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Pavlou M, Ambler G, Omar RZ, Goodwin AT, Trivedi U, Ludman P, de Belder M. Outlier identification and monitoring of institutional or clinician performance: an overview of statistical methods and application to national audit data. BMC Health Serv Res 2023; 23:23. [PMID: 36627627 PMCID: PMC9832645 DOI: 10.1186/s12913-022-08995-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Institutions or clinicians (units) are often compared according to a performance indicator such as in-hospital mortality. Several approaches have been proposed for the detection of outlying units, whose performance deviates from the overall performance. METHODS We provide an overview of three approaches commonly used to monitor institutional performances for outlier detection. These are the common-mean model, the 'Normal-Poisson' random effects model and the 'Logistic' random effects model. For the latter we also propose a visualisation technique. The common-mean model assumes that the underlying true performance of all units is equal and that any observed variation between units is due to chance. Even after applying case-mix adjustment, this assumption is often violated due to overdispersion and a post-hoc correction may need to be applied. The random effects models relax this assumption and explicitly allow the true performance to differ between units, thus offering a more flexible approach. We discuss the strengths and weaknesses of each approach and illustrate their application using audit data from England and Wales on Adult Cardiac Surgery (ACS) and Percutaneous Coronary Intervention (PCI). RESULTS In general, the overdispersion-corrected common-mean model and the random effects approaches produced similar p-values for the detection of outliers. For the ACS dataset (41 hospitals) three outliers were identified in total but only one was identified by all methods above. For the PCI dataset (88 hospitals), seven outliers were identified in total but only two were identified by all methods. The common-mean model uncorrected for overdispersion produced several more outliers. The reason for observing similar p-values for all three approaches could be attributed to the fact that the between-hospital variance was relatively small in both datasets, resulting only in a mild violation of the common-mean assumption; in this situation, the overdispersion correction worked well. CONCLUSION If the common-mean assumption is likely to hold, all three methods are appropriate to use for outlier detection and their results should be similar. Random effect methods may be the preferred approach when the common-mean assumption is likely to be violated.
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Affiliation(s)
| | | | | | - Andrew T. Goodwin
- grid.440194.c0000 0004 4647 6776Department of Cardiothoracic Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK ,grid.139534.90000 0001 0372 5777National Institute for Cardiovascular Outcomes Research (NICOR), Barts Health NHS Trust, London, UK
| | - Uday Trivedi
- Department of Cardiac Surgery, University Hospital Sussex NHS Foundation Trust, Brighton, UK
| | - Peter Ludman
- grid.139534.90000 0001 0372 5777National Institute for Cardiovascular Outcomes Research (NICOR), Barts Health NHS Trust, London, UK ,grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Mark de Belder
- grid.139534.90000 0001 0372 5777National Institute for Cardiovascular Outcomes Research (NICOR), Barts Health NHS Trust, London, UK
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Michail M, Cockburn J, Tanseco KVP, Arunothayaraj S, Hill A, Trivedi U, Hildick-Smith D. Feasibility of transcaval access TAVI in morbidly obese patients: A single-center experience. Catheter Cardiovasc Interv 2022; 100:1302-1306. [PMID: 36321613 DOI: 10.1002/ccd.30465] [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: 03/24/2022] [Revised: 08/06/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We report a single-center experience in utilizing the transcaval-access transcatheter aortic valve implantation (TAVI) as an alternative approach in morbidly obese patients. BACKGROUND Morbidly obese patients present frequently for TAVI. Transfemoral arterial access TAVI in these patients is technically challenging due to deep arterial access, resulting in a higher risk of vascular complications. Transcaval access TAVI is increasingly used in patients with prohibitive iliofemoral arterial access. METHODS We used the transcaval approach for eight morbidly obese patients who had otherwise technically feasible femoral arterial access. This technique provides an alternative arterial access point that potentially circumvents some of the challenges relating to femoral arterial access. RESULTS We report eight morbidly obese patients with a mean body mass index of 42.3 ± 6.2 kg/m2 who underwent transcaval access TAVI at our center (mean EuroScore II 2.47 ± 1.83%). The patient mean age was 70.3 ± 9.8 years; six were female. All eight patients underwent a successful and uncomplicated procedure. The median time to discharge was 2 days and all patients were alive at 30 days. CONCLUSIONS Transcaval access TAVI is a feasible alternative for morbidly obese patients and may reduce vascular complications. Further data are required to evaluate the safety of this approach.
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Affiliation(s)
- Michael Michail
- Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton, UK
| | - James Cockburn
- Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton, UK
| | | | | | - Andrew Hill
- Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton, UK
| | - Uday Trivedi
- Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton, UK
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Toff WD, Hildick-Smith D, Kovac J, Mullen MJ, Wendler O, Mansouri A, Rombach I, Abrams KR, Conroy SP, Flather MD, Gray AM, MacCarthy P, Monaghan MJ, Prendergast B, Ray S, Young CP, Crossman DC, Cleland JGF, de Belder MA, Ludman PF, Jones S, Densem CG, Tsui S, Kuduvalli M, Mills JD, Banning AP, Sayeed R, Hasan R, Fraser DGW, Trivedi U, Davies SW, Duncan A, Curzen N, Ohri SK, Malkin CJ, Kaul P, Muir DF, Owens WA, Uren NG, Pessotto R, Kennon S, Awad WI, Khogali SS, Matuszewski M, Edwards RJ, Ramesh BC, Dalby M, Raja SG, Mariscalco G, Lloyd C, Cox ID, Redwood SR, Gunning MG, Ridley PD. Effect of Transcatheter Aortic Valve Implantation vs Surgical Aortic Valve Replacement on All-Cause Mortality in Patients With Aortic Stenosis: A Randomized Clinical Trial. JAMA 2022; 327:1875-1887. [PMID: 35579641 PMCID: PMC9115619 DOI: 10.1001/jama.2022.5776] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [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] [Indexed: 01/02/2023]
Abstract
IMPORTANCE Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical aortic valve replacement and is the treatment of choice for patients at high operative risk. The role of TAVI in patients at lower risk is unclear. OBJECTIVE To determine whether TAVI is noninferior to surgery in patients at moderately increased operative risk. DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical trial conducted at 34 UK centers, 913 patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk due to age or comorbidity were enrolled between April 2014 and April 2018 and followed up through April 2019. INTERVENTIONS TAVI using any valve with a CE mark (indicating conformity of the valve with all legal and safety requirements for sale throughout the European Economic Area) and any access route (n = 458) or surgical aortic valve replacement (surgery; n = 455). MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality at 1 year. The primary hypothesis was that TAVI was noninferior to surgery, with a noninferiority margin of 5% for the upper limit of the 1-sided 97.5% CI for the absolute between-group difference in mortality. There were 36 secondary outcomes (30 reported herein), including duration of hospital stay, major bleeding events, vascular complications, conduction disturbance requiring pacemaker implantation, and aortic regurgitation. RESULTS Among 913 patients randomized (median age, 81 years [IQR, 78 to 84 years]; 424 [46%] were female; median Society of Thoracic Surgeons mortality risk score, 2.6% [IQR, 2.0% to 3.4%]), 912 (99.9%) completed follow-up and were included in the noninferiority analysis. At 1 year, there were 21 deaths (4.6%) in the TAVI group and 30 deaths (6.6%) in the surgery group, with an adjusted absolute risk difference of -2.0% (1-sided 97.5% CI, -∞ to 1.2%; P < .001 for noninferiority). Of 30 prespecified secondary outcomes reported herein, 24 showed no significant difference at 1 year. TAVI was associated with significantly shorter postprocedural hospitalization (median of 3 days [IQR, 2 to 5 days] vs 8 days [IQR, 6 to 13 days] in the surgery group). At 1 year, there were significantly fewer major bleeding events after TAVI compared with surgery (7.2% vs 20.2%, respectively; adjusted hazard ratio [HR], 0.33 [95% CI, 0.24 to 0.45]) but significantly more vascular complications (10.3% vs 2.4%; adjusted HR, 4.42 [95% CI, 2.54 to 7.71]), conduction disturbances requiring pacemaker implantation (14.2% vs 7.3%; adjusted HR, 2.05 [95% CI, 1.43 to 2.94]), and mild (38.3% vs 11.7%) or moderate (2.3% vs 0.6%) aortic regurgitation (adjusted odds ratio for mild, moderate, or severe [no instance of severe reported] aortic regurgitation combined vs none, 4.89 [95% CI, 3.08 to 7.75]). CONCLUSIONS AND RELEVANCE Among patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk, TAVI was noninferior to surgery with respect to all-cause mortality at 1 year. TRIAL REGISTRATION isrctn.com Identifier: ISRCTN57819173.
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Affiliation(s)
| | - William D Toff
- Department of Cardiovascular Sciences, University of Leicester, Leicester, England
- National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, England
| | - Jan Kovac
- Department of Cardiovascular Sciences, University of Leicester, Leicester, England
- National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England
| | - Michael J Mullen
- Institute of Cardiovascular Science, University College London, London, England
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital NHS Foundation Trust, London, England
| | - Anita Mansouri
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Ines Rombach
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Keith R Abrams
- Centre for Health Economics, University of York, York, England
- Department of Statistics, University of Warwick, Coventry, England
- Department of Health Sciences, University of Leicester, Leicester, England
| | - Simon P Conroy
- Department of Health Sciences, University of Leicester, Leicester, England
| | - Marcus D Flather
- Norwich Medical School, University of East Anglia, Norwich, England
| | - Alastair M Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, England
| | - Mark J Monaghan
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, England
| | | | - Simon Ray
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, England
| | | | | | - John G F Cleland
- Robertson Centre for Biostatistics and Glasgow Clinical Trials Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Mark A de Belder
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, England
| | - Peter F Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, England
| | - Stephen Jones
- Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, England
| | - Cameron G Densem
- Department of Cardiology, Royal Papworth Hospital, Cambridge, England
| | - Steven Tsui
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, England
| | - Manoj Kuduvalli
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, England
| | - Joseph D Mills
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, England
| | - Adrian P Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Rana Sayeed
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Ragheb Hasan
- Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, England
| | - Douglas G W Fraser
- Department of Cardiovascular Medicine, University of Manchester, Manchester, England
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, England
| | - Simon W Davies
- Cardiac Department, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England
| | - Alison Duncan
- Cardiac Department, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England
| | - Nick Curzen
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, England
| | - Sunil K Ohri
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, England
| | | | - Pankaj Kaul
- Department of Cardiac Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, England
| | - Douglas F Muir
- Department of Cardiology, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, England
| | - W Andrew Owens
- Department of Cardiothoracic Surgery, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, England
| | - Neal G Uren
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Renzo Pessotto
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Simon Kennon
- Barts Heart Centre, Barts Health NHS Trust, London, England
| | - Wael I Awad
- Barts Heart Centre, Barts Health NHS Trust, London, England
| | - Saib S Khogali
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, England
| | | | - Richard J Edwards
- Cardiothoracic Department, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, England
| | | | - Miles Dalby
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England
| | - Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England
| | - Giovanni Mariscalco
- Department of Cardiovascular Sciences, University of Leicester, Leicester, England
- National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England
| | - Clinton Lloyd
- Department of Cardiothoracic Surgery, Derriford Hospital, Plymouth, England
| | - Ian D Cox
- Department of Cardiology, Derriford Hospital, Plymouth, England
| | - Simon R Redwood
- Cardiovascular Division, King's College London, British Heart Foundation Centre of Research Excellence, Rayne Institute, St Thomas' Hospital, London, England
| | - Mark G Gunning
- Cardiology Department, Royal Stoke University Hospital, Stoke-on-Trent, England
| | - Paul D Ridley
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, England
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D'Auria F, Santo DF, Myat A, Lorusso R, Ravaux JM, Trivedi U, Hildick-Smith D. Apical versus subclavian transcatheter aortic valve implantation: An 8-year United Kingdom analysis. J Card Surg 2022; 37:978-984. [PMID: 35146801 DOI: 10.1111/jocs.16298] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/03/2021] [Accepted: 12/20/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Subclavian (SC) and transapical (TA) approaches are the main alternatives to the default femoral delivery for transcatheter aortic valve implantation (TAVI). The aim of this study was to compare complications and morbidity/mortality associated with SC and TA in a long-term time frame. METHODS From January 2007 to July 2015, 1506 patients underwent TAVI surgery in 36 United Kingdom TAVI centers. Primary outcomes were complications according to VARC-2 criteria. The secondary outcome was long-term survival. RESULTS The enrolled patients were distributed as follows: 1216 in the TA group and 290 in the SC group. There were no differences in the rates of acute myocardial infarction, emergency valve-in-valve, paravalvular leak, balloon post dilatation, cardiac tamponade, stroke, renal replacement therapy, vascular injuries, and 30-day mortality among the groups. Conversely, the rate of permanent pacemaker implantation (p = .02), the procedural time duration (p = .04), and the 12-month mortality (p = .03) was higher in SC than in TA, while in-hospital length of stay was reduced in SC than in TA (p = .01). Up to 8 years, the long-term mortality was not different among groups (p = .77), and no difference in long-term survival between self- versus balloon-expandable devices was found (p = .26). CONCLUSIONS According to our results, TA provided the best 12-month survival compared to SC, while the long-term survival up to 2900 days is not significantly different between groups, so SC and TA may both represent a safe non-femoral access if femoral is precluded.
