washington, DC
| | - Fred H Edwards
- Shands Jacksonville, University of Florida, College of Medicine-Jacksonville, Jacksonville, Florida
| | | | - David M Shahian
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marshall Lewis Jacobs
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Bakaeen FG, Shroyer ALW, Gammie JS, Sabik JF, Cornwell LD, Coselli JS, Rosengart TK, O'Brien SM, Wallace A, Shahian DM, Grover FL, Puskas JD. Trends in use of off-pump coronary artery bypass grafting: Results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. J Thorac Cardiovasc Surg 2014; 148:856-3, 864.e1; discussion 863-4. [DOI: 10.1016/j.jtcvs.2013.12.047] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 10/28/2013] [Accepted: 12/04/2013] [Indexed: 11/30/2022]
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Edwards FH, Shahian DM, Grau-Sepulveda MV, Grover FL, Mayer JE, O'Brien SM, DeLong E, Peterson ED, McKay C, Shaw RE, Garratt KN, Dangas GD, Messenger J, Klein LW, Popma JJ, Weintraub WS. Composite outcomes in coronary bypass surgery versus percutaneous intervention. Ann Thorac Surg 2014; 97:1983-8; discussion 1988-90. [PMID: 24775805 DOI: 10.1016/j.athoracsur.2014.01.087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/08/2014] [Accepted: 01/14/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Recent observational studies show that patients with multivessel coronary disease have a long-term survival advantage with coronary artery bypass grafting (CABG) compared with percutaneous coronary intervention (PCI). Important nonfatal outcomes may also affect optimal treatment recommendation. METHODS CABG was compared with percutaneous catheter intervention by using a composite of death, myocardial infarction (MI), or stroke. Medicare patients undergoing revascularization for stable multivessel coronary disease from 2004 through 2008 were identified in national registries. Short-term clinical information from the registries was linked to Medicare data to obtain long-term follow-up out to 4 years from the time of the procedure. Propensity scoring with inverse probability weighting was used to adjust for baseline risk factors. RESULTS There were 86,244 CABG and 103,549 PCI patients. The mean age was 74 years, with a median 2.67 years of follow-up. At 4 years, the propensity-adjusted adjusted cumulative incidence of MI was 3.2% in CABG compared with 6.6% in PCI (risk ratio, 0.49; 95% confidence interval, 0.45 to 0.53). At 4 years, the cumulative incidence of stroke was 4.5% in CABG compared with 3.1% in PCI patients (risk ratio, 1.43; 95% confidence interval, 1.31 to 1.54). This difference was primarily due to the higher 30-day stroke rate for CABG (1.55% vs 0.37%). For the composite of death, MI, or stroke, the 4-year adjusted cumulative incidence was 21.6% for CABG and 26.7% for PCI (risk ratio, 0.81; 95% confidence interval, 0.78 to 0.83). CONCLUSIONS The 4-year composite event rate of death, MI, and stroke favored CABG, whereas the risk of stroke alone favored PCI.
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Affiliation(s)
| | | | | | | | - John E Mayer
- Children's Hospital Boston, Boston, Massachusetts
| | - Sean M O'Brien
- Duke Clinical Research Institute, Durham, North Carolina
| | | | | | | | - Richard E Shaw
- California Pacific Medical Center, San Francisco, California
| | - Kirk N Garratt
- Lenox Hill Heart and Vascular Institute of New York, New York, New York
| | | | - John Messenger
- University of Colorado School of Medicine, Aurora, Colorado
| | - Lloyd W Klein
- Advocate Illinois Masonic Medical Center, Chicago, Illinois
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Rich J, Grover FL, Prager RL, Speir A. Quality improvement in cardiac surgery: January 30, 2013, Los Angeles, CA. Semin Thorac Cardiovasc Surg 2013; 25:171-91. [PMID: 24216534 DOI: 10.1053/j.semtcvs.2013.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jeffrey Rich
- Mid-Atlantic Cardiothoracic Surgeones, Ltd., Norfolk, VA..
