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Pollari F, Berretta P, Albertini A, Carrel T, Teoh K, Meuris B, Villa E, Kappert U, Andreas M, Solinas M, Misfeld M, Savini C, Fiore A, Shrestha M, Santarpino G, Martinelli GL, Mignosa C, Glauber M, Yan T, Fischlein T, Di Eusanio M. Pacemaker after Sutureless and Rapid-Deployment Prostheses: A Progress Report from the SURD-IR. Thorac Cardiovasc Surg 2023; 71:557-565. [PMID: 36257545 DOI: 10.1055/s-0042-1757778] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the need for postoperative permanent pacemaker implantation (PPI) following sutureless and rapid-deployment aortic valve replacement (SuRD-AVR) in the context of a progress report from a large multicenter international registry (SURD-IR). METHODS We retrospectively analyzed 4,166 patients who underwent SuRD-AVR between 2008 and 2019. The primary outcome was the need for PPI before discharge. The study population was analyzed separately according to the implanted prostheses (Su cohort and RD cohort). Each cohort was divided into two groups based on the operation date: an early group ("EG" = 2008-2016) and a late group ("LG" = 2017-2019). RESULTS The rate of PPI decreased significantly in the Su cohort over time (EG = 10.8% vs LG = 6.3%, p < 0.001). In the Su cohort, a decrease in age, risk profile, and incidence of bicuspid aortic valve, increased use of anterior right thoracotomy, reduction of cardiopulmonary bypass time and of associated procedures, and more frequent use of smaller prostheses were observed over time. In the RD cohort, the rate of PPI was stable over time (EG = 8.8% vs LG = 9.3%, p = 0.8). In this cohort, a younger age, lower risk profile, and higher incidence of concomitant septal myectomy were observed over time. CONCLUSION Our analysis showed a significant decrease in the PPI rate in patients who underwent Su-AVR over time. Patient selection as well as surgical improvements and a more accurate sizing could be correlated with this phenomenon. The RD cohort revealed no significant differences either in patient's characteristics or in PPI rate between the two time periods.
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Affiliation(s)
- Francesco Pollari
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Paolo Berretta
- Department of Cardiac Surgery, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Alberto Albertini
- Department of Cardiovascular Surgery, Maria Cecilia Hospital GVM Care and Research, Cotignola, Italy
| | - Thierry Carrel
- Department of Cardiovascular Surgery, Inselspital University Hospital Bern, Bern, Switzerland
| | - Kevin Teoh
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Bart Meuris
- KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Emmanuel Villa
- Poliambulanza Foundation Hospital Institute, Brescia, Lombardia, Italy
| | - Utz Kappert
- Heart Centre Dresden University Hospital of the University of Technology Dresden, Dresden, Sachsen, Germany
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Marco Solinas
- Heart Hospital Pasquinucci Hospital of Massa, Massa, Toscana, Italy
| | - Martin Misfeld
- Department of Cardiac Surgery, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Carlo Savini
- Alma Mater Studiorum University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Antonio Fiore
- Centre Hospitalier Universitaire Henri Mondor, Creteil, Île-de-France, France
| | - Malakh Shrestha
- Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany
| | | | | | | | | | | | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Marco Di Eusanio
- Azienda Ospedaliero Universitaria Ospedali Riuniti Umberto I G M Lancisi G Salesi, Ancona, Marche, Italy
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Weber C, Golding SE, Yarker J, Teoh K, Lewis R, Ratcliffe E, Munir F, Wheele T, Windlinger L. Work fatigue during COVID-19 lockdown teleworking: the role of psychosocial, environmental, and social working conditions. Front Psychol 2023; 14:1155118. [PMID: 37260958 PMCID: PMC10228694 DOI: 10.3389/fpsyg.2023.1155118] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/21/2023] [Indexed: 06/02/2023] Open
Abstract
Background During national lockdowns in response to the COVID-19 pandemic, previously office-based workers who transitioned to home-based teleworking faced additional demands (e.g., childcare, inadequate homeworking spaces) likely resulting in poor work privacy fit. Previous office research suggests poor work privacy fit is associated with lower wellbeing and higher work fatigue. Emerging evidence suggests a relationship between childcare duties during pandemic teleworking and work fatigue. In addition to psychosocial working conditions (job demand, job control, and job change management), which are acknowledged predictors of work fatigue, this poses a significant threat to occupational health during pandemic teleworking. However, the relative effects of aspects of the psychosocial environment (job demands and resources), the home office environment (including privacy fit), and the social environment (childcare) on work fatigue as well as their interactions are under-explored. Objective This study examined the relationships between the psychosocial, environmental, and social working conditions of teleworking during the first COVID-19 lockdown and work fatigue. Specifically, the study examined teleworkers' physical work environment (e.g., if and how home office space is shared, crowding, and noise perceptions) as predictors of privacy fit and the relationship between privacy fit, childcare, psychosocial working conditions (job demand, job control, and job change management), and work fatigue. Work privacy fit was hypothesized to mediate the relationship between childcare and work fatigue. Methods An online cross-sectional survey was conducted with teleworkers (n = 300) during the first COVID-19 lockdown in April and May 2020; most participants were in Germany, Switzerland, and the United Kingdom. Results Path analysis was used to examine the hypothesized relationships. Privacy fit was lower for those reporting greater levels of noise in home-working spaces and those feeling crowded at home. Work fatigue was lower amongst those with greater privacy fit and higher amongst those with high levels of job demand. An indirect relationship was observed between childcare and work fatigue with privacy fit mediating this relationship. Conclusion The influence of privacy fit has so far been largely neglected in research on teleworking, especially during the pandemic. However, its contribution to workers' wellbeing should be acknowledged in occupational health strategies.
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Affiliation(s)
- Clara Weber
- Institute of Facility Management, School of Life Sciences and Facility Management, Zurich University of Applied Sciences, Zurich, Switzerland
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Sarah E. Golding
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Joanna Yarker
- Department of Organisational Psychology, Birkbeck University of London, London, United Kingdom
| | - Kevin Teoh
- Department of Organisational Psychology, Birkbeck University of London, London, United Kingdom
| | - Rachel Lewis
- Department of Organisational Psychology, Birkbeck University of London, London, United Kingdom
| | - Eleanor Ratcliffe
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Theresa Wheele
- Institute of Facility Management, School of Life Sciences and Facility Management, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Lukas Windlinger
- Institute of Facility Management, School of Life Sciences and Facility Management, Zurich University of Applied Sciences, Zurich, Switzerland
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Teoh K, Singh J, Medisauskaite A, Hassard J. Doctors' perceived working conditions, psychological health and patient care: a meta-analysis of longitudinal studies. Occup Environ Med 2023; 80:61-69. [PMID: 36635099 DOI: 10.1136/oemed-2022-108486] [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: 05/20/2022] [Accepted: 11/17/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Studies have demonstrated an association between doctors' perceived working conditions, and their psychological well-being and patient care. However, few have examined inter-relationships among these three domains, and even fewer using longitudinal designs. Using meta-analytical structural equation modelling, we tested longitudinal relationships among doctors' perceived working conditions, their psychological well-being and patient care. We further tested if doctors' psychological well-being mediates the relationship between perceived working conditions and patient care. METHODS We carried out a systematic review using Academic Search Premier, Business Source Premier, PsycInfo, PsycArticles and Medline for the 20-year period between January 2000 and the start of the pandemic (January 2020). We included studies with practising doctors as participants, and that reported a quantifiable bivariate effect size between at least two of the three constructs of interest-perceived working conditions (ie, job demands, job resource), psychological well-being (ie, emotional exhaustion, work engagement) and patient care (ie, clinical care, patient safety). We pooled relationship effect sizes using random-effects meta-analysis, before testing for indirect effects using two-stage structural equation modelling. RESULTS Twenty-three samples from 11 countries representing 7275 doctors were meta-analysed. The results indicated that job resources predicted work engagement (ρ=0.18; 95% CI 0.11 to 0.24) and emotional exhaustion (ρ=-0.21; 95% CI -0.31 to -0.11), while job demands predicted emotional exhaustion (ρ=0.27; 95% CI 0.17 to 0.36). Better clinical care was also associated with higher levels of job resources (ρ=0.16; 95% CI 0.04 to 0.29), and lower levels of emotional exhaustion (ρ=-0.21; 95% CI -0.37 to -0.12) and job demands (ρ=-0.27; 95% CI -0.43 to -0.10). Both factors of the work environment were associated with clinical care through doctors' emotional exhaustion, but there were insufficient studies to test the indirect effects for work engagement or patient safety. CONCLUSION Our results demonstrate the need for a systems perspective to address working conditions to support both doctors' psychological well-being and patient care. Interventions should target doctors' job resources as they are more strongly associated with psychological well-being. However, given that job demands were strongly associated with emotional exhaustion, and in turn, clinical care, there is a need to better manage doctors' workload, conflict and pressure to support the current psychological well-being crises among this occupational group. PROSPERO REGISTRATION NUMBER CRD42020189070.
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Affiliation(s)
- Kevin Teoh
- Department of Organizational Psychology, Birkbeck University of London, London, UK
| | - Jasmeet Singh
- Psychology Department, Nottingham Trent University, Nottingham, UK
| | | | - Juliet Hassard
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
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Lai R, Teoh K, Plakiotis C. Factors Contributing to Stress and Well-Being Among Trainee Psychiatrists in Victoria, Australia. Adv Exp Med Biol 2023; 1425:93-104. [PMID: 37581784 DOI: 10.1007/978-3-031-31986-0_9] [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] [Indexed: 08/16/2023]
Abstract
Doctors in training experience stress, as they balance the demands of working and studying at the same time. As evidenced by reports of suicides among trainee doctors, it is clear that the level of stress they experience is dangerously high. Long working hours, which can lead to exhaustion, burnout, and time taken away from meaningful activities and relationships outside of work, are a large contributor to trainee stress and increase the likelihood of mental illness and suicidal ideation. For psychiatry trainees, this workload burden is also compounded by a high emotional burden associated with the nature of their work, including patient suicides, aggression, and threats. This study sought to investigate the factors that contribute to the stress and well-being of psychiatry trainees, through in-depth interviews analyzed via qualitative, template analysis. The main sources of stress identified were workload, aspects related to the psychiatry training program, and workplace-based aggression. Supervision, external supports such as family and health professionals, and distraction or "switching off" were the main sources of well-being support. Overall, this study highlighted the importance of structural factors in the workplace and training program in psychiatry trainee stress and well-being levels. Workload and training commitments limited the amount of time trainees could devote to well-being-related activities, despite their awareness of these. This study contributes useful insights into how we can better look after the mental health and well-being of psychiatry trainees, as future leaders of our mental health system.
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Affiliation(s)
- Rhoda Lai
- Monash Ageing Research Centre (MONARC), Monash University, Melbourne, VIC, Australia
| | - Kevin Teoh
- Department of Organizational Psychology, University of London, Birkbeck, UK
| | - Christos Plakiotis
- Monash Ageing Research Centre (MONARC), Monash University, Melbourne, VIC, Australia.
- Aged Persons Mental Health Service, Monash Health, Melbourne, VIC, Australia.
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia.
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Lai R, Teoh K, Plakiotis C. The Impact of Changes in Mental Health Legislation on Psychiatry Trainee Stress in Victoria, Australia. Adv Exp Med Biol 2023; 1425:199-205. [PMID: 37581794 DOI: 10.1007/978-3-031-31986-0_19] [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] [Indexed: 08/16/2023]
Abstract
In Victoria, Australia, the introduction of a new state Mental Health Act (MHA) in 2014 resulted in changes to the workload and type of work undertaken by trainee psychiatrists. In addition to long working hours, workload intensity is most often cited by trainees as a factor that leads to fatigue, with trainees often taking work home or doing overtime in order to fulfill work responsibilities and satisfy training requirements. This administrative burden is compounded by the high emotional burden associated with the practice of psychiatry, including patient suicides, aggression, and threats. This study aimed to explore the impact of these legislative changes on psychiatry trainees' stress and well-being, using a qualitative research methodology involving semi-structured interviews. Despite reporting that the length and number of reports they were preparing under the new MHA had increased, as had the amount of time spent at Tribunal hearings, psychiatry trainees were understanding of the necessity of MHA changes in improving patient rights. The trainees did not express a desire for the MHA changes to be reversed, but rather recognition by their workplaces that changes are also needed at a ground level-such as an increase in staff numbers-to accommodate for these. While mental health legislative changes are designed to improve the system and better protect patient rights, measures must also be taken to ensure that any policy-level changes are adequately adjusted for in hospital staffing levels.
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Affiliation(s)
- Rhoda Lai
- Monash Ageing Research Centre (MONARC), Monash University, Melbourne, VIC, Australia
| | - Kevin Teoh
- Department of Organizational Psychology, University of London, Birkbeck, UK
| | - Christos Plakiotis
- Monash Ageing Research Centre (MONARC), Monash University, Melbourne, VIC, Australia.
- Aged Persons Mental Health Service, Monash Health, Melbourne, VIC, Australia.
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia.
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Dunning A, Teoh K, Martin J, Spiers J, Buszewicz M, Chew-Graham C, Taylor AK, Gopfert A, Van Hove M, Appleby L, Riley R. Relationship between working conditions and psychological distress experienced by junior doctors in the UK during the COVID-19 pandemic: a cross-sectional survey study. BMJ Open 2022; 12:e061331. [PMID: 35998957 PMCID: PMC9402444 DOI: 10.1136/bmjopen-2022-061331] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This paper explored the self-reported prevalence of depression, anxiety and stress among junior doctors during the COVID-19 pandemic. It also reports the association between working conditions and psychological distress experienced by junior doctors. DESIGN A cross-sectional online survey study was conducted, using the 21-item Depression, Anxiety and Stress Scale and Health and Safety Executive scale to measure psychological well-being and working cultures of junior doctors. SETTING The National Health Service in the UK. PARTICIPANTS A sample of 456 UK junior doctors was recruited online during the COVID-19 pandemic from March 2020 to January 2021. RESULTS Junior doctors reported poor mental health, with over 40% scoring extremely severely depressed (45.2%), anxious (63.2%) and stressed (40.2%). Both gender and ethnicity were found to have a significant influence on levels of anxiety. Hierarchical multiple linear regression analysis outlined the specific working conditions which significantly predicted depression (increased demands (β=0.101), relationships (β=0.27), unsupportive manager (β=-0.111)), anxiety (relationships (β=0.31), change (β=0.18), demands (β=0.179)) and stress (relationships (β=0.18), demands (β=0.28), role (β=0.11)). CONCLUSIONS The findings illustrate the importance of working conditions for junior doctors' mental health, as they were significant predictors for depression, anxiety and stress. Therefore, if the mental health of junior doctors is to be improved, it is important that changes or interventions specifically target the working environment rather than factors within the individual clinician.