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Affiliation(s)
- Francesca D'Auria
- Cardiac Surgery, Cardiac Center, Brighton and Sussex University Hospital, Royal Sussex County Hospital, Brighton and Hove, UK.,Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Danilo F Santo
- Cardiac Surgery, Cardiac Center, Brighton and Sussex University Hospital, Royal Sussex County Hospital, Brighton and Hove, UK
| | - Aung Myat
- Cardiac Surgery, Cardiac Center, Brighton and Sussex University Hospital, Royal Sussex County Hospital, Brighton and Hove, UK
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Justine M Ravaux
- Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Uday Trivedi
- Cardiac Surgery, Cardiac Center, Brighton and Sussex University Hospital, Royal Sussex County Hospital, Brighton and Hove, UK
| | - David Hildick-Smith
- Cardiac Surgery, Cardiac Center, Brighton and Sussex University Hospital, Royal Sussex County Hospital, Brighton and Hove, UK
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Myat A, Hildick-Smith D, de Belder AJ, Trivedi U, Crowley A, Morice MC, Kandzari DE, Lembo NJ, Brown WM, Serruys PW, Kappetein AP, Sabik JF, Stone G. Geographical variations in left main coronary artery revascularisation: a prespecified analysis of the EXCEL trial. EUROINTERVENTION 2022; 17:1081-1090. [PMID: 34212863 PMCID: PMC9724945 DOI: 10.4244/eij-d-21-00338] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The EXCEL trial reported similar five-year rates of the primary composite outcome of death, myocardial infarction (MI), or stroke after percutaneous coronary intervention (PCI) compared with coronary artery bypass grafting (CABG) for treatment of obstructive left main coronary artery disease (LMCAD). AIMS We sought to determine whether these outcomes remained consistent regardless of geography of enrolment. METHODS We performed a prespecified subgroup analysis based on regional enrolment. RESULTS Among 1,905 patients randomised to PCI (n=948) or CABG (n=957), 1,075 (56.4%) were recruited at 52 European Union (EU) centres, and 752 (39.5%) were recruited at 67 North American (NA) centres. EU versus NA patients varied according to numerous baseline demographics, anatomy, pharmacotherapy and procedural characteristics. Nonetheless, the relative rates of the primary endpoint after PCI versus CABG were consistent across EU versus NA centres at 30 days and 5 years. However, NA participants had substantially higher late rates of ischaemia-driven revascularisation (IDR) after PCI, driven predominantly by the need for greater target vessel and lesion revascularisation. This culminated in a significant difference in the relative risk of the secondary composite outcome of death, MI, stroke, or IDR at 5 years (pinteraction=0.02). CONCLUSIONS In the EXCEL trial, the relative risks for the 30-day and five-year primary composite outcome of death, MI or stroke after PCI versus CABG were consistent irrespective of geography. However, five-year rates of IDR after PCI were significantly higher in NA centres, a finding the Heart Team and patients should consider when making treatment decisions. ClinicalTrials.gov identifier: NCT01205776.
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Affiliation(s)
- Aung Myat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom,Division of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Adam J. de Belder
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Aaron Crowley
- Clinical Trials Centre, Cardiovascular Research Foundation, New York, NY, USA
| | | | | | - Nicholas J. Lembo
- Clinical Trials Centre, Cardiovascular Research Foundation, New York, NY, USA,NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | | | - Patrick W. Serruys
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland,Department of Cardiology, Imperial College London, London, United Kingdom
| | | | - Joseph F. Sabik
- Department of Surgery, UH Cleveland Medical Center, Cleveland, OH, USA
| | - Gregg Stone
- Mount Sinai Hospital, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA
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Jones JM, Loubani M, Grant SW, Goodwin AT, Trivedi U, Kendall S, Jenkins DP. Cardiac surgery in older patients: hospital outcomes during a 15-year period from a complete national series. Interact Cardiovasc Thorac Surg 2021; 34:532-539. [PMID: 34788460 PMCID: PMC8972229 DOI: 10.1093/icvts/ivab320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/23/2021] [Accepted: 10/18/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- James Mark Jones
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Mahmoud Loubani
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Stuart W Grant
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiovascular Sciences, University of Manchester, UK
| | - Andrew T Goodwin
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,James Cook University Hospital, Middlesbrough, UK
| | - Uday Trivedi
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Simon Kendall
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,James Cook University Hospital, Middlesbrough, UK
| | - David P Jenkins
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Arunothayaraj S, Amin R, Kirtchuk D, Williams T, Tanseco KV, Michail M, Cockburn J, Trivedi U, Hildick-Smith D. TCT-460 Mobility Aids Predict Mortality After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jahangiri M, Bilkhu R, Embleton-Thirsk A, Dehbi HM, Mani K, Anderson J, Avlonitis V, Baghai M, Birdi I, Booth K, Bose A, Briffa N, Buchan K, Bhudia S, Cale A, Deglurkar I, Farid S, Hadjinikolaou L, Jarvis M, Javadpour SH, Jeganathan R, Kuduvalli M, Lall K, Mascaro J, Mehta D, Ohri S, Punjabi P, Venkateswaran R, Ridley P, Satur C, Stoica S, Trivedi U, Zaidi A, Yiu P, Moorjani N, Kendall S, Freemantle N. Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database. BMJ Open 2021; 11:e046491. [PMID: 34711589 PMCID: PMC8557283 DOI: 10.1136/bmjopen-2020-046491] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 09/21/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To date the reported outcomes of surgical aortic valve replacement (SAVR) are mainly in the settings of trials comparing it with evolving transcatheter aortic valve implantation. We set out to examine characteristics and outcomes in people who underwent SAVR reflecting a national cohort and therefore 'real-world' practice. DESIGN Retrospective analysis of prospectively collected data of consecutive people who underwent SAVR with or without coronary artery bypass graft (CABG) surgery between April 2013 and March 2018 in the UK. This included elective, urgent and emergency operations. Participants' demographics, preoperative risk factors, operative data, in-hospital mortality, postoperative complications and effect of the addition of CABG to SAVR were analysed. SETTING 27 (90%) tertiary cardiac surgical centres in the UK submitted their data for analysis. PARTICIPANTS 31 277 people with AVR were identified. 19 670 (62.9%) had only SAVR and 11 607 (37.1%) had AVR+CABG. RESULTS In-hospital mortality for isolated SAVR was 1.9% (95% CI 1.6% to 2.1%) and was 2.4% for AVR+CABG. Mortality by age category for SAVR only were: <60 years=2.0%, 60-75 years=1.5%, >75 years=2.2%. For SAVR+CABG these were; 2.2%, 1.8% and 3.1%. For different categories of EuroSCORE, mortality for SAVR in low risk people was 1.3%, in intermediate risk 1% and for high risk 3.9%. 74.3% of the operations were elective, 24% urgent and 1.7% emergency/salvage. The incidences of resternotomy for bleeding and stroke were 3.9% and 1.1%, respectively. Multivariable analyses provided no evidence that concomitant CABG influenced outcome. However, urgency of the operation, poor ventricular function, higher EuroSCORE and longer cross clamp and cardiopulmonary bypass times adversely affected outcomes. CONCLUSIONS Surgical SAVR±CABG has low mortality risk and a low level of complications in the UK in people of all ages and risk factors. These results should inform consideration of treatment options in people with aortic valve disease.
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Affiliation(s)
| | - Rajdeep Bilkhu
- Department of Cardiac Surgery, St Thomas' Hospital, London, UK
| | | | - Hakim-Moulay Dehbi
- University College London Institute of Clinical Trials and Methodology, London, UK
| | - Krishna Mani
- Department of Cardiac Surgery, St George's Hospital, London, UK
| | - Jon Anderson
- Department of Cardiac Surgery, Hammersmith Hospital, London, UK
| | | | - Max Baghai
- Department of Cardiac Surgery, King's College Hospital, London, UK
| | - Inderpaul Birdi
- Department of Cardiac Surgery, Essex Cardiothoracic Centre, Basildon, UK
| | - Karen Booth
- Department of Cardiac Surgery, Freeman Hospital Cardiothoracic Centre, Newcastle upon Tyne, UK
| | - Amal Bose
- Department of Cardiac Surgery, Lancashire Cardiac Centre, Blackpool, UK
| | - Norman Briffa
- Sheffield Teaching Hospitals NHS Foundation Trust Cardiothoracic Centre, Sheffield, UK
| | - Keith Buchan
- Department of Cardiac Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Alex Cale
- Department of Cardiac Surgery, Castle Hill Hospital, Cottingham, UK
| | - Indu Deglurkar
- Department of Cardiac Surgery, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Shakil Farid
- Department of Cardiac Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Leonidas Hadjinikolaou
- Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Martin Jarvis
- Department of Cardiac Surgery, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | | | - Manoj Kuduvalli
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Kulvinder Lall
- Saint Bartholomew's Hospital Barts Heart Centre, London, UK
| | - Jorge Mascaro
- Department of Cardiac Surgery, Queen Elizabeth Medical Centre, Birmingham, UK
| | - Dheeraj Mehta
- Department of Cardiac Surgery, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Sunil Ohri
- Department of Cardiac Surgery, Southampton University Hospitals NHS Trust, Southampton, UK
| | - Prakash Punjabi
- Department of Cardiac Surgery, Hammersmith Hospital, London, UK
| | | | - Paul Ridley
- Department of Cardiac Surgery, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Christopher Satur
- Department of Cardiac Surgery, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Serban Stoica
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | - Uday Trivedi
- Royal Sussex County Hospital Sussex Cardiac Centre, Brighton, UK
| | - Afzal Zaidi
- Department of Cardiac Surgery, Morriston Hospital, Swansea, UK
| | - Patrick Yiu
- Department of Cardiac Surgery, New Cross Hospital, Wolverhampton, UK
| | - Narain Moorjani
- Department of Cardiac Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Simon Kendall
- Department of Cardiac Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Nick Freemantle
- Comprehensive Clinical Trials Unit, University College London Institute of Clinical Trials and Methodology, London, UK
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9
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Amin R, Arunothayaraj S, Kirtchuk D, Williams T, Tanseco KV, Michail M, Cockburn J, Trivedi U, Hildick-Smith D. Mobility aids predict mortality after transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2021; 99:E31-E37. [PMID: 34676958 DOI: 10.1002/ccd.29981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/21/2021] [Accepted: 10/03/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Selection of appropriate patients for transcatheter aortic valve implantation (TAVI) can be challenging. Many factors can influence post-procedure outcomes. Traditional surgical scoring systems do not discriminate effectively. Medical parameters and functional indices can characterize mortality risk. Mobility is an important predictive functional index but is largely defined using subjective criteria. AIM To describe the relationship between mobility, objectively defined by the requirement for gait aids to ambulate, and all-cause 30-day and long-term mortality in patients undergoing TAVI. METHODS Mobility aid use was assessed in 1444 consecutive patients undergoing TAVI in a single center. Patients were categorized into "unaided," "1-stick," and "higher aid" groups based on the Brighton Mobility Index. Mortality tracking was obtained via the NHS Spine Portal in February 2021. RESULTS Patients were aged 82 (IQR 78-86). 66% of patients walked unaided, 26% walked with 1 stick, and 8% required more assistance (e.g., 2 sticks, a Rollator, a Zimmer frame, or a wheelchair). Overall 30-day mortality for the whole cohort was 3.5%; 1-year mortality was 12.2%. Mobility was a significant predictor of 30-day mortality (p = 0.025). Use of a higher aid was associated with a mortality odds ratio of 2.83 (95% CI: 1.39-5.74). Mobility was also a significant predictor of long-term mortality (p < 0.001). Odds ratios for 1-stick and higher aid groups were 1.45 (95% CI: 1.21-1.72) and 2.01 (95% CI: 1.55-2.60), respectively. CONCLUSION Objective assessment of mobility by gait aid use predicts both short and long-term survival in patients undergoing TAVI. Increased dependence on mobility aids is associated with a worse prognosis.