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Wagner TH, Shroyer ALW, Hattler B, Collins JF, Grover FL. The challenges with interpreting cost-effectiveness data. SCAND CARDIOVASC J 2013; 47:383. [PMID: 24200227 DOI: 10.3109/14017431.2013.851413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Todd H Wagner
- VA Palo Alto Health Economics Resource Center Menlo Park , CA , USA
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Reece TB, Welke KF, O'Brien S, Grau-Sepulveda MV, Grover FL, Gammie JS. Rethinking the ross procedure in adults. Ann Thorac Surg 2013; 97:175-81. [PMID: 24070703 DOI: 10.1016/j.athoracsur.2013.07.036] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 06/11/2013] [Accepted: 07/11/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although questionable durability has tempered enthusiasm for the Ross procedure in the last decade, the perioperative risks of the Ross procedure relative to conventional aortic valve replacement are not well described. The goal of this study is to describe both the perioperative outcomes and utilization trends of the Ross procedure in adults in The Society of Thoracic Surgeons Adult Cardiac Surgery Database. METHODS The Society of Thoracic Surgeons Adult Cardiac Surgery Database was used to review all Ross procedures performed between 1994 and 2010. The utilization of the procedure in the database was assessed. Then the preoperative comorbidities, patient demographics, and risk factors were reviewed, as were intraoperative and perioperative outcomes. RESULTS Of 648,541 aortic valve replacements during the study period, 3,054 (0.47%) were identified as Ross procedures. Utilization of the procedures as a percent of total aortic valve replacements peaked in 1998 at 1.2%, followed by a steady decline to 0.09% by 2010. More than a quarter of all Ross operations were performed at six sites. Using propensity-matching analyses, Ross patients experienced significantly more perioperative complications including reexploration (9.4% versus 5.8%; p < 0.01), renal failure (2.6% versus 0.8%; p < 0.001), and operative mortality (2.7% versus 0.9%; p = 0.001). CONCLUSIONS These data suggest that the Ross procedure is associated with greater perioperative morbidity and mortality risks compared with conventional aortic valve replacement. Recognition of these risks along with durability concerns have resulted in a dramatic decline in the number of Ross procedures performed in North America in the last decade.
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Affiliation(s)
- T Brett Reece
- Department of Surgery, University of Colorado, Denver, Colorado.
| | - Karl F Welke
- Division of Cardiothoracic Surgery, Oregon Health Sciences Center, Portland, Oregon
| | - Sean O'Brien
- Duke Clinical Research Institute, Durham, North Carolina
| | | | | | - James S Gammie
- Division of Cardiac Surgery, University of Maryland, Baltimore, Maryland
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Carroll JD, Edwards FH, Marinac-Dabic D, Brindis RG, Grover FL, Peterson ED, Tuzcu EM, Shahian DM, Rumsfeld JS, Shewan CM, Hewitt K, Holmes DR, Mack MJ. The STS-ACC Transcatheter Valve Therapy National Registry. J Am Coll Cardiol 2013; 62:1026-34. [DOI: 10.1016/j.jacc.2013.03.060] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 03/17/2013] [Accepted: 03/19/2013] [Indexed: 11/30/2022]
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Wagner TH, Hattler B, Bishawi M, Baltz JH, Collins JF, Quin JA, Grover FL, Shroyer ALW. On-Pump versus Off-Pump Coronary Artery Bypass Surgery: Cost-Effectiveness Analysis Alongside a Multisite Trial. Ann Thorac Surg 2013; 96:770-7. [DOI: 10.1016/j.athoracsur.2013.04.074] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 04/23/2013] [Accepted: 04/26/2013] [Indexed: 11/29/2022]
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Grover FL, Mack MJ. The current role of coronary artery bypass in diabetics with multivessel coronary disease. EUROINTERVENTION 2013; 9:183-6. [PMID: 23793006 DOI: 10.4244/eijv9i2a30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Frederick L Grover
- Department of Surgery, University of Colorado School of Medicine, AuroraColorado 80045, USA.