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Affiliation(s)
- Alice Dunning
- Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Kevin Teoh
- Department of Organizational Psychology, Birkbeck University of London, London, UK
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Johanna Spiers
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Marta Buszewicz
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | | | | - Anya Gopfert
- School of Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Maria Van Hove
- London School of Hygiene & Tropical Medicine, London, UK
| | - Louis Appleby
- Department of Psychiatry & Behavioral Sciences, The University of Manchester Faculty of Medical and Human Sciences, Manchester, UK
| | - Ruth Riley
- School of Health Sciences, University of Surrey, Guildford, UK
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Makhdoum A, Kim K, Koziarz A, Reza S, Alsagheir A, Pandey A, Teoh K, Alhazzani W, Lamy A, Yanagawa B, Belley-Cote EP, Whitlock R. A survey of cardiac surgeons to evaluate the use of sutureless aortic valve replacement in Canada. J Card Surg 2022; 37:3543-3549. [PMID: 35998278 DOI: 10.1111/jocs.16839] [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: 06/27/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sutureless aortic valve replacement (SuAVR) is gaining popularity for the treatment of aortic stenosis. We aimed to describe Canadian cardiac surgeons' practice patterns and perceptions regarding SuAVR. METHODS Content experts (clinicians and methodologists) developed the survey. Domains in the questionnaire include: respondent characteristics, factors influencing the decision to implant a SuAVR, barriers to SuAVR use, and interest in participating in a trial. RESULTS A total of 66 cardiac surgeons (median duration of practice: 15 years; range 8-20 years) from 18 hospitals across Canada responded to the survey for a response rate of 84%. Surgeons reported that the following patient characteristics increased the likelihood they would choose SuAVR: hostile root (73%), small annular size (55%), high Society of Thoracic Surgery risk score (42%), older age (40%), to support minimally invasive surgery (25%) and redo-operation (23%). The following patient characteristics made surgeons less likely to pursue SuAVR: young age (73%), low STS score (40%), and large annular size (30%). Reported barriers to SuAVR use included: cost (33%), permanent pacemaker risk (27%) and uncertain durability (12%). Of respondents, 73% were interested in participating in a randomized controlled trial comparing SuAVR with transcatheter aortic valve replacement. CONCLUSIONS The primary reasons for surgeons selecting SuAVR were high surgical risk and anatomical challenges. Cost is a primary factor limiting SuAVR use.
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Affiliation(s)
- Ahmad Makhdoum
- Population Research Health Institute, McMaster University, Hamilton, Canada.,Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Kevin Kim
- Population Research Health Institute, McMaster University, Hamilton, Canada.,Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alex Koziarz
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Seleman Reza
- Population Research Health Institute, McMaster University, Hamilton, Canada
| | - Ali Alsagheir
- Population Research Health Institute, McMaster University, Hamilton, Canada
| | - Arjun Pandey
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Teoh
- Southlake Regional Health Sciences Centre, Newmarket, Ontario, Canada
| | - Waleed Alhazzani
- Population Research Health Institute, McMaster University, Hamilton, Canada.,Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Andre Lamy
- Population Research Health Institute, McMaster University, Hamilton, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Emilie P Belley-Cote
- Population Research Health Institute, McMaster University, Hamilton, Canada.,Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Richard Whitlock
- Population Research Health Institute, McMaster University, Hamilton, Canada.,Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Jain A, Torres LD, Teoh K, Leka S. The impact of national legislation on psychosocial risks on organisational action plans, psychosocial working conditions, and employee work-related stress in Europe. Soc Sci Med 2022; 302:114987. [PMID: 35500313 DOI: 10.1016/j.socscimed.2022.114987] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 12/12/2021] [Revised: 03/11/2022] [Accepted: 04/20/2022] [Indexed: 11/26/2022]
Abstract
Work-related psychosocial hazards are recognised as a key priority in the future of work. Even though European Union (EU) legislation requires employers to assess and manage all types of risks to workers' health and safety associated with all types of hazards in the work environment, it does not include clear reference to psychosocial risks and work-related stress. In several EU member states, there is now more specific legislation on psychosocial risks that clarifies employer responsibilities. The aim of this study is to explore whether the introduction of specific legislation on psychosocial risks and/or work-related stress is related to organisations implementing action plans to prevent work-related stress, and in turn, better psychosocial working conditions (job demands and resources), and less reported work-related stress in the workforce. It does so by comparing EU member states and candidate countries that have introduced more specific legislation to those that have not, conducting multilevel modelling analysis by linking two representative European-level datasets, the 2014 employer European Survey of Enterprises on New & Emerging Risks and the 2015 employee European Working Conditions Survey. Findings indicate that the presence of specific national stress legislation is associated with more enterprises having a work-related stress action plan. The existence of action plans was found to be associated with increased job resources but not decreased job demands. Furthermore, only in those countries with specific national legislation on stress, job resources were found to be associated with less reported stress through the existence of organisational action plans. Findings lend support to the argument for more specific legislation on psychosocial risks/work-related stress in the EU. However, they also raise questions on whether current interventions implemented at organisational level to deal with work-related stress may be geared more towards the development of individual resources and less towards better work organisation and job design.
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Affiliation(s)
- Aditya Jain
- Nottingham University Business School, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK
| | - Luis D Torres
- Nottingham University Business School, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK
| | - Kevin Teoh
- Department of Organizational Psychology, Birkbeck, University of London, London, WC1E 7HX, UK
| | - Stavroula Leka
- Cork University Business School, University College Cork, College Road, T12 K8AF, Cork, Ireland; School of Medicine, University of Nottingham, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK.
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Attoe C, Matei R, Thompson L, Teoh K, Cross S, Cox T. Returning to clinical work and doctors' personal, social and organisational needs: a systematic review. BMJ Open 2022; 12:e053798. [PMID: 35641015 PMCID: PMC9157349 DOI: 10.1136/bmjopen-2021-053798] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE This systematic review aims to synthesise existing evidence on doctors' personal, social and organisational needs when returning to clinical work after an absence. DESIGN Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES AMED, BNI, CINAHL, EMBASE, EMCARE, HMIC, Medline, PsycINFO and PubMed were searched up to 4 June 2020. Non-database searches included references and citations of identified articles and pages 1-10 of Google and Google Scholar. ELIGIBILITY CRITERIA Included studies presented quantitative or qualitative data collected from doctors returning to work, with findings relating to personal, social or organisational needs. DATA EXTRACTION AND SYNTHESIS Data were extracted using a piloted template. Risk of bias assessment used the Medical Education Research Study Quality Instrument or Critical Appraisal Skills Programme Qualitative Checklist. Data were not suitable for meta-analyses and underwent narrative synthesis due to varied study designs and mixed methods. RESULTS Twenty-four included studies (14 quantitative, 10 qualitative) presented data from 92 692 doctors in the UK (n=13), US (n=4), Norway (n=3), Japan (n=2), Spain (n=1), Canada (n=1). All studies identified personal needs, categorised as work-life balance, emotional regulation, self-perception and identity, and engagement with return process. Seventeen studies highlighted social needs relating to professional culture, personal and professional relationships, and illness stigma. Organisational needs found in 22 studies were flexibility and job control, work design, Occupational Health services and organisational culture. Emerging resources and recommendations were highlighted. Variable quality and high risk of biases in data collection and analysis suggest cautious interpretation. CONCLUSIONS This review posits a foundational framework of returning doctors' needs, requiring further developed through methodologically robust studies that assess the impact of length and reason for absence, before developing and evaluating tailored interventions. Organisations, training programmes and professional bodies should refine support for returning doctors based on evidence.
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Affiliation(s)
- Chris Attoe
- Maudsley Learning, South London and Maudsley NHS Foundation Trust, London, UK
- Centre for Sustainable Working Life, Birkbeck University of London, London, UK
- Psychiatry Psychology and Neuroscience, King's College London Institute, London, UK
| | - Raluca Matei
- Centre for Sustainable Working Life, Birkbeck University of London, London, UK
| | - Laura Thompson
- Centre for Sustainable Working Life, Birkbeck University of London, London, UK
| | - Kevin Teoh
- Department of Organizational Psychology, Birkbeck University of London, London, UK
| | - Sean Cross
- Maudsley Learning, South London and Maudsley NHS Foundation Trust, London, UK
- Psychiatry Psychology and Neuroscience, King's College London Institute, London, UK
| | - Tom Cox
- Centre for Sustainable Working Life, Birkbeck University of London, London, UK
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10
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Vasconcelos AG, Lima EDP, Teoh K, do Nascimento E, MacLennan S, Cox T. Work-related factors in the etiology of symptoms of post-traumatic stress among first responders: the Brazilian Firefighters Longitudinal Health Study (FLoHS). CAD SAUDE PUBLICA 2021; 37:e00135920. [PMID: 34669769 DOI: 10.1590/0102-311x00135920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/23/2020] [Indexed: 11/21/2022] Open
Abstract
Two important aspects must be accounted for when discussing the mental health of first responders and, in particular, their report of post-traumatic stress symptoms (PTSS). The first concerns the provision of quantitative data from longitudinal study designs, the second concerns the sophistication of the work-related model used to frame such studies. This is a report on the development of a model for Brazilian firefighters who also work as first responders, from the establishment of a longitudinal panel design study, the Brazilian Firefighter Longitudinal Health Study (FLoHS). The first objective was to compare trainee and active firefighters based on their follow-up data with a nationwide sample of similarly aged Brazilians. The second was to test the effect that operational and organizational experiences had on firefighters' PTSS level during follow up. At baseline, trainee firefighters came from higher socioeconomic backgrounds, were healthier and less exposed to trauma compared to a similarly aged national sample. At follow up, they reported higher prevalence of smoking, sleep problems, anhedonia and were more likely to be overweight. PTSS was predicted by operational and organizational stressors, even when controlled for health status at baseline. The results present not only the differences in the predictive status of operational and organizational events in relation to PTSS, but also how the effects of such events might interact. The data suggest the need for evidence-based interventions, support provided and changes at work environments to improve report rates for mental health in general and for PTSS in particular.
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Affiliation(s)
| | | | - Kevin Teoh
- Birkbeck, University of London, London, U.K
| | - Elizabeth do Nascimento
- Faculdade de Filosofia e Ciências Humanas, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | - Tom Cox
- University of Aberdeen, Aberdeen, U.K
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11
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Bhadresha A, Teoh K, Hariharan K. 256 Charcot-Marie-Tooth Disease as A Risk Factor for Periprosthetic Fractures in Tibiotalocalcaneal Fusion With Intramedullary Nailing. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.978] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
The treatment for severe fixed hindfoot osteoarthritis secondary to Charcot-Marie-Tooth disease (CMT) disease is tibiotalocalcaneal (TTC) arthrodesis. In our centre, we have noticed a disproportionate rate of periprosthetic fractures in CMT patients following TTC arthrodesis with retrograde hindfoot nailing. The aim of this study was to test this hypothesis by evaluating our local cohort of TTC arthrodesis with retrograde hindfoot nailing.
Method
A retrospective review of patients who had TTC arthrodesis with intramedullary nailing was conducted over a seven-year period.
Results
There were 45 patients (30 male, 15 female) in our cohort. Forty-one patients achieved radiological and clinical fusion of their TTC arthrodesis. All three patients who had CMT sustained periprosthetic fracture at the tip of the nail at an average of 4 (range: 2.5 - 6) months from index operation. In comparison, no patients in the rest of the cohort sustained periprosthetic fractures. The nail position of the patients with CMT were central in both planes in all 3 patients. None of the patients with CMT had abutment of the cortex on either planes.
Conclusions
We found that there was a disproportionate rate of periprosthetic fractures in CMT patients in our cohort of TTC arthrodesis with retrograde hindfoot nailing. This suggests that CMT is a significant risk factor. The authors propose a longer nail to reduce the lever arm, with a long period of protected weight bearing till union. Elective removal of the nail to prevent this phenomenon from occurring should also be considered.
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Affiliation(s)
- A Bhadresha
- Royal Gwent Hospital, Newport, United Kingdom
| | - K Teoh
- Royal Gwent Hospital, Newport, United Kingdom
| | - K Hariharan
- Royal Gwent Hospital, Newport, United Kingdom
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12
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Kim KS, Makhdoum A, Koziarz A, Gupta S, Alsagheir A, Pandey A, Reza S, Um K, Teoh K, Alhazzani W, Lamy A, Yanagawa B, Belley-Côté EP, Whitlock RP. Outcomes of sutureless aortic valve replacement versus conventional aortic valve replacement and transcatheter aortic valve replacement, updated systematic review, and meta-analysis. J Card Surg 2021; 36:4734-4742. [PMID: 34617322 DOI: 10.1111/jocs.16044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/26/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sutureless aortic valve replacement (SuAVR) is an alternative to surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). This study compares the effectiveness of SuAVR to SAVR and TAVR. METHODS We searched MEDLINE and EMBASE from inception to July 2021 for studies evaluating SuAVR, SAVR, and TAVR in adults with aortic stenosis. We performed screening, full-text assessment, data collection, and risk of bias evaluation independently and in duplicate. We evaluated risk of bias using by Cochrane and CLARITY's tools, and certainty in evidence using the GRADE framework. Data were pooled using a random-effects model. RESULTS We identified one randomized and 78 observational studies (n = 60,689; SuAVR vs. SAVR = 39,171, vs. TAVR = 21,518). All studies were at high or unclear risk of bias, with very-low certainty in effect estimates. Compared to TAVR, SuAVR demonstrates no significant difference in mortality at 30-days (odds ratio [OR]: 0.52, 95% confidence interval [CI: 0.85, 1.16], I2 = 0%), but decreased odds at 2-years (OR: 0.39, 95% CI [0.17, 0.88], I2 = 0%). SuAVR also reduced odds of mild paravalvular regurgitation (OR: 0.11, 95% CI [0.06, 0.21], I2 = 50%). Compared to SAVR, SuAVR was associated with a similar mortality at 30-days (OR: 0.99, 95% CI [0.85, 1.16], I2 = 0%) and 2-years (OR: 0.99, 95% CI [0.43-2.30], I2 = 7%). SuAVR significantly increased odds of permanent pacemaker implantation (OR: 2.5, 95% CI [2.25, 2.77], I2 = 0%). Pooled effect estimates were consistent with results from the randomized trial comparing SuAVR and SAVR. CONCLUSION Based on very-low quality evidence, SuAVR is associated with similar short- and midterm outcomes compared to TAVR and SAVR. Comparative randomized data with long-term follow-up are required to clarify the role of SuAVR.
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Affiliation(s)
- Kevin S Kim
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Ahmad Makhdoum
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Alex Koziarz
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Saurabh Gupta
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ali Alsagheir
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Arjun Pandey
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Seleman Reza
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Kevin Um
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Teoh
- Southlake Regional Health Sciences Centre, Newmarket, Ontario, Canada
| | - Waleed Alhazzani
- Department of Health Research Methodology, Evidence and Impact, McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - André Lamy
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Emilie P Belley-Côté
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Richard P Whitlock
- Population Health Research Institute, McMaster University, Hamilton, Canada.,Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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13
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Berretta P, Meuris B, Kappert U, Andreas M, Fiore A, Solinas M, Misfeld M, Carrel TP, Villa E, Savini C, Santarpino G, Teoh K, Albertini A, Fischlein T, Martinelli G, Mignosa C, Glauber M, Shrestha M, Laufer G, Phan K, Yan T, Di Eusanio M. Sutureless versus rapid deployment aortic valve replacement: results from a multicentric registry. Ann Thorac Surg 2021; 114:758-765. [PMID: 34563505 DOI: 10.1016/j.athoracsur.2021.08.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Received: 04/18/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND To compare clinical and hemodynamic in-hospital outcomes of patients undergoing sutureless versus rapid deployment aortic valve replacement (SURD-AVR) in the large population of the Sutureless and Rapid Deployment International Registry (SURD-IR). METHODS We examined 4695 patients who underwent isolated or combined SURD-AVR. The "sutureless" Perceval valve was used in 3133 patients and the "rapid deployment" Intuity in 1562. Potential confounding factors were addressed by the use of propensity score matching. After matching, 2 well-balanced cohorts of 823 pairs (isolated SURD-AVR) and 467 pairs (combined SURD-AVR) were created. RESULTS Patients who received Perceval and Intuity valves showed similar in-hospital mortality and rate of major postoperative complications. Perceval was associated shorter cross clamp and cardiopulmonary bypass time. In the isolated SURD-AVR group, patients receiving Perceval were more likely to undergo anterior right thoracotomy incision. Postoperative transvalvular gradients were significantly lower for the Intuity valve compared to those of the Perceval valve, either in isolated and combined SURD-AVR. The Intuity valve was associated with a lower rate of postoperative mild aortic regurgitation. CONCLUSIONS Our results confirm the safety and efficacy of SURD-AVR regardless of the valve type. The Perceval valve was associated with reduced operative times and increased anterior right thoracotomy incision. The Intuity valve showed superior hemodynamic outcomes and a lower incidence of postoperative mild aortic regurgitation.