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Affiliation(s)
- Reshma Amin
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Sandeep Arunothayaraj
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - David Kirtchuk
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Timothy Williams
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Kristoffer V Tanseco
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Michael Michail
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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10
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Benedetto U, Sinha S, Dimagli A, Cooper G, Mariscalco G, Uppal R, Moorjani N, Krasopoulos G, Trivedi U, Angelini G, Akowuah E, Tsang G. 1638 Decade-Long Trends in Surgery for Acute Type A Aortic Dissection. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Little is known about unwarranted variations in care and outcomes of patients who undergo surgical repair for type A acute aortic dissection(TAAD). We aim to investigate decade-long trends in TAAD surgical repair in England.
Method
Retrospective review of the National Institute for Cardiovascular Outcomes Research (NICOR) National Adult Cardiac Surgery Audit (NACSA) registry from January 2009 to December 2018 , which prospectively collects demographic and peri-operative clinical information for all adult cardiac surgery procedures in the UK.
Results
Over the 10-year period,3,686 TAAD patients underwent surgical repair in England. A steady doubling in the overall number of operations conducted in England was observed from 237 cases recorded in 2009 to 510 in 2018. Number of procedures per hospital per year also doubled, from 10 in 2009 to 21 in 2018. The risk profile of the operated patients remained unchanged. Overall, in-hospital mortality was 17.4% with a trend toward lower mortality in the most recent years (from 22.8% in 2009 to 14.7% in 2018). There was a significant variation in operative mortality across regions with a trend towards lower mortality in regions with a high-volume hospital.
Conclusions
Surgery is the only treatment for acute TAAD but is associated with high mortality. Prompt diagnosis and referral to a specialist center is paramount. The number of operations conducted in England has doubled in 10 years and the associated survival following surgery has improved. Regional variations exist in service provision with a trend towards better survival in high volume centers.
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Affiliation(s)
- U Benedetto
- Bristol Heart Institute, Bristol, United Kingdom
| | - S Sinha
- Bristol Heart Institute, Bristol, United Kingdom
| | - A Dimagli
- Bristol Heart Institute, Bristol, United Kingdom
| | - G Cooper
- Northern General Hospital, Sheffield, United Kingdom
| | | | - R Uppal
- St. Bartholomew’s Hospital, London, United Kingdom
| | - N Moorjani
- Royal Papworth Hospital, Cambridge, United Kingdom
| | | | - U Trivedi
- Royal Sussex County Hospital, Brighton, United Kingdom
| | - G Angelini
- Bristol Heart Institute, Bristol, United Kingdom
| | - E Akowuah
- The James Cook University Hospital, Middlesbrough, United Kingdom
| | - G Tsang
- Southampton General Hospital, Southampton, United Kingdom
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11
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Benedetto U, Sinha S, Dimagli A, Cooper G, Mariscalco G, Uppal R, Moorjani N, Krasopoulos G, Kaura A, Field M, Trivedi U, Kendall S, Angelini GD, Akowuah EF, Tsang G. Decade-long trends in surgery for acute Type A aortic dissection in England: A retrospective cohort study. Lancet Reg Health Eur 2021; 7:100131. [PMID: 34557840 PMCID: PMC8454541 DOI: 10.1016/j.lanepe.2021.100131] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Little is known about variations in care and outcomes of patients undergoing surgical repair for type A aortic dissection(TAAD). We aim to investigate decade-long trends in TAAD surgical repair in England. Methods Retrospective review of the National Adult Cardiac Surgery Audit, which prospectively collects demographic and peri‑operative information for all major adult cardiac surgery procedures performed in the UK. We identified patients undergoing surgery for TAAD from January 2009-December 2018, reviewed trends in operative frequency, patient demographics, and mortality. Findings Over the 10-year period,3,680 TAAD patients underwent surgical repair in England. A doubling in the overall number of operations conducted in England was observed (235 cases in 2009 to 510 in 2018). Number of procedures per hospital per year also doubled(9 in 2009 to 23 in 2018). Overall, in-hospital mortality was 17.4% with a trend toward lower mortality in recent years(23% in 2009 to 14.7% in 2018). There was a significant variation in operative mortality between hospitals and surgeons. We also found that most patients presented towards the middle of the week and during winter. Interpretation Surgery is the only treatment for acute TAAD but is associated with high mortality. Prompt diagnosis and referral to a specialist center is paramount. The number of operations conducted in England has doubled in 10 years and the associated survival has improved. Variations exist in service provision with a trend towards better survival in high volume centers. Funding British Heart Foundation and NIHR Biomedical Research center(University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol).
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Affiliation(s)
- Umberto Benedetto
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK
| | - Shubhra Sinha
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK
| | - Arnaldo Dimagli
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK
| | | | | | | | | | | | - Amit Kaura
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Mark Field
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Simon Kendall
- The James Cook University Hospital, Middlesbrough, UK
| | - Gianni D Angelini
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK
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12
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Grant SW, Kendall S, Goodwin AT, Cooper G, Trivedi U, Page R, Jenkins DP. Trends and outcomes for cardiac surgery in the United Kingdom from 2002 to 2016. JTCVS Open 2021; 7:259-269. [PMID: 36003724 PMCID: PMC9390523 DOI: 10.1016/j.xjon.2021.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 12/13/2022]
Abstract
Objectives Cardiac surgery has evolved significantly since the turn of the century. The objective of this study was to investigate trends in cardiac surgery activity and outcomes in the United Kingdom utilizing a mandatory national cardiac surgical clinical database in the context of a comprehensive public health care system (ie, the UK National Health Service). Methods Data for all cardiac surgery procedures performed between 2002 and 2016 were extracted from the UK National Adult Cardiac Surgery Audit database. Data are validated and cleaned using reproducible algorithms. Trends in activity and outcomes were analyzed by fiscal year using linear regression. Results A total of 534,067 procedures were performed during the study period with the number of cases per year peaking in 2008/2009 at 41,426. Despite an increase in patient age and mean logistic European System for Cardiac Operative Risk Evaluation score, the in-hospital mortality rate for all cardiac surgery has fallen from 4.0% to 2.8% (P < .001). The number of isolated coronary artery bypass graft procedures has steadily declined but the total number of valve procedures has steadily increased (both P values < .001). The number of thoracic aortic procedures performed each year has doubled (P < .001), but the incidence of redo procedures has steadily declined. The proportion of emergency and salvage procedures has remained stable. Conclusions This study, which covers all cardiac surgery procedures performed in the United Kingdom for fiscal years between 2002 and 2016, demonstrates that despite an increase in patient risk profile, there has been a consistent reduction in in-hospital mortality. A number of other markers associated with quality have also improved.
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Affiliation(s)
- Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Simon Kendall
- James Cook University Hospital, Middlesbrough, United Kingdom
| | | | - Graham Cooper
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Uday Trivedi
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Richard Page
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - David P Jenkins
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
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13
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Ohri SK, Benedetto U, Luthra S, Grant SW, Goodwin AT, Trivedi U, Kendall S, Jenkins DP. Coronary artery bypass surgery in the UK, trends in activity and outcomes from a 15-year complete national series. Eur J Cardiothorac Surg 2021; 61:449-456. [PMID: 34448848 DOI: 10.1093/ejcts/ezab391] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/07/2021] [Accepted: 07/27/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to review the UK national trends in activity and outcome in coronary artery bypass graft (CABG) over a 15-year period (2002-2016). METHODS Validated data collected (2002-2016) and uploaded to National Institute for Cardiovascular Outcomes Research were used to generate summary data from the National Adult Cardiac Surgery Audit Database for the analysis. Logistic European System of Cardiac Operative Risk Evaluation was used for risk stratification with recalibration applied for governance. Data were analysed by financial year and presented as numerical, categorical, %, mean and standard deviation where appropriate. Mortality was recorded as death in hospital at any time after index CABG operation. RESULTS A total of 347 626 CABG procedures (282 883 isolated CABG, 61 109 CABG and valve and 4132 redo CABG) were recorded. Over this period annual activity reduced from 66.6% of workload to 41.7%. The mean age for isolated CABG was 65.7 years. The mean log European System of Cardiac Operative Risk Evaluation was 3.1, 5.9 and 23.2 for elective, urgent and emergency isolated CABG, respectively. There was a decline in the observed mortality for all procedures. Overall mortality for isolated CABG surgery is now 1.0% and only 0.6% for elective operations. CONCLUSIONS Quality of care and risk-adjusted mortality rates have consistently improved over the last 15 years despite the increasing risk profile of patients. There have been a consistent decline in overall case volumes and a three-fold increase in elderly cases.
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Affiliation(s)
- Sunil K Ohri
- Division of Cardiac Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Umberto Benedetto
- Division of Cardiac Surgery, University of Bristol and Bristol Royal Infirmary, Bristol, UK
| | - Suvitesh Luthra
- Division of Cardiac Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stuart W Grant
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Andrew T Goodwin
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiac Surgery, James Cook University Hospital, Middlesborough, UK
| | - Uday Trivedi
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiac Surgery, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Simon Kendall
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiac Surgery, James Cook University Hospital, Middlesborough, UK
| | - David P Jenkins
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiac Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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14
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Cockburn J, Arunothayaraj S, Gannaway A, Alsanjari O, Parker J, Trivedi U, Hildick-Smith D. Balloon seal separation leading to SAPIEN 3 transcatheter heart valve deployment failure: Complications and management. Cardiovasc Revasc Med 2021; 40S:144-147. [PMID: 34344585 DOI: 10.1016/j.carrev.2021.07.025] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 11/03/2022]
Abstract
We present two cases of failure of balloon inflation secondary to balloon separation from the delivery catheter when implanting the SAPIEN 3 transcatheter heart valve (Edwards Lifesciences, Irvine, CA, USA). Although very uncommon, this is a potentially disastrous complication of transcatheter intervention. Case 1 highlights the complexity of the problem when it occurs and subsequent complications. Case 2 highlights how to manage this issue successfully.
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Affiliation(s)
- James Cockburn
- Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton BN2 5DE, United Kingdom
| | - Sandeep Arunothayaraj
- Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton BN2 5DE, United Kingdom.
| | - Alex Gannaway
- Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton BN2 5DE, United Kingdom
| | - Osama Alsanjari
- Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton BN2 5DE, United Kingdom
| | - Jessica Parker
- Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton BN2 5DE, United Kingdom
| | - Uday Trivedi
- Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton BN2 5DE, United Kingdom
| | - David Hildick-Smith
- Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton BN2 5DE, United Kingdom
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15
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Kabahizi A, Sheikh AS, Williams T, Tanseco K, Myat A, Trivedi U, de Belder A, Cockburn J, Hildick-Smith D. Elective versus urgent in-hospital transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2021; 98:170-175. [PMID: 33713533 DOI: 10.1002/ccd.29638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/31/2021] [Accepted: 02/24/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is maturing as a treatment option and is now often undertaken during an unscheduled index hospital admission. The aim of this study was to look at procedural and mid-term outcomes of patients undergoing elective versus urgent in-hospital transcatheter aortic valve implantation. METHODS We identified a total of 1,157 patients who underwent TAVI between November 2007 and November 2019 at the Sussex Cardiac Centre in the UK. We compared the demographics, procedural outcomes, 30-day and 1-year mortality between elective and urgent patients. Emergency and salvage TAVI cases were excluded. RESULTS Of the 1,157 patients who underwent the procedure, 975 (84.3%) had elective while 182 (15.7%) had urgent TAVI. Predominant aortic stenosis was more frequent in elective patients (91.7% vs. 77.4%); p < .01), while predominant aortic regurgitation was seen more commonly in the urgent group (11.5% vs. 4.2%; p < .01). Implantation success was similar between the elective (99.1%) and urgent group (99.4%). In-hospital (1.65% vs. 1.3%: p .11), 30 day (3.5% vs. 3.3%: p .81) and 1 year (10.9% vs. 11%; p .81) mortality rates were similar in the elective and urgent groups, respectively. CONCLUSIONS In contemporary practice, urgent TAVI undertaken on the index admission can be performed at similar risk to elective outpatient TAVI.
