1
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Guo MH, Stevens LM, Chu MWA, Hage A, Chung J, El-Hamamsy I, Dagenais F, Peterson M, Herman C, Bozinovski J, Moon MC, Yamashita MH, Bittira B, Payne D, Boodhwani M. Risk score for arch reconstruction under circulatory arrest with hypothermia: The ARCH score. J Thorac Cardiovasc Surg 2024; 167:602-608.e2. [PMID: 35382936 DOI: 10.1016/j.jtcvs.2022.02.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/20/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Currently, there is no risk scores built to predict risk in thoracic aortic surgery. This study aims to develop and internally validate a risk prediction score for patients who require arch reconstruction with hypothermic circulatory arrest. METHODS From 2002 to 2018, data for 2270 patients who underwent aortic arch surgery in 12 institutions in Canada were retrospectively collected. The outcomes modeled included in-hospital mortality and a modified Society of Thoracic Surgeons-defined composite for mortality or major morbidity. Multivariable logistic regression using least absolute shrinkage and selection operator selection method and mixed-effect regression model was used to select the predictors. Internal calibration of the final models is presented with an observed-versus-predicted plot. RESULTS There were 182 in-hospital deaths (8.0%), and the incidence of Society of Thoracic Surgeons-defined composite for mortality or major morbidity was 27.9%. Variables that increased risk of mortality are age, chronic obstructive pulmonary disease, atrial fibrillation, peripheral vascular disease, New York Heart Association class ≥III symptoms, acute aortic dissection or rupture, use of elephant trunk, concomitant surgery, and increased cardiopulmonary bypass time, with median c-statistics of 0.85 on internal validation. The c-statistics was 0.77 for the model predicting Society of Thoracic Surgeons-defined composite. Internal assessment shows good overall calibration for both models. CONCLUSIONS We developed and internally validated a risk score for patients undergoing arch surgery requiring hypothermic circulatory arrest using a multicenter database. Once externally validated, the ARCH (Arch Reconstruction under Circulatory arrest with Hypothermia) score would allow for better patient risk-stratification and aid in the decision-making process for surgeons and patient prior to surgery.
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Affiliation(s)
- Ming Hao Guo
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Michael W A Chu
- Division of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada
| | - Ali Hage
- Division of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada
| | - Jennifer Chung
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ismail El-Hamamsy
- Division of Cardiac Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Francois Dagenais
- Division of Cardiac Surgery, Laval University, Quebec City, Quebec, Canada
| | - Mark Peterson
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Christine Herman
- Division of Cardiac Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John Bozinovski
- Division of Cardiac Surgery, University of British Columbia, Victoria, British Columbia, Canada
| | - Michael C Moon
- Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Michael H Yamashita
- Division of Cardiac Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bindu Bittira
- Division of Cardiac Surgery, Health Sciences North, Sudbury, Ontario, Canada
| | - Darrin Payne
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
| | - Munir Boodhwani
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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2
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Deck M, Grocott HP, Yamashita MH. Intrathecal hematoma as a neuraxial complication of lumbar cerebrospinal fluid drainage for endovascular repair of a thoracic aortic aneurysm. Can J Anaesth 2023; 70:1845-1846. [PMID: 37831351 DOI: 10.1007/s12630-023-02588-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 06/21/2023] [Accepted: 07/02/2023] [Indexed: 10/14/2023] Open
Affiliation(s)
- Megan Deck
- Department of Anesthesiology, Perioperative & Pain Medicine, University of Manitoba, Winnipeg, MB, Canada.
- Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, MB, Canada.
| | - Hilary P Grocott
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Michael H Yamashita
- Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, MB, Canada
- Division of Cardiac Surgery, Department of Surgery, The University of British Columbia, Vancouver, BC, Canada
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3
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Muller Moran HR, Spooner AJ, Yamashita MH. Commentary: An all-access pass to transcatheter aortic valve replacement. J Thorac Cardiovasc Surg 2023; 165:1372-1373. [PMID: 34049710 DOI: 10.1016/j.jtcvs.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Hellmuth R Muller Moran
- Division of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Aaron J Spooner
- Division of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Michael H Yamashita
- Division of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba, Canada.
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4
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Eikelboom R, Spooner AJ, Yamashita MH. Commentary: Mid-term outcomes in a real-world transcatheter aortic valve replacement population. J Thorac Cardiovasc Surg 2023; 165:1357-1358. [PMID: 34059339 DOI: 10.1016/j.jtcvs.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Rachel Eikelboom
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Aaron J Spooner
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Michael H Yamashita
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba, Canada.
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5
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Javidfar J, Zaaqoq AM, Labib A, Barnett AG, Hayanga JWA, Eschun G, Yamashita MH, Jacobs JP, Heinsar S, Suen JY, Fraser JF, Bassi GL, Arora RC, Peek GJ. Morbid obesity's impact on COVID-19 patients requiring venovenous extracorporeal membrane oxygenation: The covid-19 critical care consortium database review. Perfusion 2023:2676591231156487. [PMID: 36753684 PMCID: PMC9912044 DOI: 10.1177/02676591231156487] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Introduction: Obesity is associated with a worse prognosis in COVID-19 patients with acute respiratory distress syndrome (ARDS). Veno-venous (V-V) Extracorporeal Membrane Oxygenation (ECMO) can be a rescue option, however, the direct impact of morbid obesity in this select group of patients remains unclear.Methods: This is an observational study of critically ill adults with COVID-19 and ARDS supported by V-V ECMO. Data are from 82 institutions participating in the COVID-19 Critical Care Consortium international registry. Patients were admitted between 12 January 2020 to 27 April 2021. They were stratified based on Body Mass Index (BMI) at 40 kg/m2. The endpoint was survival to hospital discharge.Results: Complete data available on 354 of 401 patients supported on V-V ECMO. The characteristics of the high BMI (>40 kg/m2) and lower BMI (≤40 kg/m2) groups were statistically similar. However, the 'high BMI' group were comparatively younger and had a lower APACHE II score. Using survival analysis, older age (Hazard Ratio, HR 1.49 per-10-years, CI 1.25-1.79) and higher BMI (HR 1.15 per-5 kg/m2 increase, CI 1.03-1.28) were associated with a decreased patient survival. A safe BMI threshold above which V-V ECMO would be prohibitive was not apparent and instead, the risk of an adverse outcome increased linearly with BMI.Conclusion: In COVID-19 patients with severe ARDS who require V-V ECMO, there is an increased risk of death associated with age and BMI. The risk is linear and there is no BMI threshold beyond which the risk for death greatly increases.