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Affiliation(s)
- Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy.
| | - Bart Meuris
- Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium
| | - Utz Kappert
- Department of Cardiac Surgery, University Heart Centre Dresden, Dresden, Germany
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Antonio Fiore
- Henri Mondor Hospital, University of Paris, Paris, France
| | | | - Martin Misfeld
- University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany; Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia
| | - Thierry P Carrel
- Department of Cardiovascular Surgery, University Hospital, University of Bern, Bern, Switzerland
| | - Emmanuel Villa
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Carlo Savini
- Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy
| | - Giuseppe Santarpino
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Italy; Department of Cardiac Surgery, Anthea Hospital, GVM Care&Research, Bari, Italy; Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | - Kevin Teoh
- Southlake Regional Health Centre, Ontario, Canada
| | - Alberto Albertini
- Cardiovascular Surgery Unit, Maria Cecilia Hospital GVM care & research, Cotignola, Italy
| | - Theodor Fischlein
- Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | | | - Carmelo Mignosa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS-ISMETT, Palermo, Italy
| | - Mattia Glauber
- Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy
| | | | - Ghunter Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Tristan Yan
- Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia; The Collaborative Research (CORE) Group
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy; The Collaborative Research (CORE) Group
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14
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Riley R, Buszewicz M, Kokab F, Teoh K, Gopfert A, Taylor AK, Van Hove M, Martin J, Appleby L, Chew-Graham C. Sources of work-related psychological distress experienced by UK-wide foundation and junior doctors: a qualitative study. BMJ Open 2021; 11:e043521. [PMID: 34162634 PMCID: PMC8231022 DOI: 10.1136/bmjopen-2020-043521] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES This paper reports findings exploring work cultures, contexts and conditions associated with psychological distress in foundation and junior doctors. DESIGN Qualitative study using in-depth interviews with 21 junior doctor participants. The interviews were audio-recorded, transcribed, anonymised and imported into NVivo V.11 to facilitate data management. Data were analysed using a thematic analysis employing the constant comparative method. SETTING NHS in England. PARTICIPANTS A purposive sample of 16 female and five male junior doctor junior doctor participants who self-identified as having stress, distress, anxiety, depression and suicidal thoughts, or having attempted to kill themselves. RESULTS Analysis reported four key themes: (1) workload and working conditions; (2) toxic work cultures-including abuse and bullying, sexism and racism, culture of blaming and shaming; (3) lack of support; (4) stigma and a perceived need to appear invulnerable. CONCLUSION This study highlights the need for future solutions and interventions targeted at improving work cultures and conditions. There needs to be greater recognition of the components and cumulative effects of potentially toxic workplaces and stressors intrinsic to the work of junior doctors, such as the stress of managing high workloads and lack of access to clinical and emotional support. A cultural shift is needed within medicine to more supportive and compassionate leadership and work environments, and a zero-tolerance approach to bullying, harassment and discrimination.
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Affiliation(s)
- Ruth Riley
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Marta Buszewicz
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Farina Kokab
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Kevin Teoh
- Department of Organizational Psychology, Birkbeck University of London, London, UK
| | - Anya Gopfert
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Anna K Taylor
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Maria Van Hove
- London School of Hygiene & Tropical Medicine, London, UK
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Louis Appleby
- Psychiatry and Behavioral Sciences, University of Manchester, Manchester, UK
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15
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Riley R, Kokab F, Buszewicz M, Gopfert A, Van Hove M, Taylor AK, Teoh K, Martin J, Appleby L, Chew-Graham C. Protective factors and sources of support in the workplace as experienced by UK foundation and junior doctors: a qualitative study. BMJ Open 2021; 11:e045588. [PMID: 34162643 PMCID: PMC8231035 DOI: 10.1136/bmjopen-2020-045588] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This paper reports findings identifying foundation and junior doctors' experiences of occupational and psychological protective factors in the workplace and sources of effective support. DESIGN Interpretative, inductive, qualitative study involving in-depth interviews with 21 junior doctor participants. The interviews were audio-recorded, transcribed, anonymised and imported into NVivo V.11 to facilitate data management. Data were analysed using a thematic analysis employing the constant comparative method. SETTING National Health Service in the UK. PARTICIPANTS Participants were recruited from junior doctors through social media (eg, the British Medical Association (BMA) junior doctors' Facebook group, Twitter and the mental health research charity websites). A purposive sample of 16 females and 5 males, ethnically diverse, from a range of specialities, across the UK. Junior doctor participants self-identified as having stress, distress, anxiety, depression and suicidal thoughts or having attempted to kill themselves. RESULTS Analysis identified three main themes, with corresponding subthemes relating to protective work factors and facilitators of support: (1) support from work colleagues - help with managing workloads and emotional support; (2) supportive leadership strategies, including feeling valued and accepted, trust and communication, supportive learning environments, challenging stigma and normalising vulnerability; and (3) access to professional support - counselling, cognitive-behavioural therapy and medication through general practitioners, specialist support services for doctors and private therapy. CONCLUSIONS Findings show that supportive leadership, effective management practices, peer support and access to appropriate professional support can help mitigate the negative impact of working conditions and cultures experienced by junior doctors. Feeling connected, supported and valued by colleagues and consultants acts as an important buffer against emotional distress despite working under challenging working conditions.
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Affiliation(s)
- Ruth Riley
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Farina Kokab
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Marta Buszewicz
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Anya Gopfert
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Maria Van Hove
- London School of Hygiene & Tropical Medicine, London, UK
| | - Anna K Taylor
- Faculty of Medicine and Health, Leeds Institute of Health Sciences, Leeds, UK
| | - Kevin Teoh
- Department of Organizational Psychology, Birkbeck University of London, London, UK
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Louis Appleby
- Department of Psychiatry & Behavioral Sciences, University of Manchester, Manchester, UK
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16
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Andreas M, Berretta P, Solinas M, Santarpino G, Kappert U, Fiore A, Glauber M, Misfeld M, Savini C, Mikus E, Villa E, Phan K, Fischlein T, Meuris B, Martinelli G, Teoh K, Mignosa C, Shrestha M, Carrel TP, Yan T, Laufer G, Di Eusanio M. Minimally invasive access type related to outcomes of sutureless and rapid deployment valves. Eur J Cardiothorac Surg 2021; 58:1063-1071. [PMID: 32588056 PMCID: PMC7577292 DOI: 10.1093/ejcts/ezaa154] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Minimally invasive surgical techniques with optimal outcomes are of paramount importance. Sutureless and rapid deployment aortic valves are increasingly implanted via minimally invasive approaches. We aimed to analyse the procedural outcomes of a full sternotomy (FS) compared with those of minimally invasive cardiac surgery (MICS) and further assess MICS, namely ministernotomy (MS) and anterior right thoracotomy (ART). METHODS We selected all isolated aortic valve replacements in the Sutureless and Rapid Deployment Aortic Valve Replacement International Registry (SURD-IR, n = 2257) and performed propensity score matching to compare aortic valve replacement through FS or MICS (n = 508/group) as well as through MS and ART accesses (n = 569/group). RESULTS Postoperative mortality was 1.6% in FS and MICS patients who had a mean logistic EuroSCORE of 11%. Cross-clamp and cardiopulmonary bypass (CPB) times were shorter in the FS group than in the MICS group (mean difference 3.2 and 9.2 min; P < 0.001). Patients undergoing FS had a higher rate of acute kidney injury (5.6% vs 2.8%; P = 0.012). Direct comparison of MS and ART revealed longer mean cross-clamp and CPB times (12 and 16.7 min) in the ART group (P < 0.001). The postoperative outcome revealed a higher stroke rate (3.2% vs 1.2%; P = 0.043) as well as a longer postoperative intensive care unit [2 (1-3) vs 1 (1-3) days; P = 0.009] and hospital stay [11 (8-16) vs 8 (7-12) days; P < 0.001] in the MS group than in the ART group. CONCLUSIONS According to this non-randomized international registry, FS resulted in a higher rate of acute kidney injury. The ART access showed a lower stroke rate than MS and a shorter hospital stay than all other accesses. All these findings may be related to underlying patient risk factors.
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Affiliation(s)
- Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy
| | | | - Giuseppe Santarpino
- Città di Lecce Hospital, GVM Care & Research, Cotignola, Italy.,Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | - Utz Kappert
- Department of Cardiac Surgery, University Heart Centre Dresden, Dresden, Germany
| | - Antonio Fiore
- Department of Cardiac Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Mattia Glauber
- Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy
| | - Martin Misfeld
- University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia
| | - Carlo Savini
- Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Elisa Mikus
- Cardiovascular Surgery Unit, Maria Cecilia Hospital GVM Care & Research, Cotignola, Italy
| | - Emmanuel Villa
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Kevin Phan
- The Collaborative Research (CORE) Group, Sydney, Australia
| | - Theodor Fischlein
- Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | - Bart Meuris
- Cardiac Surgery, Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium
| | | | - Kevin Teoh
- Southlake Regional Health Centre, Newmarket, ON, Canada
| | - Carmelo Mignosa
- Department for the Treatment and Study of Cardiothoracic Diseases, Cardiothoracic Transplantation IRCCS-ISMETT, Palermo, Italy
| | - Malakh Shrestha
- Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Thierry P Carrel
- Department of Cardiovascular Surgery, University Hospital, University of Bern, Bern, Switzerland
| | - Tristan Yan
- Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia.,The Collaborative Research (CORE) Group, Sydney, Australia
| | - Guenther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy.,The Collaborative Research (CORE) Group, Sydney, Australia
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17
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Berretta P, Andreas M, Carrel TP, Solinas M, Teoh K, Fischlein T, Santarpino G, Folliguet T, Villa E, Meuris B, Mignosa C, Martinelli G, Misfeld M, Glauber M, Kappert U, Savini C, Shrestha M, Phan K, Albertini A, Yan T, Di Eusanio M. Minimally invasive aortic valve replacement with sutureless and rapid deployment valves: a report from an international registry (Sutureless and Rapid Deployment International Registry)†. Eur J Cardiothorac Surg 2020; 56:793-799. [PMID: 30820549 DOI: 10.1093/ejcts/ezz055] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [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] [Received: 11/05/2018] [Revised: 02/01/2019] [Accepted: 02/04/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The impact of sutureless and rapid deployment (SURD) valves on the clinical outcomes of patients undergoing minimally invasive aortic valve replacement (MI-AVR) has still to be defined. The aim of this study was to assess clinical characteristics and in-hospital results of patients receiving SURD-AVR through less invasive approaches in the large population of the Sutureless and Rapid Deployment International Registry (SURD-IR). METHODS Of the 1935 patients who received primary isolated SURD-AVR between 2009 and 2018, a total of 1418 (73.3%) underwent MI interventions and were included in this analysis. SURD-AVR was performed using upper ministernotomy in 56.4% (n = 800) of cases and anterior right thoracotomy in 43.6% (n = 618). Perceval S was implanted in 1011 (71.3%) patients and Edwards Intuity or Intuity Elite in 407 (28.7%) patients. RESULTS Overall in-hospital mortality and stroke rates were 1.7% and 2%, respectively. A definitive pacemaker implantation was reported in 9% of cases and significantly decreased over the observational period, from 20.6% to 5.6% (P = 0.002). The Perceval valve was associated with shorter operative times and was more frequently implanted in patients receiving anterior right thoracotomy incision. The Intuity valve was preferred in younger patients and revealed superior postoperative haemodynamic results. CONCLUSIONS SURD-AVR was largely performed through less invasive approaches and can be considered as a primary indication in MI surgery. In the SURD-IR cohort, MI SURD-AVR using both Perceval and Intuity valves appeared a safe and reproducible procedure associated with promising early results.
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Affiliation(s)
- Paolo Berretta
- Cardiac Surgery Unit, Ospedali Riuniti, Polytechnic University of Marche, Ancona, Italy
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | - Kevin Teoh
- Southlake Regional Health Centre, Newmarket, ON, Canada
| | - Theodor Fischlein
- Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | | | | | | | - Bart Meuris
- Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium
| | - Carmelo Mignosa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS-ISMETT, Palermo, Italy
| | | | | | - Mattia Glauber
- Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy
| | - Utz Kappert
- Dresden Heart Center, Department of Cardiac Surgery, Dresden University Hospital, Dresden, Germany
| | - Carlo Savini
- Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | | | | | - Tristan Yan
- The Collaborative Research (CORE) Group.,Macquarie University, Sydney, NSW, Australia
| | - Marco Di Eusanio
- The Collaborative Research (CORE) Group.,Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy
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18
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Santarpino G, Berretta P, Fischlein T, Carrel TP, Teoh K, Misfeld M, Savini C, Kappert U, Glauber M, Villa E, Meuris B, Mignosa C, Albertini A, Martinelli G, Folliguet TA, Shrestha M, Solinas M, Laufer G, Phan K, Yan T, Di Eusanio M. Operative outcome of patients at low, intermediate, high and 'very high' surgical risk undergoing isolated aortic valve replacement with sutureless and rapid deployment prostheses: results of the SURD-IR registry. Eur J Cardiothorac Surg 2020; 56:38-43. [PMID: 30689828 DOI: 10.1093/ejcts/ezy477] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 11/05/2018] [Revised: 12/10/2018] [Accepted: 12/15/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The ideal strategy for the treatment of severe aortic valve stenosis in patients of varying risk categories has become a debated topic in the last years: should the transcatheter or surgical approach be adopted? The aim of this study was to evaluate the outcomes of low-, intermediate-, high- and very high-risk patients undergoing sutureless, rapid deployment aortic valve replacement. METHODS From 2007 to 2017, data on a total of 3651 patients were collected from the Sutureless and Rapid Deployment Aortic Valve Replacement International Registry (SURD-IR). Of these, 2057 patients who underwent primary isolated aortic valve replacement were considered for this analysis and classified as being at low (EuroSCORE <5; n = 500), intermediate (EuroSCORE 5-10; n = 901), high (EuroSCORE 11-20; n = 500) and very high (EuroSCORE >20; n = 156) preoperative risk. RESULTS Overall, a less invasive approach was used in 74.1% of patients and represented the most frequent (>50%) approach in all risk categories. The Perceval prosthesis was used more frequently than other devices, especially in patients at high and very high risk. Hospital mortality was 1.6%, 0.8%, 1.9% and 2.7% in low-, intermediate-, high- and very high-risk patients, respectively, with no significant differences among subgroups. Similarly, postoperative complication rates were similar across the different risk categories. CONCLUSIONS Surgical aortic valve replacement using sutureless, rapid deployment biological valve prostheses is associated with excellent results and represents a safe and effective treatment option for patients with severe aortic valve stenosis. This seems to be particularly true in patients with a higher risk profile.