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Affiliation(s)
- Alex Kabahizi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - Azeem S Sheikh
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Timothy Williams
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - Kristoffer Tanseco
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - Aung Myat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - Adam de Belder
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
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16
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Baghai M, Wendler O, Grant SW, Goodwin AT, Trivedi U, Kendall S, Jenkins DP. Aortic valve surgery in the UK, trends in activity and outcomes from a 15-year complete national series. Eur J Cardiothorac Surg 2021; 60:1353-1357. [PMID: 34021313 DOI: 10.1093/ejcts/ezab199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Since the turn of the century, cardiac surgery has evolved quite notably. This study sought to investigate the trends in aortic valve surgery activity and subsequent outcomes in the UK by using a mandatory national cardiac surgical clinical database within the context of a comprehensive public healthcare system (National Health Service). METHODS The UK National Adult Cardiac Surgery Audit database provided data for aortic valve surgery procedures performed between 2002 and 2016, and the data were validated and cleaned using reproducible algorithms. The findings and trends in in activity and outcomes were then analysed by financial year. RESULTS During the study period, a total of 148 862 procedures were performed, with the number of cases per year peaking in 2014/2015 at 12 483. The mean in-hospital mortality rate for all aortic valve surgery has fallen from 5.6% to 3.4%, despite an increase in patient age and mean logistic EuroSCORE. While the number of isolated aortic valve replacements has remained stable at around 5000 per year, aortic valve replacement and coronary artery bypass graft have increased to over 3200 with transcatheter aortic valve implantation activity continuing to increase. CONCLUSIONS This study demonstrates that despite an increase in patient risk profile, there has been a consistent reduction in in-hospital mortality within all aortic valve surgery procedures performed in the UK over a 15-year period. Increasing catheter-based interventions have not yet resulted in a significant decrease in surgical aortic valve replacements in the UK.
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Affiliation(s)
- Max Baghai
- Cardiovascular Division, Kings College Hospital, London, UK
| | - Olaf Wendler
- Cardiovascular Division, Kings College Hospital, London, UK
| | - Stuart W Grant
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Andrew T Goodwin
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,James Cook University Hospital, Middlesbrough, UK
| | - Uday Trivedi
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Simon Kendall
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,James Cook University Hospital, Middlesbrough, UK
| | - David P Jenkins
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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17
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Benedetto U, Dimagli A, Cooper G, Uppal R, Mariscalco G, Krasopoulos G, Goodwin A, Trivedi U, Kendall S, Sinha S, Fudulu D, Angelini GD, Tsang G, Akowuah E. Neuroprotective strategies in acute aortic dissection: an analysis of the UK National Adult Cardiac Surgical Audit. Eur J Cardiothorac Surg 2021; 60:1437-1444. [PMID: 33963362 PMCID: PMC8643475 DOI: 10.1093/ejcts/ezab192] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/11/2021] [Accepted: 03/30/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES The risk of brain injury following surgery for type A aortic dissection (TAAD) remains substantial and no consensus has still been reached on which neuroprotective technique should be preferred. We aimed to investigate the association between neuroprotective strategies and clinical outcomes following TAAD repair. METHODS Using the UK National Adult Cardiac Surgical Audit, we identified 1929 patients undergoing surgery for TAAD (2011-2018). Deep hypothermic circulatory arrest (DHCA) only, unilateral (uACP), bilateral antegrade cerebral perfusion (bACP) and retrograde cerebral perfusion were used in 830, 117, 760 and 222 patients, respectively. The primary end point was a composite of death and/or cerebrovascular accident (CVA). Generalized linear mixed model was used to adjust the effect of neuroprotective strategies for other confounders. RESULTS The use of bACP was associated with longer circulatory arrest (CA) compared to other strategies. There was a trend towards lower incidence of death and/or CVA using uACP only for shorter CA. In particular, primary end point rate was 27.7% overall and 26.5%, 12.5%, 28.0% and 22.9% for CA <30 min and 28.6%, 30.4%, 33.3% and 33.0% for CA ≥30 min with DHCA only, uACP, bACP and retrograde cerebral perfusion, respectively. The use of DHCA only was associated with five-fold [odds ratio (OR) 5.35, 95% confidence interval (CI) 1.36-21.02] and two-fold (OR 1.77, 95% CI 1.01-3.09) increased risk of death and/or CVA compared to uACP and bACP, respectively, but the effect of uACP was significantly associated with CA duration (hazard ratio 0.97, 95% CI 0.94-0.99; P = 0.04). CONCLUSIONS In TAAD repair, the use of uACP and bACP was associated with a lower adjusted risk of death and/or CVA when compared to DHCA. uACP can offer some advantage but only for a shorter CA duration.
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Affiliation(s)
| | | | - Graham Cooper
- Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - Rakesh Uppal
- Barts Heart Centre, William Harvey Research Institute, London, UK
| | | | | | | | - Uday Trivedi
- Sussex Cardiac Center, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Shubhra Sinha
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Daniel Fudulu
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | - Geoffrey Tsang
- Wessex Cardiothoracic Center, University Hospital Southampton NHS Trust, Southampton, UK
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18
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MacCarthy P, Smith D, Muir D, Blackman D, Buch M, Ludman P, Appleby C, Curzen N, Hildick-Smith D, Uren N, Turner M, Trivedi U, Banning A. Extended Statement by the British Cardiovascular Intervention Society President Regarding Transcatheter Aortic Valve Implantation. Interv Cardiol 2021; 16:e03. [PMID: 33897829 PMCID: PMC8054375 DOI: 10.15420/icr.2021.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/06/2021] [Indexed: 12/21/2022] Open
Affiliation(s)
| | | | - Douglas Muir
- James Cook University Hospital Middlesbrough, UK
| | | | | | | | | | - Nick Curzen
- Southampton University Hospital Southampton, UK
| | | | - Neal Uren
- Edinburgh Royal Infirmary Edinburgh, UK
| | | | - Uday Trivedi
- Brighton and Sussex University Hospitals Sussex, UK
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19
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Myat A, Mouy F, Buckner L, Cockburn J, Baumbach A, MacCarthy P, Banning AP, Curzen N, Hilling-Smith R, Blackman DJ, Mullen M, de Belder M, Cox I, Kovac J, Manoharan G, Zaman A, Muir D, Smith D, Brecker S, Turner M, Khogali S, Malik IS, Alsanjari O, D'Auria F, Redwood S, Prendergast B, Trivedi U, Robinson D, Ludman P, de Belder A, Hildick-Smith D. Survival relative to pacemaker status after transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2021; 98:E444-E452. [PMID: 33502784 DOI: 10.1002/ccd.29498] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/08/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To determine whether a permanent pacemaker (PPM) in situ can enhance survival after transcatheter aortic valve implantation (TAVI), in a predominantly inoperable or high risk cohort. BACKGROUND New conduction disturbances are the most frequent complication of TAVI, often necessitating PPM implantation before hospital discharge. METHODS We performed an observational cohort analysis of the UK TAVI registry (2007-2015). Primary and secondary endpoints were 30-day post-discharge all-cause mortality and long-term survival, respectively. RESULTS Of 8,651 procedures, 6,815 complete datasets were analyzed. A PPM at hospital discharge, irrespective of when implantation occurred (PPM 1.68% [22/1309] vs. no PPM 1.47% [81/5506], odds ratio [OR] 1.14, 95% confidence interval [CI] 0.71-1.84; p = .58), or a PPM implanted peri- or post-TAVI only (PPM 1.44% [11/763] vs. no PPM 1.47% [81/5506], OR 0.98 [0.51-1.85]; p = .95) did not significantly reduce the primary endpoint. Patients with a PPM at discharge were older, male, had right bundle branch block at baseline, were more likely to have received a first-generation self-expandable prosthesis and had experienced more peri- and post-procedural complications including bailout valve-in-valve rescue, bleeding and acute kidney injury. A Cox proportional hazards model demonstrated significantly reduced long-term survival in all those with a PPM, irrespective of implantation timing (hazard ratio [HR] 1.14 [1.02-1.26]; p = .019) and those receiving a PPM only at the time of TAVI (HR 1.15 [1.02-1.31]; p = .032). The reasons underlying this observation warrant further investigation. CONCLUSIONS A PPM did not confer a survival advantage in the first 30 days after hospital discharge following TAVI.
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Affiliation(s)
- Aung Myat
- Sussex Cardiac Center, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.,Division of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - Florence Mouy
- Division of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - Luke Buckner
- Division of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - James Cockburn
- Sussex Cardiac Center, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Andreas Baumbach
- William Harvey Research Institute, Queen Mary University of London, London, UK.,Barts Heart Center, Barts Health NHS Trust, London, UK.,Section of Cardiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Philip MacCarthy
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Adrian P Banning
- Oxford Heart Center, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Nick Curzen
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Roland Hilling-Smith
- Sussex Cardiac Center, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Daniel J Blackman
- Yorkshire Heart Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Mark de Belder
- Barts Heart Center, Barts Health NHS Trust, London, UK.,Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK
| | - Ian Cox
- Department of Cardiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Jan Kovac
- Glenfield Hospital, University of Leicester, Leicester, UK
| | - Ganesh Manoharan
- Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Azfar Zaman
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - Douglas Muir
- Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK
| | - David Smith
- Department of Cardiology, Morriston Hospital, Swansea, UK
| | - Stephen Brecker
- Cardiology Clinical Academic Group, St. George's University of London, London, UK
| | | | - Saib Khogali
- Heart and Lung Center, New Cross Hospital, Wolverhampton, UK
| | - Iqbal S Malik
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Osama Alsanjari
- Sussex Cardiac Center, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Francesca D'Auria
- Azienda Ospedaliera Universitaria Maggiore della Carita, Novara, Italy
| | - Simon Redwood
- Cardiothoracic Directorate, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Bernard Prendergast
- Cardiothoracic Directorate, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Uday Trivedi
- Sussex Cardiac Center, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Derek Robinson
- Department of Mathematics, University of Sussex, Brighton, UK
| | - Peter Ludman
- Cardiology Department, Queen Elizabeth Hospital, Birmingham, UK
| | - Adam de Belder
- Sussex Cardiac Center, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - David Hildick-Smith
- Sussex Cardiac Center, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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20
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Hilling-Smith R, Kemp T, Dooley M, Rampat R, de Belder A, Hill A, Cockburn J, Trivedi U, Hildick-Smith D, Homsy M. Predicting the Need For Permanent Pacing After Implantation of the Repositionable Lotus Transcatheter Aortic Valve. J Invasive Cardiol 2020; 32:347-349. [PMID: 32653863] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The need for permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI) is a recognized complication due to compression of the cardiac conduction system. PPI rates vary according to type of TAVI device, implantation technique, and patient-related factors. METHODS We analyzed the baseline characteristics, and then the preprocedure and daily postprocedure electrocardiograms (ECGs) of 101 consecutive patients who underwent TAVI using the Lotus valve (Boston Scientific) between 2013 and 2015. RESULTS Mean patient age was 81.7 ± 7.7 years, 56% were male. and 21 patients were excluded because of baseline atrial fibrillation or a pre-existing PPI. Of the remaining 80 patients, a total of 28 (35%) underwent PPI at a mean 2.7 days after TAVI. There were no differences in development of new left bundle-branch block between the two groups (65% PPI group vs 74% no-PPI group; P=.37). The initial PR interval did not differ between groups (183 ms PPI group vs 184 ms no-PPI group). The PR interval increased by day 1 post procedure (232 ms PPI group vs 195 ms no-PPI group; P<.01) and day 2 (267 ms PPI group vs 211 ms no-PPI group; P<.05). CONCLUSIONS Patients with a PR interval ≤230 ms on day 1 or ≤260 ms on day 2 post TAVI using the Lotus device are at very low risk of requiring PPI, irrespective of the presence of left bundle-branch block, and can be safely discharged without prolonged monitoring.
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Affiliation(s)
| | | | | | | | | | | | | | | | - David Hildick-Smith
- Address for correspondence: David Hildick-Smith, MD, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, BN2 5BE United Kingdom.
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21
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Myat A, Buckner L, Mouy F, Cockburn J, Baumbach A, Banning AP, Blackman DJ, Curzen N, MacCarthy P, Mullen M, de Belder M, Cox I, Kovac J, Brecker S, Turner M, Khogali S, Malik IS, Alsanjari O, Redwood S, Prendergast B, Trivedi U, Robinson D, Ludman P, de Belder A, Hildick-Smith D. In-hospital stroke after transcatheter aortic valve implantation: A UK observational cohort analysis. Catheter Cardiovasc Interv 2020; 97:E552-E559. [PMID: 32779877 DOI: 10.1002/ccd.29157] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/27/2020] [Accepted: 07/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We sought to identify baseline demographics and procedural factors that might independently predict in-hospital stroke following transcatheter aortic valve implantation (TAVI). BACKGROUND Stroke is a recognized, albeit infrequent, complication of TAVI. Established predictors of procedure-related in-hospital stroke; however, remain poorly defined. METHODS We conducted an observational cohort analysis of the multicenter UK TAVI registry. The primary outcome measure was the incidence of in-hospital stroke. RESULTS A total of 8,652 TAVI procedures were performed from 2007 to 2015. There were 205 in-hospital strokes reported by participating centers equivalent to an overall stroke incidence of 2.4%. Univariate analysis showed that the implantation of balloon-expandable valves caused significantly fewer strokes (balloon-expandable 96/4,613 [2.08%] vs. self-expandable 95/3,272 [2.90%]; p = .020). After multivariable analysis, prior cerebrovascular disease (CVD) (odds ratio [OR] 1.51, 95% confidence interval [CI 1.05-2.17]; p = .03), advanced age at time of operation (OR 1.02 [0.10-1.04]; p = .05), bailout coronary stenting (OR 5.94 [2.03-17.39]; p = .008), and earlier year of procedure (OR 0.93 [0.87-1.00]; p = .04) were associated with an increased in-hospital stroke risk. There was a reduced stroke risk in those who had prior cardiac surgery (OR 0.62 [0.41-0.93]; p = .01) and a first-generation balloon-expandable valve implanted (OR 0.72 [0.53-0.97]; p = .03). In-hospital stroke significantly increased 30-day (OR 5.22 [3.49-7.81]; p < .001) and 1-year mortality (OR 3.21 [2.15-4.78]; p < .001). CONCLUSIONS In-hospital stroke after TAVI is associated with substantially increased early and late mortality. Factors independently associated with in-hospital stroke were previous CVD, advanced age, no prior cardiac surgery, and deployment of a predominantly first-generation self-expandable transcatheter heart valve.
