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Beaulieu‐Jones BR, Siegel N, Collado L, Mull HJ, Quin JA. Travel distance and outcomes after surgical aortic valve among veterans. Health Serv Res 2024; 59:e14296. [PMID: 38477023 PMCID: PMC11063085 DOI: 10.1111/1475-6773.14296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE To investigate the association between travel distance and postoperative length of stay (LOS) and discharge disposition among veterans undergoing surgical aortic valve replacement (SAVR). DATA SOURCES/STUDY SETTING We performed a retrospective cohort study of patients undergoing SAVR, with or without coronary artery bypass grafting (CABG) at VA Boston Healthcare (January 1, 2005-December 31, 2015). STUDY DESIGN Postoperative LOS and discharge disposition were compared for SAVR patients based on travel distance to the facility: <100 miles or ≥100 miles. Multivariable regression was performed to ascertain factors associated with LOS and home discharge. DATA COLLECTION/EXTRACTION METHODS Data were collected via chart review. All patients undergoing SAVR at our institution who primarily resided within the defined region were included. PRINCIPAL FINDINGS Of 597 patients studied, 327 patients underwent isolated SAVR; 270 patients underwent SAVR/CABG. Overall median (IQR) distance between the patient's residence and the hospital was 49.95 miles (27.41-129.94 miles); 190 patients (32%) resided further than 100 miles away. There were no differences in the proportion of patients with diabetes, hypertension, chronic obstructive pulmonary disease (COPD), cerebrovascular disease, atrial fibrillation, or prior myocardial infarction between groups. Overall LOS (IQR) was 9 (7-13) days and did not differ between groups (p = 0.18). The proportion of patients discharged home was higher among patients who resided more than 100 miles from the hospital (71% vs. 58%, p = 0.01). On multivariable analysis, residing further than 100 miles from the hospital was independently associated with home discharge (OR = 1.64, 95% CI: 1.09-2.48). Travel distance was not associated with LOS. CONCLUSIONS Based on our institutional experience, potential concerns of longer hospital stay or discharge to other inpatient facilities for geographically distanced patients undergoing SAVR do not appear supported. Continued examination of the drivers underlying the marked shift of veterans to the private sector appears warranted.
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Affiliation(s)
- Brendin R. Beaulieu‐Jones
- Department of SurgeryBoston Medical CenterBostonMassachusettsUSA
- VA Boston Healthcare SystemWest RoxburyMassachusettsUSA
- Department of SurgeryBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Noah Siegel
- Boston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Loreski Collado
- Department of SurgeryBoston Medical CenterBostonMassachusettsUSA
- VA Boston Healthcare SystemWest RoxburyMassachusettsUSA
- Department of SurgeryBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Hillary J. Mull
- Department of SurgeryBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Boston Healthcare SystemBostonMassachusettsUSA
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Hansén N, Ljungberg J, Bergdahl IA, Hultdin J, Näslund U, Johansson B, Söderberg S. Adipokines are possible risk markers for aortic stenosis requiring surgery. SCAND CARDIOVASC J 2023; 57:2247193. [PMID: 37592808 DOI: 10.1080/14017431.2023.2247193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/15/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVES Aortic stenosis (AS) is the most prevalent valvular heart disease among adults. The adipocyte-derived hormones, leptin and adiponectin, have profound metabolic actions. We examined whether these adipokines are independently associated with future aortic valve replacement (AVR). DESIGN In this longitudinal case-control study, we identified 336 cases who had undergone AVR due to AS, and who had previously participated in population-based health surveys. Two referents were matched to each case and leptin and adiponectin concentrations were analysed from stored baseline survey samples. Uni- and multivariable logistic regression analyses were used to estimate the risk of future AVR. An additional cohort was identified for validation including 106 cases with AVR and 212 matched referents. RESULTS Median age (interquartile range (IQR)) in years at survey was 59.9 (10.4) and at surgery 68.3 (12.7), and 48% were women. An elevated concentration of leptin was not associated with future AVR (odds ratio [95% confidence interval]) (1.10 [0.92-1.32]), although leptin was associated with a higher risk in patients with coronary artery disease (CAD) having more than 5 years between survey and AVR (1.41 [1.08-1.84]). Adiponectin was not associated with higher risk for future AVR (0.95 [0.82-1.11]), although after stratification for age, higher levels were associated with reduced risk for AVR in persons aged ≥60 years at surgery (0.79 [0.64-0.98]). In the validation study, leptin was associated with future AVR whereas adiponectin was not. None of the associations remained significant after adjustment for body mass index (BMI). CONCLUSIONS The adipokine leptin may promote the development of AS.
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Affiliation(s)
- Nike Hansén
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
| | - Johan Ljungberg
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
| | | | - Johan Hultdin
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| | - Ulf Näslund
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
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Vavilis G, Bäck M, Bárány P, Szummer K. Epidemiology of Aortic Stenosis/Aortic Valve Replacement (from the Nationwide Swedish Renal Registry). Am J Cardiol 2022; 163:58-64. [PMID: 34799087 DOI: 10.1016/j.amjcard.2021.09.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/17/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022]
Abstract
Contemporary data on the prevalence and incidence of aortic stenosis (AS) and aortic valve replacement (AVR) in patients initiating dialysis are scarce. This observational cohort study aimed to estimate (1) the point prevalence of AS and AVR at dialysis start and (2) the AS incidence and associated factors prospective to dialysis initiation. The study included 14,550 patients initiating dialysis registered in the Swedish Renal Registry between 2005 and 2018. AS was defined by the International Statistical Classification of Diseases, Tenth Revision codes, and AVR by the surgical procedure codes. Associations between covariates and outcomes were assessed in Cox regression models. The median age was 68 (57 to 77), 66% were males, and the point prevalence of AS and AVR was 3.4% and 1.1%, respectively. In those without known AS/AVR at dialysis initiation (n = 14,050), AS was diagnosed in 595 patients (incidence 16.3/1000 person-years, 95% confidence interval [CI] 15.1 to 17.7/1,000 person-years) during a median follow-up of 2.7 years (interquartile range 1.1 to 5.7). In adjusted Cox regression models, higher age (hazard ratio [HR] 1.03, 95% CI 1.02 to 1.04), male gender (HR 1.51, 95% CI 1.25 to 1.83), atrial fibrillation (HR 1.32, 95% CI 1.06 to 1.64), and hypertension (HR 1.65, 95% CI 1.03 to 2.65) were associated with incident AS. Peritoneal dialysis patients had a nonsignificant trend toward higher AS risk compared with hemodialysis (HR 1.18, 95% CI 0.99 to 1.40). About 20% of patients (n = 113) diagnosed with incident AS underwent AVR (incidence 3.1/1000 person-years, 95% CI 2.6 to 3.7/1,000). Only the male gender was associated with AVR (HR 2.07, 95% CI 1.30 to 3.30). In conclusion, the prevalence and incidence of AS and AVR in patients initiating dialysis are high. A fifth of newly diagnosed AS underwent AVR after dialysis onset.
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Affiliation(s)
- Georgios Vavilis
- Department of Medicine, Huddinge; Heart and Vascular Theme, Division of Coronary and Valvular Heart Disease, Karolinska University Hospital, Stockholm, Sweden.
| | - Magnus Bäck
- Heart and Vascular Theme, Division of Coronary and Valvular Heart Disease, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Solna
| | - Peter Bárány
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karolina Szummer
- Department of Medicine, Huddinge; Heart and Vascular Theme, Division of Coronary and Valvular Heart Disease, Karolinska University Hospital, Stockholm, Sweden
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Mack M, Carroll JD, Thourani V, Vemulapalli S, Squiers J, Manandhar P, Deeb GM, Batchelor W, Herrmann HC, Cohen DJ, Hanzel G, Gleason T, Kirtane A, Desai N, Guibone K, Hardy K, Michaels J, DiMaio JM, Christensen B, Fitzgerald S, Krohn C, Brindis RG, Masoudi F, Bavaria J. Transcatheter Mitral Valve Therapy in the United States: A Report From the STS-ACC TVT Registry. J Am Coll Cardiol 2021; 78:2326-2353. [PMID: 34711430 DOI: 10.1016/j.jacc.2021.07.058] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [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: 11/20/2020] [Revised: 07/15/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
Data for nearly all patients undergoing transcatheter edge-to-edge repair (TEER) and transcatheter mitral valve replacement (TMVR) with an approved device in the United States is captured in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. All data submitted for TEER or TMVR between 2014 and March 31, 2020, are reported. A total of 37,475 patients underwent a mitral transcatheter procedure, including 33,878 TEER and 3,597 TMVR. Annual procedure volumes for TEER have increased from 1,152 per year in 2014 to 10,460 per year in 2019 at 403 sites and for TMVR from 84 per year to 1,120 per year at 301 centers. Mortality rates have decreased for TEER at 30 days (5.6%-4.1%) and 1 year (27.4%-22.0%). Early off-label use data on TMVR in mitral valve-in-valve therapy led to approval by the U.S. Food and Drug Administration in 2017, and the 2019 30-day mortality rate was 3.9%. Overall improvements in outcomes over the last 6 years are apparent. (STS/ACC TVT Registry Mitral Module; NCT02245763).
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Affiliation(s)
- Michael Mack
- Baylor Scott & White Health, Dallas, Texas, USA.
| | - John D Carroll
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Vinod Thourani
- Department of Surgery, Piedmont Hospital, Atlanta, Georgia, USA
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Cardiology, Department of Medicine, Duke University Health Care System, Durham, North Carolina, USA
| | | | | | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Howard C Herrmann
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; St Francis Hospital, Roslyn, New York, USA
| | | | | | - Ajay Kirtane
- Cardiovascular Research Foundation, New York, New York, USA; Department of Medicine, Columbia University, New York, New York, USA
| | - Nimesh Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kim Guibone
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Karen Hardy
- CommonSpirit Health, Lexington, Kentucky, USA
| | | | | | | | | | - Carole Krohn
- The Society of Thoracic Surgeons, Chicago, Illinois, USA
| | - Ralph G Brindis
- Philip R. Lee Institute for Health Policy Studies, University of California-San Francisco, San Francisco, California, USA
| | | | - Joseph Bavaria
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Hu JJ, Bonnichsen CR, Dearani JA, Miranda WR, Johnson JN, Cetta F, Stephens EH, Aganga DO, Van Dorn CS. Adults With Tetralogy of Fallot: Early Postoperative Outcomes and Risk Factors for Complications. Mayo Clin Proc 2021; 96:2398-2406. [PMID: 34412856 DOI: 10.1016/j.mayocp.2021.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 01/06/2021] [Accepted: 01/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To report the early postoperative outcomes in adults with tetralogy of Fallot (TOF) undergoing cardiac surgery and to identify patient factors associated with complications. PATIENTS AND METHODS We performed a single-institution retrospective review of adults with TOF who underwent cardiac surgery from January 8, 2008, through June 21, 2018. Patients' characteristics, preoperative imaging, surgical interventions, outcomes, and complications were analyzed. RESULTS There were 219 adults with TOF (mean age, 40 years; range, 18-83 years; 88 [40%] female) in the study. Surgical interventions included repair or replacement of the pulmonary valve (n=199 [91%]), tricuspid valve (n=70 [32%]), mitral valve (n=13 [5.9%]), and aortic valve (n=8 [3.7%]). Three patients (1.4%) underwent first-time TOF repair. The 30-day mortality rate was 1.4% (n=3). Early postoperative complications occurred in 66 (30%) and included arrhythmias requiring treatment, dialysis requirement, liver dysfunction, respiratory failure, infection, reoperation, cardiac arrest, mechanical circulatory support, and death. Multivariate analysis found older age at current surgery (odds ratio [OR], 1.04 per year; 95% CI, 1.01 to 1.06; P<.001), longer cardiopulmonary bypass time (OR, 1.01 per minute; 95% CI, 1.01 to 1.02; P<.001), right ventricular systolic dysfunction (OR, 1.31; 95%, CI 1.02 to 1.69; P=.03), diabetes mellitus (OR, 3.50; 95% CI, 1.20 to 10.2; P=.02), and history of initial palliative surgery (OR, 1.99; 95% CI, 1.01 to 3.91; P=.05) as independent predictors of complications. CONCLUSION Surgical interventions for adult patients with TOF can be performed with low early morbidity and mortality. Clinical characteristics and preoperative testing parameters can predict risk for complications in the postoperative period.
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Affiliation(s)
- Jessie J Hu
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN
| | | | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | | | - Jonathan N Johnson
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN; Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN
| | - Frank Cetta
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN; Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN
| | | | - Devon O Aganga
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, MN; Department of Pediatric and Adolescent Medicine, Division of Pediatric Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Charlotte S Van Dorn
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN; Department of Pediatric and Adolescent Medicine, Division of Pediatric Critical Care Medicine, Mayo Clinic, Rochester, MN.