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Affiliation(s)
- Giuseppe Santarpino
- Città di Lecce Hospital, GVM Care & Research, Lecce, Italy.,Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | - Paolo Berretta
- Cardiac Surgery Unit, Ospedali Riuniti, Polytechnic University of Marche, Ancona, Italy
| | - Theodor Fischlein
- Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | | | - Kevin Teoh
- Southlake Regional Health Centre, ON, Canada
| | | | - Carlo Savini
- Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Utz Kappert
- Department of Cardiac Surgery, Dresden Heart Center, Dresden University Hospital, Dresden, Germany
| | - Mattia Glauber
- Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy
| | | | - Bart Meuris
- Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium
| | - Carmelo Mignosa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS-ISMETT, Palermo, Italy
| | | | | | | | | | | | - Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Tristan Yan
- The Collaborative Research (CORE) Group.,Macquarie University, Sydney, Australia
| | - Marco Di Eusanio
- The Collaborative Research (CORE) Group.,Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Ospedali Riuniti, Polytechnic University of Marche, Ancona, Italy
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19
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Affiliation(s)
- Gail Kinman
- Department of Organizational Psychology, Birkbeck University of London, London, UK
| | - Kevin Teoh
- Department of Organizational Psychology, Birkbeck University of London, London, UK
| | - Anne Harriss
- School of Health and Social Care, London South Bank University, London, UK
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20
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Miceli A, Berretta P, Fiore A, Andreas M, Solinas M, Santarpino G, Kappert U, Misfeld M, Savini C, Albertini A, Villa E, Phan K, Fischlein T, Meuris B, Martinelli G, Teoh K, Mignosa C, Shrestha M, Carrel TP, Yan TD, Glauber M, Di Eusanio M. Sutureless and rapid deployment implantation in bicuspid aortic valve: results from the sutureless and rapid-deployment aortic valve replacement international registry. Ann Cardiothorac Surg 2020; 9:298-304. [PMID: 32832411 DOI: 10.21037/acs-2020-surd-33] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Benefits of sutureless and rapid deployment (SURD) bioprostheses in bicuspid aortic valves (BAV) are controversial. The aim of this study is to report the outcomes of patients undergoing aortic valve replacement (AVR) for BAV from the Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR). Methods Of the 4,636 patients who received primary isolated SURD-AVR between 2007 and 2018, 191 (4.1%) BAV patients underwent AVR with SURD valve. Results Overall 30-day mortality was 1.6%. The Intuity valve was implanted in 53.9% of cases, whereas the Perceval was implanted in 46.1%. Rate of stroke for isolated AVR was 4.2%. No case of endocarditis, thromboembolism, myocardial infarction, valve dislocation or structural valve deterioration was reported in the early phase. Rate of pacemaker implantation and moderate-severe aortic regurgitation (AR) were 7.9% and 3.7%, respectively. Conclusions BAV is not considered a contraindication for the implantation of SURD valves. However, detailed information of aortic root geometry as well as the knowledge of some technical considerations are mandatory for a good outcome.
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Affiliation(s)
- Antonio Miceli
- Minimally Invasive Cardiac Surgery, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy
| | - Antonio Fiore
- Department of Cardiac Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Marco Solinas
- Department of Cardiac Surgery, Pasquinucci Heart Hospital, Massa, Italy
| | - Giuseppe Santarpino
- Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy.,Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy.,Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | - Utz Kappert
- Department of Cardiac Surgery, University Heart Centre Dresden, Dresden, Germany
| | - Martin Misfeld
- University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia
| | - Carlo Savini
- Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alberto Albertini
- Cardiovascular Surgery Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Emmanuel Villa
- Department of Cardiac Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Kevin Phan
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Theodor Fischlein
- Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | - Bart Meuris
- Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium
| | | | - Kevin Teoh
- Southlake Regional Health Centre, Ontario, Canada
| | - Carmelo Mignosa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS-ISMETT, Palermo, Italy
| | - Malakh Shrestha
- Division of Cardiothoracic Surgery, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Thierry P Carrel
- Department of Cardiovascular Surgery, University Hospital, University of Bern, Bern, Switzerland
| | - Tristan D Yan
- Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia.,The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Mattia Glauber
- Minimally Invasive Cardiac Surgery, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy.,The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
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21
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Berretta P, Arzt S, Fiore A, Carrel TP, Misfeld M, Teoh K, Villa E, Albertini A, Fischlein T, Martinelli G, Shrestha M, Savini C, Miceli A, Santarpino G, Andreas M, Mignosa C, Phan K, Meuris B, Solinas M, Yan T, Di Eusanio M. Current trends of sutureless and rapid deployment valves: an 11-year experience from the Sutureless and Rapid Deployment International Registry. Eur J Cardiothorac Surg 2020; 58:1054-1062. [DOI: 10.1093/ejcts/ezaa144] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 12/27/2019] [Revised: 02/28/2020] [Accepted: 03/18/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
Current evidence on sutureless and rapid deployment aortic valve replacement (SURD-AVR) is limited and does not allow for the assessment of the clinical impact and the evolution of procedural and clinical outcomes of this new valve technology. The Sutureless and Rapid Deployment International Registry (SURD-IR) represents a unique opportunity to evaluate the current trends and outcomes of SURD-AVR interventions.
METHODS
Data from 3682 patients enrolled between 2007 and 2018 were analysed. Patients were divided according to the date of surgery into 6 equal groups and by the type of intervention: isolated SURD-AVR (n = 2472) and combined SURD-AVR (n = 1086).
RESULTS
Across the 11-year study period, significant changes occurred in patient characteristics including a decrease in age and in estimated surgical risk. Less invasive approaches for isolated SURD-AVR increased considerably from 49.4% to 85.5%. The overall in-hospital mortality rate was 1.6% and 3.9% in isolated and combined procedures, respectively, with no change over time. The rate of perioperative stroke decreased significantly (from 4% to 0.5%), as did the rates of postoperative pacemaker implantation (from 12.8% to 5.9%) and aortic regurgitation (from 17.8% to 2.7%).
CONCLUSIONS
The present study provides a comprehensive analysis of the current trends and results of SURD-AVR interventions. The most notable changes over time were the increasing implantation of SURD valves in a younger population, with more frequent utilization of less invasive techniques. SURD-AVR demonstrated remarkable improvements in clinical outcomes with a significant reduction in the rates of stroke, pacemaker implantation and postoperative aortic regurgitation.
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Affiliation(s)
- Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy
| | - Sebastian Arzt
- Department of Cardiac Surgery, University Heart Centre Dresden, Dresden, Germany
| | - Antonio Fiore
- Henri Mondor Hospital, University of Paris, Paris, France
| | - Thierry P Carrel
- Department of Cardiovascular Surgery, University Hospital, University of Bern, Bern, Switzerland
| | - Martin Misfeld
- University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Kevin Teoh
- Southlake Regional Health Centre, Newmarket, ON, Canada
| | | | - Alberto Albertini
- Cardiovascular Surgery Unit, Maria Cecilia Hospital GVM Care & Research, Cotignola, Italy
| | - Theodor Fischlein
- Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | | | | | - Carlo Savini
- Cardiac Surgery Department, Sant’Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonio Miceli
- Istituto Clinico Sant’Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy
| | | | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Carmelo Mignosa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Kevin Phan
- The Collaborative Research (CORE) Group, Sydney, Australia
| | - Bart Meuris
- Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium
| | | | - Tristan Yan
- The Collaborative Research (CORE) Group, Sydney, Australia
- Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy
- The Collaborative Research (CORE) Group, Sydney, Australia
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22
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Santarpino G, Berretta P, Kappert U, Teoh K, Mignosa C, Meuris B, Villa E, Albertini A, Carrel TP, Misfeld M, Martinelli G, Phan K, Miceli A, Folliguet T, Shrestha M, Solinas M, Andreas M, Savini C, Yan T, Fischlein T, Di Eusanio M. Minimally Invasive Redo Aortic Valve Replacement: Results From a Multicentric Registry (SURD-IR). Ann Thorac Surg 2020; 110:553-557. [PMID: 31954690 DOI: 10.1016/j.athoracsur.2019.11.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 06/09/2019] [Revised: 10/29/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Reoperation for aortic valve replacement can be challenging and is usually associated with an increased risk for complications and mortality. The study aim was to report the results of a multicenter cohort of patients who underwent minimally invasive reoperative aortic valve replacement with a sutureless or rapid-deployment prosthesis. METHODS From 2007 to 2018 data from 3651 patients were retrospectively collected from the Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry. Of them, 63 patients who had previously undergone cardiac surgery represented the study population. In-hospital clinical and echocardiographic outcomes were recorded. RESULTS Mean age of the selected 63 patients was 75.3 ± 7.8 years and logistic EuroSCORE 10.1. Surgery was performed by ministernotomy in 43 patients (68.3%) and by anterior right thoracotomy in 20 (31.7%); 31 patients (49.2%) received the Perceval valve (Livanova PLC, London, UK) and 32 (50.8%) the Intuity valve (Edwards Lifesciences, Irvine, CA). Mean cross-clamp time was 57.8 ± 23.2 minutes and cardiopulmonary bypass time 95.0 ± 34.3 minutes. Neither conversion to full sternotomy nor in-hospital deaths occurred. Postoperative events were ischemic cerebral events in 3 patients (4.8%), need for pacemaker implantation in 2 (3.6%), bleeding requiring reoperation in 5 (8.9%), and dialysis in 1 (1.6%). Median intensive care unit stay was 1 day, and median length of hospital stay was 10 days. On echocardiographic evaluation 1 patient showed a significant postoperative aortic regurgitation. CONCLUSIONS Minimally invasive reoperative aortic valve replacement with a sutureless or rapid-deployment prosthesis is a safe and feasible treatment strategy, resulting in fast recovery and improved postoperative outcome with no mortality and an acceptable complication rate.
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Affiliation(s)
- Giuseppe Santarpino
- Città di Lecce Hospital, GVM Care & Research, Lecce, Italy; Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany; Cardiac Surgery Unit, Department of Experimental and Clinical Medicine-University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy.
| | - Utz Kappert
- Department of Cardiac Surgery, University Heart Centre Dresden, Dresden, Germany
| | - Kevin Teoh
- Southlake Regional Health Centre, Ontario, Canada
| | - Carmelo Mignosa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Bart Meuris
- Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium
| | | | - Alberto Albertini
- Cardiovascular Surgery Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Thierry P Carrel
- Department of Cardiovascular Surgery, University of Bern, Bern, Switzerland
| | - Martin Misfeld
- University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | | | | | - Antonio Miceli
- Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals, IRCCS Gruppo San Donato, Milan, Italy
| | | | | | - Marco Solinas
- Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Carlo Savini
- Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy
| | - Tristan Yan
- The Collaborative Research (CORE) Group; Macquarie University, Sydney, Australia
| | - Theodor Fischlein
- Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy; The Collaborative Research (CORE) Group
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23
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Makhdoum A, Koziarz A, Alsagheir A, Reza S, Yanagawa B, Teoh K, Belley-Côté E, Whitlock R. A SURVEY OF CARDIAC SURGEONS TO EVALUATE THE USE OF SUTURELESS AORTIC VALVE REPLACEMENT IN CANADA. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.201] [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: 11/29/2022] Open
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24
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van Diepen S, Mehta RH, Leimberger JD, Goodman SG, Fremes S, Jankowich R, Heringlake M, Anstrom KJ, Levy JH, Luber J, Nagpal AD, Duncan AE, Argenziano M, Toller W, Teoh K, Knight JD, Lopes RD, Cowper PA, Mark DB, Alexander JH. Levosimendan in patients with reduced left ventricular function undergoing isolated coronary or valve surgery. J Thorac Cardiovasc Surg 2019; 159:2302-2309.e6. [PMID: 31358329 DOI: 10.1016/j.jtcvs.2019.06.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 07/03/2018] [Revised: 06/06/2019] [Accepted: 06/11/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In the Levosimendan in Patients with Left Ventricular Systolic Dysfunction Undergoing Cardiac Surgery Requiring Cardiopulmonary Bypass (LEVO-CTS) trial, no differences in clinical outcomes were observed between levosimendan and placebo in a broad population of patients undergoing cardiac surgery. In previous studies, the benefits of levosimendan were most clearly evident in patients undergoing isolated coronary artery bypass grafting (CABG) surgery. In a prespecified analysis of LEVO-CTS, we compared treatment-related outcomes and costs across types of cardiac surgical procedures. METHODS Overall, 563 (66.4%) patients underwent isolated CABG, 97 (11.4%) isolated valve, and 188 (22.2%) combined CABG/valve surgery. Outcomes included the co-primary 4-component composite (30-day mortality, 30-day renal replacement, 5-day myocardial infarction, or 5-day mechanical circulatory support), the 2-component composite (30-day mortality or 5-day mechanical circulatory support), 90-day mortality, low cardiac output syndrome (LCOS), and 30-day medical costs. RESULTS The 4- and 2-component outcomes were not significantly different with levosimendan and placebo in patients undergoing CABG (15.2% vs 19.3% and 7.8% vs 10.4%), valve (49.0% vs 33.3% and 22.4% vs 2.1%), or combined procedures (39.6% vs 35.9% and 24.0% vs 19.6%). Ninety-day mortality was lower with levosimendan in isolated CABG (2.1% vs 7.9%; hazard ratio [HR], 0.26; 95% confidence interval [CI], 0.11-0.64), but not significantly different in valve (8.3% vs 2.0%; HR, 4.10; 95% CI, 0.46-36.72) or combined procedures (10.4% vs 7.6%; HR, 1.39; 95% CI, 0.53-3.64; interaction P = .011). LCOS (12.0% vs 22.1%; odds ratio, 0.48; 95% CI, 0.30-0.76; interaction P = .118) was significantly lower in levosimendan-treated patients undergoing isolated CABG. Excluding study drug costs, median and mean 30-day costs were $53,707 and $65,852 for levosimendan and $54,636 and $67,122 for placebo, with a 30-day mean difference (levosimendan - placebo) of -$1270 (bootstrap 95% CI, -$8722 to $6165). CONCLUSIONS Levosimendan was associated with lower 90-day mortality and LCOS in patients undergoing isolated CABG, but not in those undergoing isolated valve or combined CABG/valve procedures.