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Affiliation(s)
- Aung Myat
- Sussex Cardiac Center, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.,Division of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - Luke Buckner
- Division of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - Florence Mouy
- Division of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - James Cockburn
- Sussex Cardiac Center, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Andreas Baumbach
- William Harvey Research Institute, Queen Mary University of London, London, UK.,Barts Heart Center, Barts Health NHS Trust, London, UK.,Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Adrian P Banning
- Oxford Heart Center, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Daniel J Blackman
- Yorkshire Heart Center, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nick Curzen
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Philip MacCarthy
- Faculty of Life Sciences and Medicine, King's College London and King's College Hospital NHS Foundation Trust, London, UK
| | | | - Mark de Belder
- Barts Heart Center, Barts Health NHS Trust, London, UK.,Cardiology Department, The James Cook University Hospital, Middlesbrough, UK
| | - Ian Cox
- Department of Cardiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Jan Kovac
- Glenfield Hospital, University of Leicester, Leicester, UK
| | - Stephen Brecker
- Cardiology Clinical Academic Group, St. George's University of London and St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Mark Turner
- Bristol Heart Institute, University Hospital Bristol NHS Foundation Trust, Bristol, UK
| | - Saib Khogali
- Heart and Lung Center, New Cross Hospital, Wolverhampton, UK
| | - Iqbal S Malik
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Osama Alsanjari
- Sussex Cardiac Center, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Simon Redwood
- Cardiothoracic Directorate, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Bernard Prendergast
- Cardiothoracic Directorate, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Uday Trivedi
- Sussex Cardiac Center, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Derek Robinson
- Department of Mathematics, University of Sussex, Brighton, UK
| | - Peter Ludman
- Cardiology Department, Queen Elizabeth Hospital, Birmingham, UK
| | - Adam de Belder
- Sussex Cardiac Center, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - David Hildick-Smith
- Sussex Cardiac Center, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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22
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Rasmussen MA, Thorsen J, Dominguez-Bello MG, Blaser MJ, Mortensen MS, Brejnrod AD, Shah SA, Hjelmsø MH, Lehtimäki J, Trivedi U, Bisgaard H, Sørensen SJ, Stokholm J. Ecological succession in the vaginal microbiota during pregnancy and birth. ISME J 2020; 14:2325-2335. [PMID: 32488167 PMCID: PMC7609337 DOI: 10.1038/s41396-020-0686-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 04/20/2020] [Accepted: 05/14/2020] [Indexed: 11/09/2022]
Abstract
The mother's vaginal microbiota represents the first microbes to which a child is exposed when delivered vaginally. However, little is known about the composition and development of the vaginal microbiota during pregnancy and birth. Here, we analyzed the vaginal microbiota of 57 women in pregnancy week 24, 36 and at birth after rupture of membranes but before delivery, and further compared the composition with that of the gut and airways of the 1-week-old child. The vaginal community structure had dramatic changes in bacterial diversity and taxonomic distribution, yet carried an individual-specific signature. The relative abundance of most bacterial taxa increased stepwise from week 24 of pregnancy until birth, with a gradual decline of Lactobacillus. Mother-to-child vertical transfer, as suggested by sharing, was modest, with the strongest transfer being for Clostridiales followed by Lactobacillales and Enterobacteriales. In conclusion, late gestation is associated with an increase in maternal vaginal microbiota diversity, and vaginal bacteria at birth only modestly predict the composition of the neonatal microbiota.
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Affiliation(s)
- M A Rasmussen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Section of Chemometrics and Analytical Technologies, Department of Food Science, University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg C, Denmark
| | - J Thorsen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, 2100, Copenhagen, Denmark
| | - M G Dominguez-Bello
- Department of Biochemistry and Microbiology, Rutgers University, New Brunswick, NJ, USA
| | - M J Blaser
- Departments of Medicine and Microbiology, and the Human Microbiome Program, New York University Langone Medical Center, New York, NY, USA.,Center for Advanced Biotechnology and Medicine, Rutgers University, New Brunswick, NJ, USA
| | - M S Mortensen
- Section of Microbiology, Department of Biology, University of Copenhagen, 2100, Copenhagen, Denmark
| | - A D Brejnrod
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, 2100, Copenhagen, Denmark.,Section of Microbiology, Department of Biology, University of Copenhagen, 2100, Copenhagen, Denmark
| | - S A Shah
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M H Hjelmsø
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J Lehtimäki
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - U Trivedi
- Section of Microbiology, Department of Biology, University of Copenhagen, 2100, Copenhagen, Denmark
| | - H Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - S J Sørensen
- Section of Microbiology, Department of Biology, University of Copenhagen, 2100, Copenhagen, Denmark
| | - J Stokholm
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
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23
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Myat A, Papachristofi O, Trivedi U, Bapat V, Young C, de Belder A, Cockburn J, Baumbach A, Banning AP, Blackman DJ, MacCarthy P, Mullen M, Muir DF, Nolan J, Zaman A, de Belder M, Cox I, Kovac J, Brecker S, Turner M, Khogali S, Malik I, Redwood S, Prendergast B, Ludman P, Sharples L, Hildick-Smith D. Transcatheter aortic valve implantation via surgical subclavian versus direct aortic access: A United Kingdom analysis. Int J Cardiol 2020; 308:67-72. [PMID: 32247575 DOI: 10.1016/j.ijcard.2020.03.059] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 02/06/2020] [Accepted: 03/20/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical subclavian (SC) and direct aortic (DA) access are established alternatives to the default transfemoral route for transcatheter aortic valve implantation (TAVI). We sought to find differences in survival and procedure-related outcomes after SC- versus DA-TAVI. METHODS We performed an observational cohort analysis of cases prospectively uploaded to the UK TAVI registry. To ensure the most contemporaneous comparison, the analysis focused on SC and DA procedures performed from 2013 to 2015. RESULTS Between January 2013 and July 2015, 82 (37%) SC and 142 (63%) DA cases were performed that had validated 1-year life status. Multivariable regression analysis showed procedure duration was longer for SC cases (SC 193.5 ± 65.8 vs. DA 138.4 ± 57.7 min; p < .01) but length of hospital stay was shorter (SC 8.6 ± 9.5 vs. DA 11.9 ± 10.8 days; p = .03). Acute kidney injury was observed less frequently after SC cases (odds ratio [OR] 0.35, 95% confidence interval [CI 0.12-0.96]; p = .042) but vascular access site-related complications were more common (OR 9.75 [3.07-30.93]; p < .01). Procedure-related bleeding (OR 0.54 [0.24-1.25]; p = .15) and in-hospital stroke rate (SC 3.7% vs. DA 2.1%; p = .67) were similar. There were no significant differences in in-hospital (SC 2.4% vs. DA 4.9%; p = .49), 30-day (SC 2.4% vs. DA 4.2%; p = .71) or 1-year (SC 14.5% vs. DA 21.9%; p = .344) mortality. CONCLUSIONS Surgical subclavian and direct aortic approaches can offer favourable outcomes in appropriate patients. Neither access modality conferred a survival advantage but there were significant differences in procedural metrics that might influence which approach is selected.
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Affiliation(s)
- Aung Myat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK; Division of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - Olympia Papachristofi
- London School of Hygiene and Tropical Medicine, London, UK; Novartis Pharma AG, Basel, Switzerland
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Vinayak Bapat
- New York-Presbyterian Columbia University Medical Centre, New York, USA; Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher Young
- Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Adam de Belder
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Andreas Baumbach
- Queen Mary University of London, London, UK; Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Adrian P Banning
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Daniel J Blackman
- Yorkshire Heart Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Philip MacCarthy
- King's College London and King's College Hospital NHS Foundation Trust, London, UK
| | | | - Douglas F Muir
- Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK
| | - James Nolan
- Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke, UK
| | - Azfar Zaman
- Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - Mark de Belder
- Barts Heart Centre, Barts Health NHS Trust, London, UK; Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK
| | - Ian Cox
- Department of Cardiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Jan Kovac
- Biomedical Research Unit, University of Leicester, Leicester, UK
| | - Stephen Brecker
- Cardiology Clinical Academic Group, St. George's University of London, London, UK
| | - Mark Turner
- Department of Cardiology, Bristol Heart Institute, Bristol, UK
| | - Saib Khogali
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
| | - Iqbal Malik
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Simon Redwood
- Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Bernard Prendergast
- Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Linda Sharples
- London School of Hygiene and Tropical Medicine, London, UK
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
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24
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Alsanjari O, Parker J, Thomson C, Trivedi U, Hildick-Smith D. Thrombosis of a Percutaneous Transcatheter Mitral Valve Implant and Its Treatment. Can J Cardiol 2020; 36:1690.e5-1690.e8. [PMID: 32846141 DOI: 10.1016/j.cjca.2020.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/24/2020] [Accepted: 03/01/2020] [Indexed: 11/15/2022] Open
Abstract
Bioprosthetic heart valves do not usually require formal anticoagulation as they are less thrombogenic than their mechanical counterparts. However, valve thrombosis has been reported after both transcatheter and surgical aortic bioprosthesis implantation. Short-term anticoagulation after surgical bioprosthesis implantation is often recommended while endothelialisation of the prosthesis takes place, particularly for mitral valve implants. There have been no reports of tissue heart valve thrombosis in transcatheter mitral valve replacement. We describe our experience and successful treatment of such a case.
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Affiliation(s)
- Osama Alsanjari
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom
| | - Jessica Parker
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom
| | - Catherine Thomson
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, United Kingdom.
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25
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Holm NR, Mäkikallio T, Lindsay MM, Spence MS, Erglis A, Menown IBA, Trovik T, Kellerth T, Kalinauskas G, Mogensen LJH, Nielsen PH, Niemelä M, Lassen JF, Oldroyd K, Berg G, Stradins P, Walsh SJ, Graham ANJ, Endresen PC, Fröbert O, Trivedi U, Anttila V, Hildick-Smith D, Thuesen L, Christiansen EH. Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: updated 5-year outcomes from the randomised, non-inferiority NOBLE trial. Lancet 2020; 395:191-199. [PMID: 31879028 DOI: 10.1016/s0140-6736(19)32972-1] [Citation(s) in RCA: 231] [Impact Index Per Article: 57.8] [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: 09/23/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is increasingly used in revascularisation of patients with left main coronary artery disease in place of the standard treatment, coronary artery bypass grafting (CABG). The NOBLE trial aimed to evaluate whether PCI was non-inferior to CABG in the treatment of left main coronary artery disease and reported outcomes after a median follow-up of 3·1 years. We now report updated 5-year outcomes of the trial. METHODS The prospective, randomised, open-label, non-inferiority NOBLE trial was done at 36 hospitals in nine northern European countries. Patients with left main coronary artery disease requiring revascularisation were enrolled and randomly assigned (1:1) to receive PCI or CABG. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCE), a composite of all-cause mortality, non-procedural myocardial infarction, repeat revascularisation, and stroke. Non-inferiority of PCI to CABG was defined as the upper limit of the 95% CI of the hazard ratio (HR) not exceeding 1·35 after 275 MACCE had occurred. Secondary endpoints included all-cause mortality, non-procedural myocardial infarction, and repeat revascularisation. Outcomes were analysed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT01496651. FINDINGS Between Dec 9, 2008, and Jan 21, 2015, 1201 patients were enrolled and allocated to PCI (n=598) or CABG (n=603), with 17 subsequently lost to early follow-up. 592 patients in each group were included in this analysis. At a median of 4·9 years of follow-up, the predefined number of events was reached for adequate power to assess the primary endpoint. Kaplan-Meier 5-year estimates of MACCE were 28% (165 events) for PCI and 19% (110 events) for CABG (HR 1·58 [95% CI 1·24-2·01]); the HR exceeded the limit for non-inferiority of PCI compared to CABG. CABG was found to be superior to PCI for the primary composite endpoint (p=0·0002). All-cause mortality was estimated in 9% after PCI versus 9% after CABG (HR 1·08 [95% CI 0·74-1·59]; p=0·68); non-procedural myocardial infarction was estimated in 8% after PCI versus 3% after CABG (HR 2·99 [95% CI 1·66-5·39]; p=0·0002); and repeat revascularisation was estimated in 17% after PCI versus 10% after CABG (HR 1·73 [95% CI 1·25-2·40]; p=0·0009). INTERPRETATION In revascularisation of left main coronary artery disease, PCI was associated with an inferior clinical outcome at 5 years compared with CABG. Mortality was similar after the two procedures but patients treated with PCI had higher rates of non-procedural myocardial infarction and repeat revascularisation. FUNDING Biosensors.
