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Mirzai S, Badwan OZ, Sankar PR, Karmali R, Almaaitah S, Gomes MP, Miyasaka R, Quatromoni N, Tong MZY, Wassif H. Ross procedure after prosthetic valve thrombosis in a patient with antiphospholipid syndrome and recurrent bleeding. Int J Rheum Dis 2023. [PMID: 36808218 DOI: 10.1111/1756-185x.14596] [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: 09/06/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 02/23/2023]
Abstract
The Ross procedure allows replacement of a diseased aortic valve with pulmonary root autograft, possibly avoiding the highly thrombotic mechanical valves and immunologic deterioration of tissue valves in antiphospholipid syndrome (APS). Here, we present the use of the Ross procedure in a 42-year-old woman with mild intellectual disability, APS, and a complex anticoagulation history after she presented with thrombosis of her mechanical On-X aortic valve previously implanted for non-bacterial thrombotic endocarditis.
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Affiliation(s)
- Saeid Mirzai
- Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Rehan Karmali
- Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Saja Almaaitah
- Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marcelo P Gomes
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rhonda Miyasaka
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Neha Quatromoni
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Heba Wassif
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Zahid S, Mohamed MS, Wassif H, Nazir NT, Khan SS, Michos ED. Analysis of Cardiovascular Complications During Delivery Admissions Among Patients With Systemic Lupus Erythematosus, 2004-2019. JAMA Netw Open 2022; 5:e2243388. [PMID: 36445710 PMCID: PMC9709646 DOI: 10.1001/jamanetworkopen.2022.43388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/30/2022] Open
Abstract
IMPORTANCE Individuals with systemic lupus erythematosus (SLE) have an increased risk of pregnancy-related complications. However, data on acute cardiovascular complications during delivery admissions remain limited. OBJECTIVE To investigate whether SLE is associated with an increased risk of acute peripartum cardiovascular complications during delivery hospitalization among individuals giving birth. DESIGN, SETTING, AND PARTICIPANTS This population-based cross-sectional study was conducted with data from the National Inpatient Sample (2004-2019) by using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) codes to identify delivery hospitalizations among birthing individuals with a diagnosis of SLE. A multivariable logistic regression model was developed to report an adjusted odds ratio (OR) for the association between SLE and acute peripartum cardiovascular complications. Data were analyzed from May 1 through September 1, 2022. EXPOSURE Diagnosed SLE. MAIN OUTCOMES AND MEASURES Primary study end points were preeclampsia, peripartum cardiomyopathy, and heart failure. Secondary end points included ischemic and hemorrhagic stroke, pulmonary edema, cardiac arrhythmias, acute kidney injury (AKI), venous thromboembolism (VTE), length of stay, and cost of hospitalization. RESULTS A total of 63 115 002 weighted delivery hospitalizations (median [IQR] age, 28 [24-32] years; all were female patients) were identified, of which 77 560 hospitalizations (0.1%) were among individuals with SLE and 63 037 442 hospitalizations (99.9%) were among those without SLE. After adjustment for age, race and ethnicity, comorbidities, insurance, and income level, SLE remained an independent risk factor associated with peripartum cardiovascular complications, including preeclampsia (adjusted OR [aOR], 2.12; 95% CI, 2.07-2.17), peripartum cardiomyopathy (aOR, 4.42; 95% CI, 3.79-5.13), heart failure (aOR, 4.06; 95% CI, 3.61-4.57), cardiac arrhythmias (aOR, 2.06; 95% CI, 1.94-2.21), AKI (aOR, 7.66; 95% CI, 7.06-8.32), stroke (aOR, 4.83; 95% CI, 4.18-5.57), and VTE (aOR, 6.90; 95% CI, 6.11-7.80). For resource use, median (IQR) length of stay (3 [2-4] days vs 2 [2-3] days; P < .001) and cost of hospitalization ($4953 [$3305-$7517] vs $3722 [$2606-$5400]; P < .001) were higher for deliveries among individuals with SLE. CONCLUSIONS AND RELEVANCE This study found that SLE was associated with increased risk of complications, including preeclampsia, peripartum cardiomyopathy, heart failure, arrhythmias, AKI, stroke, and VTE during delivery hospitalization and an increased length and cost of hospitalization.