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Affiliation(s)
- Sean van Diepen
- Division of Cardiology, Departments of Critical Care and Medicine, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada.
| | - Rajendra H Mehta
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Jeffrey D Leimberger
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Shaun G Goodman
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada; Terrence Donnelly Heart Centre, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Stephen Fremes
- Schulich Heart Center, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Kevin J Anstrom
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Jerrold H Levy
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - A Dave Nagpal
- London Health Sciences Centre, London, Ontario, Canada
| | | | | | | | - Kevin Teoh
- Southlake Regional Health Center, Newmarket, Ontario, Canada
| | - J David Knight
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Patricia A Cowper
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Daniel B Mark
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - John H Alexander
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
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25
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Affiliation(s)
- Kevin Teoh
- The Department of Organizational Psychology, Birkbeck University of London, London, UK
- The Centre for Sustainable Working Life, Birkbeck University of London, London, UK
| | - Juliet Hassard
- The Centre for Sustainable Working Life, Birkbeck University of London, London, UK
- Centre for Organizational Health and Development, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tom Cox
- The Centre for Sustainable Working Life, Birkbeck University of London, London, UK
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26
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Di Eusanio M, Phan K, Berretta P, Carrel TP, Andreas M, Santarpino G, Di Bartolomeo R, Folliguet T, Meuris B, Mignosa C, Martinelli G, Misfeld M, Glauber M, Kappert U, Shrestha M, Albertini A, Teoh K, Villa E, Yan T, Solinas M. Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR): early results from 3343 patients†. Eur J Cardiothorac Surg 2018; 54:768-773. [DOI: 10.1093/ejcts/ezy132] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [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: 11/17/2017] [Accepted: 03/08/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marco Di Eusanio
- Cardiovascular Department, Cardiac Surgery Unit, Ospedali Riuniti, Polytechnic University of Marche, Ancona, Italy
- The Collaborative Research (CORE) Group, Sydney, Australia
| | - Kevin Phan
- The Collaborative Research (CORE) Group, Sydney, Australia
| | - Paolo Berretta
- Cardiovascular Department, Cardiac Surgery Unit, Ospedali Riuniti, Polytechnic University of Marche, Ancona, Italy
| | | | | | - Giuseppe Santarpino
- Città di Lecce Hospital, GVM Care & Research, Lecce, Italy
- Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | - Roberto Di Bartolomeo
- Department of Cardiac Surgery, Sant’Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Thierry Folliguet
- Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France
| | - Bart Meuris
- Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium
| | - Carmelo Mignosa
- Cardiac Surgery Unit, Centro Clinico-Diagnostico ‘G.B. Morgagni’, Heart Center, Pedara, Italy
| | | | | | - Mattia Glauber
- Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy
| | - Utz Kappert
- Dresden Heart Center, Department of Cardiac Surgery, Dresden University Hospital, Dresden, Germany
| | | | | | - Kevin Teoh
- Southlake Regional Health Centre, Newmarket, ON, Canada
| | | | - Tristan Yan
- The Collaborative Research (CORE) Group, Sydney, Australia
- Macquarie University, Sydney, Australia
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27
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Hassard J, Teoh K, Cox T. Organizational uncertainty and stress among teachers in Hong Kong: work characteristics and organizational justice. Health Promot Int 2017; 32:860-870. [PMID: 27030559 DOI: 10.1093/heapro/daw018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 11/14/2022] Open
Abstract
A growing literature now exists examining the relationship between organizational justice and employees' experience of stress. Despite the growth in this field of enquiry, there remain continued gaps in knowledge. In particular, the contribution of perceptions of justice to employees' stress within an organizational context of uncertainty and change, and in relation to the new and emerging concept of procedural-voice justice. The aim of the current study was to examine the main, interaction and additive effects of work characteristics and organizational justice perceptions to employees' experience of stress (as measured by their feelings of helplessness and perceived coping) during an acknowledged period of organizational uncertainty. Questionnaires were distributed among teachers in seven public primary schools in Hong Kong that were under threat of closure (n = 212). Work characteristics were measured using the demand-control-support model. Hierarchical regression analyses observed perceptions of job demands and procedural-voice justice to predict both teachers' feelings of helplessness and perceived coping ability. Furthermore, teacher's perceived coping was predicted by job control and a significant interaction between procedural-voice justice and distributive justice. The addition of organizational justice variables did account for unique variance, but only in relation to the measure of perceived coping. The study concludes that in addition to 'traditional' work characteristics, health promotion strategies should also address perceptions of organizational justice during times of organizational uncertainty; and, in particular, the value and importance of enhancing employee's perceived 'voice' in influencing and shaping justice-related decisions.
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Affiliation(s)
- Juliet Hassard
- Centre for Sustainable Working Life.,Department of Organizational Psychology, Clore Management Centre, Birkbeck University of London, London, WC1E 7HX, UK
| | - Kevin Teoh
- Centre for Sustainable Working Life.,Department of Organizational Psychology, Clore Management Centre, Birkbeck University of London, London, WC1E 7HX, UK
| | - Tom Cox
- Centre for Sustainable Working Life
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Abstract
With the advent of transcatheter aortic valve implantation (TAVI) techniques, a renewed interest has developed in sutureless aortic valve concepts in the last decade. The main feature of sutureless aortic valve implantation is the speed of insertion, thus making implantation easier for the surgeon. As a result, cross clamp times and myocardial ischemia may be reduced. The combined procedures (CABG with AVR in particular) can be done with a short cross clamp time. Perceval valve also provides an increased effective orifice area as compared with a stented bioprosthesis. Sutureless implantation of the Perceval valve is not only associated with shorter cross-clamp and cardiopulmonary bypass times but improved clinical outcomes too. This review covers the sutureless aortic valves and their evolution, with elaborate details on Perceval S valve in particular (which is the most widely used sutureless valve around the globe).
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Affiliation(s)
- Rahul Chandola
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room H4 06, Toronto, ON, M4N 3M5, Canada.
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29
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Clements AJ, Kinman G, Leggetter S, Teoh K, Guppy A. Exploring commitment, professional identity, and support for student nurses. Nurse Educ Pract 2015; 16:20-6. [PMID: 26095892 DOI: 10.1016/j.nepr.2015.06.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 09/18/2014] [Revised: 06/02/2015] [Accepted: 06/02/2015] [Indexed: 11/30/2022]
Abstract
Problems with the recruitment and retention of nurses globally mean that insight into the factors that might increase retention in qualified staff and students is crucial. Despite clear links between work commitment and retention, there is little research exploring commitment in student nurses and midwives. This paper reports the findings of a qualitative study designed to provide insight into commitment using semi-structured interviews conducted with nine pre-registration students and a qualitative survey completed by 171 pre-registration students. Thematic analysis of the data emphasised the impact of placement experiences on commitment via interpersonal relationships. Students typically emphasised their professional identity as the basis for commitment, although many participants also highlighted a lack of acceptance by qualified practitioners, which reduced it. There was evidence that suggested that practitioner workload may impact the student experience due to challenges in making sufficient time to provide support. Implications for retention strategies are discussed.
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Affiliation(s)
| | - Gail Kinman
- Department of Psychology, University of Bedfordshire, United Kingdom
| | - Sandra Leggetter
- Department of Healthcare Practice, University of Bedfordshire, United Kingdom
| | - Kevin Teoh
- Centre for Sustainable Working Life, Birkbeck University of London, United Kingdom
| | - Andrew Guppy
- Department of Psychology, University of Bedfordshire, United Kingdom
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30
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Di Eusanio M, Phan K, Bouchard D, Carrel TP, Dapunt OE, Di Bartolomeo R, Eichstaedt HC, Fischlein T, Folliguet T, Gersak B, Glauber M, Haverich A, Misfeld M, Oberwalder PJ, Santarpino G, Shrestha ML, Solinas M, Vola M, Alamanni F, Albertini A, Bhatnagar G, Carrier M, Clark S, Collart F, Kappert U, Kocher A, Meuris B, Mignosa C, Ouda A, Pelletier M, Rahmanian PB, Reineke D, Teoh K, Troise G, Villa E, Wahlers T, Yan TD. Sutureless Aortic Valve Replacement International Registry (SU-AVR-IR): design and rationale from the International Valvular Surgery Study Group (IVSSG). Ann Cardiothorac Surg 2015; 4:131-9. [PMID: 25870808 DOI: 10.3978/j.issn.2225-319x.2015.02.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 02/10/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sutureless aortic valve replacement (SU-AVR) is an innovative approach which shortens cardiopulmonary bypass and cross-clamp durations and may facilitate minimally invasive approach. Evidence outlining its safety, efficacy, hemodynamic profile and potential complications is replete with small-volume observational studies and few comparative publications. METHODS Minimally invasive aortic valve surgery and high-volume SU-AVR replacement centers were contacted for recruitment into a global collaborative coalition dedicated to sutureless valve research. A Research Steering Committee was formulated to direct research and support the mission of providing registry evidence warranted for SU-AVR. RESULTS The International Valvular Surgery Study Group (IVSSG) was formed under the auspices of the Research Steering Committee, comprised of 36 expert valvular surgeons from 27 major centers across the globe. IVSSG Sutureless Projects currently proceeding include the Retrospective and Prospective Phases of the SU-AVR International Registry (SU-AVR-IR). CONCLUSIONS The global pooling of data by the IVSSG Sutureless Projects will provide required robust clinical evidence on the safety, efficacy and hemodynamic outcomes of SU-AVR.
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Affiliation(s)
- Marco Di Eusanio
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Kevin Phan
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Denis Bouchard
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Thierry P Carrel
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Otto E Dapunt
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Roberto Di Bartolomeo
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Harald C Eichstaedt
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Theodor Fischlein
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Thierry Folliguet
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Borut Gersak
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Mattia Glauber
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Axel Haverich
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Martin Misfeld
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Peter J Oberwalder
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giuseppe Santarpino
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Malakh Lal Shrestha
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Marco Solinas
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Marco Vola
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Francesco Alamanni
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Alberto Albertini
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Gopal Bhatnagar
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Michel Carrier
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Stephen Clark
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Federic Collart
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Utz Kappert
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Alfred Kocher
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Bart Meuris
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Carmelo Mignosa
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Ahmed Ouda
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Marc Pelletier
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Parwis Baradaran Rahmanian
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - David Reineke
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Kevin Teoh
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giovanni Troise
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Emmanuel Villa
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Thorsten Wahlers
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
| | - Tristan D Yan
- 1 Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy ; 2 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France ; 9 University Medical Center Ljubljana, Ljubljana, Slovenia ; 10 Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy ; 11 Hannover Medical School, Hannover, Germany ; 12 University of Leipzig, Leipzig, Germany ; 13 Pasquinucci Heart Hospital, Massa, Italy ; 14 Cardiovascular Surgery Unit, St-Etienne University Hospital; 15 Milan Institute, Monzino, Italy ; 16 Salus Hospital, GVM Care & Research, Reggio Emilia, Italy ; 17 Trillium Health Center, Mississauga, Canada ; 18 Freeman Hospital, Cardiothoracic Centre, Newcastle, UK ; 19 Hopital de la Timone, Marsielle, France ; 20 Dresden Heart Center, Department of cardiac surgery, Dresden University Hospital, Dresden, Germany ; 21 Medical University Vienna, Vienna, Austria ; 22 Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium ; 23 Ferrarotto Hospital, University of Catania, Catania, Italy ; 24 New Brunswick Heart Centre, Saint John, Canada ; 25 University Hospital Cologne, Cologne, Germany ; 26 Southlake Regional Health Centre, Ontario, Canada ; 27 Poliambulanza Foundation Hospital, Brescia, Italy
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Hébert PC, Fergusson DA, Hutton B, Mazer CD, Fremes S, Blajchman M, MacAdams C, Wells G, Robblee J, Bussières J, Teoh K. Regulatory decisions pertaining to aprotinin may be putting patients at risk. CMAJ 2014; 186:1379-86. [PMID: 25267766 DOI: 10.1503/cmaj.131582] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Paul C Hébert
- Centre de Recherche (Hébert), Centre Hospitalier de L'Université de Montréal, Montréal, Que.; Département de Médecine (Hébert), Université de Montréal, Montréal, Que.; Clinical Epidemiology Program (Fergusson), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Fergusson, Hutton, Mazer), University of Ottawa, Ottawa, Ont.; Department of Anesthesia (Fremes), Keenan Center/Li Ka Shing Institute, St. Michael's Hospital, University of Toronto, Toronto, Ont.; Sunnybrook Health Sciences Centre, Department of Surgery (Blajchman), Division of Cardiac and Vascular Surgery, University of Toronto, Toronto, Ont.; Department of Pathology and Molecular Medicine (MacAdams), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Wells), University of Calgary, Calgary, Alta.; University of Ottawa Heart Institute (Robblee), Ottawa, Ont.; Hôpital Laval (Bussières), Institut Universitaire de Cardiologie et Pneumologie de l'Université Laval, Laval, Que.; Hamilton Health Science Centre (Teoh), McMaster University, Hamilton, Ont
| | - Dean A Fergusson
- Centre de Recherche (Hébert), Centre Hospitalier de L'Université de Montréal, Montréal, Que.; Département de Médecine (Hébert), Université de Montréal, Montréal, Que.; Clinical Epidemiology Program (Fergusson), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Fergusson, Hutton, Mazer), University of Ottawa, Ottawa, Ont.; Department of Anesthesia (Fremes), Keenan Center/Li Ka Shing Institute, St. Michael's Hospital, University of Toronto, Toronto, Ont.; Sunnybrook Health Sciences Centre, Department of Surgery (Blajchman), Division of Cardiac and Vascular Surgery, University of Toronto, Toronto, Ont.; Department of Pathology and Molecular Medicine (MacAdams), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Wells), University of Calgary, Calgary, Alta.; University of Ottawa Heart Institute (Robblee), Ottawa, Ont.; Hôpital Laval (Bussières), Institut Universitaire de Cardiologie et Pneumologie de l'Université Laval, Laval, Que.; Hamilton Health Science Centre (Teoh), McMaster University, Hamilton, Ont.