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Bishawi M, Shroyer AL, Rumsfeld JS, Spertus JA, Baltz JH, Collins JF, Quin JA, Almassi GH, Grover FL, Hattler B. Changes in Health-Related Quality of Life in Off-Pump Versus On-Pump Cardiac Surgery: Veterans Affairs Randomized On/Off Bypass Trial. Ann Thorac Surg 2013; 95:1946-51. [DOI: 10.1016/j.athoracsur.2012.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 12/01/2012] [Accepted: 12/04/2012] [Indexed: 11/29/2022]
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Zhang Z, Kolm P, Jurkovitz C, Edwards F, Grau-Sepulveda M, Ponirakis A, McKay C, Shahian DM, Grover FL, Mayer JE, Shaw R, O’Brien SM, Weintraub WS. Abstract 220: Cost-effectiveness of CABG vs PCI for Treatment of Multivessel Coronary Disease among Diabetes Patients---A Secondary Analysis from ASCERT. Circ Cardiovasc Qual Outcomes 2013. [DOI: 10.1161/circoutcomes.6.suppl_1.a220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The ASCERT--American College of Cardiology Foundation (ACCF) - Society of Thoracic Surgeons (STS) Database Collaboration on the Comparative Effectiveness of Revascularization Strategies study - has demonstrated that coronary artery bypass graft (CABG) surgery was associated with reduced mortality compared to percutaneous coronary intervention (PCI) at 4 years. In this study, we examined the cost-effectiveness of CABG versus PCI for treatment of multivessel coronary disease patients among diabetes patients.
Methods:
Diabetes Patients age ≥65 years with stable 2 and 3-vessel disease undergoing revascularization from 2004 through 2008 were evaluated. CABG patients with diabetes were selected from the STS National Database and the PCI patient population from The ACCF National Cardiovascular Data Registry. Costs were assessed at index, study period from years 2004 to 2008 by Diagnosis Related Group for hospitalizations. The average Medicare participant per capita expenditure in 2004 was used to estimate cost beyond the study period. Effectiveness during the study period was measured via mortality rate. Costs and effectiveness were adjusted using propensity scores and inverse probability weighting to reduce treatment selection bias. The incremental cost-effectiveness ratio (ICER) was expressed as cost per LYG.
Results:
Among diabetes patients (24,508 of 86,244 in CABG group and 25,481 of 103,549 in PCI group) at least 65 years old with two or three vessel coronary artery disease, costs were higher for CABG by $11,013 (95% CI: $10,930 to $11,136) during the index hospitalization. Over the period from 2004 through 2008 , average total costs were $28,413 for CABG versus $20,268 for PCI, a difference of $8,145 (95% CI: $7,918 to $8,373); patients undergoing CABG gained an average of 0.1524 life-years relative to PCI; the ICER of CABG, compared to PCI, was $53,500 per LYG, with 18%, 42%, 78%, and 88% of bootstrap-derived estimates <$25,000/LYG , <$50,000/LYG , <$75,000/LYG , and <$100,000/LYG, respectively.
Conclusions:
This study shows that over a period of 4 years or longer, CABG is associated with better outcomes but at higher cost than PCI in patients with diabetes.
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Affiliation(s)
| | - Paul Kolm
- Christiana Care Health System, Newark, DE
| | | | - Fred Edwards
- Univ of Florida Shands Jacksonville, Jacksonville, FL
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Abstract
Background—
A major advantage of coronary artery bypass graft surgery (CABG) relative to percutaneous coronary intervention is its durability, yet there is a paucity of information on rates and predictors of repeat coronary revascularization after CABG in the modern era.