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Affiliation(s)
- Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Timo Mäkikallio
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - M Mitchell Lindsay
- Department of Cardiology, Golden Jubilee National Hospital, Clydebank, UK
| | | | - Andrejs Erglis
- Latvia Centre of Cardiology, Paul Stradins Clinical Hospital, Riga, Latvia
| | | | - Thor Trovik
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Thomas Kellerth
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
| | | | | | - Per H Nielsen
- Department of Cardiac Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Matti Niemelä
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Jens F Lassen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Keith Oldroyd
- Department of Cardiology, Golden Jubilee National Hospital, Clydebank, UK
| | - Geoffrey Berg
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Clydebank, UK
| | - Peteris Stradins
- Latvia Centre of Cardiology, Paul Stradins Clinical Hospital, Riga, Latvia
| | | | | | - Petter C Endresen
- Department of Cardiovascular Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Ole Fröbert
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospital, Brighton, UK
| | - Vesa Anttila
- Department of Cardiac Surgery, Oulu University Hospital, Oulu, Finland
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospital, Brighton, UK
| | - Leif Thuesen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Xiang N, Trivedi U, Xie B. Artificial enveloping reverberation for binaural auralization using reciprocal maximum-length sequences. J Acoust Soc Am 2019; 145:2691. [PMID: 31046376 DOI: 10.1121/1.5095863] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/01/2018] [Indexed: 06/09/2023]
Abstract
Binaural auralization through proper room-acoustic simulation can produce a realistic listening experience as if the listener were sitting in a room with spatial perception, including enveloping reverberance. Based on analysis of experimentally measured binaural room-acoustic data, this paper discusses an approach to creating artificial but natural-sounding reverberation for binaural rendering that can be employed in simulating such an environment in an efficient way. Approaches to adjusting the spaciousness of enveloping reverberance within the context of artificially generated reverberation are investigated via hearing tests. This paper exploits the excellent pseudorandom properties of maximum-length sequences to generate deterministic and controllable decorrelations between binaural channels for artificial reverberation for room-acoustic simulations with high computational efficiency. To achieve natural-sounding enveloping reverberance in an enclosed space, and thereby an immersive environment, the shapes of both the reverberation energy decays and the spatial characteristics are found to be decisive. This paper discusses systematic hearing test results that support the mentioned finding.
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Affiliation(s)
- Ning Xiang
- Graduate Program in Architectural Acoustics, School of Architecture, Rensselaer Polytechnic Institute, Troy, New York 12180, USA
| | - Uday Trivedi
- Graduate Program in Architectural Acoustics, School of Architecture, Rensselaer Polytechnic Institute, Troy, New York 12180, USA
| | - Bosun Xie
- Acoustic Laboratory, School of Physics and Optoelectronics, South China University of Technology, Guangzhou, China
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Taggart DP, Benedetto U, Gerry S, Altman DG, Gray AM, Lees B, Gaudino M, Zamvar V, Bochenek A, Buxton B, Choong C, Clark S, Deja M, Desai J, Hasan R, Jasinski M, O'Keefe P, Moraes F, Pepper J, Seevanayagam S, Sudarshan C, Trivedi U, Wos S, Puskas J, Flather M. Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years. N Engl J Med 2019; 380:437-446. [PMID: 30699314 DOI: 10.1056/nejmoa1808783] [Citation(s) in RCA: 282] [Impact Index Per Article: 56.4] [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: 11/19/2022]
Abstract
BACKGROUND Multiple arterial grafts may result in longer survival than single arterial grafts after coronary-artery bypass grafting (CABG) surgery. We evaluated the use of bilateral internal-thoracic-artery grafts for CABG. METHODS We randomly assigned patients scheduled for CABG to undergo bilateral or single internal-thoracic-artery grafting. Additional arterial or vein grafts were used as indicated. The primary outcome was death from any cause at 10 years. The composite of death from any cause, myocardial infarction, or stroke was a secondary outcome. RESULTS A total of 1548 patients were randomly assigned to undergo bilateral internal-thoracic-artery grafting (the bilateral-graft group) and 1554 to undergo single internal-thoracic-artery grafting (the single-graft group). In the bilateral-graft group, 13.9% of the patients received only a single internal-thoracic-artery graft, and in the single-graft group, 21.8% of the patients also received a radial-artery graft. Vital status was not known for 2.3% of the patients at 10 years. In the intention-to-treat analysis at 10 years, there were 315 deaths (20.3% of the patients) in the bilateral-graft group and 329 deaths (21.2%) in the single-graft group (hazard ratio, 0.96; 95% confidence interval [CI], 0.82 to 1.12; P=0.62). Regarding the composite outcome of death, myocardial infarction, or stroke, there were 385 patients (24.9%) with an event in the bilateral-graft group and 425 patients (27.3%) with an event in the single-graft group (hazard ratio, 0.90; 95% CI, 0.79 to 1.03). CONCLUSIONS Among patients who were scheduled for CABG and had been randomly assigned to undergo bilateral or single internal-thoracic-artery grafting, there was no significant between-group difference in the rate of death from any cause at 10 years in the intention-to-treat analysis. Further studies are needed to determine whether multiple arterial grafts provide better outcomes than a single internal-thoracic-artery graft. (Funded by the British Heath Foundation and others; Current Controlled Trials number, ISRCTN46552265 .).
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Affiliation(s)
- David P Taggart
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Umberto Benedetto
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Stephen Gerry
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Douglas G Altman
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Alastair M Gray
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Belinda Lees
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Mario Gaudino
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Vipin Zamvar
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Andrzej Bochenek
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Brian Buxton
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Cliff Choong
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Stephen Clark
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Marek Deja
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Jatin Desai
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Ragheb Hasan
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Marek Jasinski
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Peter O'Keefe
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Fernando Moraes
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - John Pepper
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Siven Seevanayagam
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Catherine Sudarshan
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Uday Trivedi
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Stanislaw Wos
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - John Puskas
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
| | - Marcus Flather
- From the Nuffield Department of Surgical Sciences, John Radcliffe Hospital (D.P.T., B.L.), the Centre for Statistics in Medicine, Botnar Research Centre (S.G., D.G.A.), and the Health Economics Research Centre, Nuffield Department of Population Health (A.M.G.), University of Oxford, Oxford, the School of Clinical Sciences, University of Bristol, and Bristol Royal Infirmary, Bristol (U.B.), the Department of Cardiac Surgery, Royal Infirmary of Edinburgh, Edinburgh (V.Z.), Royal Papworth Hospital, Cambridge (C.C., C.S.), the Department of Cardiac Surgery, Freeman Hospital, Newcastle (S.C.), the Department of Cardiac Surgery, King's College Hospital (J.D.), and Royal Brompton Hospital and Imperial College London (J. Pepper), London, the Department of Cardiac Surgery, Royal Infirmary, Manchester (R.H.), the Department of Cardiac Surgery, University Hospital of Wales, Cardiff (P.O.), the Department of Cardiac Surgery, Royal Sussex County, Brighton (U.T.), and Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospital, Norwich (M.F.) - all in the United Kingdom; the Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital (M.G.), and Mount Sinai St. Luke's (J. Puskas) - both in New York; the Center for Cardiovascular Research and Development, American Heart of Poland (A.B.), and the Department of Cardiac Surgery, Medical University of Silesia (M.D., S.W.), Katowice, and the Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Wroclaw (M.J.) - all in Poland; the Department of Cardiac Surgery, Austin Health, Melbourne, VIC, Australia (B.B., S.S.); and the Heart Institute of Pernambuco, Recife, Brazil (F.M.)
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Lee S, Trivedi U, Johnson C, Farquharson C, Bergkvist GT. Optimised isolation method for RNA extraction suitable for RNA sequencing from feline teeth collected in a clinical setting and at post mortem. Vet Res Commun 2018; 43:17-27. [PMID: 30402716 DOI: 10.1007/s11259-018-9739-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 10/26/2018] [Indexed: 01/28/2023]
Abstract
Advanced next generation sequencing approaches have started to reveal the cellular and molecular complexity of the microenvironment in many tissues. It is challenging to obtain high quality RNA from mineralised tissues. We developed an optimised method of RNA extraction from feline teeth collected in a clinical setting and at post mortem. Teeth were homogenised in phenol-guanidinium solution at near-freezing temperatures and followed by solid-phase nucleic acid extraction utilising a commercially available kit. This method produced good RNA yields and improved RNA quality based on RNA integrity numbers equivalent (RINe) from an average of 3.6 to 5.6. No correlation was found between RNA purity parameters measured by A260:280 or A230:260 ratios and degree of RNA degradation. This implies that RNA purity indicators cannot be reliably used as parameters of RNA integrity. Two reference genes (GAPDH, RPS19) showed significant changes in expression levels by qPCR at low and moderate RINe values, while RPL17 was stable at all RINe values tested. Furthermore, we investigated the effect of quantity and quality of RNA on the quality of the resultant RNA sequencing (RNA-Seq) data. Thirteen RNA-seq data showed similar duplication and mapping rates (94 to 95%) against the feline genome regardless of RINe values. However one low yield sample with a high RINe value showed a high duplication rate and it was an outlier on the RNA-seq multidimensional scaling plot. We conclude that the overall yield of RNA was more important than quality of RNA for RNA-seq quality control. These results will guide researchers who wish to perform RNA extractions from mineralised tissues, especially if collecting in a clinical setting with the recognised restraints that this imposes.
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Affiliation(s)
- S Lee
- The Royal (Dick) School of Veterinary Studies and the Roslin Institute, The University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, UK.
| | - U Trivedi
- Edinburgh Genomics, The University of Edinburgh, Charlotte Auerbach Road, Edinburgh, EH9 3FL, UK
| | - C Johnson
- Centre for Applied Anatomy, University of Bristol, Southwell Street, Bristol, BS2 8EJ, UK
| | - C Farquharson
- The Royal (Dick) School of Veterinary Studies and the Roslin Institute, The University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - G T Bergkvist
- The Royal (Dick) School of Veterinary Studies and the Roslin Institute, The University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, UK
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D’Auria F, Myat A, Trivedi U, Hildick-Smith D. RF82 TEN YEARS UNITED KINGDOM EXPERIENCE IN SURVIVAL FOR SURGICAL TAVI APPROACHES. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549970.90657.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Rahman MS, Cockburn J, Trivedi U, Hildick-Smith D. Transcatheter aortic valve-in-valve treatment in prior Sorin Freedom Solo valve. EUROINTERVENTION 2018; 14:e280-e281. [PMID: 29235435 DOI: 10.4244/eij-d-17-00850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cockburn J, Hildick-Smith DJ, Trivedi U, de Belder AJ. Re: A case for palliative percutaneous coronary intervention. Heart 2017; 103:967. [PMID: 28566519 DOI: 10.1136/heartjnl-2017-311293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- James Cockburn
- Department of Cardiology, Sussex Cardiac Centre, Brighton, UK
| | | | - Uday Trivedi
- Department of Cardiothoracic Surgery, Royal Sussex County Hospital, Brighton, UK
| | - Adam J de Belder
- Department of Cardiothoracic Surgery, Royal Sussex County Hospital, Brighton, UK
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Rampat R, Khawaja MZ, Hilling-Smith R, Byrne J, MacCarthy P, Blackman DJ, Krishnamurthy A, Gunarathne A, Kovac J, Banning A, Kharbanda R, Firoozi S, Brecker S, Redwood S, Bapat V, Mullen M, Aggarwal S, Manoharan G, Spence MS, Khogali S, Dooley M, Cockburn J, de Belder A, Trivedi U, Hildick-Smith D. Conduction Abnormalities and Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement Using the Repositionable LOTUS Device. JACC Cardiovasc Interv 2017. [DOI: 10.1016/j.jcin.2017.03.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Martin GP, Sperrin M, Ludman PF, de Belder MA, Gale CP, Toff WD, Moat NE, Trivedi U, Buchan I, Mamas MA. Inadequacy of existing clinical prediction models for predicting mortality after transcatheter aortic valve implantation. Am Heart J 2017; 184:97-105. [PMID: 28224933 PMCID: PMC5333927 DOI: 10.1016/j.ahj.2016.10.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/27/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND The performance of emerging transcatheter aortic valve implantation (TAVI) clinical prediction models (CPMs) in national TAVI cohorts distinct from those where they have been derived is unknown. This study aimed to investigate the performance of the German Aortic Valve, FRANCE-2, OBSERVANT and American College of Cardiology (ACC) TAVI CPMs compared with the performance of historic cardiac CPMs such as the EuroSCORE and STS-PROM, in a large national TAVI registry. METHODS The calibration and discrimination of each CPM were analyzed in 6676 patients from the UK TAVI registry, as a whole cohort and across several subgroups. Strata included gender, diabetes status, access route, and valve type. Furthermore, the amount of agreement in risk classification between each of the considered CPMs was analyzed at an individual patient level. RESULTS The observed 30-day mortality rate was 5.4%. In the whole cohort, the majority of CPMs over-estimated the risk of 30-day mortality, although the mean ACC score (5.2%) approximately matched the observed mortality rate. The areas under ROC curve were between 0.57 for OBSERVANT and 0.64 for ACC. Risk classification agreement was low across all models, with Fleiss's kappa values between 0.17 and 0.50. CONCLUSIONS Although the FRANCE-2 and ACC models outperformed all other CPMs, the performance of current TAVI-CPMs was low when applied to an independent cohort of TAVI patients. Hence, TAVI specific CPMs need to be derived outside populations previously used for model derivation, either by adapting existing CPMs or developing new risk scores in large national registries.