| | - Brian Hutton
- Centre de Recherche (Hébert), Centre Hospitalier de L'Université de Montréal, Montréal, Que.; Département de Médecine (Hébert), Université de Montréal, Montréal, Que.; Clinical Epidemiology Program (Fergusson), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Fergusson, Hutton, Mazer), University of Ottawa, Ottawa, Ont.; Department of Anesthesia (Fremes), Keenan Center/Li Ka Shing Institute, St. Michael's Hospital, University of Toronto, Toronto, Ont.; Sunnybrook Health Sciences Centre, Department of Surgery (Blajchman), Division of Cardiac and Vascular Surgery, University of Toronto, Toronto, Ont.; Department of Pathology and Molecular Medicine (MacAdams), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Wells), University of Calgary, Calgary, Alta.; University of Ottawa Heart Institute (Robblee), Ottawa, Ont.; Hôpital Laval (Bussières), Institut Universitaire de Cardiologie et Pneumologie de l'Université Laval, Laval, Que.; Hamilton Health Science Centre (Teoh), McMaster University, Hamilton, Ont
| | - C David Mazer
- Centre de Recherche (Hébert), Centre Hospitalier de L'Université de Montréal, Montréal, Que.; Département de Médecine (Hébert), Université de Montréal, Montréal, Que.; Clinical Epidemiology Program (Fergusson), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Fergusson, Hutton, Mazer), University of Ottawa, Ottawa, Ont.; Department of Anesthesia (Fremes), Keenan Center/Li Ka Shing Institute, St. Michael's Hospital, University of Toronto, Toronto, Ont.; Sunnybrook Health Sciences Centre, Department of Surgery (Blajchman), Division of Cardiac and Vascular Surgery, University of Toronto, Toronto, Ont.; Department of Pathology and Molecular Medicine (MacAdams), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Wells), University of Calgary, Calgary, Alta.; University of Ottawa Heart Institute (Robblee), Ottawa, Ont.; Hôpital Laval (Bussières), Institut Universitaire de Cardiologie et Pneumologie de l'Université Laval, Laval, Que.; Hamilton Health Science Centre (Teoh), McMaster University, Hamilton, Ont
| | - Stephen Fremes
- Centre de Recherche (Hébert), Centre Hospitalier de L'Université de Montréal, Montréal, Que.; Département de Médecine (Hébert), Université de Montréal, Montréal, Que.; Clinical Epidemiology Program (Fergusson), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Fergusson, Hutton, Mazer), University of Ottawa, Ottawa, Ont.; Department of Anesthesia (Fremes), Keenan Center/Li Ka Shing Institute, St. Michael's Hospital, University of Toronto, Toronto, Ont.; Sunnybrook Health Sciences Centre, Department of Surgery (Blajchman), Division of Cardiac and Vascular Surgery, University of Toronto, Toronto, Ont.; Department of Pathology and Molecular Medicine (MacAdams), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Wells), University of Calgary, Calgary, Alta.; University of Ottawa Heart Institute (Robblee), Ottawa, Ont.; Hôpital Laval (Bussières), Institut Universitaire de Cardiologie et Pneumologie de l'Université Laval, Laval, Que.; Hamilton Health Science Centre (Teoh), McMaster University, Hamilton, Ont
| | - Morris Blajchman
- Centre de Recherche (Hébert), Centre Hospitalier de L'Université de Montréal, Montréal, Que.; Département de Médecine (Hébert), Université de Montréal, Montréal, Que.; Clinical Epidemiology Program (Fergusson), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Fergusson, Hutton, Mazer), University of Ottawa, Ottawa, Ont.; Department of Anesthesia (Fremes), Keenan Center/Li Ka Shing Institute, St. Michael's Hospital, University of Toronto, Toronto, Ont.; Sunnybrook Health Sciences Centre, Department of Surgery (Blajchman), Division of Cardiac and Vascular Surgery, University of Toronto, Toronto, Ont.; Department of Pathology and Molecular Medicine (MacAdams), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Wells), University of Calgary, Calgary, Alta.; University of Ottawa Heart Institute (Robblee), Ottawa, Ont.; Hôpital Laval (Bussières), Institut Universitaire de Cardiologie et Pneumologie de l'Université Laval, Laval, Que.; Hamilton Health Science Centre (Teoh), McMaster University, Hamilton, Ont
| | - Charles MacAdams
- Centre de Recherche (Hébert), Centre Hospitalier de L'Université de Montréal, Montréal, Que.; Département de Médecine (Hébert), Université de Montréal, Montréal, Que.; Clinical Epidemiology Program (Fergusson), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Fergusson, Hutton, Mazer), University of Ottawa, Ottawa, Ont.; Department of Anesthesia (Fremes), Keenan Center/Li Ka Shing Institute, St. Michael's Hospital, University of Toronto, Toronto, Ont.; Sunnybrook Health Sciences Centre, Department of Surgery (Blajchman), Division of Cardiac and Vascular Surgery, University of Toronto, Toronto, Ont.; Department of Pathology and Molecular Medicine (MacAdams), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Wells), University of Calgary, Calgary, Alta.; University of Ottawa Heart Institute (Robblee), Ottawa, Ont.; Hôpital Laval (Bussières), Institut Universitaire de Cardiologie et Pneumologie de l'Université Laval, Laval, Que.; Hamilton Health Science Centre (Teoh), McMaster University, Hamilton, Ont
| | - George Wells
- Centre de Recherche (Hébert), Centre Hospitalier de L'Université de Montréal, Montréal, Que.; Département de Médecine (Hébert), Université de Montréal, Montréal, Que.; Clinical Epidemiology Program (Fergusson), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Fergusson, Hutton, Mazer), University of Ottawa, Ottawa, Ont.; Department of Anesthesia (Fremes), Keenan Center/Li Ka Shing Institute, St. Michael's Hospital, University of Toronto, Toronto, Ont.; Sunnybrook Health Sciences Centre, Department of Surgery (Blajchman), Division of Cardiac and Vascular Surgery, University of Toronto, Toronto, Ont.; Department of Pathology and Molecular Medicine (MacAdams), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Wells), University of Calgary, Calgary, Alta.; University of Ottawa Heart Institute (Robblee), Ottawa, Ont.; Hôpital Laval (Bussières), Institut Universitaire de Cardiologie et Pneumologie de l'Université Laval, Laval, Que.; Hamilton Health Science Centre (Teoh), McMaster University, Hamilton, Ont
| | - Jim Robblee
- Centre de Recherche (Hébert), Centre Hospitalier de L'Université de Montréal, Montréal, Que.; Département de Médecine (Hébert), Université de Montréal, Montréal, Que.; Clinical Epidemiology Program (Fergusson), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Fergusson, Hutton, Mazer), University of Ottawa, Ottawa, Ont.; Department of Anesthesia (Fremes), Keenan Center/Li Ka Shing Institute, St. Michael's Hospital, University of Toronto, Toronto, Ont.; Sunnybrook Health Sciences Centre, Department of Surgery (Blajchman), Division of Cardiac and Vascular Surgery, University of Toronto, Toronto, Ont.; Department of Pathology and Molecular Medicine (MacAdams), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Wells), University of Calgary, Calgary, Alta.; University of Ottawa Heart Institute (Robblee), Ottawa, Ont.; Hôpital Laval (Bussières), Institut Universitaire de Cardiologie et Pneumologie de l'Université Laval, Laval, Que.; Hamilton Health Science Centre (Teoh), McMaster University, Hamilton, Ont
| | - Jean Bussières
- Centre de Recherche (Hébert), Centre Hospitalier de L'Université de Montréal, Montréal, Que.; Département de Médecine (Hébert), Université de Montréal, Montréal, Que.; Clinical Epidemiology Program (Fergusson), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Fergusson, Hutton, Mazer), University of Ottawa, Ottawa, Ont.; Department of Anesthesia (Fremes), Keenan Center/Li Ka Shing Institute, St. Michael's Hospital, University of Toronto, Toronto, Ont.; Sunnybrook Health Sciences Centre, Department of Surgery (Blajchman), Division of Cardiac and Vascular Surgery, University of Toronto, Toronto, Ont.; Department of Pathology and Molecular Medicine (MacAdams), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Wells), University of Calgary, Calgary, Alta.; University of Ottawa Heart Institute (Robblee), Ottawa, Ont.; Hôpital Laval (Bussières), Institut Universitaire de Cardiologie et Pneumologie de l'Université Laval, Laval, Que.; Hamilton Health Science Centre (Teoh), McMaster University, Hamilton, Ont
| | - Kevin Teoh
- Centre de Recherche (Hébert), Centre Hospitalier de L'Université de Montréal, Montréal, Que.; Département de Médecine (Hébert), Université de Montréal, Montréal, Que.; Clinical Epidemiology Program (Fergusson), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Medicine (Fergusson, Hutton, Mazer), University of Ottawa, Ottawa, Ont.; Department of Anesthesia (Fremes), Keenan Center/Li Ka Shing Institute, St. Michael's Hospital, University of Toronto, Toronto, Ont.; Sunnybrook Health Sciences Centre, Department of Surgery (Blajchman), Division of Cardiac and Vascular Surgery, University of Toronto, Toronto, Ont.; Department of Pathology and Molecular Medicine (MacAdams), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Wells), University of Calgary, Calgary, Alta.; University of Ottawa Heart Institute (Robblee), Ottawa, Ont.; Hôpital Laval (Bussières), Institut Universitaire de Cardiologie et Pneumologie de l'Université Laval, Laval, Que.; Hamilton Health Science Centre (Teoh), McMaster University, Hamilton, Ont
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Whitlock R, Healey JS, Connolly SJ, Wang J, Danter MR, Tu JV, Novick R, Fremes S, Teoh K, Khera V, Yusuf S. Predictors of early and late stroke following cardiac surgery. CMAJ 2014; 186:905-11. [PMID: 25047983 DOI: 10.1503/cmaj.131214] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Much is known about the short-term risks of stroke following cardiac surgery. We examined the rate and predictors of long-term stroke in a cohort of patients who underwent cardiac surgery. METHODS We obtained linked data for patients who underwent cardiac surgery in the province of Ontario between 1996 and 2006. We analyzed the incidence of stroke and death up to 2 years postoperatively. RESULTS Of 108,711 patients, 1.8% (95% confidence interval [CI] 1.7%-1.9%) had a stroke perioperatively, and 3.6% (95% CI 3.5%-3.7%) had a stroke within the ensuing 2 years. The strongest predictors of both early and late stroke were advanced age (≥ 65 year; adjusted hazard ratio [HR] for all stroke 1.9, 95% CI 1.8-2.0), a history of stroke or transient ischemic attack (adjusted HR 2.1, 95% CI 1.9-2.3), peripheral vascular disease (adjusted HR 1.6, 95% CI 1.5-1.7), combined coronary bypass grafting and valve surgery (adjusted HR 1.7, 95% CI 1.5-1.8) and valve surgery alone (adjusted HR 1.4, 95% CI 1.2-1.5). Preoperative need for dialysis (adjusted odds ratio [OR] 2.1, 95% CI 1.6-2.8) and new-onset postoperative atrial fibrillation (adjusted OR 1.5, 95% CI 1.3-1.6) were predictors of only early stroke. A CHADS2 score of 2 or higher was associated with an increased risk of stroke or death compared with a score of 0 or 1 (19.9% v. 9.3% among patients with a history of atrial fibrillation, 16.8% v. 7.8% among those with new-onset postoperative atrial fibrillation and 14.8% v. 5.8% among those without this condition). INTERPRETATION Patients who had cardiac surgery were at highest risk of stroke in the early postoperative period and had continued risk over the ensuing 2 years, with similar risk factors over these periods. New-onset postoperative atrial fibrillation was a predictor of only early stroke. The CHADS2 score predicted stroke risk among patients with and without atrial fibrillation.
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Affiliation(s)
- Richard Whitlock
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont
| | - Jeff S Healey
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont
| | - Stuart J Connolly
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont
| | - Julie Wang
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont
| | - Matthew R Danter
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont
| | - Jack V Tu
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont
| | - Richard Novick
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont.
| | - Stephen Fremes
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont
| | - Kevin Teoh
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont
| | - Vikas Khera
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont
| | - Salim Yusuf
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont
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Whitlock R, Teoh K, Vincent J, Devereaux P, Lamy A, Paparella D, Zuo Y, Sessler DI, Shah P, Villar JC, Karthikeyan G, Urrútia G, Alvezum A, Zhang X, Abbasi SH, Zheng H, Quantz M, Yared JP, Yu H, Noiseux N, Yusuf S. Rationale and design of the steroids in cardiac surgery trial. Am Heart J 2014; 167:660-5. [PMID: 24766975 DOI: 10.1016/j.ahj.2014.01.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 01/30/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Steroids may improve outcomes in high-risk patients undergoing cardiac surgery with the use of cardiopulmonary bypass (CBP). There is a need\ for a large randomized controlled trial to clarify the effect of steroids in such patients. METHODS We plan to randomize 7,500 patients with elevated European System for Cardiac Operative Risk Evaluation who are undergoing cardiac surgery with the use of CBP to methylprednisolone or placebo. The first coprimary outcome is 30-day all-cause mortality, and the most second coprimary outcome is a composite of death, MI, stroke, renal failure, or respiratory failure within 30 days. Other outcomes include a composite of MI or mortality at 30 days, new onset atrial fibrillation, bleeding and transfusion requirements, length of intensive care unit stay and hospital stay, infection, stroke, wound complications, gastrointestinal complications, delirium, postoperative insulin use and peak blood glucose, and all-cause mortality at 6 months. RESULTS As of October 22, 2013, 7,034 patients have been recruited into SIRS in 82 centers from 18 countries. Patient's mean age is 67.3 years, and 60.4% are male. The average European System for Cardiac Operative Risk Evaluation is 7.0 with 22.1% having an isolated coronary artery bypass graft procedure, and 66.1% having a valve procedure. CONCLUSIONS SIRS will lead to a better understanding of the safety and efficacy of prophylactic steroids for cardiac surgery requiring CBP.
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Garg AX, Vincent J, Cuerden M, Parikh C, Devereaux PJ, Teoh K, Yusuf S, Hildebrand A, Lamy A, Zuo Y, Sessler DI, Shah P, Abbasi SH, Quantz M, Yared JP, Noiseux N, Tagarakis G, Rochon A, Pogue J, Walsh M, Chan MTV, Lamontagne F, Salehiomran A, Whitlock R. Steroids In caRdiac Surgery (SIRS) trial: acute kidney injury substudy protocol of an international randomised controlled trial. BMJ Open 2014; 4:e004842. [PMID: 24598306 PMCID: PMC3948633 DOI: 10.1136/bmjopen-2014-004842] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Steroids In caRdiac Surgery trial (SIRS) is a large international randomised controlled trial of methylprednisolone or placebo in patients undergoing cardiac surgery with the use of a cardiopulmonary bypass pump. At the time of surgery, compared with placebo, methylprednisolone divided into two intravenous doses of 250 mg each may reduce the risk of postoperative acute kidney injury (AKI). METHODS AND ANALYSIS With respect to the study schedule, over 7000 substudy eligible patients from 81 centres in 18 countries were randomised in December 2013. The authors will use a logistic regression to estimate the adjusted OR of methylprednisolone versus placebo on the primary outcome of AKI in the 14 days following surgery (a postoperative increase in serum creatinine of ≥50%, or ≥26.5 μmol/L, from the preoperative value). The stage of AKI will also be considered, as will the outcome of AKI in those with and without preoperative chronic kidney disease. After receipt of grant funding, the authors began to record additional perioperative serum creatinine measurements in consecutive patients enrolled at substudy participating centres, and patients were invited to enroll in a 6-month serum creatinine collection. In these trial subpopulations, the authors will consider the outcome of AKI defined in alternate ways, and the outcome of a 6-month change in kidney function from the preoperative value. ETHICS AND DISSEMINATION The authors were competitively awarded a grant from the Canadian Institutes of Health Research for this SIRS AKI substudy. Ethics approval was obtained for additional serum creatinine recordings in consecutive patients enrolled at participating centres. The additional kidney data collection first began for patients enrolled after 1 March 2012. In patients who provided consent, the last 6-month kidney outcome data will be collected in 2014. The results will be reported no later than 2015. CLINICAL TRIAL REGISTRATION Number NCT00427388.
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Whitlock R, Healey J, Vincent J, Brady K, Teoh K, Royse A, Shah P, Guo Y, Alings M, Folkeringa RJ, Paparella D, Colli A, Meyer SR, Legare JF, Lamontagne F, Reents W, Böning A, Connolly S. Rationale and design of the Left Atrial Appendage Occlusion Study (LAAOS) III. Ann Cardiothorac Surg 2014; 3:45-54. [PMID: 24516797 DOI: 10.3978/j.issn.2225-319x.2013.12.06] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 12/26/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND Occlusion of the left atrial appendage (LAA) is a promising approach to stroke prevention in atrial fibrillation (AF). However, evidence of its efficacy and safety to date is lacking. We herein describe the rationale and design of a definitive LAA occlusion trial in cardiac surgical patients with AF. METHODS We plan to randomize 4,700 patients with AF in whom on-pump cardiac surgical procedure is planned to undergo LAA occlusion or no LAA occlusion. The primary outcome is the first occurrence of stroke or systemic arterial embolism over a mean follow-up of four years. Other outcomes include total mortality, operative safety outcomes (chest tube output in the first post-operative 24 hours, rate of post-operative re-exploration for bleeding in the first 48 hours post-surgery and 30-day mortality), re-hospitalization for heart failure, major bleed, and myocardial infarction. RESULTS Left Atrial Appendage Occlusion Study (LAAOS) III is funded in a vanguard phase by the Canadian Institutes for Health Research (CIHR), the Canadian Network and Centre for Trials Internationally, and the McMaster University Surgical Associates. As of September 9, 2013, 162 patients have been recruited into the study. CONCLUSIONS LAAOS III will be the largest trial to explore the efficacy of LAA occlusion for stroke prevention. Its results will lead to a better understanding of stroke in AF and the safety and efficacy of surgical LAA occlusion.