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Ding Y, Wan M, Zhang H, Wang C, Dai Z. Comparison of postprocedural new-onset atrial fibrillation between transcatheter and surgical aortic valve replacement: A systematic review and meta-analysis based on 16 randomized controlled trials. Medicine (Baltimore) 2021; 100:e26613. [PMID: 34260547 PMCID: PMC8284731 DOI: 10.1097/md.0000000000026613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/22/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Presently, transcatheter aortic valve replacement (TAVR) as an effective and convenient intervention has been adopted extensively for patients with severe aortic disease. However, after surgical aortic valve replacement (SAVR) and TAVR, the incidence of new-onset atrial fibrillation (NOAF) is prevalently found. This meta-analysis was designed to comprehensively compare the incidence of NOAF at different times after TAVR and SAVR for patients with severe aortic disease. METHODS A systematic search of PubMed, Embase, Cochrane Library, and Web of Science up to October 1, 2020 was conducted for relevant studies that comparing TAVR and SAVR in the treatment of severe aortic disease. The primary outcomes were the incidence of NOAF with early, midterm and long term follow-up. The secondary outcomes included permanent pacemaker (PM) implantation, myocardial infarction (MI), cardiogenic shock, as well as mortality and other complications. Two reviewers assessed trial quality and extracted the data independently. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2. RESULTS A total of 16 studies including 13,310 patients were identified. The pooled results indicated that, compared with SAVR, TAVR experienced a significantly lower incidence of 30-day/in-hospital, 1-year, 2-year, and 5-year NOAF, with pooled risk ratios (RRs) of 0.31 (95% confidence interval [CI] 0.23-0.41; 5725 pts), 0.30 (95% CI 0.24-0.39; 6321 pts), 0.48 (95% CI 0.38-0.61; 3441 pts), and 0.45 (95% CI 0.37-0.55; 2268 pts) respectively. In addition, TAVR showed lower incidence of MI (RR 0.62; 95% CI 0.40-0.97) and cardiogenic shock (RR 0.34; 95% CI 0.19-0.59), but higher incidence of permanent PM (RR 3.16; 95% CI 1.61-6.21) and major vascular complications (RR 2.22; 95% CI 1.14-4.32) at 30-day/in-hospital. At 1- and 2-year after procedure, compared with SAVR, TAVR experienced a significantly higher incidence of neurological events, transient ischemic attacks (TIA), permanent PM, and major vascular complications, respectively. At 5-year after procedure, compared with SAVR, TAVR experienced a significantly higher incidence of TIA and re-intervention respectively. There was no difference in 30-day, 1-year, 2-year, and 5-year all-cause or cardiovascular mortality as well as stroke between TAVR and SAVR. CONCLUSIONS Our analysis showed that TAVR was superior to SAVR in decreasing the both short and long term postprocedural NOAF. TAVR was equal to SAVR in early, midterm and long term mortality. In addition, TAVR showed lower incidence of 30-day/in-hospital MI and cardiogenic shock after procedure. However, pooled results showed that TAVR was inferior to SAVR in reducing permanent pacemaker implantation, neurological events, TIA, major vascular complications, and re-intervention.
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Affiliation(s)
| | - Minmin Wan
- Outpatient Department, Zhebei Mingzhou hospital, Huzhou, China
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Yankey GS, Jackson LR, Marts C, Chiswell K, Wu A, Ugowe F, Wilson J, Vemulapalli S, Samad Z, Thomas KL. African American-Caucasian American differences in aortic valve replacement in patients with severe aortic stenosis. Am Heart J 2021; 234:111-121. [PMID: 33453161 PMCID: PMC9899489 DOI: 10.1016/j.ahj.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 01/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Among patients with severe aortic stenosis (AS), there are limited data on aortic valve replacement (AVR), reasons for nonreceipt and mortality by race. METHODS Utilizing the Duke Echocardiography Laboratory Database, we analyzed data from 110,711 patients who underwent echocardiography at Duke University Medical Center between 1999 and 2013. We identified 1,111 patients with severe AS who met ≥1 of 3 criteria for AVR: ejection fraction ≤50%, diagnosis of heart failure, or need for coronary artery bypass surgery. Logistic regression models were used to assess the association between race, AVR and 1-year mortality. χ2 testing was used to assess potential racial differences in reasons for AVR nonreceipt. RESULTS Among the 1,111 patients (143 AA and 968 CA) eligible for AVR, AA were more often women, had more diabetes, renal insufficiency, aortic regurgitation and left ventricular hypertrophy. CA were more often smokers, had more ischemic heart disease, hyperlipidemia and higher median income levels. There were no racial differences in surgical risk utilizing logistic euroSCORES. Relative to CA, AA had lower rates of AVR (adjusted odds ratio 0.46, 95% CI 0.3-0.71, P < .001) yet similar 1-year mortality (aHR 0.81, 95% CI 0.57-1.17, P = .262). There were no significant differences in reasons for AVR nonreceipt. CONCLUSIONS We identified 143 African Americans (AA) and 968 Caucasian Americans(CA) with severe AS who met prespecified criteria for AVR.. AA relative to CA were more often women, had more diabetes, renal insufficiency, and left ventricular hypertrophy, however had less tobacco use, ischemic heart disease, hyperlipidemia and lower median income levels. Among patients with severe AS, AA relative to CA had lower rates of AVR (adjusted odds ratio 0.46, 95% CI 0.3-0.71, P < .001) without significant differences in reasons for AVR nonreceipt and similar 1-year mortality.
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Affiliation(s)
| | - Larry R Jackson
- Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Colin Marts
- Duke University School of Medicine, Durham, NC
| | | | - Angie Wu
- Duke Clinical Research Institute, Durham, NC
| | | | | | - Sreekanth Vemulapalli
- Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | | | - Kevin L Thomas
- Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC.
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Abstract
BACKGROUND Cardiovascular research has traditionally been dedicated to "tombstone" outcomes, with little attention dedicated to the patient's perspective. We evaluated disability-free survival as a patient-defined outcome after cardiac surgery. METHODS We conducted a retrospective cohort study of patients aged 40 years and older who underwent coronary artery bypass grafting (CABG) or single or multiple valve (aortic, mitral, tricuspid) surgery in Ontario between Oct. 1, 2008, and Dec. 31, 2016. The primary outcome was disability (a composite of stroke, 3 or more nonelective hospital admissions and admission to a long-term care facility) within 1 year after surgery. We assessed the procedure-specific risk of disability using cumulative incidence functions, and the relative effect of covariates on the subdistribution hazard using Fine and Gray models. RESULTS The study included 72 824 patients. The 1-year incidence of disability and death was 2431 (4.6%) and 1839 (3.5%) for CABG, 677 (6.5%) and 539 (5.2%) for single valve, 118 (9.0%) and 140 (10.7%) for multiple valve, 718 (9.0%) and 730 (9.2%) for CABG and single valve, and 87 (13.1%) and 94 (14.1%) for CABG and multiple valve surgery, respectively. With CABG as the reference group, the adjusted hazard ratios for disability were 1.34 (95% confidence interval [CI] 1.21-1.48) after single valve, 1.43 (95% CI 1.18-1.75) after multiple valve, 1.38 (95% CI 1.26-1.51) after CABG and single valve, and 1.78 (95% CI 1.43-2.23) after CABG and multiple valve surgery. Combined CABG and multiple valve surgery, heart failure, creatinine 180 μmol/L or greater, alcohol use disorder, dementia and depression were independent risk factors for disability. INTERPRETATION The cumulative incidence of disability was lowest after CABG and highest after combined CABG and multiple valve surgery. Our findings point to a need for models that predict personalized disability risk to enable better patient-centred care.
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Affiliation(s)
- Louise Y Sun
- The Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine (Sun), University of Ottawa Heart Institute; the School of Epidemiology and Public Health (Sun), University of Ottawa; the Institute for Clinical Evaluative Sciences (Sun, Bader Eddeen); the Division of Cardiac Surgery, Department of Surgery (Mesana), University of Ottawa Heart Institute, Ottawa, Ont.
| | - Anan Bader Eddeen
- The Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine (Sun), University of Ottawa Heart Institute; the School of Epidemiology and Public Health (Sun), University of Ottawa; the Institute for Clinical Evaluative Sciences (Sun, Bader Eddeen); the Division of Cardiac Surgery, Department of Surgery (Mesana), University of Ottawa Heart Institute, Ottawa, Ont
| | - Thierry G Mesana
- The Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine (Sun), University of Ottawa Heart Institute; the School of Epidemiology and Public Health (Sun), University of Ottawa; the Institute for Clinical Evaluative Sciences (Sun, Bader Eddeen); the Division of Cardiac Surgery, Department of Surgery (Mesana), University of Ottawa Heart Institute, Ottawa, Ont
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Kamoen V, Calle S, El Haddad M, De Backer T, De Buyzere M, Timmermans F. Diagnostic and Prognostic Value of Several Color Doppler Jet Grading Methods in Patients With Mitral Regurgitation. Am J Cardiol 2021; 143:111-117. [PMID: 33352207 DOI: 10.1016/j.amjcard.2020.12.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 01/07/2023]
Abstract
Color Doppler is a widely used ultrasound imaging method for assessing mitral regurgitation (MR) in clinical practice. Nevertheless, color Doppler-based grading of the MR jet has been rarely considered in clinical studies. We investigated the diagnostic and prognostic value of several color Doppler MR jet grading methods and compared them with quantitative grading of MR. The MR color Doppler jet was assessed in 476 MR patients using an 'integrated' eyeballing approach by quantifying the color Doppler jet area, jet area/left atrium area and jet length and using quantitative methods. Clinical endpoints were scored as major adverse clinical events, including cardiovascular death, heart failure hospitalization and mitral valve intervention. When assessed by three echocardiographers, there was a moderate inter-observer agreement for eyeballing color Doppler grade of MR (intraclass correlation coefficient 0.69, p < 0.001). The intra-observer agreement was good for all color Doppler approaches. In primary MR, eyeballing color Doppler correlated well with (in)direct measures of MR severity, with a negative predictive value of 91% when using a grade 2 color Doppler as cut-off. In secondary MR, eyeballing color Doppler grade and jet length were predictors of clinical outcome in Cox proportional hazards analysis (p = 0.003), independent of pulmonary pressures, atrial and ventricular volumes. Overall, the integrated eyeballing approach performed better than color Doppler quantification of the MR jet area and length. In conclusion, this study shows that color Doppler grading of the distal MR jet performs well in predicting events in primary and secondary MR, compared to quantitative grading methods.
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Affiliation(s)
- Victor Kamoen
- Department of Cardiology, Heart Center, Ghent University Hospital, Belgium.
| | - Simon Calle
- Department of Cardiology, Heart Center, Ghent University Hospital, Belgium
| | - Milad El Haddad
- Department of Cardiology, Heart Center, Ghent University Hospital, Belgium
| | - Tine De Backer
- Department of Cardiology, Heart Center, Ghent University Hospital, Belgium
| | - Marc De Buyzere
- Department of Cardiology, Heart Center, Ghent University Hospital, Belgium
| | - Frank Timmermans
- Department of Cardiology, Heart Center, Ghent University Hospital, Belgium
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Cheng C, Bohbot Y, Michelena HI, Rusinaru D, Fay F, Elmkies F, Sarano ME, Tribouilloy C. Clinical Outcomes of Adults With Bicuspid Aortic Valve: A European Perspective. Mayo Clin Proc 2021; 96:648-657. [PMID: 33673916 DOI: 10.1016/j.mayocp.2020.04.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 12/14/2019] [Accepted: 04/14/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the clinical history of patients with a wide age range diagnosed with bicuspid aortic valve (BAV) and no surgical indication and to evaluate the long-term outcome of patients with BAV referred for elective surgery. PATIENTS AND METHODS Between 2005 and 2017, 350 consecutive patients with no surgical indication (surveillance group, mean age 53±16, 71% men) and 191 with a surgical indication (surgical group, mean age 59±13, 71% men) were prospectively included. Median follow-up was 80 (32 to 115) months. RESULTS In the surveillance group, the 5-year and 10-year survival rates were 93±1% and 89±2%, respectively, with a relative survival of patients with BAV compared with an age- and sex-matched control population of 98.7%. During follow-up, the cumulative 10-year incidence of aortic valve and aorta surgery was high; of 35±4%, the incidence of native valve infective endocarditis (IE) of 0.2% per patient-year, and no cases of aortic dissection were observed. In the surgical group, the 5-year and 10-year survival rates were 97±1% and 89±3%, respectively, with a relative survival of 99.4% compared with the general population. The incidence of IE was 0.4% per patient-year, and no cases of aortic dissection were observed. CONCLUSION This regional cohort shows that the 10-year survival rates of patients with BAV and a wide age range, but mostly middle-aged adults, were similar to those of the general population with a very low rate of complications. Adherence to prophylactic surgical indications and younger age might have contributed to this lack of difference.
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Affiliation(s)
- Charles Cheng
- Department of Cardiology, Amiens University Hospital, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, France; EA 7517 MP3CV Université de Picardie Jules Verne, Amiens, France
| | | | - Dan Rusinaru
- Department of Cardiology, Amiens University Hospital, France; EA 7517 MP3CV Université de Picardie Jules Verne, Amiens, France
| | - Floriane Fay
- Department of Cardiology, Amiens University Hospital, France
| | | | | | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, France; EA 7517 MP3CV Université de Picardie Jules Verne, Amiens, France.