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Affiliation(s)
- Jeffrey Javidfar
- Division of Cardiothoracic
Surgery, Department of Surgery, Emory School of
Medicine, USA
| | - Akram M Zaaqoq
- Department of Critical Care
Medicine, MedStar Washington Hospital
Center, Georgetown University, USA
| | - Ahmed Labib
- Medical Intensive Care
Unit, Department of Medicine, Hamad General Hospital, Qatar
| | - Adrian G Barnett
- School of Public Health & Social
Work, Queensland University of
Technology, Australia
| | - JW Awori Hayanga
- Department of Cardiovascular &
Thoracic Surgery, West Virginia
University, USA
| | - Greg Eschun
- Department of Medicine, Section of Critical Care
Medicine, Max Rady College of
Medicine, University of Manitoba, Canada
| | - Michael H Yamashita
- Department of Surgery, Section of Cardiac
Surgery, Max Rady College of
Medicine, University of Manitoba, Canada
| | - Jeffrey P Jacobs
- Congenital Heart Center, Department of Surgery, University of Florida, USA
| | - Silver Heinsar
- Critical Care Research
Group, The Prince Charles
Hospital, and University of
Queensland, Australia
| | - Jacky Y Suen
- Critical Care Research
Group, The Prince Charles
Hospital, and University of
Queensland, Australia
| | - John F Fraser
- Critical Care Research
Group, The Prince Charles
Hospital, and University of
Queensland, Australia
| | - Gianluigi Li Bassi
- Critical Care Research
Group, The Prince Charles
Hospital, and University of
Queensland, Australia
| | - Rakesh C Arora
- Heart &Vascular
Institute, Division of Cardiac
Surgery, University Hospitals, USA
| | - Giles J Peek
- Congenital Heart Center, Department of Surgery, University of Florida, USA
| | - on behalf of the Covid-19 Critical Care Consortium (COVID
Critical)
- Division of Cardiothoracic
Surgery, Department of Surgery, Emory School of
Medicine, USA
- Department of Critical Care
Medicine, MedStar Washington Hospital
Center, Georgetown University, USA
- Medical Intensive Care
Unit, Department of Medicine, Hamad General Hospital, Qatar
- School of Public Health & Social
Work, Queensland University of
Technology, Australia
- Department of Cardiovascular &
Thoracic Surgery, West Virginia
University, USA
- Department of Medicine, Section of Critical Care
Medicine, Max Rady College of
Medicine, University of Manitoba, Canada
- Department of Surgery, Section of Cardiac
Surgery, Max Rady College of
Medicine, University of Manitoba, Canada
- Congenital Heart Center, Department of Surgery, University of Florida, USA
- Critical Care Research
Group, The Prince Charles
Hospital, and University of
Queensland, Australia
- Heart &Vascular
Institute, Division of Cardiac
Surgery, University Hospitals, USA
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Yan W, Yamashita MH. Commentary: Using the right tools for the job: Revisiting renal preservation during open thoracoabdominal aortic aneurysm repair. J Thorac Cardiovasc Surg 2023; 165:580-581. [PMID: 33875256 DOI: 10.1016/j.jtcvs.2021.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Weiang Yan
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael H Yamashita
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, University of Manitoba, Winnipeg, Manitoba, Canada.
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7
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Muller Moran HR, Yamashita MH, Arora RC. Reply: Right, wrong, or somewhere in between? JTCVS Open 2022; 11:153. [PMID: 36172407 PMCID: PMC9510788 DOI: 10.1016/j.xjon.2022.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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8
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Hyde EK, Throndson K, Arcinas LA, Shah AH, Hiebert B, Yamashita MH, Lee Samson D, Maric A, Love R, Poettcker D, Arora RC, Seifer CM, Kass M. Validation of the Emory Risk Score in the Transcatheter Aortic Valve Implantation Population: A Canadian Perspective. CJC Open 2022; 4:1060-1068. [PMID: 36562015 PMCID: PMC9764109 DOI: 10.1016/j.cjco.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/22/2022] [Indexed: 02/01/2023] Open
Abstract
Background Permanent pacemaker (PPM) implantation may be indicated post-transcatheter aortic valve implantation (TAVI). The Emory Risk Score (ERS) is a validated predictive risk score of the need for a PPM post-TAVI using a balloon-expandable valve. Our objectives were to determine the validity of the ERS in our local TAVI population with both balloon-expandable and self-expanding valves and to identify additional electrocardiographic (ECG) parameters predictive of the need for a PPM post-TAVI. Methods Retrospective chart and electronic database reviews were performed to collect demographic and procedural information. Two expert readers reviewed all ECGs. Independent factors associated with PPM implantation were examined with multivariable logistic regression via a stepwise selection process with calculation of the area under the receiver operating characteristic curve to assess model discrimination. Results The overall PPM implantation rate was 11.7%; rates were 9% for the Sapien 3 valves, 10% for the Evolut Pro valves, and 17% for the Evolut R valves. The ERS was found to not be predictive of need for PPM post-TAVI for the entire cohort. Right bundle branch block was the only ERS parameter independently associated with new PPM implant (8.5% vs 25%, odds ratio = 3.59, P = 0.01). No additional ECG parameters met the criteria for statistical significance. Conclusions The poor predictive value of the ERS in determining the need for a PPM post-TAVI in our patient population suggests that further refinement of a formula (or risk-calculator) is warranted. Identification of a precise risk-calculator is likely to facilitate patient mobilization and reduce inpatient healthcare resource utilization.
