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Wong SY, Wellens J, Helmus D, Marlow L, Brann S, Martinez Pazos V, Weinberg A, Moran HR, McGregor C, Vermeire S, Watanabe K, Kamikozuru K, Ahuja V, Vermani S, Lindsay JO, Kingston A, Dutta U, Kaur H, Silverberg MS, Milgrom R, Chien Ng S, Mak JWY, Cadwell K, Thompson C, Colombel JF, Satsangi J. Geography Influences Susceptibility to SARS-CoV-2 Serological Response in Patients With Inflammatory Bowel Disease: Multinational Analysis From the ICARUS-IBD Consortium. Inflamm Bowel Dis 2023; 29:1693-1705. [PMID: 37354560 DOI: 10.1093/ibd/izad097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/09/2022] [Indexed: 06/26/2023]
Abstract
BACKGROUND Beyond systematic reviews and meta-analyses, there have been no direct studies of serological response to COVID-19 in patients with inflammatory bowel disease (IBD) across continents. In particular, there has been limited data from Asia, with no data reported from India. The ICARUS-IBD (International study of COVID-19 Antibody Response Under Sustained immunosuppression in IBD) consortium assessed serological response to SARS-CoV-2 in patients with IBD in North America, Europe, and Asia. METHODS The ICARUS-IBD study is a multicenter observational cohort study spanning sites in 7 countries. We report seroprevalence data from 2303 patients with IBD before COVID-19 vaccination between May 2020 and November 2021. SARS-CoV-2 anti-spike and anti-nucleocapsid antibodies were analyzed. RESULTS The highest and lowest SARS-CoV-2 anti-spike seropositivity rates were found in Asia (81.2% in Chandigarh and 57.9% in Delhi, India; and 0% in Hong Kong). By multivariable analysis, country (India: odds ratio [OR], 18.01; 95% confidence interval [CI], 12.03-26.95; P < .0001; United Kingdom: OR, 2.43; 95% CI, 1.58-3.72; P < .0001; United States: OR, 2.21; 95% CI, 1.27-3.85; P = .005), male sex (OR, 1.46; 95% CI, 1.07-1.99; P = .016), and diabetes (OR, 2.37; 95% CI, 1.04-5.46; P = .039) conferred higher seropositivity rates. Biological therapies associated with lower seroprevalence (OR, 0.22; 95% CI, 0.15-0.33; P < .0001). Multiple linear regression showed associations between anti-spike and anti-nucleocapsid titers with medications (P < .0001) but not with country (P = .3841). CONCLUSIONS While the effects of medications on anti-SARS-CoV-2 antibody titers in patients with IBD were consistent across sites, geographical location conferred the highest risk of susceptibility to serologically detectable SARS-CoV-2 infection. Over half of IBD patients in India were seropositive prior to vaccination. These insights can help to inform shielding advice, therapeutic choices, and vaccine strategies in IBD patients for COVID-19 and future viral challenges.
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Affiliation(s)
- Serre-Yu Wong
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Judith Wellens
- Department of Gastroenterology and Hepatology, Leuven University Hospitals, Leuven, Belgium
| | - Drew Helmus
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luke Marlow
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stephanie Brann
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Vicky Martinez Pazos
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alan Weinberg
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hunter R Moran
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Colleen McGregor
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, Leuven University Hospitals, Leuven, Belgium
| | - Kenji Watanabe
- Center for Inflammatory Bowel Disease, Division of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Koji Kamikozuru
- Center for Inflammatory Bowel Disease, Division of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Vineet Ahuja
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Shubi Vermani
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - James O Lindsay
- Center for Immunobiology, Blizard Institute, Queen Mary University of London - Barts Health NHS Trust, London, United Kingdom
| | - Ashley Kingston
- Center for Immunobiology, Blizard Institute, Queen Mary University of London - Barts Health NHS Trust, London, United Kingdom
| | - Usha Dutta
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harmandeep Kaur
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mark S Silverberg
- Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Raquel Milgrom
- Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Siew Chien Ng
- Division of Gastroenterology and Hepatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Joyce Wing Yan Mak
- Division of Gastroenterology and Hepatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Ken Cadwell
- Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Pennsylvania, PA, USA
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine of the University of Pennsylvania, Pennsylvania, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine of the University of Pennsylvania, Pennsylvania, PA, USA
| | - Craig Thompson
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Warwick, United Kingdom
| | - Jean-Frédéric Colombel
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jack Satsangi
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Hassanein W, Kane L, Lezberg P, Hassanein A, Dang N, LaFrancesca S, Kaw A, Brann S, Omara M, Reddy S, Ihnken K, Salihi MA, Zafar F, Khayal T. First Report on the Performance of the National OCS Program (NOP) in U.S. Heart and Lung Transplants. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.636] [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: 04/05/2023] Open
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Wellens J, Brann S, Adams A, Marlow L, Lindsay JO, Satsangi JJ. Determinants of uptake of a third dose of SARS-CoV-2 vaccines in patients with inflammatory bowel disease. Lancet Gastroenterol Hepatol 2022; 7:507. [PMID: 35397229 PMCID: PMC8986165 DOI: 10.1016/s2468-1253(22)00120-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Judith Wellens
- Translational Gastro-intestinal Unit, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK; Translational Research for Gastrointestinal Diseases, University Hospitals Leuven, Leuven, Belgium.