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11
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Alqahtani F, Kawsara A, Alkhouli M. Trends in the Use of Isolated Surgical and Transcatheter Aortic Valve Replacement in Patients Younger Than 70 Years of Age. Mayo Clin Proc 2020; 95:2571-2572. [PMID: 33153649 DOI: 10.1016/j.mayocp.2020.09.018] [Citation(s) in RCA: 1] [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: 08/24/2020] [Accepted: 09/14/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Fahad Alqahtani
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, MN
| | - Akram Kawsara
- Division of Cardiology, West Virginia University, Morgantown
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, MN
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12
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Sun F, Liu H, Zhang Q, Lu F, Zhan H, Zhou J. Impact of atrial fibrillation on outcomes of patients treated by transcatheter mitral valve repair: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22195. [PMID: 33019394 PMCID: PMC7535682 DOI: 10.1097/md.0000000000022195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Conflicting data have been reported related to the impact of atrial fibrillation (AF) on outcomes after transcatheter mitral valve repair with MitraClip (MC) implantation. In this study, we assessed the prognosis of MC-treated patients according to the presence of pre-existing AF. METHODS Randomized and observational studies reporting outcomes of pre-existing AF or sinus rhythm in patients undergoing MC treatment were identified with an electronic search. Outcomes of interest were short-and long-term mortality, stroke, bleeding, rehospitalization, myocardial infarction (MI), cardiogenic shock, acute procedure success, the hospital stay, and the number of Clips implanted. RESULTS Eight studies (8466 individuals) were eligible. Compared to sinus rhythm, long-term mortality, the risk of bleeding, rehospitalization, and longer hospital stay were significantly higher in AF groups, whereas similar correlations were found in the analysis of other outcomes. CONCLUSION AF may be related with worse outcomes in patients undergoing MC implantation, including long-term mortality, major bleeding, and rehospitalization. AF should be taken into account when referring a patient for MC treatment.
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Affiliation(s)
| | | | - Qi Zhang
- Department of Endovascular Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fanfan Lu
- Department of Cardiovascular Surgery
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13
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Christ T, Paun AC, Grubitzsch H, Holinski S, Falk V, Dushe S. Long-term results after the Ross procedure with the decellularized AutoTissue Matrix P® bioprosthesis used for pulmonary valve replacement. Eur J Cardiothorac Surg 2020; 55:885-892. [PMID: 30508165 DOI: 10.1093/ejcts/ezy377] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 07/09/2018] [Revised: 09/25/2018] [Accepted: 10/04/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Since 1967, the Ross procedure has been performed to treat aortic valve disease using homografts for pulmonary valve replacement. The decellularized Matrix P® prosthesis was developed to overcome (some) limitations of homografts. Until now, the long-term outcome data have been unavailable. METHODS Between 2002 and 2010, the Ross procedures using the Matrix P prosthesis were performed in 492 adult patients (mean age 57.2 ± 10.6 years, range 21-73 years) at our institution. Patient data were prospectively collected and analysed (3617.3 patient-years, mean follow-up 7.7 ± 4.3 years). Completeness of follow-up at 1, 5 and 10 years was 98.4%, 94.5% and 91.0%, respectively. RESULTS Hospital mortality was 3.9% (n = 19). During follow-up, 121 patients died resulting in a survival rate at 5, 10 and 12.5 years of 82.8 ± 1.7%, 70.4 ± 2.3% and 62.4 ± 2.9%, respectively. Echocardiography revealed a high incidence of relevant dysfunction of the Matrix P prosthesis and subsequent right ventricular failure. Primary reoperation/reintervention was necessary for 150 Matrix P and 48 autografts. Freedom from pulmonary valve reoperation at 5, 10 and 12.5 years was 76.2 ± 2.1%, 58.6 ± 2.9% and 53.4 ± 3.4%, respectively. The autograft function and the left ventricular function showed similar results as previously reported with a freedom from autograft reoperation at 5, 10 and 12.5 years of 91.8 ± 1.4%, 86.1 ± 2.0% and 86.1 ± 2.0%, respectively. CONCLUSIONS The Matrix P prosthesis used for the right ventricular outflow tract reconstruction in the Ross procedure showed unfavourable long-term echocardiographic results with a high rate of reoperation/reintervention for structural pulmonary valve failure. As a consequence, long-term survival of this patient cohort was impaired. Based on these findings, the use of the Matrix P prosthesis for pulmonary valve replacement for Ross procedures in adults should not be recommended.
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Affiliation(s)
- Torsten Christ
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alexandru Claudiu Paun
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Herko Grubitzsch
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Holinski
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Simon Dushe
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Ito S, Nkomo VT, Orsinelli DA, Lin G, Cavalcante J, Popma JJ, Adams DH, Checuti SJ, Deeb GM, Boulware M, Huang J, Little SH, Cohen SA, Reardon MJ, Oh JK. Impact of Stroke Volume Index and Left Ventricular Ejection Fraction on Mortality After Aortic Valve Replacement. Mayo Clin Proc 2020; 95:69-76. [PMID: 31902431 DOI: 10.1016/j.mayocp.2019.10.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/09/2019] [Revised: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the impact of stroke volume index (SVI) and left ventricular ejection fraction (LVEF) on prognosis in patients with severe aortic stenosis, comparing those undergoing transcatheter aortic valve replacement (TAVR) and those with surgical AVR (SAVR). PATIENTS AND METHODS A total of 742 patients from the CoreValve US Pivotal High-Risk Trial randomized to TAVR (n=389) or SAVR (n=353) from February 2011 to September 2012 were stratified by an SVI of 35 mL/m2 and LVEF of 50% for comparing all-cause mortality at 1 year. RESULTS The prevalence of an SVI of less than 35 mL/m2 in patients who underwent TAVR and SAVR was 35.8% (125 of 349) and 31.3% (96 of 307), respectively; LVEF of less than 50% was present in 18.1% (63 of 348) and 19.6% (60 of 306), respectively. Among patients with an SVI of less than 35 mL/m2, 1-year mortality was similar between patients with TAVR and SAVR (16.3% vs 22.2%; P=.25). However, in those with an SVI of 35 mL/m2 or greater, 1-year mortality was lower in those with TAVR than SAVR (10.3% vs 17.3%; P=.03). In patients with an LVEF of less than 50%, mortality was not affected by AVR approach (P>.05). In patients with an LVEF of 50% or higher, TAVR was associated with lower mortality than SAVR when SVI was preserved (9.8% vs 18.6%; P=.01). Mortality was not affected by SVI within the same AVR approach when LVEF was 50% or higher. CONCLUSION In patients with severe aortic stenosis at high risk, there is a significant interaction between AVR approach and the status of SVI and LVEF. When LVEF or SVI was reduced, prognosis was similar regardless of AVR approach. In those with preserved LVEF or SVI, TAVR was associated with a better prognosis than SAVR. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01240902.
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Affiliation(s)
- Saki Ito
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - David A Orsinelli
- Department of Cardiology, Ohio State University Wexner Medical Center, Columbus
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Jeffrey J Popma
- Department of Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - David H Adams
- Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY
| | - Stanley J Checuti
- Department of Cardiac Surgery and Interventional Cardiology, University of Michigan Hospitals, Ann Arbor
| | - G Michael Deeb
- Department of Cardiac Surgery and Interventional Cardiology, University of Michigan Hospitals, Ann Arbor
| | - Michael Boulware
- Department of Clinical Research and Statistical Services, Medtronic, Minneapolis, MN
| | - Jian Huang
- Department of Clinical Research and Statistical Services, Medtronic, Minneapolis, MN
| | - Stephen H Little
- Department of Cardiology and Cardiothoracic Surgery, Houston Methodist Debakey Heart and Vascular Center, TX
| | - Sidney A Cohen
- Department of Clinical Research and Statistical Services, Medtronic, Minneapolis, MN; Division of Cardiovascular Medicine, Perelman School of Medicine, Philadelphia, PA
| | - Michael J Reardon
- Department of Cardiology and Cardiothoracic Surgery, Houston Methodist Debakey Heart and Vascular Center, TX
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
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15
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Imielski B, Malaisrie SC, Pham DT, Kruse J, Andrei AC, Liu M, Cox JL, McCarthy PM. The impact of intraoperative residual mild regurgitation after repair of degenerative mitral regurgitation. J Thorac Cardiovasc Surg 2019; 161:1215-1224.e4. [PMID: 31735391 DOI: 10.1016/j.jtcvs.2019.10.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 05/03/2019] [Revised: 09/03/2019] [Accepted: 10/02/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES During degenerative mitral repair, surgeons must decide if further repair is warranted for residual mild mitral regurgitation. We examined the incidence of mild mitral regurgitation, late echocardiographic and clinical outcomes, and influence of surgical experience in decision making. METHODS From April 2004 to June 2018, 1155 of 1195 patients with pure degenerative disease underwent repair (97% repair rate). Propensity score matching was performed between patients with trace/no mitral regurgitation and patients with mild residual mitral regurgitation. Late echocardiographic outcome and freedom from reoperation were compared using competing-risks models. A comparison of outcomes of the referent surgeon (89.8% of repairs) with all other surgeons was performed. RESULTS Mild mitral regurgitation was present in 73 patients (6%). Propensity score-matched analyses compared 69 patients with mild mitral regurgitation with 198 patients without mitral regurgitation. Late moderate or greater mitral regurgitation was higher in those with mild mitral regurgitation than in those with no mitral regurgitation (17% vs 7%, P = .033), as was late moderate-severe or greater mitral regurgitation (6% vs 1%, P = .016). Ten-year freedom from reoperation was low in both groups (99.5% no vs 96.9% mild; P = .10). The referent surgeon had fewer patients with mild residual mitral regurgitation (6% vs 11%, P = .027) and less progression of mitral regurgitation compared with other surgeons (late moderate or greater mitral regurgitation 6% vs 15%, P = .002). CONCLUSIONS Residual mild mitral regurgitation was uncommon, and late progression to moderate or greater mitral regurgitation was rare and never led to late mitral reoperation. Experienced surgeons may be better able to determine repairs likely to remain stable, and most mild residual mitral regurgitation does not require re-repair.
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Affiliation(s)
- Bartlomiej Imielski
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Medicine, Chicago, Ill
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Medicine, Chicago, Ill
| | - Duc Thinh Pham
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Medicine, Chicago, Ill
| | - Jane Kruse
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Medicine, Chicago, Ill
| | - Adin-Cristian Andrei
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University, Chicago, Ill
| | - Menghan Liu
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Medicine, Chicago, Ill
| | - James L Cox
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Medicine, Chicago, Ill
| | - Patrick M McCarthy
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Medicine, Chicago, Ill.
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de-Miguel-Díez J, López-de-Andrés A, Hernández-Barrera V, De Miguel-Yanes JM, Méndez-Bailón M, Muñoz-Rivas N, Jiménez-García R. Trends, characteristics, in-hospital outcomes and mortality in surgical mitral valve replacement among patients with and without COPD in Spain (2001-2015). PLoS One 2019; 14:e0221263. [PMID: 31425536 PMCID: PMC6699799 DOI: 10.1371/journal.pone.0221263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 08/04/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE We examined trends, characteristics and in-hospital outcomes in mechanical and bioprosthetic surgical mitral valve replacement (SMVR) among patients with and without chronic obstructive pulmonary disease (COPD) in Spain from 2001 to 2015. We also identified factors associated with in-hospital mortality (IHM) in both groups of patients according to the implanted valve type. METHODS We analyzed data from the Spanish National Hospital Discharge Database for patients aged 40 years or over. We selected admissions of patients whose medical procedures included SMVR. We grouped hospitalizations by COPD status. RESULTS Over 43,024 patients identified, 83.63% underwent mechanical mitral valve replacement and 16.37% bioprosthetic valve (6.71% and 7.78% with COPD, respectively). The incidence of SMVR decreased for mechanical valves and increased for bioprosthetic valves over time in both groups of patients. The incidence of SMVR admissions was lower among COPD patients than in those without COPD, both for mechanical and bioprosthetic valves. IHM decreased significantly over time, regardless of the type of valve, in both groups of patients. COPD was associated with a significant increase in IHM, but only among patients who underwent bioprosthetic SMVR (OR 1.32, 95% CI 1.01-1.73). CONCLUSIONS The incidence of mechanical SMVR decreased while that of bioprosthetic SMVR increased over time in both groups of patients. COPD patients were less surgically operated than non-COPD patients for both valve types. In COPD patients, bioprosthetic SMVR was proportionally more used than mechanical SMVR. Mortality decreased over time for both valve types in patients with and without COPD. COPD increased in-hospital mortality among patients undergoing a biological SMVR.