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Affiliation(s)
- Emily K. Hyde
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada,Corresponding author: Emily Hyde, CR1040 – 369 av. Taché Ave., Winnipeg, Manitoba R2H 2A6, Canada. Tel.: +1-204-235-3391.
| | - Karen Throndson
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Liane A. Arcinas
- Department of Internal Medicine, Section of Cardiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ashish H. Shah
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada,Department of Internal Medicine, Section of Cardiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brett Hiebert
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Michael H. Yamashita
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada,Department of Surgery, Section of Cardiac Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Anita Maric
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Reid Love
- Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Denise Poettcker
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Rakesh C. Arora
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada,Department of Surgery, Section of Cardiac Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Colette M. Seifer
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada,Department of Internal Medicine, Section of Cardiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Malek Kass
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada,Department of Internal Medicine, Section of Cardiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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9
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Sato K, White N, Fanning JP, Obonyo N, Yamashita MH, Appadurai V, Ciullo A, May M, Worku ET, Helms L, Ohshimo S, Juzar DA, Suen JY, Bassi GL, Fraser JF, Arora RC. Impact of renin-angiotensin-aldosterone system inhibition on mortality in critically ill COVID-19 patients with pre-existing hypertension: a prospective cohort study. BMC Cardiovasc Disord 2022; 22:123. [PMID: 35321649 PMCID: PMC8942148 DOI: 10.1186/s12872-022-02565-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/11/2021] [Accepted: 03/16/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The influence of renin-angiotensin-aldosterone system (RAAS) inhibitors on the critically ill COVID-19 patients with pre-existing hypertension remains uncertain. This study examined the impact of previous use of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) on the critically ill COVID-19 patients. METHODS Data from an international, prospective, observational cohort study involving 354 hospitals spanning 54 countries were included. A cohort of 737 COVID-19 patients with pre-existing hypertension admitted to intensive care units (ICUs) in 2020 were targeted. Multi-state survival analysis was performed to evaluate in-hospital mortality and hospital length of stay up to 90 days following ICU admission. RESULTS A total of 737 patients were included-538 (73%) with pre-existing hypertension had received ACEi/ARBs before ICU admission, while 199 (27%) had not. Cox proportional hazards model showed that previous ACEi/ARB use was associated with a decreased hazard of in-hospital death (HR, 0.74, 95% CI 0.58-0.94). Sensitivity analysis adjusted for propensity scores showed similar results for hazards of death. The average length of hospital stay was longer in ACEi/ARB group with 21.2 days (95% CI 19.7-22.8 days) in ICU and 6.7 days (5.9-7.6 days) in general ward compared to non-ACEi/ARB group with 16.2 days (14.1-18.6 days) and 6.4 days (5.1-7.9 days), respectively. When analysed separately, results for ACEi or ARB patient groups were similar for both death and discharge. CONCLUSIONS In critically ill COVID-19 patients with comorbid hypertension, use of ACEi/ARBs prior to ICU admission was associated with a reduced risk of in-hospital mortality following adjustment for baseline characteristics although patients with ACEi/ARB showed longer length of hospital stay. Clinical trial registration The registration number: ACTRN12620000421932; The date of registration: 30, March 2020; The URL of the registration: https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12620000421932 .
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Affiliation(s)
- Kei Sato
- Critical Care Research Group, The Prince Charles Hospital, Level 3, Clinical Sciences Building, Chermside, Brisbane, QLD, 4032, Australia. .,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Nicole White
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Jonathon P Fanning
- Critical Care Research Group, The Prince Charles Hospital, Level 3, Clinical Sciences Building, Chermside, Brisbane, QLD, 4032, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nchafatso Obonyo
- Critical Care Research Group, The Prince Charles Hospital, Level 3, Clinical Sciences Building, Chermside, Brisbane, QLD, 4032, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Wellcome Trust Centre for Global Health Research, Imperial College London, London, UK.,Initiative to Develop African Research Leaders/KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Michael H Yamashita
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Vinesh Appadurai
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Department of Cardiology, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Anna Ciullo
- Division of Emergency Medicine, Department of Surgery, University of Utah Health, Salt Lake City, UT, 84132, USA
| | - Meryta May
- Department of Microbiology, Sullivan Nicolaides Pathology, Brisbane, QLD, Australia
| | - Elliott T Worku
- Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Leticia Helms
- Critical Care Research Group, The Prince Charles Hospital, Level 3, Clinical Sciences Building, Chermside, Brisbane, QLD, 4032, Australia
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Dafsah A Juzar
- Intensive Cardiovascular Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.,Division Intensive & Emergency Cardiovascular Care, Department Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Jacky Y Suen
- Critical Care Research Group, The Prince Charles Hospital, Level 3, Clinical Sciences Building, Chermside, Brisbane, QLD, 4032, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Level 3, Clinical Sciences Building, Chermside, Brisbane, QLD, 4032, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Level 3, Clinical Sciences Building, Chermside, Brisbane, QLD, 4032, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Rakesh C Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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10
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Suliman A, Yan W, Yamashita MH, Krentz AD, Mhanni A, Garber PJ. A previously undescribed pathogenic variant in FBN1 gene causing Marfan syndrome: a case report. Eur Heart J Case Rep 2022; 6:ytac063. [PMID: 35372756 PMCID: PMC8972828 DOI: 10.1093/ehjcr/ytac063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/28/2021] [Accepted: 02/02/2022] [Indexed: 11/21/2022]
Abstract
Background Marfan syndrome (MFS) is an autosomal dominant multisystem connective tissue disorder with increased risk of aortopathy with a high risk of subsequent life-threatening aortic dissection. Diagnosing this condition is reliant on recognizing clinical features and genetic testing for confirming diagnosis, using the revised Ghent criteria. Case summary We identified a 49-year-old patient who presented with dyspnoea, with Marfan syndrome (MFS) and a previously unreported variant in the fibrillin-1 gene (FBN1), designated c.7016G>C. Prior to identifying the new gene variant, this patient did not meet the revised Ghent criteria for MFS diagnosis. We present clinical and molecular evidence supporting the likely pathogenic nature of this variant, leading to earlier therapy and intervention. Discussion The discovery of a new pathogenic gene will expand the current aortopathy and MFS database and may lead to more informed clinical management decisions for the timing and nature of interventions.