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Mäkikallio T, Holm NR, Lindsay M, Spence MS, Erglis A, Menown IBA, Trovik T, Eskola M, Romppanen H, Kellerth T, Ravkilde J, Jensen LO, Kalinauskas G, Linder RBA, Pentikainen M, Hervold A, Banning A, Zaman A, Cotton J, Eriksen E, Margus S, Sørensen HT, Nielsen PH, Niemelä M, Kervinen K, Lassen JF, Maeng M, Oldroyd K, Berg G, Walsh SJ, Hanratty CG, Kumsars I, Stradins P, Steigen TK, Fröbert O, Graham ANJ, Endresen PC, Corbascio M, Kajander O, Trivedi U, Hartikainen J, Anttila V, Hildick-Smith D, Thuesen L, Christiansen EH. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet 2016; 388:2743-2752. [PMID: 27810312 DOI: 10.1016/s0140-6736(16)32052-9] [Citation(s) in RCA: 525] [Impact Index Per Article: 65.6] [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: 09/19/2016] [Revised: 10/06/2016] [Accepted: 10/06/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) is the standard treatment for revascularisation in patients with left main coronary artery disease, but use of percutaneous coronary intervention (PCI) for this indication is increasing. We aimed to compare PCI and CABG for treatment of left main coronary artery disease. METHODS In this prospective, randomised, open-label, non-inferiority trial, patients with left main coronary artery disease were enrolled in 36 centres in northern Europe and randomised 1:1 to treatment with PCI or CABG. Eligible patients had stable angina pectoris, unstable angina pectoris, or non-ST-elevation myocardial infarction. Exclusion criteria were ST-elevation myocardial infarction within 24 h, being considered too high risk for CABG or PCI, or expected survival of less than 1 year. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCE), a composite of all-cause mortality, non-procedural myocardial infarction, any repeat coronary revascularisation, and stroke. Non-inferiority of PCI to CABG required the lower end of the 95% CI not to exceed a hazard ratio (HR) of 1·35 after up to 5 years of follow-up. The intention-to-treat principle was used in the analysis if not specified otherwise. This trial is registered with ClinicalTrials.gov identifier, number NCT01496651. FINDINGS Between Dec 9, 2008, and Jan 21, 2015, 1201 patients were randomly assigned, 598 to PCI and 603 to CABG, and 592 in each group entered analysis by intention to treat. Kaplan-Meier 5 year estimates of MACCE were 29% for PCI (121 events) and 19% for CABG (81 events), HR 1·48 (95% CI 1·11-1·96), exceeding the limit for non-inferiority, and CABG was significantly better than PCI (p=0·0066). As-treated estimates were 28% versus 19% (1·55, 1·18-2·04, p=0·0015). Comparing PCI with CABG, 5 year estimates were 12% versus 9% (1·07, 0·67-1·72, p=0·77) for all-cause mortality, 7% versus 2% (2·88, 1·40-5·90, p=0·0040) for non-procedural myocardial infarction, 16% versus 10% (1·50, 1·04-2·17, p=0·032) for any revascularisation, and 5% versus 2% (2·25, 0·93-5·48, p=0·073) for stroke. INTERPRETATION The findings of this study suggest that CABG might be better than PCI for treatment of left main stem coronary artery disease. FUNDING Biosensors, Aarhus University Hospital, and participating sites.
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Affiliation(s)
- Timo Mäkikallio
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Mitchell Lindsay
- Department of Cardiology, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Mark S Spence
- Belfast Heart Centre, Belfast Trust, Belfast, Northern Ireland
| | - Andrejs Erglis
- Latvia Centre of Cardiology, Paul Stradins Clinical Hospital, Riga, Latvia
| | | | - Thor Trovik
- Department of Cardiology, University of Northern Norway, Tromsø, Norway
| | - Markku Eskola
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | | | - Thomas Kellerth
- Department of Cardiology, Örebro University Hospital, Örebro, Sweden
| | - Jan Ravkilde
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | | | | | - Anders Hervold
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Azfar Zaman
- Department of Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle, UK
| | - Jamen Cotton
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
| | - Erlend Eriksen
- Department of Cardiology, Haukeland University Hospital, Bergen, Norway
| | - Sulev Margus
- Department of Cardiology, East Tallinn Hospital, Tallinn, Estonia
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA, USA
| | - Per H Nielsen
- Department of Cardiac Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Matti Niemelä
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Kari Kervinen
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Jens F Lassen
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Keith Oldroyd
- Department of Cardiology, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Geoff Berg
- Department of Cardiology, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Simon J Walsh
- Belfast Heart Centre, Belfast Trust, Belfast, Northern Ireland
| | - Colm G Hanratty
- Belfast Heart Centre, Belfast Trust, Belfast, Northern Ireland
| | - Indulis Kumsars
- Latvia Centre of Cardiology, Paul Stradins Clinical Hospital, Riga, Latvia
| | - Peteris Stradins
- Latvia Centre of Cardiology, Paul Stradins Clinical Hospital, Riga, Latvia
| | - Terje K Steigen
- Department of Cardiology, University of Northern Norway, Tromsø, Norway
| | - Ole Fröbert
- Department of Cardiology, Örebro University Hospital, Örebro, Sweden
| | | | - Petter C Endresen
- Department of Cardiovascular Surgery, University of Northern Norway, Tromsø, Norway
| | - Matthias Corbascio
- Department of Cardiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Olli Kajander
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospital, Brighton, UK
| | | | - Vesa Anttila
- Department of Cardiac Surgery, Oulu University Hospital, Finland
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospital, Brighton, UK
| | - Leif Thuesen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Hilling-Smith R, Cockburn J, Dooley M, Parker J, Newton A, Hill A, Trivedi U, de Belder A, Hildick-Smith D. Rapid pacing using the 0.035-in. Retrograde left ventricular support wire in 208 cases of transcatheter aortic valve implantation and balloon aortic valvuloplasty. Catheter Cardiovasc Interv 2016; 89:783-786. [DOI: 10.1002/ccd.26720] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 07/18/2016] [Accepted: 07/21/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Roland Hilling-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Royal Sussex County Hospital; Brighton BN2 5BE England, United Kingdom
| | - James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Royal Sussex County Hospital; Brighton BN2 5BE England, United Kingdom
| | - Maureen Dooley
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Royal Sussex County Hospital; Brighton BN2 5BE England, United Kingdom
| | - Jessica Parker
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Royal Sussex County Hospital; Brighton BN2 5BE England, United Kingdom
| | - Andrea Newton
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Royal Sussex County Hospital; Brighton BN2 5BE England, United Kingdom
| | - Andrew Hill
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Royal Sussex County Hospital; Brighton BN2 5BE England, United Kingdom
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Royal Sussex County Hospital; Brighton BN2 5BE England, United Kingdom
| | - Adam de Belder
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Royal Sussex County Hospital; Brighton BN2 5BE England, United Kingdom
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Royal Sussex County Hospital; Brighton BN2 5BE England, United Kingdom
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36
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Affiliation(s)
- James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Adam de Belder
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Kouerinis IA, Benjamin M, Karathanasis I, Peskesis G, Kantsos C, Sarri G, Karagkiouzis G, Trivedi U. Ectatic-Fistulous Coronary Artery Lesion: A Newly Proposed Nomenclature. Int Cardiovasc Res J 2016. [DOI: 10.17795/icrj-10(03)143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Cockburn J, Dooley M, Parker J, Hill A, Hutchinson N, de Belder A, Trivedi U, Hildick-Smith D. Transcatheter aortic valve-in-valve treatment of degenerative stentless supra-annular Freedom Solo valves: A single centre experience. Catheter Cardiovasc Interv 2016; 89:438-444. [DOI: 10.1002/ccd.26623] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/20/2016] [Accepted: 05/23/2016] [Indexed: 11/10/2022]
Affiliation(s)
- James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospital, Eastern Road; Brighton, BN2 5BE UK
| | - Maureen Dooley
- Sussex Cardiac Centre, Brighton and Sussex University Hospital, Eastern Road; Brighton, BN2 5BE UK
| | - Jessica Parker
- Sussex Cardiac Centre, Brighton and Sussex University Hospital, Eastern Road; Brighton, BN2 5BE UK
| | - Andrew Hill
- Sussex Cardiac Centre, Brighton and Sussex University Hospital, Eastern Road; Brighton, BN2 5BE UK
| | - Nevil Hutchinson
- Sussex Cardiac Centre, Brighton and Sussex University Hospital, Eastern Road; Brighton, BN2 5BE UK
| | - Adam de Belder
- Sussex Cardiac Centre, Brighton and Sussex University Hospital, Eastern Road; Brighton, BN2 5BE UK
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospital, Eastern Road; Brighton, BN2 5BE UK
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospital, Eastern Road; Brighton, BN2 5BE UK
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39
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Bapat VN, Lim ZY, Laine M, Lange R, Bleiziffer S, Trivedi U, Hildick-Smith D, Gotberg M, Modine T, Luckraz H, Khogali S, Schofer J, Allocco D, Redwood S. FEASIBILITY OF DIRECT AORTIC IMPLANTATION OF THE LOTUS VALVE: A MULTICENTER EXPERIENCE. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32164-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cockburn J, Dooley M, de Belder A, Trivedi U, Hildick-Smith D. A comparison between surgical risk scores for predicting outcome in patients undergoing transcatheter aortic valve implantation. J Cardiovasc Surg (Torino) 2016; 58:467-472. [PMID: 26981704 DOI: 10.23736/s0021-9509.16.09339-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Surgical risk scoring systems are of modest value in predicting outcome following transcatheter aortic valve implantation (TAVI). There is no consensus as to which scoring system is the most useful. We examined the efficacy of all four currently available global scorings systems (Additive EuroScore [aES], Logistic EuroScore [LES], EuroScore II [ES II], Society of Thoracic Surgeons [STS] Score) in predicting outcome, both in the short (30 day) and longer term, in patients undergoing TAVI. METHODS Additive EuroScore (aES), Logistic EuroScore (LES), EuroScore II (ES II), and Society of Thoracic Surgeons (STS) score were assessed in 312 consecutive TAVI patients. Mortality tracking was obtained from the Office of National Statistics as of May 2014. RESULTS Mean age was 81.2±7.0 years; 53.2% were male. Mean aES, LES, ESII and STS were 9.7±1.9, 17.4±9.4, 6.1±4.3 and 4.6±2.8, respectively. Thirty-day mortality was 4.8%; long-term mortality (maximum 5.8 years, mean 2.2±1.5 years) was 25.3%. Using both univariate and multivariate modelling all four scoring systems failed to predict outcomes in the short term. In the longer term, univariable analysis demonstrated that higher aES and LES scores were associated with higher mortality (aES P=0.0048, LES P=0.054, respectively). After multivariable analysis, only higher aES remained significant. CONCLUSIONS Surgical risk scores are poor at predicting outcomes in patients undergoing TAVI, particularly in the short term.