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Affiliation(s)
- Javier de-Miguel-Díez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
- * E-mail:
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - José M. De Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Spain
| | - Manuel Méndez-Bailón
- Internal Medicine Department, Hospital Universitario Clínico San Carlos, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Nuria Muñoz-Rivas
- Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
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Wang TKM, Liao YWB, Choi D, Harmos S, Haydcok D, Gerber I. Mitral valve surgery with or without coronary bypass grafting: eight-year cohort study. N Z Med J 2019; 132:50-58. [PMID: 31415499] [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: 06/10/2023]
Abstract
AIMS A significant minority of patients undergoing mitral valve surgery (MVR) have indication for coronary artery bypass grafting (CABG). The risks of combination surgeries are not well appreciated and maybe more than additive. We compared the characteristics and outcomes of MVR+/-CABG performed at our centre. METHODS Consecutive patients undergoing isolated MVR or with concurrent (MVR+)CABG at Auckland City Hospital during 2005-2012 were compared for baseline and operative characteristics and outcomes in univariable and multivariable analyses. RESULTS A total of 178 MVR+CABG and 407 MVR patients were included. MVR+CABG patients had higher age, CCS and NYHA Class, cardiopulmonary bypass time, and higher prevalence of urgent surgery, hypertension, diabetes, renal impairment, myocardial infarction/coronary artery disease, congestive heart failure/impaired ejection fraction and peripheral vascular disease, although lower prevalence of active endocarditis and previous valve surgery (all P<0.05). MVR+CABG had higher mortality (operative 11.2% vs 2.5% P<0.001; one and five-year survival 85% vs 96% and 78% vs 87% P=0.041) and composite morbidity 53.4% vs 18.9% P<0.001, including acute renal failure, prolonged ventilation, return to theatre (all P<0.001) but not stroke. In multivariable analyses, MVR+CABG was independently associated with higher operative mortality odds ratio 2.07 95% confidence interval 1.09-3.93 and composite morbidity 2.38 (1.03-5.47), but not long-term mortality. CONCLUSION MVR+CABG compared to MVR patients had more comorbidities and greater operative risk, and were independently associated with higher operative mortality and composite morbidity, but not independently associated with higher long-term mortality.
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Affiliation(s)
- Tom Kai Ming Wang
- Cardiologist, Department of Cardiology, Middlemore Hospital (previous Cardiology Advanced Trainee Registrar, Green Lane Cardiovascular Service, Auckland City Hospital), Auckland
| | - Yi-Wen Becky Liao
- Cardiology Advanced Trainee Registrar, Department of Cardiology, Tauranga Hospital, Tauranga
| | - David Choi
- Anaesthetic Registrar, Department of Anaesthetics, Auckland City Hospital, Auckland
| | - Sophie Harmos
- Renal Advanced Trainee Registrar, Department of Renal Medicine, Auckland City Hospital, Auckland
| | - David Haydcok
- Clinical Director Cardiothoracic Surgeon, Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland
| | - Ivor Gerber
- Cardiologist, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland
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Kaier K, von Zur Mühlen C, Zirlik A, Bothe W, Hehn P, Zehender M, Bode C, Stachon P. Estimating the additional costs per life saved due to transcatheter aortic valve replacement: a secondary data analysis of electronic health records in Germany. Eur J Health Econ 2019; 20:625-632. [PMID: 30600467 DOI: 10.1007/s10198-018-1023-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/11/2018] [Indexed: 06/09/2023]
Abstract
Aortic stenosis (AS) is the most common valvular heart disease, with a dismal prognosis when untreated. Recommended therapy is surgical (SAVR) or transcatheter (TAVR) aortic valve replacement. Based on a retrospective cohort of isolated SAVR and TAVR procedures performed in Germany in 2015 (N = 17,826), we examine the impact of treatment selection on in-hospital mortality and total in-hospital costs for a variety of at-risk populations. Since patients were not randomized to the two treatment options, the two endpoints in-hospital mortality and reimbursement are analyzed using logistic and linear regression models with 20 predefined patient characteristics as potential confounders. Incremental cost-effectiveness ratios were calculated as a ratio of the risk-adjusted reimbursement and mortality differences with 95% confidence intervals obtained by Fieller's theorem. Our study shows that TF-TAVR is more costly that SAVR and that cost differences between the procedures vary little between patient groups. Results regarding in-hospital mortality are mixed. SAVR is the predominant procedure among younger patients. For patients older than 85 years or at intermediate and higher pre-operative risk TF-TAVR seems to be the treatment of choice. Incremental cost-effectiveness ratios (ICER) are most favorable for patients older than 85 years (ICER €154,839, 95% CI €89,163-€302,862), followed by patients at higher pre-operative risk (ICER €413,745, 95% CI €258,027-€952,273). A hypothetical shift from SAVR towards TF-TAVR among patients at intermediate pre-operative risk is associated with a less favorable ICER (€1,486,118, 95% CI €764,732-€23,692,323), as the risk-adjusted mortality benefit is relatively small (- 0.97% point), while the additional reimbursement is still eminent (+€14,464). From a German healthcare system payer's perspective, the additional costs per life saved due to TAVR are most favorable for patients older than 85 and/or at higher pre-operative risk.
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Affiliation(s)
- Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79104, Freiburg, Germany
| | - Constantin von Zur Mühlen
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79104, Freiburg, Germany
| | - Andreas Zirlik
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79104, Freiburg, Germany
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Wolfgang Bothe
- Department of Cardiac and Vascular Surgery, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philip Hehn
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Manfred Zehender
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79104, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79104, Freiburg, Germany
| | - Peter Stachon
- Department of Cardiology and Angiology I, Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79104, Freiburg, Germany.
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Bortolussi G, McNulty D, Waheed H, Mawhinney JA, Freemantle N, Pagano D. Identifying cardiac surgery operations in hospital episode statistics administrative database, with an OPCS-based classification of procedures, validated against clinical data. BMJ Open 2019; 9:e023316. [PMID: 30904838 PMCID: PMC6475180 DOI: 10.1136/bmjopen-2018-023316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 01/20/2019] [Accepted: 01/31/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Administrative databases with dedicated coding systems in healthcare systems where providers are funded based on services recorded have been shown to be useful for clinical research, although their reliability is still questioned. We devised a custom classification of procedures and algorithms based on OPCS, enabling us to identify open heart surgeries from the English administrative database, Hospital Episode Statistics, with the objective of comparing the incidence of cardiac procedures in administrative and clinical databases. DESIGN A comparative study of the incidence of cardiac procedures in administrative and clinical databases. SETTING Data from all National Health Service Trusts in England, performing cardiac surgery. PARTICIPANTS Patients classified as having cardiac surgery across England between 2004 and 2015, using a combination of procedure codes, age >18 and consultant specialty, where the classification was validated against internal and external benchmarks. RESULTS We identified a total of 296 426 cardiac surgery procedures, of which majority of the procedures were coronary artery bypass grafting (CABG), aortic valve replacement (AVR), mitral repair and aortic surgery. The matching at local level was 100% for CABG and transplant, >90% for aortic valve and major aortic procedures and >80% for mitral. At national level, results were similar for CABG (IQR 98.6%-104%), AVR (IQR 105%-118%) and mitral valve replacement (IQR 86.2%-111%). CONCLUSIONS We set up a process which can identify cardiac surgeries in England from administrative data. This will lead to the development of a risk model to predict early and late postoperative mortality, useful for risk stratification, risk prediction, benchmarking and real-time monitoring. Once appropriately adjusted, the system can be applied to other specialties, proving especially useful in those areas where clinical databases are not fully established.
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Affiliation(s)
- Giacomo Bortolussi
- Quality and Outcome Research Unit, University Hospital Birmingham, Birmingham, UK
| | - David McNulty
- Quality and Outcome Research Unit, University Hospital Birmingham, Birmingham, UK
| | - Hina Waheed
- Quality and Outcome Research Unit, University Hospital Birmingham, Birmingham, UK
| | - Jamie A Mawhinney
- Quality and Outcome Research Unit, University Hospital Birmingham, Birmingham, UK
| | - Nick Freemantle
- Quality and Outcome Research Unit, University Hospital Birmingham, Birmingham, UK
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Domenico Pagano
- Quality and Outcome Research Unit, University Hospital Birmingham, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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Abstract
Cardiac surgery under cardiopulmonary bypass (CPB) accounts for most consumption of red blood cells (RBCs). Identifying risk factors for massive red blood cell transfusion (MRT) in cardiac surgery may help to reduce this consumption.We retrospectively analyzed 8238 patients who underwent valve surgery and/or coronary artery bypass grafting (CABG) under CPB at 2 major heart centers in China. Uni- and multivariate logistic regression was carried out to assess whether risk factors for MRT (defined as receiving at least 4 units RBCs) varied with type of cardiac surgery.A total of 1691 patients (21%) received at least 4 units RBCs (6.77 ± 4.78 units per person). This MRT group consumed 70% of the total units of allogeneic RBCs in the study. MRT incidence was 2-fold higher among patients undergoing CABG with or without valve surgery than among patients undergoing valve surgery alone. Multivariate logistic analysis identified the following MRT risk factors common to valve surgery alone, CABG alone, and their combination: female sex, older age, renal dysfunction, lower body mass index, lower preoperative hemoglobin, and longer CPB. Several independent MRT risk factors were also identified specific to valve surgery: active endocarditis, nonatrial fibrillation, smaller left atrium diameter, abnormal international normalized ratio, and repeat surgery.Different types of cardiac surgery share several, but not all, MRT risk factors. This study may help guide the prediction and management of patients at higher MRT risk.
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Affiliation(s)
- Dou Huang
- Department of Anesthesiology and Translational Center, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Changwei Chen
- Department of Anesthesiology and Translational Center, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Yue Ming
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jing Liu
- Department of Anesthesiology and Translational Center, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Li Zhou
- Department of Anesthesiology and Translational Center, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Fengjiang Zhang
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Min Yan
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lei Du
- Department of Anesthesiology and Translational Center, West China Hospital, Sichuan University, Chengdu, Sichuan
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Kamiya H, Kitahara H, Kanda H, Ise H, Nakanishi S, Ishikawa N, Kunisawa T, Minol JP, Lichtenberg A, Akhyari P. Transfer of a minimally invasive mitral valve repair program from a high-volume center to a very low volume center: how many cases are necessary to maintain acceptable results? Gen Thorac Cardiovasc Surg 2019; 67:577-584. [PMID: 30659508 DOI: 10.1007/s11748-019-01065-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/07/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate whether minimally invasive mitral valve repair (MIMVR) can be transferred from a high-volume center into a very small volume center and to clarify how many cases are necessary for maintenance of this program, early outcomes of MIMVR in Asahikawa Medical University were compared with those results in patients operated by a single surgeon in Duesseldorf University Hospital. METHODS Sixty-five patients who underwent MIMVR in Asahikawa Medical University (group A) between May 2014 and July 2018 and 134 patients who underwent MIMVR in Duesseldorf University Hospital (group D) between September 2009 and January 2014 by a surgeon who started MIMVS later in Asahikawa were retrospectively analyzed. RESULTS In group D, there were more patients with ischemic mitral valve regurgitation and with annular calcification than in group A. Survival rate at 6 months and 1 year was 98.5% and 98.5% in group A and 92.9% and 91.3% in group D, respectively. EuroSCORE II was significantly higher in patients dead within 30 days and within the first year. CONCLUSIONS The present study demonstrated that MIMVR programs can be transferred with acceptable early results into very low volume centers, if the team is developed by surgeons who are well trained and experienced in MIMVR. Moreover, the present study suggested that case number for maintenance of acceptable results may be obviously less than the previous recognition that this kind of specialized surgery could be maintained with at least 50 cases annually. However, meticulous preparations for surgery are essential for satisfactory surgical outcomes.