| | - Stephanie Brann
- Translational Gastro-intestinal Unit, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Alex Adams
- Translational Gastro-intestinal Unit, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Luke Marlow
- Translational Gastro-intestinal Unit, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - James O Lindsay
- Barts Health NHS Trust, The Royal London Hospital, London, UK; Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine Queen Mary University of London, London, UK
| | - Jack J Satsangi
- Translational Gastro-intestinal Unit, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Kehara H, Kashem M, Mangukia C, Sunagawa G, Yanagida R, Brann S, Toyoda Y, Shigemura N. Prevalence and Impact of Preoperative Peripheral Arterial Disease on Outcomes Following Geriatric Lung Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.395] [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: 10/18/2022] Open
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Montgomery K, Ander E, Tran T, Rakita V, Brann S, Toyoda Y, Hamad E. Survival Outcomes with Regards to Implant Strategies in Heart Transplantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1211] [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: 10/21/2022] Open
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6
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Kehara H, Yanagida R, Kashem A, Mangukia C, Sunagawa G, Brann S, Leotta E, Boova R, Shigemura N, Minakata K, Toyoda Y. Outcomes after Lung Re-Transplantation: A Single-Center Experience. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1028] [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: 10/21/2022] Open
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Montgomery K, Toyoda Y, Kashem M, Sunagawa G, Shigemura N, Yanagida R, Minakata K, Brann S, Leotta E. Lung Transplantation: Is the Switch to Interrupted Suturing Worth it? J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.986] [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: 11/26/2022] Open
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8
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Sunagawa G, Kehara H, Kashem M, Mangukia C, Brann S, Leotta E, Yanagida R, Minakata K, Cordova F, Toyoda Y, Shigemura N. Single Lung Transplant Remains a Viable Alternative to Double Lung Transplantation for the Patients with Severe Secondary Pulmonary Hypertension. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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9
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Tran T, Kashem M, Kanaparthi J, Zhao H, Brann S, Leotta E, Minakata K, Yanagida R, Sunagawa G, Shigemura N, Toyoda Y. Lung Transplant Survival Regarding Past and Concomitant Cardiac Revascularization. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1040] [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: 11/27/2022] Open
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Dutta S, Kashem A, Sunagawa G, Brann S, Leotta E, Shigemura N, Toyoda Y. Impact of Donor Age on IPF Patient Survival in Lung Transplantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.503] [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: 10/24/2022] Open
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11
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Sunagawa G, Kashem M, Leotta E, Kromah F, Brann S, Gomez-Abraham J, Keshavamurthy S, Minakata K, Cordova F, Toyoda Y, Shigemura N. Pushing the Envelope in Single Lung Transplantation for Secondary Pulmonary Hypertension: Identifying an Upper Limit of Pressures. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.552] [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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12
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Sunagawa G, Kashem M, Leotta E, Kromah F, Brann S, Gomez-Abraham J, Keshavamurthy S, Minakata K, Cordova F, Toyoda Y, Shigemura N. ‘Side-Mismatched’ Single Lung Transplantation Does Not Compromise the Transplant Outcomes. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1071] [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: 10/27/2022] Open
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Yoshizumi T, Sunagawa G, Brann S, Keshavamurthy S, Dulam V, Gomez-Abraham J, Kashem M, Minakata K, Shigemura N, Toyoda Y. A Study for Bridge to Lung Transplant with Extracorporeal Membrane Oxygenation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
Between September 1998 and February 2003, 204 children underwent cardiac surgery in Trinidad and Tobago to correct or palliate congenital heart disease. The defects included isolated ventricular or atrial septal defects as well as tetralogy of fallot and coarctation of the aorta. A few patients also had complex cyanotic congenital heart disease. The patients ranged in age from 2 days to 17 years. In some cases, palliative surgery was undertaken as a first step towards complete correction but the majority of patients underwent complete repair. The commonest postoperative complications were haemorrhage and small transient pericardial effusions. The overall mortality rate was < 1%. This paper describes the cardiac lesions, post-operative morbidity and mortality of these patients.