Methods and Results—
We included patients ≥65 years from the Society of Thoracic Surgeons’ National Adult Cardiac Surgery Database who were undergoing first-time isolated CABG from 1991 to 2007 (n=723 134, median age 73 years). After linking to Medicare claims data, long-term outcomes of CABG (up to 18 years after surgery) were examined by use of cumulative incidence curves. Multivariable Cox proportional hazard analysis was used to identify factors associated with 1- and 5-year repeat revascularization trends and variability. We found that the overall 18-year survival rate was 20%. Cumulative incidences of any repeat revascularization (percutaneous coronary intervention or CABG, yet most often percutaneous coronary intervention) were 2%, 7%, 13%, and 16% at 1, 5, 10, and 18 years after surgery, respectively. The rates of repeat CABG procedures were quite low for all time points (0.1%, 0.6%, 1.3%, and 1.7%, respectively). Female sex, disease severity represented by a history of percutaneous coronary intervention, preoperative dialysis, and partial revascularization were strongly associated with a higher revascularization rate, whereas advanced age, left main disease, and smoking were associated with a lower rate. There was approximately a 2-fold variation in repeat revascularization rates across centers at 1 year (interquartile range 1.7–3.6%) and 5 years (interquartile range 6.7–12.0%).
Conclusions—
Repeat revascularization is performed infrequently among older patients who undergo CABG; however, these rates vary substantially by patient subgroups and among providers.
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Affiliation(s)
- Emil L. Fosbøl
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.L.F., Y.Z., E.D.P.); the Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, MA (D.M.S.); the Division of Cardiothoracic Surgery, University of Colorado School of Medicine, and the Surgical Service, Denver VA Medical Center, Denver, CO (F.L.G.); and the Department of Cardiothoracic Surgery, University of Florida, Jacksonville, FL (F.H.E.)
| | - Yue Zhao
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.L.F., Y.Z., E.D.P.); the Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, MA (D.M.S.); the Division of Cardiothoracic Surgery, University of Colorado School of Medicine, and the Surgical Service, Denver VA Medical Center, Denver, CO (F.L.G.); and the Department of Cardiothoracic Surgery, University of Florida, Jacksonville, FL (F.H.E.)
| | - David M. Shahian
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.L.F., Y.Z., E.D.P.); the Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, MA (D.M.S.); the Division of Cardiothoracic Surgery, University of Colorado School of Medicine, and the Surgical Service, Denver VA Medical Center, Denver, CO (F.L.G.); and the Department of Cardiothoracic Surgery, University of Florida, Jacksonville, FL (F.H.E.)
| | - Frederick L. Grover
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.L.F., Y.Z., E.D.P.); the Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, MA (D.M.S.); the Division of Cardiothoracic Surgery, University of Colorado School of Medicine, and the Surgical Service, Denver VA Medical Center, Denver, CO (F.L.G.); and the Department of Cardiothoracic Surgery, University of Florida, Jacksonville, FL (F.H.E.)
| | - Fred H. Edwards
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.L.F., Y.Z., E.D.P.); the Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, MA (D.M.S.); the Division of Cardiothoracic Surgery, University of Colorado School of Medicine, and the Surgical Service, Denver VA Medical Center, Denver, CO (F.L.G.); and the Department of Cardiothoracic Surgery, University of Florida, Jacksonville, FL (F.H.E.)
| | - Eric D. Peterson
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.L.F., Y.Z., E.D.P.); the Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, MA (D.M.S.); the Division of Cardiothoracic Surgery, University of Colorado School of Medicine, and the Surgical Service, Denver VA Medical Center, Denver, CO (F.L.G.); and the Department of Cardiothoracic Surgery, University of Florida, Jacksonville, FL (F.H.E.)