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Affiliation(s)
- Hiroyuki Kamiya
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, 078-8510, Japan.
| | - Hiroto Kitahara
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Hirotsugu Kanda
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Hayato Ise
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Sentaro Nakanishi
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Natsuya Ishikawa
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Takayuki Kunisawa
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Jan-Philipp Minol
- Department of Cardiovascular Surgery, Duesseldorf University, Moorenstrasse 5, 40225, Duesseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiovascular Surgery, Duesseldorf University, Moorenstrasse 5, 40225, Duesseldorf, Germany
| | - Payam Akhyari
- Department of Cardiovascular Surgery, Duesseldorf University, Moorenstrasse 5, 40225, Duesseldorf, Germany
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Schranz AJ, Fleischauer A, Chu VH, Wu LT, Rosen DL. Trends in Drug Use-Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017: A Study of Statewide Discharge Data. Ann Intern Med 2019; 170:31-40. [PMID: 30508432 PMCID: PMC6548681 DOI: 10.7326/m18-2124] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Drug use-associated infective endocarditis (DUA-IE) is increasing as a result of the opioid epidemic. Infective endocarditis may require valve surgery, but surgical treatment of DUA-IE has invoked controversy, and the extent of its use is unknown. Objective To examine hospitalization trends for DUA-IE, the proportion of hospitalizations with surgery, patient characteristics, length of stay, and charges. Design 10-year analysis of a statewide hospital discharge database. Setting North Carolina hospitals, 2007 to 2017. Patients All patients aged 18 years or older hospitalized for IE. Measurements Annual trends in all IE admissions and in IE hospitalizations with valve surgery, stratified by patients' drug use status. Characteristics of DUA-IE surgical hospitalizations, including patient demographic characteristics, length of stay, disposition, and charges. Results Of 22 825 IE hospitalizations, 2602 (11%) were for DUA-IE. Valve surgery was performed in 1655 IE hospitalizations (7%), including 285 (17%) for DUA-IE. Annual DUA-IE hospitalizations increased from 0.92 to 10.95 and DUA-IE hospitalizations with surgery from 0.10 to 1.38 per 100 000 persons. In the final year, 42% of IE valve surgeries were performed in patients with DUA-IE. Compared with other surgical patients with IE, those with DUA-IE were younger (median age, 33 vs. 56 years), were more commonly female (47% vs. 33%) and white (89% vs. 63%), and were primarily insured by Medicaid (38%) or uninsured (35%). Hospital stays for DUA-IE were longer (median, 27 vs. 17 days), with higher median charges ($250 994 vs. $198 764). Charges for 282 DUA-IE hospitalizations exceeded $78 million. Limitation Reliance on administrative data and billing codes. Conclusion DUA-IE hospitalizations and valve surgeries increased more than 12-fold, and nearly half of all IE valve surgeries were performed in patients with DUA-IE. The swell of patients with DUA-IE is reshaping the scope, type, and financing of health care resources needed to effectively treat IE. Primary Funding Source National Institutes of Health.
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Affiliation(s)
- Asher J. Schranz
- Division of Infectious Diseases, University of North Carolina at Chapel Hill
| | - Aaron Fleischauer
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention
| | - Vivian H. Chu
- Division of Infectious Diseases, Duke University School of Medicine
| | - Li-Tzy Wu
- Departments of Psychiatry and Behavioral Sciences and Medicine, Duke University School of Medicine
- Duke Clinical Research Institute, Duke University Medical Center
- Center for Child and Family Policy, Duke University
| | - David L. Rosen
- Division of Infectious Diseases, University of North Carolina at Chapel Hill
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Schneider U, Schmid A, Linder R, Horenkamp-Sonntag D, Verheyen F. The Choice of Transcatheter Aortic Valve Implementation (TAVI): Do Patient Co-morbidity and Hospital Ownership Type Matter? Appl Health Econ Health Policy 2018; 16:735-744. [PMID: 30039347 DOI: 10.1007/s40258-018-0414-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Innovative technologies challenge healthcare systems, as evidence on costs and benefits frequently usually are slow to reflect new technology. We investigated these dynamics for Germany, using the emergence of transcatheter aortic valve implementation (TAVI) as an alternative to conventional aortic valve replacements (CAVR). OBJECTIVE We focused on the role of patient co-morbidity-which would be a medical explanation for adopting TAVI-and hospital ownership status, hypothesizing that for-profit facilities are more likely to capitalize on the favorable reimbursement conditions of TAVI. METHODS The analysis uses claims data from the Techniker Krankenkasse, the largest health insurance fund in Germany, for the years 2009-2015, covering 2892 patients with TAVI and 9523 with CAVR. The decision on TAVI versus CAVR was estimated for patient-level data, that is, socioeconomic data as well as co-morbidity. At the hospital level, we included the ownership type. We also controlled for effects of the respective owner (rather than the type of ownership), including a random intercept. RESULTS While the co-morbidity score of TAVI patients was much higher in the early years, over time, the score almost converged with that of CAVR patients. This is in agreement with emerging evidence that suggests the use of TAVI also leads to better patient outcomes. Our results indicate that the type of ownership does not drive the switch to TAVI. We found little, if any, effect from the respective owner, regardless of ownership type. CONCLUSION Overall, the effects of co-morbidity suggest that providers acted responsibly when adopting TAVI while evidence was still emerging.
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Affiliation(s)
- Udo Schneider
- WINEG-Scientific Institute of TK for Benefit and Efficiency in Health Care, Bramfelder Str. 140, 22305, Hamburg, Germany.
| | - Andreas Schmid
- Department of Law and Economics, JP Health Care Management, University of Bayreuth, Universitätsstr. 30, 95447, Bayreuth, Germany
| | - Roland Linder
- WINEG-Scientific Institute of TK for Benefit and Efficiency in Health Care, Bramfelder Str. 140, 22305, Hamburg, Germany
| | - Dirk Horenkamp-Sonntag
- WINEG-Scientific Institute of TK for Benefit and Efficiency in Health Care, Bramfelder Str. 140, 22305, Hamburg, Germany
| | - Frank Verheyen
- Techniker Krankenkasse, Bramfelder Str. 140, 22305, Hamburg, Germany
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Shuto T, Miyamoto S. [Transcatheter Aortic Valve Implantation for Sever Aortic Valve Stenosis]. Kyobu Geka 2018; 71:815-820. [PMID: 30310032] [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: 06/08/2023]
Abstract
Since reimbursements for transcatheter aortic valve implantation(TAVI) for severe aortic valve stenosis began in 2013, TAVI has spread rapidly in Japan. TAVI is currently performed in nearly 100,000 cases a year worldwide, and more than 4,000 procedures performed annually in Japan. The TAVI valves available in Japan are Edwards' "SAPIEN" and the Medtronic "Evolut R". The "SAPIEN" is a balloon-expanding valve and can be placed via a transfemoral or transapical approach. In contrast, the "Evolut R" is a self-expanding valve and can be placed via the transfemoral, transsubclavian or direct aortic approach. The surgical indications for TAVI are high-risk patients in whom surgical aortic valve replacement (SAVR) cannot be performed by conventional thoracotomy, and dialysis patients are excluded. With the evolution of the associated devices, the performance of TAVI has become comparable to that of SAVR. The outcomes of TAVI in Japan are particularly good compared with the results of the world. Globally, TAVI treatment is being adopted in intermediate- to low-risk patients as well as in high-risk patients. TAVI treatment is expected to continue to spread in the future.
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Affiliation(s)
- Takashi Shuto
- Department of Cardiovascular Surgery, Oita University, Yufu, Japan
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Abstract
BACKGROUND The best surgical option for severe ischemic mitral regurgitation (IMR) is still controversial. The aim of this study was to perform a meta-analysis to compare the clinical outcomes of mitral valve repair (MVP) with replacement (MVR). METHODS A literature search was conducted in PubMed, Embase, and Medline using the terms "ischemic mitral regurgitation" and "repair or annuloplasty or reconstruction" and "replacement" in the title/abstract field. The primary outcomes of interest were perioperative mortality and long-term survival. Secondary outcomes were mitral regurgitation (MR) recurrence and reoperation. RESULTS Of 276 studies, 13 studies met the inclusion and exclusion criteria. A total of 1993 patients were included in these studies, consisting of 1259 (63%) repair cases, and 734 (37%) replacement cases. Perioperative mortality was lower with MVP compared with MVR [OR 0.61; (95% CI, 0.43-0.87; P < .05)]. There was no difference with respect to long-term survival [HR 0.75; (95% CI, 0.52-1.09; P = .14)] and reoperation [OR 0.77; (95% CI, 0.38-1.57; P = .47)]. MVP is associated with a higher recurrence of MR [OR = 4.09; (95% CI, 1.82-9.19; P < .001)]. CONCLUSION MVP is associated with a lower perioperative mortality but a higher recurrence of MR compared with MVR for severe IMR. No differences were found with respect to long-term survival and reoperation.
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Alqahtani F, Aljohani S, Amin AH, Al-Hijji M, Ali OO, Holmes DR, Alkhouli M. Effect of Race on the Incidence of Aortic Stenosis and Outcomes of Aortic Valve Replacement in the United States. Mayo Clin Proc 2018; 93:607-617. [PMID: 29506780 DOI: 10.1016/j.mayocp.2017.11.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 09/06/2017] [Revised: 10/28/2017] [Accepted: 11/09/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the effect of race on the incidence of aortic stenosis (AS) and utilization and outcomes of aortic valve replacement (AVR). PATIENTS AND METHODS Patients older than 60 years hospitalized with a primary diagnosis of AS and those who underwent AVR between 2003 and 2014 were included. Adjusted and unadjusted incidence of AS-related hospitalizations, utilization rates of AVR, in-hospital morbidity and mortality, and resource utilization was compared between whites and African Americans (AAs). RESULTS Between January 1, 2003, and December 31, 2014, the incidence of AS-related admissions increased from 13 (95% CI, 12.8-13.2) to 26 (95% CI, 25.7-26.4) cases per 100,000 patient-years in whites and from 3 (95% CI, 3.5-3.8) to 9.5 (95% CI, 9.4-9.8) cases per 100,000 patient-years in AAs (P<.001). The incidence density ratio decreased from 4.3 (95% CI, 2.27-6.6) in 2003 to 2.7 (95% CI, 1.1-3.8) in 2014. The ratio of AVR to AS-related admissions was 11.3% in whites and 6.7% in AAs (P<.001). Crude in-hospital mortality after AVR was higher in AAs (6.4% vs 4.7%; P<.001). However, after propensity score matching, in-hospital morality after isolated AVR was not significantly different between AAs and whites (4.7% vs 3.7%; P=.12). African Americans also had longer hospitalizations (12±12 days vs 10±9 days; P<.001), higher rates of nonhome discharge (32.1% vs 27.2%; P=.004), and higher cost of hospitalization ($55,631±$37,773 vs $52,521±$38,040; P<.001). CONCLUSIONS African Americans undergo AVR less than whites. The underlying etiology of this disparity is multifactorial, but may be related to a lower incidence of AS in AAs. Aortic valve replacement is associated with similar risk-adjusted in-hospital mortality but higher cost and longer hospitalizations in AAs than in whites.
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Affiliation(s)
- Fahad Alqahtani
- Division of Cardiology, West Virginia University, Morgantown, WV
| | - Sami Aljohani
- Division of Cardiology, West Virginia University, Morgantown, WV
| | - Ali Hama Amin
- Division of Cardiology, West Virginia University, Morgantown, WV
| | | | - Oluseun O Ali
- Novant Health Heart & Vascular Institute, Charlotte, NC
| | | | - Mohamad Alkhouli
- Division of Cardiology, West Virginia University, Morgantown, WV; Department of Cardiology, Mayo Clinic, Rochester, MN.
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Zhang S, Gaiser S, Kolominsky-Rabas PL. Cardiac implant registries 2006-2016: a systematic review and summary of global experiences. BMJ Open 2018; 8:e019039. [PMID: 29654008 PMCID: PMC5898296 DOI: 10.1136/bmjopen-2017-019039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 01/10/2018] [Accepted: 03/06/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The importance of Cardiac Implant Registry (CIR) for ensuring a long-term follow-up in postmarket surveillance has been recognised and approved, but there is lack of consensus standards on how to establish a CIR. The aim of this study is to investigate the structure and key elements of CIRs in the past decade (2006-2016) and to provide recommendations on 'best practice' approaches. SETTINGS AND PARTICIPANTS A systematic search on CIR was employed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The following databases were searched: the PubMed (Medline), ScienceDirect and the Scopus database, EMBASE. After identifying the existing CIRs, an aggregative approach will be used to explore key elements emerging in the identified registries. RESULTS The following 82 registries were identified: 18 implantable cardioverterdefibrillator (ICD) registries, 7 cardiac resynchronisation therapy (CRT) registries, 5 pacemaker registries and 6 cardiovascular implantable electronic device registries which combined ICD, pacemaker and CRT implantation data; as well as 22 coronary stent registries and 24 transcatheteraortic heart valve implantation registries. While 71 national or local registries are from a single country, 44 are from European countries and 9 are located in USA. The following criteria have been summarised from the identified registries, including: registry working group, ethic issues, transparency, research objective, inclusion criteria, compulsory participation, endpoint, sample size, data collection basement, data collection methods, data entry, data validation and statistical analysis. CONCLUSIONS Registries provide a 'real-world' picture for patients, physicians, manufacturers, payers, decision-makers and other stakeholders. CIRs are important for regulatory decisions concerning the safety and therefore approval issues of the medical device; for payers CIRs provide evidence on the medical device benefit and drive the decision whether the product should be reimbursed or not; for hospitals CIRs' data are important for sound procurement decisions, and CIRs also help patients and their physicians to joint decision-making which of the products is the most appropriate.