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Affiliation(s)
- Asem Suliman
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Weiang Yan
- Section of Cardiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Michael H Yamashita
- Section of Cardiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Aizeddin Mhanni
- Genetics and Metabolism Program, Department of Pediatrics & Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Philip J Garber
- Section of Cardiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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11
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Rossong H, Debreuil S, Yan W, Hiebert BM, Singal RK, Arora RC, Yamashita MH. Long-Term Survival and Quality of Life after Extracorporeal Membrane Oxygenation. J Thorac Cardiovasc Surg 2022:S0022-5223(22)00204-5. [DOI: 10.1016/j.jtcvs.2021.10.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
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12
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Javidfar J, Zaaqoq AM, Yamashita MH, Eschun G, Jacobs JP, Heinsar S, Hayanga JW, Peek GJ, Arora RC. Venovenous extracorporeal membrane oxygenation in obese patients. JTCVS Tech 2021; 10:335-348. [PMID: 34806050 PMCID: PMC8592387 DOI: 10.1016/j.xjtc.2021.08.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/18/2021] [Indexed: 01/14/2023] Open
Affiliation(s)
- Jeffrey Javidfar
- Division of Cardiothoracic Surgery, Department of Surgery, Emory School of Medicine, Atlanta, Ga
| | - Akram M. Zaaqoq
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC
| | - Michael H. Yamashita
- Section of Cardiac Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Greg Eschun
- Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeffrey P. Jacobs
- Department of Surgery, Congenital Heart Center, University of Florida, Gainesville, Fla
| | - Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Queensland, Australia
| | - Jeremiah W. Hayanga
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Giles J. Peek
- Department of Surgery, Congenital Heart Center, University of Florida, Gainesville, Fla
| | - Rakesh C. Arora
- Section of Cardiac Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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13
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Ibrahim M, Stevens LM, Ouzounian M, Hage A, Dagenais F, Peterson M, El-Hamamsy I, Boodhwani M, Bozinovski J, Moon MC, Yamashita MH, Atoui R, Bittira B, Payne D, Lachapelle K, Chu MW, Chung JCY. Evolving Surgical Techniques and Improving Outcomes for Aortic Arch Surgery in Canada. CJC Open 2021; 3:1117-1124. [PMID: 34712938 PMCID: PMC8531226 DOI: 10.1016/j.cjco.2021.05.001] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background To explore evolving surgical techniques and outcomes for aortic arch surgery. Methods A total of 2435 consecutive patients underwent aortic arch repair with hypothermic circulatory arrest between 2008 and 2018 in 12 institutions across Canada. Trends in patient characteristics, surgical techniques, and in-hospital outcomes, including major morbidity or mortality, were examined. Results From 2008 to 2018, the age of patients (62.3 ± 13.2 years) and the proportion of women (30.2%) undergoing arch surgery did not change significantly. Aortic diameters at operation decreased (2008: 58 ± 13 mm; 2018: 53 ± 11 mm; P < 0.01). Surgeons performed more valve-sparing root replacements (2008: 0%; 2018: 15%; P < 0.001) and fewer Bentall procedures (2008: 27%; 2018: 20%; P < 0.01). Total arch replacement rates were similar (P = 0.18); however, elephant trunk (2008: 9.5%; 2018: 19%; P < 0.001) and frozen elephant trunk (2008: 3.1%; 2018: 15%; P < 0.001) repair rates have increased. Over time, higher nadir temperatures (2008: 18 [17-21]°C; 2018: 25 [23-28]°C; P < 0.001), and more frequent antegrade cerebral perfusion (2008: 61%; 2018: 83%; P < 0.001) were used. For elective cases, in-hospital mortality rates declined (2008: 6.8%; 2018: 1.2%; P = < 0.01), as did major morbidity or mortality (2008: 24%; 2018: 13%; P < 0.001) and transfusion rates (2008: 61%; 2018: 41%; P < 0.001), but stroke rates remained constant (2008: 6.8%; 2018: 5.3%; P = 0.12). Outcomes remained the same over time for urgent or emergent cases. Conclusions Outcomes have improved over the past decade in Canada for elective aortic arch surgery, in the context of operating on smaller aortas, and more frequent use of moderate hypothermia and antegrade cerebral perfusion. Further research is needed to improve stroke rates and outcomes in the emergency setting.
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Affiliation(s)
- Marina Ibrahim
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Louis-Mathieu Stevens
- Centre Hospitalier de l'Université de Montreal, University of Montreal, Montreal, Quebec, Canada
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ali Hage
- Division of Cardiac Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Francois Dagenais
- Division of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Mark Peterson
- Division of Cardiac Surgery, St Micheal's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ismail El-Hamamsy
- Division of Cardiac Surgery, Mount Sinai Hospital, New York, New York, USA
| | - Munir Boodhwani
- Division of Cardiac Surgery, Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - John Bozinovski
- Division of Cardiac Surgery, Royal Jubilee Hospital, University of British Colombia, Victoria, British Columbia, Canada
| | - Michael C. Moon
- Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Michael H. Yamashita
- Division of Cardiovascular Surgery, St Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rony Atoui
- Division of Cardiac Surgery, Health Sciences North, Sudbury, Ontario, Canada
| | - Bindu Bittira
- Division of Cardiac Surgery, Health Sciences North, Sudbury, Ontario, Canada
| | - Darrin Payne
- Division of Cardiac Surgery, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Kevin Lachapelle
- Division of Cardiac Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Michael W.A. Chu
- Division of Cardiac Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Jennifer C.-Y. Chung
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
- Corresponding author: Dr Jennifer C.-Y. Chung, Division of Cardiac Surgery, Toronto General Hospital, 200 Elizabeth St 4N-466, Toronto, Ontario M5G 2C4, Canada. Tel.: +1-416-340-4745; fax: +1-416-340-3498.