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Shahian DM, Jacobs JP, Edwards FH, Brennan JM, Dokholyan RS, Prager RL, Wright CD, Peterson ED, McDonald DE, Grover FL. The society of thoracic surgeons national database. Heart 2013; 99:1494-501. [PMID: 23335498 DOI: 10.1136/heartjnl-2012-303456] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIMS The Society of Thoracic Surgeons (STS) National Database collects detailed clinical information on patients undergoing adult cardiac, paediatric and congenital cardiac, and general thoracic surgical operations. These data are used to support risk-adjusted, nationally benchmarked performance assessment and feedback; voluntary public reporting; quality improvement initiatives; guideline development; appropriateness determination; shared decision making; research using cross-sectional and longitudinal registry linkages; comparative effectiveness studies; government collaborations including postmarket surveillance; regulatory compliance and reimbursement strategies. INTERVENTIONS All database participants receive feedback reports which they may voluntarily share with their hospitals or payers, or publicly report. STS analyses are regularly used as the basis for local, regional and national quality improvement efforts. POPULATION More than 90% of adult cardiac programmes in the USA participate, as do the majority of paediatric cardiac programmes, and general thoracic participation continues to increase. Since the inception of the Database in 1989, more than 5 million patient records have been submitted. BASELINE DATA Each of the three subspecialty databases includes several hundred variables that characterise patient demographics, diagnosis, medical history, clinical risk factors and urgency of presentation, operative details and postoperative course including adverse outcomes. DATA CAPTURE Data are entered by trained data abstractors and by the care team, using detailed data specifications for each element. DATA QUALITY Quality and consistency checks assure accurate and complete data, missing data are rare, and audits are performed annually of selected participant sites. ENDPOINTS All major outcomes are reported including complications, status at discharge and mortality. DATA ACCESS Applications for STS Database participants to use aggregate national data for research are available at http://www.sts.org/quality-research-patient-safety/research/publications-and-research/access-data-sts-national-database.
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Affiliation(s)
- David M Shahian
- Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, , Boston, Massachusetts, USA
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Messenger JC, Ho KKL, Young CH, Slattery LE, Draoui JC, Curtis JP, Dehmer GJ, Grover FL, Mirro MJ, Reynolds MR, Rokos IC, Spertus JA, Wang TY, Winston SA, Rumsfeld JS, Masoudi FA. The National Cardiovascular Data Registry (NCDR) Data Quality Brief: the NCDR Data Quality Program in 2012. J Am Coll Cardiol 2012; 60:1484-8. [PMID: 22999725 DOI: 10.1016/j.jacc.2012.07.020] [Citation(s) in RCA: 301] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 06/29/2012] [Accepted: 07/02/2012] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The National Cardiovascular Data Registry (NCDR) developed the Data Quality Program to meet the objectives of ensuring the completeness, consistency, and accuracy of data submitted to the observational clinical registries. The Data Quality Program consists of 3 main components: 1) a data quality report; 2) a set of internal quality assurance protocols; and 3) a yearly data audit program. BACKGROUND Since its inception in 1997, the NCDR has been the basis for the development of performance and quality metrics, site-level quality improvement programs, and peer-reviewed health outcomes research. METHODS Before inclusion in the registry, data are filtered through the registry-specific algorithms that require predetermined levels of completeness and consistency for submitted data fields as part of the data quality report. Internal quality assurance protocols enforce data standards before reporting. Within each registry, 300 to 625 records are audited annually in 25 randomly identified sites (i.e., 12 to 25 records per audited site). RESULTS In the 2010 audits, the participant average raw accuracy of data abstraction for the CathPCI Registry, ICD Registry, and ACTION Registry-GWTG were, respectively, 93.1% (range, 89.4% minimum, 97.4% maximum), 91.2% (range, 83.7% minimum, 95.7% maximum), and 89.7.% (range, 85% minimum, 95% maximum). CONCLUSIONS The 2010 audits provided evidence that many fields in the NCDR accurately represent the data from the medical charts. The American College of Cardiology Foundation is undertaking a series of initiatives aimed at creating a quality assurance rapid learning system, which, when complete, will monitor, evaluate, and improve data quality.
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Affiliation(s)
- John C Messenger
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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