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Affiliation(s)
- Shixuan Zhang
- Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich- Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
- National Leading-Edge Cluster Medical Technologies "Medical Valley EMN", Erlangen, Germany
| | | | - Peter L Kolominsky-Rabas
- Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich- Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
- National Leading-Edge Cluster Medical Technologies "Medical Valley EMN", Erlangen, Germany
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Kaneko T, Shekar P, Ivkovic V, Longford NT, Huang CC, Sigurdsson MI, Neely RC, Yammine M, Ejiofor JI, Montiero Vieira V, Shahram JT, Habchi KM, Malzberg GW, Martin PS, Bloom J, Isselbacher EM, Muehlschlegel JD, Sundt TM, Body SC. Should the dilated ascending aorta be repaired at the time of bicuspid aortic valve replacement? Eur J Cardiothorac Surg 2018; 53:560-568. [PMID: 29149323 PMCID: PMC6018902 DOI: 10.1093/ejcts/ezx387] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/25/2017] [Accepted: 10/05/2017] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Bicuspid aortic valve (BAV) is the most common congenital valvular abnormality and frequently presents with accelerated calcific aortic valve disease, requiring aortic valve replacement (AVR) and thoracic aortic aneurysm and dissection. Supporting evidence for Association Guidelines of aortic dimensions for aortic resection is sparse. We sought to determine whether concurrent repair of dilated or aneurysmal aortic disease during AVR in patients with BAV substantially improves morbidity and mortality outcomes. METHODS Mortality and reoperation outcomes of 1301 adults with BAV and dilated aorta undergoing AVR-only surgery were compared to patients undergoing AVR with aortic resection (AVR-AR) using Cox proportional hazards modelling and patient matching. RESULTS Clinically important differences in patient characteristics, aortic valve function and aortic dimensions were identified between cohorts. Event rates were low, with rates of reoperation and death within 1 year of only 1.8% and 5.4%, respectively, and no aortic dissection observed during follow-up. There were no significant differences in reoperation or mortality outcomes between the AVR-only and AVR-AR cohorts. Age, aortic dimension or a combination thereof was not associated with better or worse outcomes after each AVR-AR compared with AVR. CONCLUSIONS We conclude AVR-only and AVR-AR surgery have low morbidity and mortality and have utility over a wide range of age and aortic sizes. Our results do not provide support for the 45-mm aortic dimension recommended in the current guidelines for aortic resection while performing AVR or any other specific dimension.
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Affiliation(s)
- Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Prem Shekar
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Vladimir Ivkovic
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Chuan-Chin Huang
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Martin I Sigurdsson
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Robert C Neely
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Maroun Yammine
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Julius I Ejiofor
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Vanessa Montiero Vieira
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jasmine T Shahram
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Karam M Habchi
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Gregory W Malzberg
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Peter S Martin
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jordan Bloom
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - J Daniel Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Simon C Body
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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Borregaard B, Sørensen J, Ekholm O, Møller JE, Riber LP, Thrysoee L, Thorup CB, Vamosi M, Christensen AV, Rasmussen TB, Berg SK. Sociodemographic, Clinical and Patient-Reported Outcomes and Readmission After Heart Valve Surgery. J Heart Valve Dis 2018; 27:78-86. [PMID: 30560603] [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: 06/09/2023]
Abstract
BACKGROUND Readmissions after heart valve surgery represent a significant burden for both the patient and the healthcare system. The study aim was to identify independent predictors of readmission within 180 days after surgery in a population of patients undergoing heart valve surgery. METHODS Demographic and clinical information was obtained from national registers. Patient-reported outcomes (PROs) including Short Form 12 (SF-12) and EuroQol 5D (EQ-5D) were measured at discharge as part of a national, cross-sectional study (DenHeart). Predictors of first readmission were investigated. RESULTS Among a total of 1,084 patients (65% men; mean age 68 years; 354 responded to questionnaires), 534 (49%) were readmitted. Responding patients who were readmitted were younger and a greater proportion had undergone mitral valve surgery. A significantly higher proportion of non-responders was readmitted. No significant differences were found in PROs between patients readmitted and those not readmitted, and receiver operating characteristic (ROC) curves showed no predictive effect of SF-12 and EQ-5D. Survival analysis using Cox proportional hazard models showed that prior percutaneous coronary intervention (PCI) (HR 1.50, CI 1.10; 2.05, p = 0.010) and a history of heart failure (HR 1.37, CI 1.10; 1.72, p = 0.006) were predictive of readmission. CONCLUSIONS Readmission rates after heart valve surgery are high and often seen in patients who have undergone PCI and heart failure before surgery. Predictors for these high readmissions rates are difficult to establish based on medical history and type of surgery. PROs at discharge contribute information regarding a patient's perception of their often poor quality of life, but do not predict readmission.
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Affiliation(s)
- Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Jan Sørensen
- Danish Centre for Health Economics Research (COHERE), Institute of Public Health, University of Southern Denmark, Odense, Denmark
- Healthcare Outcome Research Centre (HORC), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Jacob E Møller
- University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lars P Riber
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Lars Thrysoee
- University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Charlotte B Thorup
- Department of Cardiology and Department of Cardiothoracic Surgery & Clinical Nursing Research Unit. Aalborg University Hospital, Denmark
| | - Marianne Vamosi
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Section for Nursing, Aarhus University, Aarhus, Denmark
| | - Anne V Christensen
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Trine B Rasmussen
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte, Denmark
| | - Selina K Berg
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Bennink G, Torii S, Brugmans M, Cox M, Svanidze O, Ladich E, Carrel T, Virmani R. A novel restorative pulmonary valved conduit in a chronic sheep model: Mid-term hemodynamic function and histologic assessment. J Thorac Cardiovasc Surg 2017; 155:2591-2601.e3. [PMID: 29366582 DOI: 10.1016/j.jtcvs.2017.12.046] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [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: 03/14/2017] [Revised: 11/23/2017] [Accepted: 12/09/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the safety and the short-term function of a novel pulmonary valved conduit (Xeltis Pulmonary Valved Conduit; XPV) up to 12 months in a sheep model. METHODS XPV and Hancock bioprosthetic valved conduits (H, used as control) were implanted in adult sheep in the pulmonary artery position. Animals were killed at 2 months (n = 6 XPV), 6 months (n = 6 XPV and n = 3 H), and 12 months (n = 6 XPV) and examined histologically. During follow-up, function of the device as well as diameter of both XPV and H were assessed by transthoracic echocardiography. RESULTS Of 18 animals that received an XPV, 15 survived until they were killed; 3 animals that received H survived the planned observational interval. XPV showed mild neointimal thickening and degradation beginning at 2 months with an ongoing process until 12 months. Only 1 of the 18 animals with XPV had significant calcification at 6 months. Pathologic specimen did not show any significant narrowing of the conduit whereas neointimal thickness showed a peak at 6 months. Inflammatory process reached a maximum at 6 months and the degradation process at 12 months. Gel permeation chromatography analysis showed molecular weight loss beginning at 2 months with a peak at 12 months for the conduit with slower absorption for the leaflets. The wall of the H conduits showed more neointimal thickening, narrowing, and calcification compared with XPV, but the leaflets demonstrated minimal changes. CONCLUSIONS Both conduits demonstrated an acceptable safety and functionality. Significant calcification was rarely observed in the XPV, whereas the H developed more neointimal thickness with calcification of the porcine aortic root portion of the wall.
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Affiliation(s)
- Ger Bennink
- Department of Pediatric Cardio-Thoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.
| | | | | | | | | | | | - Thierry Carrel
- Department of Cardiovascular Surgery, University of Bern, Bern, Switzerland
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Oterhals K, Haaverstad R, Nordrehaug JE, Eide GE, Norekvål TM. Self-reported health status, treatment decision and survival in asymptomatic and symptomatic patients with aortic stenosis in a Western Norway population undergoing conservative treatment: a cross-sectional study with 18 months follow-up. BMJ Open 2017; 7:e016489. [PMID: 28827255 PMCID: PMC5629730 DOI: 10.1136/bmjopen-2017-016489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 07/05/2017] [Accepted: 07/19/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To investigate symptoms and self-reported health of patients conservatively treated for aortic stenosis (AS) and to identify factors associated with treatment decision and patient outcomes. DESIGN A cross-sectional survey with an 18-month follow-up. SETTING One tertiary university hospital in Western Norway. PARTICIPANTS In all, 1436 patients were diagnosed with AS between 2000 and 2012, and those 245 still under conservative treatment in 2013 were included in this study. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measures were symptoms and self-reported health status. Secondary outcomes were treatment decision and patient survival after 18 months. RESULTS A total of 136 patients with mean (SD) age 79 (12) years, 52% men responded. Among conservatively treated patients 77% were symptomatic. The symptom most frequently experienced was dyspnoea. Symptomatic patients reported worse physical and mental health compared with asymptomatic patients (effect size 1.24 and 0.74, respectively). In addition, symptomatic patients reported significantly higher levels of anxiety and depression compared with asymptomatic patients. However, symptom status did not correlate with haemodynamic severity of AS. After 18 months, 117 (86%) were still alive, 20% had undergone surgical aortic valve replacement (AVR) and 7% transcatheter aortic valve implantation (TAVI). When adjusting for age, gender, symptomatic status, severity of AS and European system for cardiac operative risk evaluation (EuroSCORE), patients with severe AS had more than sixfold chance of being scheduled for AVR or TAVI compared with those with moderate AS (HR 6.3, 95% CI 1.9 to 21.2, p=0.003). Patients with EuroSCORE ≥11 had less chance for undergoing AVR or TAVI compared with those with EuroSCORE ≤5 (HR 0.06, 95% CI 0.01 to 0.46, p=0.007). CONCLUSIONS Symptoms affected both physical and mental health in conservatively treated patients with AS. Many patients with symptomatic severe AS are not scheduled for surgery, despite the recommendations in current guidelines. The referral practice for AVR is a path for further investigation.
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Affiliation(s)
- Kjersti Oterhals
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rune Haaverstad
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Geir Egil Eide
- Department of Research and Development, Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Hawkins RB, Downs EA, Johnston LE, Mehaffey JH, Fonner CE, Ghanta RK, Speir AM, Rich JB, Quader MA, Yarboro LT, Ailawadi G. Impact of Transcatheter Technology on Surgical Aortic Valve Replacement Volume, Outcomes, and Cost. Ann Thorac Surg 2017; 103:1815-1823. [PMID: 28450137 PMCID: PMC5596915 DOI: 10.1016/j.athoracsur.2017.02.039] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/16/2017] [Accepted: 02/13/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) represents a disruptive technology that is rapidly expanding in use. We evaluated the effect on surgical aortic valve replacement (SAVR) patient selection, outcomes, volume, and cost. METHODS A total of 11,565 patients who underwent SAVR, with or without coronary artery bypass grafting (2002 to 2015), were evaluated from the Virginia Cardiac Services Quality Initiative database. Patients were stratified by surgical era: pre-TAVR era (2002 to 2008, n = 5,113), early-TAVR era (2009 to 2011, n = 2,709), and commercial-TAVR era (2012 to 2015, n = 3,743). Patient characteristics, outcomes, and resource utilization were analyzed by univariate analyses. RESULTS Throughout the study period, statewide SAVR volumes increased with median volumes of pre-TAVR: 722 cases/year, early-TAVR: 892 cases/year, and commercial-TAVR: 940 cases/year (p = 0.005). Implementation of TAVR was associated with declining Society of Thoracic Surgeons predicted risk of mortality among SAVR patients (3.7%, 2.6%, and 2.4%; p < 0.0001), despite increasing rates of comorbid disease. The mortality rate was lowest in the current commercial-TAVR era (3.9%, 4.3%, and 3.2%; p = 0.05), and major morbidity decreased throughout the time period (21.2%, 20.5%, and 15.2%; p < 0.0001). The lowest observed-to-expected ratios for both occurred in the commercial-TAVR era (0.9 and 0.9, respectively). Resource utilization increased generally, including total cost increases from $42,835 to $51,923 to $54,710 (p < 0.0001). CONCLUSIONS At present, SAVR volumes have not been affected by the introduction of TAVR. The outcomes for SAVR continue to improve, potentially due to availability of transcatheter options for high-risk patients. Despite rising costs for SAVR, open approaches still provide a significant cost advantage over TAVR.
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Affiliation(s)
- Robert B Hawkins
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Emily A Downs
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Lily E Johnston
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - J Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Clifford E Fonner
- Virginia Cardiac Services Quality Initiative, Falls Church, Virginia
| | - Ravi K Ghanta
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Alan M Speir
- INOVA Heart and Vascular Institute, Falls Church, Virginia
| | - Jeffrey B Rich
- Virginia Cardiac Services Quality Initiative, Falls Church, Virginia
| | - Mohammed A Quader
- Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Leora T Yarboro
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
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Ansar T, Ali TA, Shahid S, Fatimi SH, Murtaza G. Superior septal approach versus left atrial approach for mitral valve replacement: A retrospective cohort study. J PAK MED ASSOC 2017; 67:322-326. [PMID: 28138196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To compare the outcomes of superior septal approach and left atrial approach for mitral valve replacement. METHODS This retrospective cohort study was conducted at the Aga Khan University Hospital, Karachi, and comprised records of patients who had undergone isolated mitral valve replacement from May 2003 to April 2012. Cases were reviewed for the outcomes [primary: loss of normal sinus rhythm; secondary: complications, residual defect and mortality]. Patients with prior history of dysrhythmia, low ejection fraction (<30%), emergency/redo mitral valve replacement and concomitant coronary artery bypass grafting were excluded. SPSS 19 was used for data analysis. RESULTS Of the 78 patients, 52(66.67%) were of superior septal approach and 26(33.33%) of left atrial approach. Both groups were comparable for baseline variables except cardiopulmonary bypass and cross-clamp times, which were significantly shorter in the superior septal approach group than the left septal approach group (p<0.05). No residual atrial septal defect was found in any approach. Although loss of normal sinus rhythm was observed more frequent in superior septal approach 25(48%) compared to left septal approach 10(38.4%), but the difference was statistically insignificant (p=0.28). Age was the only significant variable affecting loss of normal sinus rhythm after adjusting for approaches. The difference of post-operative complications was also statistically insignificant between superior 9(17.3%) and left septal approach 4(15.38%) (p=1.0)]. CONCLUSIONS The operative durations were significantly higher in left atrial approach compared to superior septal approach.