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14
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Ibrahim M, Stevens L, Ouzounian M, Hage A, Dagenais F, Peterson M, El-Hamamsy I, Boodhwani M, Bozinovski J, Moon M, Yamashita MH, Atoui R, Bittira B, Payne D, Lachapelle K, Chu M, Chung J. EVOLVING SURGICAL TECHNIQUES AND IMPROVING OUTCOMES FOR AORTIC ARCH SURGERY IN CANADA. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.212] [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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15
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Ha ACT, Verma S, Mazer CD, Quan A, Yanagawa B, Latter DA, Yau TM, Jacques F, Brown CD, Singal RK, Yamashita MH, Saha T, Teoh KH, Lam BK, Deyell MW, Wilson M, Hibino M, Cheung CC, Kosmopoulos A, Garg V, Brodutch S, Teoh H, Zuo F, Thorpe KE, Jüni P, Bhatt DL, Verma A. Effect of Continuous Electrocardiogram Monitoring on Detection of Undiagnosed Atrial Fibrillation After Hospitalization for Cardiac Surgery: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2121867. [PMID: 34448866 PMCID: PMC8397929 DOI: 10.1001/jamanetworkopen.2021.21867] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE Postoperative atrial fibrillation (POAF) occurring after cardiac surgery is associated with adverse outcomes. Whether POAF persists beyond discharge is not well defined. OBJECTIVE To determine whether continuous cardiac rhythm monitoring enhances detection of POAF among cardiac surgical patients during the first 30 days after hospital discharge compared with usual care. DESIGN, SETTING, AND PARTICIPANTS This study is an investigator-initiated, open-label, multicenter, randomized clinical trial conducted at 10 Canadian centers. Enrollment spanned from March 2017 to March 2020, with follow-up through September 11, 2020. As a result of the COVID-19 pandemic, enrollment stopped on July 17, 2020, at which point 85% of the proposed sample size was enrolled. Cardiac surgical patients with CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, female sex) score greater than or equal to 4 or greater than or equal to 2 with risk factors for POAF, no history of preoperative AF, and POAF lasting less than 24 hours during hospitalization were enrolled. INTERVENTIONS The intervention group underwent continuous cardiac rhythm monitoring with wearable, patch-based monitors for 30 days after randomization. Monitoring was not mandated in the usual care group within 30 days after randomization. MAIN OUTCOMES AND MEASURES The primary outcome was cumulative AF and/or atrial flutter lasting 6 minutes or longer detected by continuous cardiac rhythm monitoring or by a 12-lead electrocardiogram within 30 days of randomization. Prespecified secondary outcomes included cumulative AF lasting 6 hours or longer and 24 hours or longer within 30 days of randomization, death, myocardial infarction, ischemic stroke, non-central nervous system thromboembolism, major bleeding, and oral anticoagulation prescription. RESULTS Of the 336 patients randomized (163 patients in the intervention group and 173 patients in the usual care group; mean [SD] age, 67.4 [8.1] years; 73 women [21.7%]; median [interquartile range] CHA2DS2-VASc score, 4.0 [3.0-4.0] points), 307 (91.4%) completed the trial. In the intent-to-treat analysis, the primary end point occurred in 32 patients (19.6%) in the intervention group vs 3 patients (1.7%) in the usual care group (absolute difference, 17.9%; 95% CI, 11.5%-24.3%; P < .001). AF lasting 6 hours or longer was detected in 14 patients (8.6%) in the intervention group vs 0 patients in the usual care group (absolute difference, 8.6%; 95% CI, 4.3%-12.9%; P < .001). CONCLUSIONS AND RELEVANCE In post-cardiac surgical patients at high risk of stroke, no preoperative AF history, and AF lasting less than 24 hours during hospitalization, continuous monitoring revealed a significant increase in the rate of POAF after discharge that would otherwise not be detected by usual care. Studies are needed to examine whether these patients will benefit from oral anticoagulation therapy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02793895.
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Affiliation(s)
- Andrew C. T. Ha
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - C. David Mazer
- Department of Anesthesiology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Adrian Quan
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Bobby Yanagawa
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David A. Latter
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Terrence M. Yau
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Frédéric Jacques
- University Institute of Cardiology and Respirology of Québec, Quebec City, Quebec, Canada
| | - Craig D. Brown
- Division of Cardiac Surgery, New Brunswick, Saint John, New Brunswick, Canada
| | - Rohit K. Singal
- Division of Surgery, Cardiac Science Program, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Michael H. Yamashita
- Division of Surgery, Cardiac Science Program, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Tarit Saha
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Kingston, Ontario, Canada
| | - Kevin H. Teoh
- Southlake Regional Health Center, University of Toronto, Newmarket, Ontario, Canada
| | - Buu-Khanh Lam
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marc W. Deyell
- Division of Cardiology, St Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Marnee Wilson
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Makoto Hibino
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Andrew Kosmopoulos
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vinay Garg
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shira Brodutch
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Hwee Teoh
- Department of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Fei Zuo
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Kevin E. Thorpe
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Deepak L. Bhatt
- Heart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Atul Verma
- Southlake Regional Health Center, University of Toronto, Newmarket, Ontario, Canada
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16
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Maguire D, Yamashita MH, Grocott HP. Retained Intracardiac Bullet Fragment: Is It a Missile Embolism or Simply a Gunshot Wound to the Heart? A A Pract 2021; 15:e01381. [PMID: 33625118 DOI: 10.1213/xaa.0000000000001381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Duncan Maguire
- Department of Anesthesia, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael H Yamashita
- Division of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada, Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Hilary P Grocott
- Department of Anesthesia, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,
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17
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Yan W, Yamashita MH. Commentary: Adapting for our patients: Reducing intraoperative adverse events as new technologies emerge. JTCVS Tech 2020; 6:88-89. [PMID: 34318153 PMCID: PMC8300914 DOI: 10.1016/j.xjtc.2020.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 11/29/2020] [Accepted: 12/15/2020] [Indexed: 11/01/2022] Open
Affiliation(s)
- Weiang Yan
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Michael H Yamashita
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada
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18
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Eikelboom R, Yamashita MH. Commentary: Until the ideal aortic valve prosthesis is invented, pick your poison! J Thorac Cardiovasc Surg 2020; 164:1456-1457. [PMID: 33451838 DOI: 10.1016/j.jtcvs.2020.11.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 10/31/2022]
Affiliation(s)
- Rachel Eikelboom
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Michael H Yamashita
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba, Canada.
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19
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Muller Moran HR, Yamashita MH, Arora RC. Commentary: Vita ex machina-life from the machine. J Thorac Cardiovasc Surg 2020; 161:1333-1334. [PMID: 33494916 DOI: 10.1016/j.jtcvs.2020.11.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Hellmuth R Muller Moran
- Division of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Michael H Yamashita
- Division of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Rakesh C Arora
- Division of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba, Canada.
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20
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Lodewyks CL, Prior HJ, Hiebert BM, Nickel NC, Yamashita MH, Ouzounian M, Kumar KK, Arora RC, Tangri N. A Province-Wide Analysis of the Epidemiology of Thoracic Aortic Disease: Incidence Is Increasing in a Sex-Specific Way. Can J Cardiol 2020; 36:1729-1738. [DOI: 10.1016/j.cjca.2019.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 10/29/2019] [Accepted: 11/06/2019] [Indexed: 12/01/2022] Open
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21
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Deck M, Grocott HP, Yamashita MH. Aberrant right subclavian artery: an impediment to transesophageal echocardiography. Can J Anaesth 2020; 68:423-424. [PMID: 33083926 DOI: 10.1007/s12630-020-01837-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 09/25/2020] [Accepted: 10/04/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Megan Deck
- Department of Anesthesiology, Perioperative & Pain Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Hilary P Grocott
- Department of Anesthesiology, Perioperative & Pain Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, MB, Canada
| | - Michael H Yamashita
- Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, MB, Canada.,Division of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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22
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Maguire D, Lodewyks C, Yamashita MH. Lost but eventually found: delayed removal of an intramyocardial bullet. Can J Anaesth 2020; 68:256-257. [PMID: 33025457 DOI: 10.1007/s12630-020-01821-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Duncan Maguire
- Department of Anesthesia, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
| | - Carly Lodewyks
- Division of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, MB, Canada
| | - Michael H Yamashita
- Division of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, MB, Canada
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23
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Muller Moran HR, Yamashita MH. Commentary: Preaching to the wire. JTCVS Tech 2020; 4:150-151. [PMID: 34317993 PMCID: PMC8307788 DOI: 10.1016/j.xjtc.2020.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 09/13/2020] [Accepted: 09/24/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Hellmuth R. Muller Moran
- Division of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Michael H. Yamashita
- Division of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba, Canada
- Address for reprints: Michael H. Yamashita, MDCM, MPH, FRCSC, St Boniface Hospital, Y3519—409 Tache Ave, Winnipeg, Manitoba, Canada R2H 2A6.