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Affiliation(s)
- Salman Zahid
- Department of Medicine, Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York
| | - Mohamed S. Mohamed
- Department of Medicine, Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York
| | - Heba Wassif
- Division of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Noreen T. Nazir
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Sadiya S. Khan
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Goldar G, Garraud C, Sifuentes AA, Wassif H, Jain V, Klein AL. Autoimmune Pericarditis: Multimodality Imaging. Curr Cardiol Rep 2022; 24:1633-1645. [PMID: 36219367 DOI: 10.1007/s11886-022-01785-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF THE REVIEW The purpose of this review is to understand the underlying mechanism that leads to pericarditis in systemic autoimmune and autoinflammatory diseases. The underlying mechanism plays a vital role in the appropriate management of patients. In addition, we will review the current landscape of available cardiac imaging modalities with emphasis on pericardial conditions as well as proposed treatment and management tailored toward pericardial autoimmune and autoinflammatory processes. RECENT FINDINGS Approximately 22% of all cases of pericarditis with a known etiology are caused by systemic autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, and vasculitis. In recent years, there have been advancements of imaging modalities including cardiac MRI, cardiac CT scan, and PET scan and their respective nuances in regard to contrast use, technique, and views which clinicians may utilize to better understand the extent of a patient's pericardial pathology and the trajectory of his or her disease process. In this review, we will discuss systemic autoimmune and autoinflammatory diseases that involve the pericardium. We will also review different imaging modalities that are currently used to further characterize such conditions. Having a deeper understanding of such techniques will improve patient outcomes by helping clinicians tailor treatment plans according to the unique underlying condition.
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Affiliation(s)
- Ghazaleh Goldar
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA.
| | - Cassandra Garraud
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA
| | - Aaron A Sifuentes
- University of Michigan Department of Internal Medicine, Ann Arbor, MI, USA
| | - Heba Wassif
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA
| | - Vardhmaan Jain
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, 44195, USA
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Mirzai S, Kanaan CN, Berglund F, Mountis M, Wassif H. How do we maximize diuresis in acute decompensated heart failure? Cleve Clin J Med 2022; 89:561-565. [DOI: 10.3949/ccjm.89a.22016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Wassif H, Saad M, Desai R, Hajj‐Ali RA, Menon V, Chaudhury P, Nakhla M, Puri R, Prasada S, Reed GW, Ziada K, Kapadia S, Desai M, Mentias A. Outcomes Following Acute Coronary Syndrome in Patients With and Without Rheumatic Immune‐Mediated Inflammatory Diseases. J Am Heart Assoc 2022; 11:e026411. [DOI: 10.1161/jaha.122.026411] [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
Rheumatic immune mediated inflammatory diseases (IMIDs) are associated with high risk of acute coronary syndrome. The long‐term prognosis of acute coronary syndrome in patients with rheumatic IMIDs is not well studied.
Methods and Results
We identified Medicare beneficiaries admitted with a primary diagnosis of myocardial infarction (MI) from 2014 to 2019. Outcomes of patients with MI and concomitant rheumatic IMIDs including systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, dermatomyositis, or psoriasis were compared with propensity matched control patients without rheumatic IMIDs. One‐to‐three propensity‐score matching was done for exact age, sex, race, ST‐segment–elevation MI, and non–ST‐segment–elevation MI variables and greedy approach on other comorbidities. The study primary outcome was all‐cause mortality. The study cohort included 1 654 862 patients with 3.6% prevalence of rheumatic IMIDs, the most common of which was rheumatoid arthritis, followed by systemic lupus erythematosus. Patients with rheumatic IMIDs were younger, more likely to be women, and more likely to present with non–ST‐segment–elevation MI. Patients with rheumatic IMIDs were less likely to undergo coronary angiography, percutaneous coronary intervention or coronary artery bypass grafting. After propensity‐score matching, at median follow up of 24 months (interquartile range 9–45), the risk of mortality (adjusted hazard ratio [HR], 1.15 [95% CI, 1.14–1.17]), heart failure (HR, 1.12 [95% CI 1.09–1.14]), recurrent MI (HR, 1.08 [95% CI 1.06–1.11]), and coronary reintervention (HR, 1.06 [95% CI, 1.01–1.13]) (
P
<0.05 for all) was higher in patients with versus without rheumatic IMIDs.
Conclusions
Patients with MI and rheumatic IMIDs have higher risk of mortality, heart failure, recurrent MI, and need for coronary reintervention during follow‐up compared with patients without rheumatic IMIDs.