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Affiliation(s)
- Tooba Ansar
- Medical Student, The Aga Khan University Hospital, Karachi
| | - Taimur Asif Ali
- Department of Cardiothoracic Surgery, The Aga Khan University Hospital, Karachi
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Schueler R, Öztürk C, Sinning JM, Werner N, Welz A, Hammerstingl C, Nickenig G. Impact of baseline tricuspid regurgitation on long-term clinical outcomes and survival after interventional edge-to-edge repair for mitral regurgitation. Clin Res Cardiol 2016; 106:350-358. [PMID: 27999930 DOI: 10.1007/s00392-016-1062-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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: 09/23/2016] [Accepted: 12/08/2016] [Indexed: 12/20/2022]
Abstract
AIMS Tricuspid regurgitation (TR) in patients with mitral valve disease is associated with poor outcome and mortality. Only limited data on the impact of TR on functional outcome and survival in patients undergoing MitraClip procedures are available. METHODS AND RESULTS 261 patients (mean age 76.6 ± 10, EuroScore 15.9 ± 15.1%) with symptomatic mitral regurgitation (MR) (75.2% functional MR) undergoing MitraClip procedure were included and followed for 721 ± 19.4 days. At baseline 54.7% presented with TR grade 0/I, 29.5% with grade II, 13.4% with grade III and 2.3% with grade IV. When dividing groups according to baseline TR grades, follow-up (FU)-NYHA class was significantly improved only in patients with TR ≤ II (p = 0.05). FU-6-min walking distance increased significantly in the overall cohort (p = 0.05), in patients with TR ≤ II (p = 0.007), but not in patients with TR > II (p = 0.4). Moreover, FU-NT-pro-BNP levels were higher in patients with TR > II (p = 0.05), compared to patients with TR ≤ II. There was a higher mortality according to baseline TR > II and multivariate Cox regression revealed TR > II as the strongest independent predictor for mortality (hazard ratio 2.04). CONCLUSIONS Concomitant TR at baseline negatively influences functional outcome and mortality in patients undergoing MitraClip procedures. Our results underline the need for dedicated interventional strategies for the treatment of TR in patients with symptomatic MR.
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Affiliation(s)
- Robert Schueler
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
| | - Can Öztürk
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Jan-Malte Sinning
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Nikos Werner
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Armin Welz
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Christoph Hammerstingl
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Georg Nickenig
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
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Boulanouar D. Mid-terme results of cardiac surgery of valve replacement by mechanical prosthesis. About 861 patients. Tunis Med 2016; 94:648. [PMID: 28994867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Patients with mechanical valvular prostheses are becoming more numerous in our country. Their medical care poses a number of problems in a particular socio-economic context of our geographical regions. AIM The purpose of this study was to identify the complications of this heart valve replacement surgery by mechanical prostheses and try to compare our results with those of literature. METHODS From January 1998 to June 2003, 861 patients were operated for acquired valvular heart disease (413 men and 448 women), average age 39±11 years. It was 495 mitral valve replacement, 205 aortic valve replacement, 158 mitral-aortic replacement and 3 aorto-mitral-tricuspid replacement. One hundred seventy eight (178) gestures were needed on the tricuspid valve. RESULTS Hospital mortality was 6.2% CI [5.0 - 8.5]. Remote 9 years mortality was 21 deaths. No structural deterioration prosthesis occurred. Hospital Morbidity was 14 thromboembolism, 52 hemorrhage and 8 mediastinitis. Remote morbidity was 3 strokes, 2 serious gastrointestinal bleeding and two endocarditis. The survival rate at 5 years was 90 % CI [0.88 - 0.91]. CONCLUSION Heart valve replacement surgery with mechanical prostheses gives satisfactory results in the medium term.
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Eide LSP, Ranhoff AH, Fridlund B, Haaverstad R, Hufthammer KO, Kuiper KKJ, Nordrehaug JE, Norekvål TM. Readmissions and mortality in delirious versus non-delirious octogenarian patients after aortic valve therapy: a prospective cohort study. BMJ Open 2016; 6:e012683. [PMID: 27707832 PMCID: PMC5073576 DOI: 10.1136/bmjopen-2016-012683] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To determine whether postoperative delirium predicts first-time readmissions and mortality in octogenarian patients within 180 days after aortic valve therapy with surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI), and to determine the most common diagnoses at readmission. DESIGN Prospective cohort study of patients undergoing elective SAVR or TAVI. SETTING Tertiary university hospital that performs all SAVRs and TAVIs in Western Norway. PARTICIPANTS Patients 80+ years scheduled for SAVR or TAVI and willing to participate in the study were eligible. Those unable to speak Norwegian were excluded. Overall, 143 patients were included, and data from 136 are presented. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was a composite variable of time from discharge to first all-cause readmission or death. Secondary outcomes were all-cause first readmission alone and mortality within 180 days after discharge, and the primary diagnosis at discharge from first-time readmission. Delirium was assessed with the confusion assessment method. First-time readmissions, diagnoses and mortality were identified in hospital information registries. RESULTS Delirium was identified in 56% of patients. The effect of delirium on readmissions and mortality was greatest during the first 2 months after discharge (adjusted HR 2.9 (95% CI 1.5 to 5.7)). Of 30 first-time readmissions occurring within 30 days, 24 (80%) were patients who experienced delirium. 1 patient (non-delirium group) died within 30 days after therapy. Delirious patients comprised 35 (64%) of 55 first-time readmissions occurring within 180 days. Circulatory system diseases and injuries were common causes of first-time readmissions within 180 days in delirious patients. 8 patients died 180 days after the procedure; 6 (75%) of them experienced delirium. CONCLUSIONS Delirium in octogenarians after aortic valve therapy might be a serious risk factor for postoperative morbidity and mortality. Cardiovascular disorders and injuries were associated with first-time readmissions in these patients.
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Affiliation(s)
- Leslie S P Eide
- Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anette H Ranhoff
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bengt Fridlund
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Rune Haaverstad
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Karel K J Kuiper
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Pappalardo F, Franco A, Crescenzi G, De Simone F, Torracca L, Zangrillo A. Anticoagulation management in patients undergoing open heart surgery by activated clotting time and whole blood heparin concentration. Perfusion 2016; 21:285-90. [PMID: 17201083 DOI: 10.1177/0267659106074770] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To investigate the changes in perioperative anticoagulation management using a heparin-concentration-based system (HMS), and its effect on postoperative outcome. Methods: A total of 39 patients undergoing elective primary open heart surgery were randomly assigned to a heparin-concentration-based system approach (study group: 17 patients) or a standard ACT-based anticoagulation system (control group: 22 patients). Measurements and main results: Patients in the study group received a statistically significant higher dose of heparin (median 29 000 IU with IQR 22 500 33 500 IU versus median 19 000 IU with IQR 17 775 21 500 IU; p <0.001) and a smaller dose of protamine (median 170 mg with IQR 145 190 mg versus median 200 mg with IQR 180-250 mg; p=0.008) compared to the control group. Postoperative platelet count was significantly higher in the study group (164± 45×109/L versus 125±27 × 109/L, p=0.002). None of the study patients, but six patients in the control group required transfusion of blood products (p=0.02). No differences were recorded in postoperative antithrombin activity, bleeding, and other clinical outcomes. Conclusion: he HMS system, by facilitating maintenance of a stable heparin concentration, and by determining an appropriate dose of protamine, is associated with reduced platelet consumption and does not increase AT-III consumption and postoperative bleeding.
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Affiliation(s)
- Federico Pappalardo
- Department of Cardiovascular Anesthesia and Intensive Care, San Raffaele Hospital, Milan, Italy.
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Abstract
Doppler ultrasound has been used to detect microemboli during and after cardiopulmonary bypass (CPB). The aim of the present study was to examine the frequency of microembolic signals (MES) in patients one year after heart valve replacement, to look for possible risk factors associated with MES and for any correlation with cerebral events. One hundred patients, 69 male and 31 female, mean age 66.3±12.4 years, were examined one year after heart valve replacement. Thirty patients, 61% male and 39% female, mean age 62.5±8.7 years, who had undergone cardiovascular operations without heart valve pathology served as controls. A newly developed micro-emboli detector, EMEX-25 (Hatteland Instrumentering, Norway) was used to detect MES from both carotid arteries. MES were detected in 61% of the valve patients. A correlation was found between the number of MES, previous cardiovascular operations, emergency surgery and EuroSCORE ( p<0.05). There was no correlation between the number of MES and the level of anticoagulation expressed as international normalization ratio (INR), atrial fibrillation, serum-cholesterol, New York heart association (NYHA) class, gender, age, valve type or valve position. The average number of MES was not increased in seven patients who had experienced major (three) or minor (transient, four) cerebral events during follow-up. In the 30 nonvalve controls, MES were detected in 46% of the patients. MES were detected in valve patients as well as in nonvalve patients one year after surgery. In valve patients, a significant correlation was found between MES and previous surgery, emergency surgery and EuroSCORE. There was no correlation between the number of MES and INR level or postoperative cerebral events.
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Affiliation(s)
- Vadim Dalinin
- Department of Thoracic and Cardiovascular Surgery, Rikshospitalet, University of Oslo, Norway
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Keeling WB, Sundt T, Leacche M, Okita Y, Binongo J, Lasajanak Y, Aklog L, Lattouf OM. Outcomes After Surgical Pulmonary Embolectomy for Acute Pulmonary Embolus: A Multi-Institutional Study. Ann Thorac Surg 2016; 102:1498-1502. [PMID: 27373187 DOI: 10.1016/j.athoracsur.2016.05.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/02/2016] [Accepted: 05/02/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surgical pulmonary embolectomy (SPE) has been sparingly used for the successful treatment of massive and submassive pulmonary emboli. To date, all data regarding SPE have been limited to single-center experiences. The purpose of this study was to document short-term outcomes after SPE for acute pulmonary emboli (PE) at four high-volume institutions. METHODS A retrospective review of multiple local Society of Thoracic Surgeons databases of adults undergoing SPE from 1998 to 2014 for acute PE was performed (n = 214). Demographic, operative, and outcomes data were collected and analyzed. Patients were summarily categorized as having either massive or submassive PEs based on the presence or absence of preoperative vasopressors. RESULTS A total of 214 patients with acute PE were treated by SPE. The mean age was 56.0 ± 14.5 years, and 92 (43.6%) patients were female. Of those, 176 (82.2%) PEs were submassive and 38 (17.8%) were massive. Fifteen (7.0%) patients underwent concomitant cardiac procedures, with 10 (4.7%) having simultaneous valvular interventions and 5 (2.4%) undergoing concomitant bypass grafting. Cardiopulmonary bypass (CPB) was used for all cases. Cardioplegic arrest was used for 80 (37.4%) patients. The median CPB and aortic cross clamp times were 71.5 (interquartile range [IQR], 47.0-109.5) and 46.0 (IQR, 26.0-74.5), respectively. Notably, only 25 (11.7%) patients died in the hospital. Mortality was highest among the 28 patients who experienced preoperative cardiac arrest (9, 32.1%) CONCLUSIONS: These data represent the first multicenter experience with SPE for acute pulmonary emboli. Surgical pulmonary embolectomy for acute massive and submassive PE is safe and can be performed with acceptable in-hospital outcomes; the procedure should be included in the multimodality treatment of life-threatening pulmonary emboli.
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Affiliation(s)
- W Brent Keeling
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia.
| | - Thor Sundt
- Division of Cardiothoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Marzia Leacche
- Division of Cardiothoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Yutaka Okita
- Division of Cardiothoracic Surgery, Kobe University, Kobe, Japan
| | - Jose Binongo
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - Yi Lasajanak
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | | | - Omar M Lattouf
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
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Abstract
A retrospective study was performed in patients under and over 65 years old implanted with a mechanical valve, to compare late mortality and morbidity. Of 381 patients who underwent mechanical valve replacement at Nagoya University in the 1990s, 357 (11 hospital deaths and 13 lost to follow-up; 96.4% follow-up rate) were followed up for 7.9 ± 3.3 years (2,811 patient-years). They were divided into two groups either side of 65 years of age at operation. The young and elderly patient groups contained 275 and 82 patients, respectively. The survival rate in the young group was 96.1% (95% confidence interval, 93.7%–98.5%) at 5 years and 92.0% (95% confidence interval, 88.3%–95.7%) at 10 years, which was significantly better than 88.0% (95% confidence interval, 80.6%–95.4%) at 5 years and 73.8% (95% confidence interval, 66.2%–85.4%) at 10 years in the elderly group. The two groups did not differ significantly in the incidence of thromboembolic events, bleeding events, endocarditis, or reoperation. We are also encouraged by the fact that mechanical valves are not a risk factor for late mortality or morbidity, even in elderly patients.