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24
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Parr CJ, Kass M, Yamashita MH, Jassal DS. Thrombosis of a mechanical mitral valve: a sticky situation. Eur Heart J 2020; 41:2816. [PMID: 32129837 DOI: 10.1093/eurheartj/ehaa126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 02/10/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Christopher J Parr
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, St. Boniface Hospital, 409 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada
| | - Malek Kass
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, St. Boniface Hospital, 409 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada.,Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, St. Boniface Hospital, 409 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada
| | - Michael H Yamashita
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, St. Boniface Hospital, 409 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada
| | - Davinder S Jassal
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, St. Boniface Hospital, 409 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada.,Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, St. Boniface Hospital, 409 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada
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25
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Eikelboom R, Sanjanwala R, Le ML, Yamashita MH, Arora RC. Postoperative Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Meta-Analysis. Ann Thorac Surg 2020; 111:544-554. [PMID: 32687821 DOI: 10.1016/j.athoracsur.2020.05.104] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/09/2020] [Accepted: 05/11/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) after cardiac surgery is associated with longer hospital stay and increased in-hospital death and stroke, but its long-term implications remain incompletely understood. A systematic literature review was undertaken to investigate the impact of POAF on long-term death and stroke in adult patients who undergo cardiac operations. METHODS Electronic databases (Cochrane, Embase, Ovid MEDLINE, and PubMed) were queried from inception to October 2018. Included studies compared long-term outcomes after cardiac operations in patients with and without POAF. Adjusted and unadjusted meta-analyses examined death, stroke, and major adverse cardiac and cerebrovascular events. Risk of bias was evaluated with the Newcastle-Ottawa Scale. RESULTS The inclusion criteria were met by 32 studies describing 155,575 patients who had undergone cardiac operations. POAF occurred in 36,988 patients (23.7%). Meta-analysis of 10 studies (44,367 patients) demonstrated increased 1-year death in patients with POAF (odds ratio, 2.60; 95% confidence interval, 2-3.38; P < .01). Aggregate adjusted hazard of death (16 studies, n = 84,295) was also increased in patients with POAF (hazard ratio, 1.25; 95% confidence interval, 1.2-1.3; P < .01). CONCLUSIONS This systematic review and meta-analysis identified an association between POAF and long-term death after cardiac surgery. More comprehensive POAF prevention and management, including more stringent follow-up for POAF recurrence after hospital discharge, may be indicated. The included studies used inconsistent definitions of POAF and variable exclusion criteria; however, estimates of heterogeneity are low. Differences in preoperative comorbidities, such as age, ejection fraction, and obesity, may not be fully accounted for in adjusted analyses. Future work is required to delineate mechanisms linking POAF and death in this population.
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Affiliation(s)
- Rachel Eikelboom
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Rohan Sanjanwala
- Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Me-Linh Le
- Libraries, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael H Yamashita
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada; Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada
| | - Rakesh C Arora
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada; Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada.
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26
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Chung J, Stevens LM, Chu MWA, Dagenais F, Peterson MD, Boodhwani M, Bozinovski J, El-Hamamsy I, Yamashita MH, Atoui R, Bittira B, Payne D, Ouzounian M. The impact of age on patients undergoing aortic arch surgery: Evidence from a multicenter national registry. J Thorac Cardiovasc Surg 2020; 162:759-766.e1. [PMID: 32178917 DOI: 10.1016/j.jtcvs.2020.02.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Elderly patients are typically offered aortic surgery at similar diameter thresholds as younger patients, despite limited data quantifying their operative risk. We aim to report the incremental risk experienced by elderly patients undergoing aortic arch surgery. METHODS In total, 2520 patients underwent aortic arch surgery between 2002 and 2018 in 10 centers. Patients were divided into 3 groups: <65 years (n = 1325), 65 to 74 years (n = 737), and ≥75 years (n = 458). Outcomes of interest were in-hospital mortality, stroke, and the modified Society of Thoracic Surgeons composite for mortality or major morbidity (STS-COMP). Multivariable modeling was performed to determine the association of age with these outcomes. RESULTS As age increased, there was an increasing rate of comorbidities, including diabetes (P < .001), renal failure (P < .001), and previous stroke (P = .01). Rates of acute aortic syndrome (P = .50) and total arch repair were similar (P = .59) between groups. Older patients had greater mortality (<65: 6.1% vs 65-74: 9.0% vs ≥75: 14%, P < .001), stroke (6.3% vs 7.7% vs 11%, P = .01) and STS-COMP (25% vs 32% vs 38%, P < .001). After multivariable risk-adjustment, a step-wise increase in complications was observed in the older age groups relative to the youngest in terms of in-hospital mortality (65-74: odds ratio [OR] 1.57, P = .04; ≥75: OR, 2.94, P = .001) and STS-COMP (65-74: OR, 1.57, P < .001; ≥75: OR, 1.96, P < .001). CONCLUSIONS Older patients experienced elevated rates of mortality and morbidity following aortic arch surgery. These results support a more measured approach when evaluating elderly patients. Further research is needed on age-dependent natural history of thoracic aneurysms and size thresholds for intervention.
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Affiliation(s)
- Jennifer Chung
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Michael W A Chu
- Division of Cardiac Surgery, Western University, London, Ontario, Canada
| | - Francois Dagenais
- Division of Cardiac Surgery, Laval University, Quebec City, Quebec, Canada
| | - Mark D Peterson
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Munir Boodhwani
- Division of Cardiac Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - John Bozinovski
- Division of Cardiac Surgery, University of British Columbia, Victoria, British Columbia, Canada
| | - Ismail El-Hamamsy
- Division of Cardiac Surgery, University of Montreal, Montreal, Ontario, Canada
| | - Michael H Yamashita
- Division of Cardiac Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rony Atoui
- Division of Cardiac Surgery, Health Sciences North, Sudbury, Ontario, Canada
| | - Bindu Bittira
- Division of Cardiac Surgery, Health Sciences North, Sudbury, Ontario, Canada
| | - Darrin Payne
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada.