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Affiliation(s)
- Richard Whitlock
- Department of Surgery, McMaster University, Hamilton, Canada ; ; Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Jeff Healey
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada ; ; Department of Medicine, McMaster University, Hamilton, Canada
| | - Jessica Vincent
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Kate Brady
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Kevin Teoh
- Department of Surgery, McMaster University, Hamilton, Canada ; ; Department of Surgery, Southlake Regional Health Centre, Newmarket, Canada
| | - Alistair Royse
- Department of Surgery, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Pallav Shah
- Department of Cardiothoracic Surgery, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Yingqiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Marco Alings
- Department of Cardiology and Electrophysiology, Amphia Ziekenhuis, Breda, the Netherlands
| | - Richard J Folkeringa
- Department of Cardiology, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Domenico Paparella
- Division of Cardiac Surgery, Department of Emergency and Organ Transplant (DETO), University of Bari Aldo Moro, Bari, Italy
| | - Andrea Colli
- Department of Cardiology, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Steven R Meyer
- Department of Surgery, University of Alberta, Edmonton, Canada
| | | | - François Lamontagne
- Centre de recherché Clinique Étienne-Lebel and Faculté de Médecine et des Sciences de la Santé, Univesité de Sherbrooke, Sherbrooke, Canada
| | - Wilko Reents
- Department of Cardiac Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
| | - Andreas Böning
- Department of Cardiovascular Surgery, University of Giessen, Giessen, Germany
| | - Stuart Connolly
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada ; ; Department of Medicine, McMaster University, Hamilton, Canada
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Mazine A, Bouhout I, Teoh K, Carrier M, Christakis G, Bhatnagar G, Bouchard D. Sutureless Aortic Valve Replacement With the Perceval S Prosthesis : a Canadian Multicenter Study. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.599] [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: 10/26/2022] Open
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Bainey KR, Natarajan MK, Mercuri M, Lai T, Teoh K, Chu V, Whitlock RP, Velianou JL. Treatment assignment of high-risk symptomatic severe aortic stenosis patients referred for transcatheter AorticValve implantation. Am J Cardiol 2013; 112:100-3. [PMID: 23561589 DOI: 10.1016/j.amjcard.2013.02.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 02/26/2013] [Accepted: 02/26/2013] [Indexed: 10/27/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has become an option for patients with symptomatic severe aortic stenosis whose co-morbidities place them at high surgical risk. However, little is known regarding treatment allocation. From May 2008 to May 2011, all high-risk patients with symptomatic severe aortic stenosis referred to an experienced single-center TAVI clinic were reviewed. A total of 170 consecutive patients were evaluated. Of these, 58 (34%) were accepted for TAVI (mean age 81 ± 8 years). Thirty-three patients (19%) were accepted for conventional aortic valve replacement (AVR; mean age 83 ± 6 years). Sixty-two patients (37%) were treated conservatively (mean age 83 ± 6 years). Seventeen patients (10%) died awaiting complete assessment. At 30 days, all-cause mortality was 10% in the TAVI group, 3% in the conventional AVR group, and 32% in the conservatively treated group. Multivariate-adjustment identified the absence of chronic obstructive pulmonary disease (hazard ratio 0.30, 95% confidence interval 0.09 to 0.98, p <0.05) and the absence of frailty (hazard ratio 0.19, 95% confidence interval 0.07 to 0.55, p <0.01) as independent predictors of conventional AVR. In conclusion, of the high-risk patients with severe aortic stenosis referred for TAVI at a large single center, approximately 1/2 were accepted for intervention (conventional AVR or TAVI), and roughly 1/3 were treated conservatively.
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Whitlock R, Mathew J, Eikelboom J, Al-Saleh AM, Yuan F, Teoh K. Processed residual pump blood in cardiac surgery: the Processed Residual Blood in Cardiac surgery trial. Transfusion 2012; 53:1487-92. [DOI: 10.1111/j.1537-2995.2012.03958.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 09/21/2012] [Accepted: 09/26/2012] [Indexed: 11/29/2022]
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Arsenault KA, Paikin JS, Hirsh J, Dale B, Whitlock RP, Teoh K, Young E, Ginsberg JS, Weitz JI, Eikelboom JW. Subtle differences in commercial heparins can have serious consequences for cardiopulmonary bypass patients: A randomized controlled trial. J Thorac Cardiovasc Surg 2012; 144:944-950.e3. [DOI: 10.1016/j.jtcvs.2012.05.065] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 04/26/2012] [Accepted: 05/17/2012] [Indexed: 11/15/2022]
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Teoh K, Christakis G, Bouchard D, Carrier M, Bhatnagar G. 741 Aortic Valve Replacement With Perceval S Sutureless Valve: Initial Canadian/North American Experience. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.670] [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: 11/30/2022] Open
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41
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Arsenault K, Paikin J, Hirsh J, Dale B, Whitlock R, Teoh K, Young E, Ginsberg J, Weitz J, Eikelboom J. 504 Subtle Differences in Commercial Heparins Can Have Serious Consequences for Cardiopulmonary Bypass Patients: a randomized controlled trial. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.460] [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: 11/28/2022] Open
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Rodes-Cabau J, Webb J, Cheung A, Ye J, Dumont E, Chris F, Osten M, Natarajan M, Velianou JL, Martucci G, DeVarennes B, Thompson CR, Chisholm R, Peterson M, Lichtenstein S, Toggweiler S, Doyle D, DeLarochellière R, Dumesnil J, Teoh K, Chu V, Cheema A, Wood D, Pibarot P, Horlick E. LONG-TERM OUTCOMES FOLLOWING TRANSCATHETER AORTIC VALVE IMPLANTATION: INSIGHTS ON PROGNOSTIC FACTORS AND VALVE DURABILITY FROM THE CANADIAN MULTICENTER EXPERIENCE. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60011-4] [Citation(s) in RCA: 4] [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] [Indexed: 11/29/2022]
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Robertson I, Teoh K, McMurray I, Roberts P, Sochos A. Research-Informed Learning in the Psychology Curriculum: An Initial Evaluation. Psychology Learning & Teaching 2011. [DOI: 10.2304/plat.2011.10.2.84] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Research-informed teaching and learning have become an important area for development in psychology departments. There is an assumption that staff research can enhance the curriculum and the student experience. The methods of research and statistical awareness are also deemed important skills for a student in professional psychology to develop. This article reports an evaluation of the degree to which research informs staff teaching and the impact of research methods teaching on student employability. Undergraduate students and recent graduates were surveyed in a mixed qualitative and quantitative research design involving questionnaires, focus groups and a job analysis. A discrepancy was found between lecturers' and students' views of the extent to which staff's research informed their teaching. While lecturers regarded themselves as researchers as well as teachers, students regarded them as mainly teachers and ‘entertainers’. Where staff did refer to their own research to illustrate their teaching they were regarded as enthusiastic and authoritative. Staff-led projects in particular had a positive impact on both students and staff as they appeared to enhance group identity among the students involved and to improve students' understanding of research design. The focus on research, research methods, statistics and research ethics appears to have led some students to develop a critical attitude to events and information in the media and everyday life.
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Affiliation(s)
| | - Kevin Teoh
- University of Bedfordshire, United Kingdom
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McGillion M, Cook A, Victor JC, Carroll S, Weston J, Teoh K, Arthur HM. Effectiveness of percutaneous laser revascularization therapy for refractory angina. Vasc Health Risk Manag 2010; 6:735-47. [PMID: 20859544 PMCID: PMC2941786 DOI: 10.2147/vhrm.s8222] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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] [Received: 08/24/2010] [Indexed: 12/03/2022] Open
Abstract
Refractory angina is a debilitating disease characterized by persistent cardiac pain resistant to all conventional treatments for coronary artery disease. Percutaneous myocardial laser revascularization (PMLR) has been proposed to improve symptoms in these patients. We used meta-analysis to assess the effectiveness of PMLR versus optimal medical therapy for improving angina symptoms, health-related quality of life (HRQL), and exercise performance; the impact on all-cause mortality was also examined. Seven trials, involving a total of 1,213 participants were included. Our primary analyses showed that at 12-month follow-up, those who had received PMLR had ≥2 Canadian Cardiovascular Society class angina symptom reductions, OR 2.13 (95% CI, 1.22 to 3.73), as well as improvements in aspects of HRQL including angina frequency, SMD = 0.29 (95% CI, 0.05 to 0.52), disease perception, SMD = 0.37 (95% CI, 0.14 to 0.61), and physical limitations, SMD = 0.29 (95% CI, 0.05 to 0.53). PMLR had no significant impact on all-cause mortality. Our secondary analyses, in which we considered data from one trial that featured a higher-dose laser group, yielded no significant overall impact of PMLR across outcomes. While PMLR may be effective for improving angina symptoms and related burden, further work is needed to clarify appropriate dose and impact on disease-specific mortality and adverse cardiac events.
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Jenkins PJ, Teoh K, Simpson PM, Dave J, Simpson AHWR, Breusch S. Clostridium difficile in patients undergoing primary hip and knee replacement. ACTA ACUST UNITED AC 2010; 92:994-8. [PMID: 20595121 DOI: 10.1302/0301-620x.92b7.23412] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Antibiotic prophylaxis is routinely administered during joint replacement surgery and may predispose patients to Clostridium difficile-associated disease (CDAD). The primary aim of this study was to determine the incidence of this following joint replacement, using a cefuroxime-based regimen. Patients developing CDAD were compared with a control group of patients without CDAD. The incidence of the former was 1.7 per 1000 primary joint replacements. Those patients prescribed additional antibiotics had a higher incidence of CDAD (p = 0.047), but there was no difference between the two groups in relation to the use of gastroprotective agents (p = 0.703). A trial of a new prophylaxis regimen would require 43 198 patients in each arm to show a reduction of one case per 1000 procedures. Cefuroxime-based antibiotic prophylaxis is safe in patients undergoing primary elective joint replacement.
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Affiliation(s)
- P J Jenkins
- Department of Orthopaedic, Surgery, Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh, EH16 4SU, UK.
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Rodés-Cabau J, Webb JG, Cheung A, Ye J, Dumont E, Feindel CM, Osten M, Natarajan MK, Velianou JL, Martucci G, DeVarennes B, Chisholm R, Peterson MD, Lichtenstein SV, Nietlispach F, Doyle D, DeLarochellière R, Teoh K, Chu V, Dancea A, Lachapelle K, Cheema A, Latter D, Horlick E. Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience. J Am Coll Cardiol 2010; 55:1080-90. [PMID: 20096533 DOI: 10.1016/j.jacc.2009.12.014] [Citation(s) in RCA: 760] [Impact Index Per Article: 54.3] [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: 10/02/2009] [Revised: 11/11/2009] [Accepted: 12/17/2009] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of this study was: 1) to evaluate the acute and late outcomes of a transcatheter aortic valve implantation (TAVI) program including both the transfemoral (TF) and transapical (TA) approaches; and 2) to determine the results of TAVI in patients deemed inoperable because of either porcelain aorta or frailty. BACKGROUND Very few data exist on the results of a comprehensive TAVI program including both TA and TF approaches for the treatment of severe aortic stenosis in patients at very high or prohibitive surgical risk. METHODS Consecutive patients who underwent TAVI with the Edwards valve (Edwards Lifesciences, Inc., Irvine, California) between January 2005 and June 2009 in 6 Canadian centers were included. RESULTS A total of 345 procedures (TF: 168, TA: 177) were performed in 339 patients. The predicted surgical mortality (Society of Thoracic Surgeons risk score) was 9.8 +/- 6.4%. The procedural success rate was 93.3%, and 30-day mortality was 10.4% (TF: 9.5%, TA: 11.3%). After a median follow-up of 8 months (25th to 75th interquartile range: 3 to 14 months) the mortality rate was 22.1%. The predictors of cumulative late mortality were peri-procedural sepsis (hazard ratio [HR]: 3.49, 95% confidence interval [CI]: 1.48 to 8.28) or need for hemodynamic support (HR: 2.58, 95% CI: 1.11 to 6), pulmonary hypertension (PH) (HR: 1.88, 95% CI: 1.17 to 3), chronic kidney disease (CKD) (HR: 2.30, 95% CI: 1.38 to 3.84), and chronic obstructive pulmonary disease (COPD) (HR: 1.75, 95% CI: 1.09 to 2.83). Patients with either porcelain aorta (18%) or frailty (25%) exhibited acute outcomes similar to the rest of the study population, and porcelain aorta patients tended to have a better survival rate at 1-year follow-up. CONCLUSIONS A TAVI program including both TF and TA approaches was associated with comparable mortality as predicted by surgical risk calculators for the treatment of patients at very high or prohibitive surgical risk, including porcelain aorta and frail patients. Baseline (PH, COPD, CKD) and peri-procedural (hemodynamic support, sepsis) factors but not the approach determined worse outcomes.
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Affiliation(s)
- Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
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Guru V, Tu JV, Etchells E, Anderson GM, Naylor CD, Novick RJ, Feindel CM, Rubens FD, Teoh K, Mathur A, Hamilton A, Bonneau D, Cutrara C, Austin PC, Fremes SE. Relationship Between Preventability of Death After Coronary Artery Bypass Graft Surgery and All-Cause Risk-Adjusted Mortality Rates. Circulation 2008; 117:2969-76. [PMID: 18541752 DOI: 10.1161/circulationaha.107.722249] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [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 goal of this study was to determine the relationship between all-cause, risk-adjusted, in-hospital mortality after coronary artery bypass graft surgery and the proportion of preventable in-hospital deaths as a measure of quality of care at an institution level.
Methods and Results—
We conducted a retrospective analysis of 347 randomly selected in-hospital deaths after isolated coronary artery bypass graft surgery at 9 institutions in Ontario over the period of 1998 to 2003. Nurse-abstracted chart summaries were reviewed by 2 experienced cardiac surgeons who were blinded to patient, surgeon, and hospital and used a standardized implicit tool to identify preventable death. A third reviewer reassessed all cases in which the first 2 reviewers disagreed. Rates of preventable deaths were estimated for each hospital and compared with all-cause mortality rates. A structured adverse event audit completed by each surgeon-reviewer was used to identify quality improvement opportunities for the preventable deaths. A total of 111 of 347 deaths (32%) were judged preventable despite a low risk-adjusted mortality range (1.3% to 3.1%) across hospitals. No significant correlation was found between all-cause, risk-adjusted in-hospital mortality rates and the proportion of preventable deaths at the hospital level (Spearman coefficient, −0.42;
P
=0.26). A large proportion of preventable deaths were related to problems in the operating room (86%) and intensive care unit (61%). Many deaths were associated with deviations in perioperative care (32% based on concurrence of 2 reviewers, and another 42% in cases in which 1 reviewer reached that opinion).