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Affiliation(s)
- G Henry
- Department of Child Health, The University of the West Indies, St Augustine, Trinidad and Tobago, West Indies.
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Thomas CN, Maharaj P, Bodapati S, John R, Rahaman R, Henry R, Brann S. The initial Trinidad experience with Cine MRI in clinical cardiology. W INDIAN MED J 2002; 51:47-51. [PMID: 12089881] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
We describe the initial Trinidad experience with Magnetic Resonance Imaging (MRI) and Cine MRI as a diagnostic tool in clinical cardiology. Six patients from the following categories were referred for Cine MRI evaluation: congenital heart disease, valvular heart disease, aortic diseases, cardiomyopathy and intracardiac mass. All patients underwent echocardiography. MRI and Cine MRI were performed on all patients using a Siemens Magnetom 1.0 Tesla MR system at MRI Trinidad and Tobago Ltd. Selected patients underwent Angiography and/or computed tomography (CT) scanning. Clinical data and images of the six patients evaluated are described. MRI and Cine MRI provided excellent anatomical and functional details of the heart and aorta in five patients with dissection of the aorta, aneurysm of the ascending aorta, suspected left ventricular apical thrombus, infiltrative cardiomyopathy and arrhythmogenic right ventricular dysplasia. Technical difficulty was experienced with one patient who had a congenital defect (common atrium). In this study, Cine MRI provided excellent images in all but one patient. This new noninvasive technique enhanced diagnostic capabilities and facilitated management in patients with certain cardiovascular diseases.
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Affiliation(s)
- C N Thomas
- Cardiopulmonary Research Unit, University of the West Indies, Eric Williams Medical Sciences Complex, Champs Fleurs, Trinidad and Tobago.
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Chamberlain MH, Henry R, Brann S, Angelini GD. Surgical management of a gigantic circumflex coronary artery aneurysm with fistulous connection to the coronary sinus. Eur J Cardiothorac Surg 2001; 20:1255-7. [PMID: 11717043 DOI: 10.1016/s1010-7940(01)00998-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We report the successful management of a gigantic circumflex coronary artery aneurysm with fistulisation into the coronary sinus. Transoesophageal echocardiography allowed continuous visualisation of ventricular wall motion during dissection and closure of the aneurysm whilst operating on cardiopulmonary bypass on the beating heart.
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Affiliation(s)
- M H Chamberlain
- Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol BS2 8HW, Uk
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Brann S, Martineau R, Cartier R. Left main coronary artery stenosis: early experience with surgical revascularization without cardiopulmonary bypass. J Cardiovasc Surg (Torino) 2000; 41:175-9. [PMID: 10901518] [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: 02/17/2023]
Abstract
BACKGROUND To determine the safety of surgical revascularization without cardiopulmonary bypass (CPB) in left main stem (LMS) coronary stenosis. METHODS AND RESULTS Between October 1996 and April 1998, 67 consecutive patients with a > or =50% LMS stenosis underwent coronary revascularization without bypass (BH) and were compared to a contemporary group of 160 patients revascularized with conventional bypass (CPB). Mean ages in both groups were similar: 63.1 and 64.5 years in BH and CPB groups respectively (p=0.91). Significant triple vessel disease occurred in 40 (80%) and 75 (47.5%) patients in BH and CPB groups respectively (p=NS). Average grafts per patient was numbered 3.1 in BH group and 2.9 in CPB group (p=NS). The perioperative infarction rate (defined arbitrarily as a CK-MB >100 U/l) was 4% (2 patients, excluding 1 preoperative infarct) and 3.1% (5 patients, excluding 2 preoperative infarcts) in groups BH and CPB respectively (p=0.28). Postoperative blood transfusion requirements were less in BH group (19 patients, 38%) compared to CPB group (103 patients, 64.4%), (p=0.04). Postoperative inotropic requirements were similar in both groups; BH group (15 patients, 30%) and CPB group (72 patients, 45%). Mean hospital stay was 6.4 and 7.6 days in BH and CPB groups respectively (p=0.49). The hospital mortality rate was 0% and 3.8% (6 patients) in BH and CPB groups respectively (p=NS). CONCLUSIONS Our early experience suggests that non-CPB surgical revascularization in LMS stenosis is a feasible and safe alternative to conventional cardiopulmonary bypass.