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Affiliation(s)
- Sadanari Sawaki
- Department of Cardiothoracic Surgery, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan.
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Prasongsukarn K, Jamieson WRE, Germann E, Chan F, Lichtenstein SV. Aortic and Mitral Prosthetic Valve Replacement in Age Groups 61–65 & 66–70 Years. Asian Cardiovasc Thorac Ann 2016; 15:127-33. [PMID: 17387195 DOI: 10.1177/021849230701500210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prosthesis choice for aortic and mitral valve replacements in patients aged 61–70 years is difficult. We evaluated prostheses in age groups 61–65 and 66–70 years. Freedom from major thromboembolism and hemorrhage was greater for bioprostheses than mechanical prostheses in both age groups after aortic valve replacement, but only in the younger age group after mitral valve replacement. Freedom from valve-related re-operation was greater after mitral valve replacement with mechanical prostheses in both age groups, but no difference after aortic valve replacement. Valve type was predictive of major thromboembolism and hemorrhage, except in older patients undergoing mitral valve replacement. Bioprostheses are favored for aortic valve replacement in both age groups, but the risk of re-operation with a bioprosthesis in the mitral position in patients aged 61–65 years favors a mechanical prosthesis. Prosthesis choice is less definite in those aged 66–70 years.
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Pericas JM, Falces C, Moreno A, Marco F, Mestres CA, Miro JM. Neglecting enterococci may lead to a misinterpretation of the consequences of last changes in endocarditis prophylaxis American Heart Association guidelines. J Am Coll Cardiol 2016; 66:2156. [PMID: 26541930 DOI: 10.1016/j.jacc.2015.07.083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 07/22/2015] [Indexed: 11/28/2022]
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Pilmis B, Mizrahi A, Laincer A, Couzigou C, El Helali N, Nguyen Van JC, Abassade P, Cador R, Le Monnier A. Infective endocarditis: Clinical presentation, etiology, and early predictors of in-hospital case fatality. Med Mal Infect 2016; 46:44-8. [PMID: 26809359 DOI: 10.1016/j.medmal.2015.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 12/04/2015] [Accepted: 12/29/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE We aimed to assess the clinical presentation, microbial etiology and outcome of patients presenting with infective endocarditis (IE). PATIENTS AND METHODS We conducted a four-year retrospective study including all patients presenting with IE. RESULTS We included 121 patients in the study. The median age was 74.8years. Most patients had native valve IE (57%). Staphylococcus aureus accounted for 24.8% of all IE. Surgery was indicated for 70 patients (57.9%) but actually performed in only 55 (44.7%). Factors associated with surgery were younger age (P=0.002) and prosthetic valve IE (P=0.001). Risk factors associated with in-hospital mortality were diabetes mellitus (OR=3.17), chronic renal insufficiency (OR=6.62), and surgical indication (OR=3.49). Mortality of patients who underwent surgery was one sixth of that of patients with surgical indication who did not have the surgery (P<0.001).
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Affiliation(s)
- B Pilmis
- Équipe mobile de microbiologie clinique, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - A Mizrahi
- Laboratoire de microbiologie clinique et dosage des anti-infectieux, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - A Laincer
- Laboratoire de microbiologie clinique et dosage des anti-infectieux, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - C Couzigou
- Équipe mobile de microbiologie clinique, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France; Équipe opérationnelle d'hygiène, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - N El Helali
- Laboratoire de microbiologie clinique et dosage des anti-infectieux, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - J-C Nguyen Van
- Laboratoire de microbiologie clinique et dosage des anti-infectieux, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - P Abassade
- Service de cardiologie, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - R Cador
- Service de cardiologie, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - A Le Monnier
- Laboratoire de microbiologie clinique et dosage des anti-infectieux, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
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Viktorsson SA, Helgason D, Orrason AW, Aspelund T, Sigurdsson MI, Geirsson A, Gudbjartsson T. Favorable Survival after Aortic Valve Replacement Compared to the General Population. J Heart Valve Dis 2016; 25:8-13. [PMID: 27989077] [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: 06/06/2023]
Abstract
BACKGROUND A comparison was made between the long-term survival of patients undergoing aortic valve replacement (AVR) for aortic stenosis and of the general Icelandic population, using centralized registries. METHODS A total of 366 AVR patients (231 males, 135 females; mean age 70.1 years) operated on for aortic stenosis in Iceland between 2002 and 2011 was included in the study. Concomitant coronary artery bypass grafting was performed in 54% of cases. Short-term complications and 30-day mortality were analyzed. The patients' overall survival was compared with the survival of Icelanders of the same age and gender. The median follow up was 4.7 years. RESULTS A bioprosthesis was used in 81% of the patients; the median prosthesis size was 25 mm. Atrial fibrillation (68%) and acute kidney injury (23%) were the most common complications, and the 30-day operative mortality was 6%. Overall survival at one year and five years was 92% and 82%, respectively. There was no difference in survival between the surgical cohorts and expected survival of Icelanders of the same age and gender (p = 0.08), except for the first 30 postoperative days. CONCLUSIONS Despite the significant rate of short-term complications, the long-term survival of patients undergoing AVR for aortic stenosis was good compared to the general population of the same age and gender. These results confirmed the value of AVR as an excellent treatment option for aortic stenosis, as it offers a normalization of the patients' life expectancy.
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Affiliation(s)
- Sindri A Viktorsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik
- Faculty of Medicine, University of Iceland
| | | | | | - Thor Aspelund
- Faculty of Medicine, University of Iceland
- The Icelandic Heart Association
| | | | - Arnar Geirsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik
- Faculty of Medicine, University of Iceland
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik
- Faculty of Medicine, University of Iceland
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DeSimone DC, Wilson WR, Baddour LM. Trends in Infective Endocarditis Incidence, Microbiology, and Valve Replacement in the United States From 2000 to 2011: The Devil Is in the Details. J Am Coll Cardiol 2015; 66:1201-2. [PMID: 26338002 DOI: 10.1016/j.jacc.2015.05.079] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 05/19/2015] [Indexed: 11/28/2022]
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Pant S, Deshmukh A, Mehta JL. Reply: Trends in Infective Endocarditis: Incidence, Microbiology, and Valve Replacement in the United States From 2000 to 2011: The Devil Is in the Details. J Am Coll Cardiol 2015; 66:1202-3. [PMID: 26338003 DOI: 10.1016/j.jacc.2015.06.1330] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 06/02/2015] [Indexed: 11/27/2022]
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Marks DJB, Hyams C, Koo CY, Pavlou M, Robbins J, Koo CS, Rodger G, Huggett JF, Yap J, Macrae MB, Swanton RH, Zumla AI, Miller RF. Clinical features, microbiology and surgical outcomes of infective endocarditis: a 13-year study from a UK tertiary cardiothoracic referral centre. QJM 2015; 108:219-29. [PMID: 25223570 DOI: 10.1093/qjmed/hcu188] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 11/13/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) causes substantial morbidity and mortality. Patient and pathogen profiles, as well as microbiological and operative strategies, continue to evolve. The impact of these changes requires evaluation to inform optimum management and identify individuals at high risk of early mortality. AIM Identification of clinical and microbiological features, and surgical outcomes, among patients presenting to a UK tertiary cardiothoracic centre for surgical management of IE between 1998 and 2010. DESIGN Retrospective observational cohort study. METHODS Clinical, biochemical, microbiological and echocardiographic data were identified from clinical records. Principal outcomes were all-cause 28-day mortality and duration of post-operative admission. RESULTS Patients (n = 336) were predominantly male (75.0%); median age 52 years (IQR = 41-67). Most cases involved the aortic (56.0%) or mitral (53.9%) valves. Microbiological diagnoses, obtained in 288 (85.7%) patients, included streptococci (45.2%); staphylococci (34.5%); Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella (HACEK) organisms (3.0%); and fungi (1.8%); 11.3% had polymicrobial infection. Valve replacement in 308 (91.7%) patients included mechanical prostheses (69.8%), xenografts (24.0%) and homografts (6.2%). Early mortality was 12.2%, but fell progressively during the study (P = 0.02), as did median duration of post-operative admission (33.5 to 10.5 days; P = 0.0003). Multivariable analysis showed previous cardiothoracic surgery (OR = 3.85, P = 0.03), neutrophil count (OR = 2.27, P = 0.05), albumin (OR = 0.94, P = 0.04) and urea (OR = 2.63, P < 0.001) predicted early mortality. CONCLUSIONS This study demonstrates reduced post-operative early mortality and duration of hospital admission for IE patients over the past 13 years. Biomarkers (previous cardiothoracic surgery, neutrophil count, albumin and urea), predictive of early post-operative mortality, require prospective evaluation to refine algorithms, further improve outcomes and reduce healthcare costs associated with IE.
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Affiliation(s)
- D J B Marks
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - C Hyams
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - C Y Koo
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - M Pavlou
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - J Robbins
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - C S Koo
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - G Rodger
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - J F Huggett
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - J Yap
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - M B Macrae
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - R H Swanton
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - A I Zumla
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - R F Miller
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
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Allareddy V, Elangovan S, Rampa S, Shin K, Nalliah RP, Allareddy V. Presence of gingivitis and periodontitis significantly increases hospital charges in patients undergoing heart valve surgery. J Mass Dent Soc 2015; 63:10-16. [PMID: 25872281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To examine the prevalence and impact of gingivitis and periodontitis in patients having heart valve surgical procedures. METHODS Nationwide Inpatient Sample for the years 2004-2010 was used. All patients who had heart valve surgical procedures were selected. Prevalence of gingivitis/periodontitis was examined in these patients. Impact of gingivitis/periodontitis on hospital charges, length of stay, and infectious complications was examined. RESULTS 596,190 patients had heart valve surgical procedures. Gingivitis/periodontitis was present in 0.2 percent. Outcomes included: median hospital charges ($175,418 with gingivitis/ periodontitis versus $149,353 without gingivitis/periodontitis) and median length of stay (14 days with gingivitis/periodontitis versus 8 days without gingivitis/periodontitis). After adjusting for the effects of patient- and hospital-level confounding factors, hospital charges and length of stay were significantly higher (p < 0.001) in those with gingivitis/periodontitis compared to their counterparts. Further, patients with gingivitis/periodontitis had significantly higher odds for having bacterial infections (OR = 3.41, 95% CI = 2.33-4.98, p < 0.0001) when compared to those without gingivitis/periodontitis. CONCLUSION Presence of gingivitis and periodontitis is associated with higher risk for bacterial infections and significant hospital resource utilization.
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Spiliopoulos K, Giamouzis G, Haschemi A, Karangelis D, Antonopoulos N, Fink G, Kemkes BM, Gansera B. Surgical management of infective endocarditis: early and long-term mortality analysis. single-center experience and brief literature review. Hellenic J Cardiol 2014; 55:462-474. [PMID: 25432198] [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: 06/04/2023] Open
Abstract
INTRODUCTION In this study we evaluated factors that affect the early and long-term postoperative outcomes of patients with infective endocarditis. METHODS We retrospectively reviewed 94 patients (68 male, 26 female, mean age 58.3 ± 13.1 years, range 20-85 years) with proven infective native (n=85) or prosthetic valve (n=9) endocarditis who underwent heart valve surgery between September 1997 and December 2007. Fifty-four patients (57.4%) underwent aortic, 28 (29.8%) mitral, 3 (3.2%) tricuspid, 8 (8.5%) double, and one patient (1%) triple valve surgery. In 75.5% of the procedures we implanted mechanical valves, in 13.8% biological prostheses, and 10.7% were reconstructive or other procedures. Midterm follow up was 100% complete with a cumulative duration of 545 patient-years (maximum 12 years). RESULTS Overall hospital mortality (30 days) was 8.5% (n=8). Causes of early mortality were low cardiac output syndrome in 2 cases, sepsis with multiple organ failure in 5 cases, and intracerebral bleeding in one patient. Development of postoperative low cardiac output syndrome (p=0.01) was identified as an independent predictor of early mortality. Overall late mortality was 25.6% (n=22) with a cumulative rate of 4.03% per patient-year. Causes of late death were predominantly of extracardiac origin. Kaplan-Meier survival analysis revealed a cumulative survival rate at 12 years of 57.2%. Cox regression analysis identified diabetes mellitus (p=0.016) and postoperative low cardiac output syndrome (p=0.03) as independent late mortality factors. CONCLUSIONS Heart valve surgery in patients with infective endocarditis is associated with increased but acceptable early and long-term mortality. The mid-term prognosis is similar to that of patients undergoing elective valve replacement surgery.
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Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Cardiovascular Surgery, Heart Center, Klinikum München Bogenhausen GmbH, Munich, Germany
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