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Yan W, Yamashita MH. Commentary: Patient selection is key to improving postcardiotomy extracorporeal membrane oxygenation outcomes. J Thorac Cardiovasc Surg 2019; 159:1855-1856. [PMID: 31445756 DOI: 10.1016/j.jtcvs.2019.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Weiang Yan
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Michael H Yamashita
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada.
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Chung J, Stevens LM, Ouzounian M, El-Hamamsy I, Bouhout I, Dagenais F, Cartier A, Peterson MD, Boodhwani M, Guo M, Bozinovski J, Yamashita MH, Lodewyks C, Atoui R, Bittira B, Payne D, Tarola C, Chu MWA. Sex-Related Differences in Patients Undergoing Thoracic Aortic Surgery. Circulation 2019; 139:1177-1184. [DOI: 10.1161/circulationaha.118.035805] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ming Guo
- University of Ottawa, Canada (M.B., M.G.)
| | | | | | | | - Rony Atoui
- Health Sciences North, Sudbury, Canada (R.A., B.B.)
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Martin A, Yamashita MH. Commentary: Bioprosthetic aortic valve replacement: A high standard of comparison for transcatheter aortic valve implantation. J Thorac Cardiovasc Surg 2018; 157:2200-2201. [PMID: 30538024 DOI: 10.1016/j.jtcvs.2018.10.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 10/29/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Aaron Martin
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Michael H Yamashita
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba, Canada.
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Yan W, Arora RC, Yamashita MH. Commentary: Does valve choice matter in patients receiving hemodialysis? J Thorac Cardiovasc Surg 2018; 157:2187-2188. [PMID: 30414775 DOI: 10.1016/j.jtcvs.2018.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 09/17/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Weiang Yan
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Rakesh C Arora
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Michael H Yamashita
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada.
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Yamashita MH, Luqman Z, Menkis AH, Arora RC. Coronary Artery Bypass Grafting-The Long-term Solution? Can J Cardiol 2018; 34:953-955. [PMID: 29887220 DOI: 10.1016/j.cjca.2018.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/13/2018] [Accepted: 03/13/2018] [Indexed: 11/17/2022] Open
Affiliation(s)
- Michael H Yamashita
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, and Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Zubair Luqman
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, and Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Alan H Menkis
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, and Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Rakesh C Arora
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, and Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba, Canada.
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Campo JJ, Yamashita MH, Malaisrie SC. Creating a 90° curve in polyester grafts during thoracic aortic surgery using the pleat technique. J Thorac Cardiovasc Surg 2017; 154:414-416. [PMID: 28314531 DOI: 10.1016/j.jtcvs.2016.12.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/06/2016] [Accepted: 12/20/2016] [Indexed: 11/17/2022]
Affiliation(s)
- John J Campo
- Bluhm Cardiovascular Institute, Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Ill
| | - Michael H Yamashita
- Bluhm Cardiovascular Institute, Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Ill
| | - S Chris Malaisrie
- Bluhm Cardiovascular Institute, Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Ill.
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Yanagawa B, Ruel M, Bonneau C, Lee MM, Chung J, Al Shouli S, Fagan A, Al Khalifa A, White CW, Yamashita MH, Currie ME, Teoh H, Mewhort HE, Verma S. Dual antiplatelet therapy use by Canadian cardiac surgeons. J Thorac Cardiovasc Surg 2015; 150:1548-54.e3. [DOI: 10.1016/j.jtcvs.2015.08.066] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 08/06/2015] [Accepted: 08/17/2015] [Indexed: 10/23/2022]
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Verma S, Yanagawa B, Kalra S, Ruel M, Peterson MD, Yamashita MH, Fagan A, Currie ME, White CW, Wai Sang SL, Rosu C, Singh S, Mewhort H, Gupta N, Fedak PWM. Knowledge, attitudes, and practice patterns in surgical management of bicuspid aortopathy: a survey of 100 cardiac surgeons. J Thorac Cardiovasc Surg 2013; 146:1033-1040.e4. [PMID: 23988289 DOI: 10.1016/j.jtcvs.2013.06.037] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [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: 03/30/2013] [Revised: 06/10/2013] [Accepted: 06/27/2013] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Clinical practice guidelines have been established for surgical management of the aorta in bicuspid aortic valve disease. We hypothesized that surgeons' knowledge of and attitudes toward bicuspid aortic valve aortopathy influence their surgical approaches. METHODS We surveyed cardiac surgeons to probe the knowledge of, attitudes toward, and surgical management of bicuspid aortopathy. A total of 100 Canadian adult cardiac surgeons participated. RESULTS Fifty-two percent of surgeons believed that the mechanism underlying aortic dilation in those with bicuspid aortic valve was due to an inherent genetic abnormality of the aorta, whereas only 2% believed that altered valve-related processes were involved in this process. Only a minority (15%) believed that bicuspid valve leaflet fusion type is associated with a unique pattern of aortic dilatation aortic phenotype. Sixty-five percent of surgeons recommended echocardiographic screening of first-degree relatives of patients with bicuspid aortic valve. Most surgeons (61%) elected to replace the aorta when the diameter is 45 mm or greater at the time of valve surgery. Fifty-five percent of surgeons surveyed suggested that in the absence of concomitant valvular disease, they would recommend ascending aortic replacement at a threshold of 50 mm or greater. Approximately one third of surgeons suggested that they would elect to replace a mildly dilated ascending aorta (40 mm) at the time of valve surgery. The most common surgical approach (61%) for combined valve and aortic surgery was aortic valve replacement and supracoronary replacement of the ascending aorta, and only a minority suggested the use of deep hypothermic circulatory arrest and open distal anastomosis. More aggressive approaches were favored with greater surgeon experience, and when circulatory arrest was chosen, the majority (68%) suggested they would use antegrade cerebral perfusion. In the setting of aortic insufficiency and a dilated aorta, 42% of surgeons suggested that they would perform valve-sparing surgery. Of note, 40% of respondents used an index measure of aortic size to body surface area in addition to absolute aortic diameter in assessing the threshold for intervention. CONCLUSIONS This large survey uncovered significant gaps in the knowledge and attitudes of surgeons toward the diagnosis and management of bicuspid aortopathy, many of which were at odds with current guideline recommendations. Efforts to promote knowledge translation in this area are strongly encouraged.