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Affiliation(s)
- Heba Wassif
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Marwan Saad
- Lifespan Cardiovascular Institute Providence RI
- Department of Medicine, Division of Cardiovascular Medicine, Warren Alpert Medical School of Brown University Providence RI
| | - Rajul Desai
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Rula A. Hajj‐Ali
- Department of Rheumatic and Immunologic Disease Cleveland Clinic Cleveland OH
| | - Venu Menon
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Pulkit Chaudhury
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Michael Nakhla
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Rishi Puri
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Sameer Prasada
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Grant W. Reed
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Khaled Ziada
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Samir Kapadia
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Milind Desai
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Amgad Mentias
- Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
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Waldman CE, Min JH, Wassif H, Freeman AM, Rzeszut AK, Reilly J, Theriot P, Soliman AM, Thamman R, Bhatt A, Bhavnani SP. COVID-19 telehealth preparedness: a cross-sectional assessment of cardiology practices in the USA. Per Med 2022; 19:411-422. [PMID: 35912812 DOI: 10.2217/pme-2021-0179] [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] [Indexed: 11/21/2022]
Abstract
Aim: The COVID-19 pandemic forced medical practices to augment healthcare delivery to remote and virtual services. We describe the results of a nationwide survey of cardiovascular professionals regarding telehealth perspectives. Materials & methods: A 31-question survey was sent early in the pandemic to assess the impact of COVID-19 on telehealth adoption & reimbursement. Results: A total of 342 clinicians across 42 states participated. 77% were using telehealth, with the majority initiating usage 2 months after the COVID-19 shutdown. A variety of video-based systems were used. Telehealth integration requirements differed, with electronic medical record integration being mandated in more urban than rural practices (70 vs 59%; p < 0.005). Many implementation barriers surfaced, with over 75% of respondents emphasizing reimbursement uncertainty and concerns for telehealth generalizability given the complexity of cardiovascular diseases. Conclusion: Substantial variation exists in telehealth practices. Further studies and legislation are needed to improve access, reimbursement and the quality of telehealth-based cardiovascular care.
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Affiliation(s)
- Carly E Waldman
- Department of Internal Medicine, Scripps Clinic, San Diego, CA, USA.,Division of Cardiology, Healthcare Innovation Laboratory, Prebys Cardiovascular Institute, Scripps Clinic, San Diego, CA 92037,USA
| | - Jean H Min
- Department of Internal Medicine, Scripps Clinic, San Diego, CA, USA.,Division of Cardiology, Healthcare Innovation Laboratory, Prebys Cardiovascular Institute, Scripps Clinic, San Diego, CA 92037,USA
| | - Heba Wassif
- Department of Cardiovascular Medicine, Section of Clinical Cardiology, Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44103, USA
| | - Andrew M Freeman
- Department of Medicine, Division of Cardiology, National Jewish Health, Denver, CO 80206, USA
| | - Anne K Rzeszut
- American College of Cardiology, Heart House, Washington, DC 20037, USA
| | - Jack Reilly
- American College of Cardiology, Heart House, Washington, DC 20037, USA
| | - Paul Theriot
- American College of Cardiology, Heart House, Washington, DC 20037, USA
| | - Ahmed M Soliman
- Division of Cardiology, Houston Methodist DeBakey Cardiology Associates, Houston, TX 77030, USA
| | - Ritu Thamman
- Division of Medicine, University of Pittsburg School of Medicine, Pittsburg, PA 15213, USA
| | - Ami Bhatt
- Division of Cardiology, Adult Congenital Heart Disease Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sanjeev P Bhavnani
- Division of Cardiology, Healthcare Innovation Laboratory, Prebys Cardiovascular Institute, Scripps Clinic, San Diego, CA 92037,USA
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Gad MM, Lichtman D, Saad AM, Isogai T, Bansal A, Abdallah MS, Roselli E, Chatterjee S, Reed GW, Kapadia SR, Menon V, Wassif H. Autoimmune connective tissue diseases and aortic valve replacement outcomes: a population-based study. European Heart Journal Open 2022; 2:oeac024. [PMID: 35919348 PMCID: PMC9242052 DOI: 10.1093/ehjopen/oeac024] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/26/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Patients with autoimmune connective tissue diseases (CTDs) have a high burden of valvular heart disease and are often thought of as high surgical risk patients.
Methods and results
Patients undergoing aortic valve replacement (AVR) were identified in the Nationwide Readmissions Database between January 2012 and December 2018. Patients with a history of systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, mixed C, Sjögren syndrome, polymyositis, and dermatomyositis were included in the CTD cohort. Patients undergoing coronary artery bypass grafting concomitantly with AVR were excluded. A total of 569 600 hospitalizations were included, of which16 531 (2.9%) had CTD. CTD patients were more likely to be females, with higher rates of heart failure, pulmonary hypertension, and more likely to be insured by Medicare. CTD patients had lower mortality than non-CTD patients [odds ratio (OR) 0.66; 95% confidence interval (CI): 0.59–0.74] and stroke [OR 0.87; 95% (CI): 0.79–0.97]. CTD patients undergoing SAVR had lower mortality [OR 0.69; 95% (CI): 0.60–0.80] and stroke [OR 0.86; 95% (CI): 0.75–0.98). CTD patients undergoing TAVR had lower mortality outcomes [OR 0.67; 95% (CI): 0.56–0.80]; however, they had comparable stroke outcomes [OR 0.97; 95% (CI): 0.83–1.13, P = 0.69].