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Affiliation(s)
- S Brann
- Department of Cardiac Surgery, Montreal Heart Institute, Quebec, Canada
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Cartier R, Brann S, Dagenais F, Martineau R, Couturier A. Systematic off-pump coronary artery revascularization in multivessel disease: experience of three hundred cases. J Thorac Cardiovasc Surg 2000; 119:221-9. [PMID: 10649196 DOI: 10.1016/s0022-5223(00)70176-0] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.3] [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: 11/30/2022]
Abstract
OBJECTIVE We sought to report our recent experience with off-pump coronary artery revascularization in multivessel disease. METHODS Between October 1996 and December 1998, 300 off-pump beating heart operations were performed at the Montreal Heart Institute by a single surgeon, representing 94% of all procedures undertaken during this same time frame (97% for 1998). This cohort of patients was compared with 1870 patients operated on with cardiopulmonary bypass from 1995 to 1996. RESULTS Mean age, sex distribution, and preoperative risk factors were comparable for the two groups. On average, 2.92 +/- 0.8 and 2.84 +/- 0.6 grafts per patient were completed in the beating heart and cardiopulmonary bypass groups, respectively. A majority of patients (70%) had either a triple or quadruple bypass. Coronary anastomoses were achieved with myocardial mechanical stabilization and heart "verticalization." Ischemic time was shorter in the beating heart group (29.8 +/- 0.9 vs 45 +/- 0.4 minutes, P <.05). Similarly, the need for transfusion was significantly less in the beating heart group (beating heart operations, 34%; cardiopulmonary bypass, 66%; P <.005). Reduced use of postoperative intra-aortic counterpulsation, as well as a lower rise in creatine kinase MB isoenzyme, was observed in the beating heart group. Operative mortality rates (beating heart operations, 1. 3%; cardiopulmonary bypass, 2%) and perioperative myocardial infarction (beating heart operations, 3.6%; cardiopulmonary bypass, 4.2%) were comparable for the two groups. CONCLUSION In a majority of patients, off-pump complete coronary artery revascularization is an acceptable alternative to conventional operations, yielding good results given progressive experience, rigorous technique, and adequate coronary artery stabilization.
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Affiliation(s)
- R Cartier
- Department of Cardiac Surgery, Montreal Heart Institute, Quebec, Canada.
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Cartier R, Brann S, Martineau R, Couturier A. [Left main coronary artery stenosis and revascularization in the beating heart. Short- and long-term experience]. Ann Chir 1999; 53:701-5. [PMID: 10584379] [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: 02/14/2023]
Abstract
OBJECT To determine the safety of surgical revascularization without cardiopulmonary bypass in left main coronary artery stenosis. METHODS Between October 1996 and October 1998, 67 patients with a left main stem stenosis (LMS) (> 50%) underwent revascularization on beating heart surgery (BHS) and were compared to a cohort of 192 patients with LMS disease that were operated on under cardiopulmonary bypass (CPB) during 1996. RESULTS Mean age and sex distribution and prevalence of preoperative risk factors were the same in both groups as well as the average number of grafts per patient was 3.1 +/- 0.7 and 2.9 +/- 0.7 in BHS and CPB groups respectively. Perioperative infarction rate (defined arbitrarily as a CK-MB > 100 IUL) was 2.9% in BHS group and 3.1% in CPB group. Postoperative blood transfusion requirements were less in BHS group (38%) compared to CPB group (64%), p < 0.05. Inotropic requirements postoperatively were similar in both groups. Hospital stay was shorter in BHS group (6.8 days) compared to CPB group (7.6 days) although not significant. There was no operative mortality in BHS group whereas 4.7% died postoperatively in CPB group. CONCLUSION Our experience suggests that non-bypass surgical revascularization is a feasible and safe alternative to conventional cardiopulmonary bypass.
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Affiliation(s)
- R Cartier
- Département de Chirurgie Cardiaque (chirurgien cardiovasculaire), Institut de Cardiologie de Montréal, Québec, Canada
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Abstract
A term neonate with hypoplastic left heart syndrome underwent surgical palliation using the Norwood procedure on day 2 of life. The postoperative course was complicated by recurrent systemic desaturation leading to death. Postmortem histologic examination of lung tissue confirmed the clinical impression of fixed pulmonary vascular disease. Some neonates with a restrictive interatrial communication may have pulmonary vascular disease at birth, which will negatively influence survival irrespective of the type of palliation undertaken.
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Affiliation(s)
- S Brann
- Heart Unit, Birmingham Children's Hospital, England
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