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Affiliation(s)
- Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Yamashita MH, Ye J, Jamieson WRE, Cheung A, Lichtenstein SV. Conventional aortic valve replacement remains a safe option in patients aged > or = 70 years: a 20-year experience. J Heart Valve Dis 2012; 21:148-155. [PMID: 22645847] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Increased life expectancy has resulted in the elderly frequently presenting with severe aortic stenosis. It has therefore become important to define indications for conventional aortic valve replacement (AVR) and transcatheter aortic valve implantation (TAVI) in this patient population. Thus, patients aged > or = 70 years undergoing conventional isolated AVR were evaluated for predictors of early and late mortality. METHODS A retrospective analysis was conducted of prospectively collected data available from 1,061 consecutive patients (age range: 70-94 years) who underwent isolated AVR between 1982 and 2002. The patient age groups were 70-74 years (n = 466), 75-79 years (n = 367), and > or = 80 years (n = 228). The mean follow up was 6.0 +/- 4.4 years, and the total follow up 6,390 patient-years. Twenty-two variables were considered as potential risk factors for early and late mortality. RESULTS Early mortality was higher in patients aged > or = 80 years than in those aged 70-79 years. Early mortality in patients aged > or = 80 years was lower between 1998 and 2002 than between 1982 and 1997. Multivariate predictors of early mortality were age > or = 80 years, operative status, previous intervention, renal failure, and mitral regurgitation. The early nonfatal complication rate was similar for patients aged 70-79 years and > or = 80 years, but late mortality was lower between 1998 and 2002 than between 1982 and 1997 in patients aged 70-79 years, and in those aged > or = 80 years. The 10-year actuarial survivals after AVR in patients aged 70-74, 75-79, and > or = 80 years were 54 +/- 3.0%, 43 +/- 3.8% and 17 +/- 3.9%, respectively. Multivariate predictors of late mortality were age 75-79 years, age > or = 80 years, peripheral vascular disease (PVD) and chronic obstructive pulmonary disease (COPD). Female gender was shown to be protective. CONCLUSION Early mortality was higher in patients aged > or = 80 years undergoing AVR, though this has declined recently and is currently at an acceptable level. Other important predictors of mortality in elderly patients undergoing AVR are operative status, previous interventions, renal failure, mitral regurgitation, male gender, PVD, and COPD. Thus, conventional AVR remains a safe treatment option for the elderly patient.
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Yamashita MH, Skarsgard PL. Intermediate and early rupture of expanded polytetrafluoroethylene neochordae after mitral valve repair. Ann Thorac Surg 2011; 92:341-3. [PMID: 21718872 DOI: 10.1016/j.athoracsur.2011.01.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 01/09/2011] [Accepted: 01/12/2011] [Indexed: 10/18/2022]
Abstract
Neochordae construction using an expanded polytetrafluoroethylene suture is an accepted surgical technique to correct mitral regurgitation due to mitral valve prolapse. We report two cases of intermediate and early rupture of CV-5 expanded polytetrafluoroethylene neochordae after mitral valve repair. As a result of these cases, we now use CV-3 expanded polytetrafluoroethylene for neochordae construction with no failures.
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Affiliation(s)
- Michael H Yamashita
- Division of Cardiovascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
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Abstract
OBJECTIVE To compare laparoscopic hepatic resection (LHR) with open hepatic resection (OHR) for benign and malignant tumors. DATA SOURCES MEDLINE, CENTRAL, and EMBASE databases were searched for relevant studies published between January 1, 1998, and May 1, 2009. STUDY SELECTION Studies clearly documenting a comparison of LHR with OHR for benign and malignant neoplasms were selected. DATA EXTRACTION Operative and postoperative measures, resection margins, complications, and survival outcomes were evaluated. Weighted mean differences, relative risks, and hazard ratios (HRs) were calculated using a random-effects model. RESULTS Twenty-six studies were included in the meta-analysis. The HR of death for malignant tumors was significantly lower in the LHR group compared with the OHR group (HR, 0.64; P = .04). The HR of recurrence for malignant tumors was not significantly different between the 2 groups (HR, 0.79; P = .37). The LHR group had a lower operative blood loss (weighted mean difference, -161 mL; P < .001) and relative risk of total postoperative complications (relative risk, 0.40; P < .001). Duration of hospital stay, days of intravenous narcotic use, and days until oral intake were all significantly lower in the LHR group compared with the OHR group. Operative time between LHR and OHR was not significantly different. CONCLUSIONS Laparoscopic hepatic resection for malignant tumors is associated with a long-term survival that is at least comparable, if not superior, to OHR with no difference in disease recurrence. The use of LHR for benign and malignant tumors is a safe alternative to OHR with potential operative and postoperative benefits.
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Affiliation(s)
- Kris P Croome
- Harvard School of Public Health, Boston, Massachusetts, USA
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ElBardissi AW, DiBardino DJ, Chen FY, Yamashita MH, Cohn LH. Is early antithrombotic therapy necessary in patients with bioprosthetic aortic valves in normal sinus rhythm? J Thorac Cardiovasc Surg 2010; 139:1137-45. [DOI: 10.1016/j.jtcvs.2009.10.064] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 09/07/2009] [Accepted: 10/01/2009] [Indexed: 11/26/2022]
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Abstract
Many patients have been fit with orthoses and arrive to the clinic stating that their symptoms failed to resolve, or were even worse with use of the devices. Upon further questioning, they reveal that they may or may not have been evaluated thoroughly, according to the areas of evaluation that were explored in this article. Furthermore, they may have been casted in weight bearing, and often by a technician, instead of the medical provider. They usually have no awareness of having been maintained in a neutral STJ position for casting and generally remark that they were not educated at all regarding the contributory factors for their particular gait pathomechanics or pathology. Providers who dispense custom foot orthoses include physicians, physical therapists, podiatrists, pedorthotists, and chiropractors. Because of the number of disciplines that consider foot orthoses as part of their scope of practice, the presence of a frustrating lack of uniformity with respect to knowledge base, evaluation skills, casting skills, and treatment philosophy within this population is understandable. Even the language that is used to describe positions, motions, deformity, and pathology vary based on specialty and specific training. Not surprisingly, unacceptable disparities are present, even within the same disciplines. This huge variability undermines the credibility of those practitioners who thoughtfully and deliberately fabricate devices based on sound biomechanical principles. It behooves the referring provider, as well as his/her patients, to know the background of, and the evaluation procedures that are used by, the practitioner who will be evaluating the patient for custom foot orthoses.
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