Conclusions
Outcomes for patients with CTD requiring AVR are not inferior to their non-CTD counterparts. A comprehensive heart team selection of patients undergoing AVR approaches should place CTD history under consideration; however, pre-existing CTD should not be prohibitive of AVR interventions.
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Affiliation(s)
- Mohamed M. Gad
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
- Gillings School of Global Public Health, the University of North Carolina at Chapel Hill , Chapel Hill, NC 27599, USA
| | - Devora Lichtman
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Anas M. Saad
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Agam Bansal
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Mouin S. Abdallah
- Department of Cardiology, Medstar Heart and Vascular Institute , Fairfax, VA 22031, USA
| | - Eric Roselli
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Soumya Chatterjee
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Grant W. Reed
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Samir R. Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Venu Menon
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
| | - Heba Wassif
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA
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Bansal A, Jaber WA, Cremer P, Wassif H, Mentias A, Menon V. Impact of hospital volume of valve operations on the utilization and outcomes of surgery for patients with infective endocarditis. Eur Heart J Acute Cardiovasc Care 2022; 11:102-110. [PMID: 34871384 DOI: 10.1093/ehjacc/zuab116] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 06/13/2023]
Abstract
AIMS Valve surgery is indicated and can be life-saving in patients with infective endocarditis (IE). We evaluated the impact of hospital valvular surgery volume on utilization and outcomes of surgery for IE. METHODS AND RESULTS National Inpatient Sample (NIS) database was used for IE hospitalizations from 2008 to 2015. Hospitals were divided into quartiles based on valve surgery volume with quartile 1 (Q1) indicating lowest volume and quartile 4 (Q4) highest volume. Primary outcome was utilization of valve surgery in patients hospitalized with IE and secondary outcomes were in-hospital mortality and length of stay for IE patients undergoing valve surgery. Volume-outcome relationship was analysed both as categorical (quartiles) and continuous variable (restricted cubic splines). A total of 36 471 hospitalizations for IE were identified using the NIS database from 2008 to 2015 of which 17.33% underwent any valve surgery. Utilization rates of valve surgery for IE were significantly higher in Q4 hospitals (Q1: 6.73%; Q2: 10.39%; Q3: 14.91%; Q4: 2321%). Amongst the admissions for IE endocarditis undergoing valve surgery, there was no significant difference in in-hospital mortality when analysed as a categorical variable (as quartiles). However, when analysed as a continuous variable we note significant variation in outcomes across the Q4 hospitals, with highest volume centres having reduced mortality rates and length of stay. CONCLUSION Hospital valvular surgery volume has direct impact on utilization and outcomes of surgery for IE. Given rising rates of IE and ongoing intravenous drug pandemic, there is need for regionalization of care for IE patients and development of 'endocarditis centres of excellence' for improved patient outcomes.
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Affiliation(s)
- Agam Bansal
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave Cleveland, OH 44195, USA
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave Cleveland, OH 44195, USA
| | - Paul Cremer
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave Cleveland, OH 44195, USA
| | - Heba Wassif
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave Cleveland, OH 44195, USA
| | - Amgad Mentias
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave Cleveland, OH 44195, USA
| | - Venu Menon
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave Cleveland, OH 44195, USA
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Wassif H, Hussain M, Collier PH, Moudgil R. Immunotherapy-mediated valvulitis: a new cardiovascular immunotherapy-related adverse event. Eur Heart J Cardiovasc Imaging 2020; 21:1102. [PMID: 32417890 DOI: 10.1093/ehjci/jeaa113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Heba Wassif
- Section of Clinical Cardiology and Cardiovascular Imaging, Department of Cardiovascular Medicine Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Muzna Hussain
- Section of Clinical Cardiology and Cardiovascular Imaging, Department of Cardiovascular Medicine Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Patrick H Collier
- Section of Clinical Cardiology and Cardiovascular Imaging, Department of Cardiovascular Medicine Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Rohit Moudgil
- Section of Clinical Cardiology and Cardiovascular Imaging, Department of Cardiovascular Medicine Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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