Conclusions—
Approximately one third of in-hospital coronary artery bypass graft deaths were judged preventable by surgeon reviewers. All-cause risk-adjusted mortality rates are convenient measures of institutional quality of care but were not correlated with preventable mortality in our jurisdiction. Providers should conduct detailed adverse event audits to drive meaningful improvements in quality.
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Affiliation(s)
- Veena Guru
- From the Institute For Clinical Evaluative Sciences, Toronto (V.G., J.V.T., G.M.A., C.D.N., P.C.A., S.E.F.); Divisions of Cardiac and Vascular Surgery (V.G., S.E.F.) and General Internal Medicine (J.V.T., E.E., C.D.N.), Sunnybrook Health Sciences Centre, the Division of Cardiovascular Surgery, University Health Network (C.M.F.), and the Division of Cardiovascular Surgery, St Michael’s Hospital (D.B.), University of Toronto, Toronto; Division of Cardiac Surgery, London Health Sciences Centre, London
| | - Jack V. Tu
- From the Institute For Clinical Evaluative Sciences, Toronto (V.G., J.V.T., G.M.A., C.D.N., P.C.A., S.E.F.); Divisions of Cardiac and Vascular Surgery (V.G., S.E.F.) and General Internal Medicine (J.V.T., E.E., C.D.N.), Sunnybrook Health Sciences Centre, the Division of Cardiovascular Surgery, University Health Network (C.M.F.), and the Division of Cardiovascular Surgery, St Michael’s Hospital (D.B.), University of Toronto, Toronto; Division of Cardiac Surgery, London Health Sciences Centre, London
| | - Edward Etchells
- From the Institute For Clinical Evaluative Sciences, Toronto (V.G., J.V.T., G.M.A., C.D.N., P.C.A., S.E.F.); Divisions of Cardiac and Vascular Surgery (V.G., S.E.F.) and General Internal Medicine (J.V.T., E.E., C.D.N.), Sunnybrook Health Sciences Centre, the Division of Cardiovascular Surgery, University Health Network (C.M.F.), and the Division of Cardiovascular Surgery, St Michael’s Hospital (D.B.), University of Toronto, Toronto; Division of Cardiac Surgery, London Health Sciences Centre, London
| | - Geoffrey M. Anderson
- From the Institute For Clinical Evaluative Sciences, Toronto (V.G., J.V.T., G.M.A., C.D.N., P.C.A., S.E.F.); Divisions of Cardiac and Vascular Surgery (V.G., S.E.F.) and General Internal Medicine (J.V.T., E.E., C.D.N.), Sunnybrook Health Sciences Centre, the Division of Cardiovascular Surgery, University Health Network (C.M.F.), and the Division of Cardiovascular Surgery, St Michael’s Hospital (D.B.), University of Toronto, Toronto; Division of Cardiac Surgery, London Health Sciences Centre, London
| | - C. David Naylor
- From the Institute For Clinical Evaluative Sciences, Toronto (V.G., J.V.T., G.M.A., C.D.N., P.C.A., S.E.F.); Divisions of Cardiac and Vascular Surgery (V.G., S.E.F.) and General Internal Medicine (J.V.T., E.E., C.D.N.), Sunnybrook Health Sciences Centre, the Division of Cardiovascular Surgery, University Health Network (C.M.F.), and the Division of Cardiovascular Surgery, St Michael’s Hospital (D.B.), University of Toronto, Toronto; Division of Cardiac Surgery, London Health Sciences Centre, London
| | - Richard J. Novick
- From the Institute For Clinical Evaluative Sciences, Toronto (V.G., J.V.T., G.M.A., C.D.N., P.C.A., S.E.F.); Divisions of Cardiac and Vascular Surgery (V.G., S.E.F.) and General Internal Medicine (J.V.T., E.E., C.D.N.), Sunnybrook Health Sciences Centre, the Division of Cardiovascular Surgery, University Health Network (C.M.F.), and the Division of Cardiovascular Surgery, St Michael’s Hospital (D.B.), University of Toronto, Toronto; Division of Cardiac Surgery, London Health Sciences Centre, London
| | - Christopher M. Feindel
- From the Institute For Clinical Evaluative Sciences, Toronto (V.G., J.V.T., G.M.A., C.D.N., P.C.A., S.E.F.); Divisions of Cardiac and Vascular Surgery (V.G., S.E.F.) and General Internal Medicine (J.V.T., E.E., C.D.N.), Sunnybrook Health Sciences Centre, the Division of Cardiovascular Surgery, University Health Network (C.M.F.), and the Division of Cardiovascular Surgery, St Michael’s Hospital (D.B.), University of Toronto, Toronto; Division of Cardiac Surgery, London Health Sciences Centre, London
| | - Fraser D. Rubens
- From the Institute For Clinical Evaluative Sciences, Toronto (V.G., J.V.T., G.M.A., C.D.N., P.C.A., S.E.F.); Divisions of Cardiac and Vascular Surgery (V.G., S.E.F.) and General Internal Medicine (J.V.T., E.E., C.D.N.), Sunnybrook Health Sciences Centre, the Division of Cardiovascular Surgery, University Health Network (C.M.F.), and the Division of Cardiovascular Surgery, St Michael’s Hospital (D.B.), University of Toronto, Toronto; Division of Cardiac Surgery, London Health Sciences Centre, London
| | - Kevin Teoh
- From the Institute For Clinical Evaluative Sciences, Toronto (V.G., J.V.T., G.M.A., C.D.N., P.C.A., S.E.F.); Divisions of Cardiac and Vascular Surgery (V.G., S.E.F.) and General Internal Medicine (J.V.T., E.E., C.D.N.), Sunnybrook Health Sciences Centre, the Division of Cardiovascular Surgery, University Health Network (C.M.F.), and the Division of Cardiovascular Surgery, St Michael’s Hospital (D.B.), University of Toronto, Toronto; Division of Cardiac Surgery, London Health Sciences Centre, London
| | - Avdesh Mathur
- From the Institute For Clinical Evaluative Sciences, Toronto (V.G., J.V.T., G.M.A., C.D.N., P.C.A., S.E.F.); Divisions of Cardiac and Vascular Surgery (V.G., S.E.F.) and General Internal Medicine (J.V.T., E.E., C.D.N.), Sunnybrook Health Sciences Centre, the Division of Cardiovascular Surgery, University Health Network (C.M.F.), and the Division of Cardiovascular Surgery, St Michael’s Hospital (D.B.), University of Toronto, Toronto; Division of Cardiac Surgery, London Health Sciences Centre, London
| | - Andrew Hamilton
- From the Institute For Clinical Evaluative Sciences, Toronto (V.G., J.V.T., G.M.A., C.D.N., P.C.A., S.E.F.); Divisions of Cardiac and Vascular Surgery (V.G., S.E.F.) and General Internal Medicine (J.V.T., E.E., C.D.N.), Sunnybrook Health Sciences Centre, the Division of Cardiovascular Surgery, University Health Network (C.M.F.), and the Division of Cardiovascular Surgery, St Michael’s Hospital (D.B.), University of Toronto, Toronto; Division of Cardiac Surgery, London Health Sciences Centre, London
| | - Daniel Bonneau
- From the Institute For Clinical Evaluative Sciences, Toronto (V.G., J.V.T., G.M.A., C.D.N., P.C.A., S.E.F.); Divisions of Cardiac and Vascular Surgery (V.G., S.E.F.) and General Internal Medicine (J.V.T., E.E., C.D.N.), Sunnybrook Health Sciences Centre, the Division of Cardiovascular Surgery, University Health Network (C.M.F.), and the Division of Cardiovascular Surgery, St Michael’s Hospital (D.B.), University of Toronto, Toronto; Division of Cardiac Surgery, London Health Sciences Centre, London
| | - Charles Cutrara
- From the Institute For Clinical Evaluative Sciences, Toronto (V.G., J.V.T., G.M.A., C.D.N., P.C.A., S.E.F.); Divisions of Cardiac and Vascular Surgery (V.G., S.E.F.) and General Internal Medicine (J.V.T., E.E., C.D.N.), Sunnybrook Health Sciences Centre, the Division of Cardiovascular Surgery, University Health Network (C.M.F.), and the Division of Cardiovascular Surgery, St Michael’s Hospital (D.B.), University of Toronto, Toronto; Division of Cardiac Surgery, London Health Sciences Centre, London
| | - Peter C. Austin
- From the Institute For Clinical Evaluative Sciences, Toronto (V.G., J.V.T., G.M.A., C.D.N., P.C.A., S.E.F.); Divisions of Cardiac and Vascular Surgery (V.G., S.E.F.) and General Internal Medicine (J.V.T., E.E., C.D.N.), Sunnybrook Health Sciences Centre, the Division of Cardiovascular Surgery, University Health Network (C.M.F.), and the Division of Cardiovascular Surgery, St Michael’s Hospital (D.B.), University of Toronto, Toronto; Division of Cardiac Surgery, London Health Sciences Centre, London
| | - Stephen E. Fremes
- From the Institute For Clinical Evaluative Sciences, Toronto (V.G., J.V.T., G.M.A., C.D.N., P.C.A., S.E.F.); Divisions of Cardiac and Vascular Surgery (V.G., S.E.F.) and General Internal Medicine (J.V.T., E.E., C.D.N.), Sunnybrook Health Sciences Centre, the Division of Cardiovascular Surgery, University Health Network (C.M.F.), and the Division of Cardiovascular Surgery, St Michael’s Hospital (D.B.), University of Toronto, Toronto; Division of Cardiac Surgery, London Health Sciences Centre, London
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Fergusson DA, Hébert PC, Mazer CD, Fremes S, MacAdams C, Murkin JM, Teoh K, Duke PC, Arellano R, Blajchman MA, Bussières JS, Côté D, Karski J, Martineau R, Robblee JA, Rodger M, Wells G, Clinch J, Pretorius R. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med 2008; 358:2319-31. [PMID: 18480196 DOI: 10.1056/nejmoa0802395] [Citation(s) in RCA: 693] [Impact Index Per Article: 43.3] [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: 12/25/2022]
Abstract
BACKGROUND Antifibrinolytic agents are commonly used during cardiac surgery to minimize bleeding and to reduce exposure to blood products. We sought to determine whether aprotinin was superior to either tranexamic acid or aminocaproic acid in decreasing massive postoperative bleeding and other clinically important consequences. METHODS In this multicenter, blinded trial, we randomly assigned 2331 high-risk cardiac surgical patients to one of three groups: 781 received aprotinin, 770 received tranexamic acid, and 780 received aminocaproic acid. The primary outcome was massive postoperative bleeding. Secondary outcomes included death from any cause at 30 days. RESULTS The trial was terminated early because of a higher rate of death in patients receiving aprotinin. A total of 74 patients (9.5%) in the aprotinin group had massive bleeding, as compared with 93 (12.1%) in the tranexamic acid group and 94 (12.1%) in the aminocaproic acid group (relative risk in the aprotinin group for both comparisons, 0.79; 95% confidence interval [CI], 0.59 to 1.05). At 30 days, the rate of death from any cause was 6.0% in the aprotinin group, as compared with 3.9% in the tranexamic acid group (relative risk, 1.55; 95% CI, 0.99 to 2.42) and 4.0% in the aminocaproic acid group (relative risk, 1.52; 95% CI, 0.98 to 2.36). The relative risk of death in the aprotinin group, as compared with that in both groups receiving lysine analogues, was 1.53 (95% CI, 1.06 to 2.22). CONCLUSIONS Despite the possibility of a modest reduction in the risk of massive bleeding, the strong and consistent negative mortality trend associated with aprotinin, as compared with the lysine analogues, precludes its use in high-risk cardiac surgery. (Current Controlled Trials number, ISRCTN15166455 [controlled-trials.com].).
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Abstract
This study reports the experience of one treatment centre with routine surveillance MRI following excision of musculoskeletal sarcoma. The case notes, MRI and histology reports for 57 patients were reviewed. The primary outcome was local tumour recurrence detected on either surveillance MRI in asymptomatic patients, or interval MRI in patients with clinical concern. A total of 47 patients had a diagnosis of soft-tissue sarcoma and ten of a primary bone tumour. A total of 13 patients (22%) had local recurrence. Nine were identified on a surveillance scan, and four by interval scans. The cost of surveillance is estimated to be £4414 per recurrence detected if low-grade tumours with clear resection margins are excluded. Surveillance scanning has a role in the early detection of local recurrence of bone and soft-tissue sarcoma.
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Affiliation(s)
| | - K. Teoh
- Department of Orthopaedic Surgery
| | - T. Evans
- Edinburgh Cancer Centre, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK
| | - I. Beggs
- Department of Radiology, Royal Infirmary, 51 Little France, Old Dalkeith Road, Edinburgh EH16 4SU, UK
| | - J. Robb
- Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh EH9 1LF, UK
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50
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Mueed I, Tazzeo T, Liu C, Pertens E, Zhang Y, Cybulski I, Semelhago L, Noora J, Lamy A, Teoh K, Chu V, Janssen LJ. Isoprostanes constrict human radial artery by stimulation of thromboxane receptors, Ca2+ release, and RhoA activation. J Thorac Cardiovasc Surg 2008; 135:131-8. [PMID: 18179929 DOI: 10.1016/j.jtcvs.2007.06.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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: 02/07/2007] [Revised: 04/27/2007] [Accepted: 06/11/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Radial artery vasospasm remains a potential cause of early graft failure after coronary bypass graft surgery, despite pretreatment with alpha-adrenergic or calcium channel blockers. We examined the roles of isoprostanes and prostanoid receptors selective for thromboxane A2 in the vasoconstriction of human radial arteries. METHODS Human radial arterial segments were pretreated intraoperatively with verapamil/papaverine or nitroglycerine/phenoxybenzamine, or not treated. In the laboratory, we measured isometric contractions in ring segments, vasoconstriction in pressurized segments, and changes in [Ca2+] and K+ currents in single cells. RESULTS Although phenoxybenzamine eliminated adrenergic responses, the isoprostane 15-F(2t)-IsoP and 2 closely related E-ring molecules (15-E(1t)-IsoP and 15-E(2t)-IsoP) still evoked powerful contractions; 15-E(2t)-IsoP was approximately 10-fold more potent than the other 2 agents. Responses were mediated through thromboxane receptors because they were sensitive to ICI-192605. Furthermore, they were sensitive to the Rho-kinase inhibitors Y-27632 or H-1152 (both 10(-5) mol/L) or to cyclopiazonic acid (which depletes the internal Ca2+ pool), but not to nifedipine. In single cells, 15-E(2t)-IsoP elevated [Ca2+]i and suppressed K+ current. CONCLUSIONS Isoprostanes accumulate after coronary artery bypass graft surgery, yet none of the currently available antispasm treatments for radial artery grafts is effective against isoprostane-induced vasoconstriction. It is imperative that more specific treatment strategies be developed. We found that isoprostane responses in radial arteries are mediated by prostanoid receptors selective for thromboxane A2 with activation of Rho-kinase and release of Ca2+. Pretreatment of radial artery grafts with Rho-associated kinase inhibitors may potentially reduce postoperative graft spasm. Clinical studies to test this are indicated.
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Affiliation(s)
- Irem Mueed
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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