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Affiliation(s)
- James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK -
| | - Maureen Dooley
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Adam de Belder
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Rampat R, Khawaja MZ, Byrne J, MacCarthy P, Blackman DJ, Krishnamurthy A, Gunarathne A, Kovac J, Banning A, Kharbanda R, Firoozi S, Brecker S, Redwood S, Bapat V, Mullen M, Aggarwal S, Manoharan G, Spence MS, Khogali S, Dooley M, Cockburn J, de Belder A, Trivedi U, Hildick-Smith D. Transcatheter Aortic Valve Replacement Using the Repositionable LOTUS Valve. JACC Cardiovasc Interv 2016; 9:367-372. [DOI: 10.1016/j.jcin.2015.12.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/24/2015] [Accepted: 12/03/2015] [Indexed: 02/07/2023]
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Fröhlich GM, Baxter PD, Malkin CJ, Scott DJA, Moat NE, Hildick-Smith D, Cunningham D, MacCarthy PA, Trivedi U, de Belder MA, Ludman PF, Blackman DJ. Comparative survival after transapical, direct aortic, and subclavian transcatheter aortic valve implantation (data from the UK TAVI registry). Am J Cardiol 2015; 116:1555-9. [PMID: 26409640 DOI: 10.1016/j.amjcard.2015.08.035] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [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: 06/10/2015] [Revised: 08/04/2015] [Accepted: 08/04/2015] [Indexed: 12/20/2022]
Abstract
Many patients have iliofemoral vessel anatomy unsuitable for conventional transfemoral (TF) transcatheter aortic valve implantation (TAVI). Safe and practical alternatives to the TF approach are, therefore, needed. This study compared outcomes of alternative nonfemoral routes, transapical (TA), direct aortic (DA), and subclavian (SC), with standard femoral access. In this retrospective study, data from 3,962 patients in the UK TAVI registry were analyzed. All patients who received TAVI through a femoral, subclavian, TA, or DA approach were eligible for inclusion. The primary outcome measure was survival up to 2 years. Median Logistic EuroSCORE was similar for SC, DA, and TA but significantly lower in the TF cohort (22.1% vs 20.3% vs 21.2% vs 17.0%, respectively, p <0.0001). Estimated 1-year survival rate was similar for TF (84.6 ± 0.7%) and SC (80.5 ± 3%, p = 0.27) but significantly worse for TA (74.7 ± 1.6%, p <0.001) and DA (75.2 ± 3.3%, p <0.001). A Cox proportional hazard model was used to analyze survival up to 2 years. Survival in the SC group was not significantly different from the TF group (hazard ratio [HR] 1.22, 95% confidence interval [CI] 0.88 to 1.70, p = 0.24). In contrast, survival in the TA (HR 1.74, 95% CI 1.43 to 2.11; p <0.001) and DA (HR 1.55, 95% CI 1.13 to 2.14; p <0.01) cohorts was significantly reduced compared with TF. In conclusion, TA and DA TAVI were associated with similar survival, both significantly worse than with the TF route. In contrast, subclavian access was not significantly different from TF and may represent the safest nonfemoral access route for TAVI.
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Affiliation(s)
- Georg M Fröhlich
- Department of Cardiology, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Paul D Baxter
- Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, United Kingdom
| | | | - D Julian A Scott
- Department of Vascular Surgery, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Neil E Moat
- Department of Cardiac Surgery, Royal Brompton Hospital, London, United Kingdom
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - David Cunningham
- National Institute for Cardiovascular Outcomes Research, University College London, London, United Kingdom
| | - Philip A MacCarthy
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Mark A de Belder
- Department of Cardiology, James Cook University Hospital, Middlesborough, United Kingdom
| | - Peter F Ludman
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Daniel J Blackman
- Department of Cardiology, Leeds Teaching Hospitals, Leeds, United Kingdom.
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Cockburn J, Singh MS, Rafi NHM, Dooley M, Hutchinson N, Hill A, Trivedi U, de Belder A, Hildick-Smith D. Poor mobility predicts adverse outcome better than other frailty indices in patients undergoing transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2015; 86:1271-7. [PMID: 26119601 DOI: 10.1002/ccd.25991] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 04/04/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Surgical risk scoring systems are poor at predicting outcome in patients undergoing transcatheter aortic valve implantation (TAVI). Frailty indices might more accurately predict outcome. AIMS To examine multiple frailty indices as markers of performance to see whether they predict outcomes both in the shorter (30 days) and longer terms (5 years) in patients who have undergone TAVI. METHODS Frailty indices (Mobility; Brighton Mobility Index, New York Heart Association (NYHA), Karnofsky Performance Index, Canadian Study Health Association (CSHA) clinical frailty scale, and Katz Index of Dependence) were assessed in 312 consecutive TAVI patients. Mortality tracking was obtained from the Office of National Statistics as of May 2014. RESULTS Mean age was 81.2 ± 7.0 years; 53.2% were male. Mean Logistic EuroSCORE and STS were 17.4 ± 9.4 and 4.6 ± 2.8, respectively. Mean peak aortic valve gradient and aortic valve area were 79.1 ± 28.0 mm Hg and 0.72 ± 0.25 cm(2) , respectively. 30-day mortality was 4.8%; long-term mortality (maximum 5.8 years, mean 2.2 ± 1.5 years) was 25.3%. Both univariate and multivariate analyses confirmed poor mobility (defined as severe impairment of mobility secondary to musculoskeletal or neurological dysfunction (Euroscore II risk)), as the best predictor of adverse outcome over both the short-term (OR 4.03, 95% CI (1.36-11.96), P = 0.012 (30 days)) and longer term (OR 2.15, 95% CI (1.33-3.48), P = 0.002, (2.2 ± 1.5 years.)). CONCLUSION Poor mobility predicts worse survival among patients undergoing TAVI, both in the shorter and longer terms. Our data suggest that mobility impairment, of either neurological or musculoskeletal etiology, is an appropriate screening measure when considering patients for TAVI.
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Affiliation(s)
- James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Meera Sundar Singh
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Nur Hanis Mohammed Rafi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Maureen Dooley
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Nevil Hutchinson
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Andrew Hill
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Adam de Belder
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
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Chue CD, Ferro CJ, de Belder MA, Moat NE, Wendler O, Trivedi U, Ludman PF, Townend JN. IMPACT OF RENAL FUNCTION ON SURVIVAL AFTER TRANS-CATHETER AORTIC VALVE IMPLANTATION: AN ANALYSIS OF THE UNITED KINGDOM REGISTRY. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61713-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bapat V, Ihlberg L, Lim ZY, Hildick-Smith D, Bleiziffer S, Khogali S, Laine M, Lange R, Trivedi U, Luckraz H, Redwood S. CRT-839 Transaortic Transcatheter Aortic Valve Implantation of Lotus valve: First in man multicenter experience. JACC Cardiovasc Interv 2015. [DOI: 10.1016/j.jcin.2014.12.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ludman PF, Moat N, de Belder MA, Blackman DJ, Duncan A, Banya W, MacCarthy PA, Cunningham D, Wendler O, Marlee D, Hildick-Smith D, Young CP, Kovac J, Uren NG, Spyt T, Trivedi U, Howell J, Gray H. Transcatheter aortic valve implantation in the United Kingdom: temporal trends, predictors of outcome, and 6-year follow-up: a report from the UK Transcatheter Aortic Valve Implantation (TAVI) Registry, 2007 to 2012. Circulation 2015; 131:1181-90. [PMID: 25637628 DOI: 10.1161/circulationaha.114.013947] [Citation(s) in RCA: 232] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND We assessed trends in the performance of transcatheter aortic valve implantation in the United Kingdom from the first case in 2007 to the end of 2012. We analyzed changes in case mix, complications, outcomes to 6 years, and predictors of mortality. METHODS AND RESULTS Annual cohorts were examined. Mortality outcomes were analyzed in the 92% of patients from England and Wales for whom independent mortality tracking was available. A total of 3980 transcatheter aortic valve implantation procedures were performed. In successive years, there was an increase in frequency of impaired left ventricular function, but there was no change in Logistic EuroSCORE. Overall 30-day mortality was 6.3%; it was highest in the first cohort (2007-2008), after which there were no further significant changes. One-year survival was 81.7%, falling to 37.3% at 6 years. Discharge by day 5 rose from 16.7% in 2007 and 2008 to 28% in 2012. The only multivariate preprocedural predictor of 30-day mortality was Logistic EuroSCORE ≥40. During long-term follow-up, multivariate predictors of mortality were preprocedural atrial fibrillation, chronic obstructive pulmonary disease, creatinine >200 μmol/L, diabetes mellitus, and coronary artery disease. The strongest independent procedural predictor of long-term mortality was periprocedural stroke (hazard ratio=3.00; P<0.0001). Nonfemoral access and postprocedural aortic regurgitation were also significant predictors of adverse outcome. CONCLUSIONS We analyzed transcatheter aortic valve implantation in an entire country, with follow-up over 6 years. Although clinical profiles of enrolled patients remained unchanged, longer-term outcomes improved, and patients were discharged earlier. Periprocedural stroke, nonfemoral access, and postprocedural aortic regurgitation are predictors of adverse outcome, along with intrinsic patient risk factors.
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Affiliation(s)
- Peter F Ludman
- From Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); Royal Brompton and Harefield Hospital, London, UK (N.M., A.D.); James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Leeds Teaching Hospitals, Leeds, UK (D.J.B.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK (W.B.); Kings College Hospital, London, UK (P.A.M., O.W.); National Institute for Cardiovascular Outcome Research, London, UK (D.C., D.M.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (D.H.-S., U.T.); St. Thomas's Hospital, London, UK (C.P.Y.); Leicester Cardiovascular Biomedical Research Unit, University Hospital NHS Trust, Leicester, UK (J.K., T.S.); Royal Infirmary of Edinburgh, Edinburgh, UK (N.G.U.); West Midlands Public Health England Centre, Birmingham, UK (J.H.); and University Hospital Southampton, Southampton, UK (H.G.)
| | - Neil Moat
- From Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); Royal Brompton and Harefield Hospital, London, UK (N.M., A.D.); James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Leeds Teaching Hospitals, Leeds, UK (D.J.B.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK (W.B.); Kings College Hospital, London, UK (P.A.M., O.W.); National Institute for Cardiovascular Outcome Research, London, UK (D.C., D.M.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (D.H.-S., U.T.); St. Thomas's Hospital, London, UK (C.P.Y.); Leicester Cardiovascular Biomedical Research Unit, University Hospital NHS Trust, Leicester, UK (J.K., T.S.); Royal Infirmary of Edinburgh, Edinburgh, UK (N.G.U.); West Midlands Public Health England Centre, Birmingham, UK (J.H.); and University Hospital Southampton, Southampton, UK (H.G.)
| | - Mark A de Belder
- From Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); Royal Brompton and Harefield Hospital, London, UK (N.M., A.D.); James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Leeds Teaching Hospitals, Leeds, UK (D.J.B.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK (W.B.); Kings College Hospital, London, UK (P.A.M., O.W.); National Institute for Cardiovascular Outcome Research, London, UK (D.C., D.M.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (D.H.-S., U.T.); St. Thomas's Hospital, London, UK (C.P.Y.); Leicester Cardiovascular Biomedical Research Unit, University Hospital NHS Trust, Leicester, UK (J.K., T.S.); Royal Infirmary of Edinburgh, Edinburgh, UK (N.G.U.); West Midlands Public Health England Centre, Birmingham, UK (J.H.); and University Hospital Southampton, Southampton, UK (H.G.)
| | - Daniel J Blackman
- From Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); Royal Brompton and Harefield Hospital, London, UK (N.M., A.D.); James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Leeds Teaching Hospitals, Leeds, UK (D.J.B.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK (W.B.); Kings College Hospital, London, UK (P.A.M., O.W.); National Institute for Cardiovascular Outcome Research, London, UK (D.C., D.M.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (D.H.-S., U.T.); St. Thomas's Hospital, London, UK (C.P.Y.); Leicester Cardiovascular Biomedical Research Unit, University Hospital NHS Trust, Leicester, UK (J.K., T.S.); Royal Infirmary of Edinburgh, Edinburgh, UK (N.G.U.); West Midlands Public Health England Centre, Birmingham, UK (J.H.); and University Hospital Southampton, Southampton, UK (H.G.)
| | - Alison Duncan
- From Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); Royal Brompton and Harefield Hospital, London, UK (N.M., A.D.); James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Leeds Teaching Hospitals, Leeds, UK (D.J.B.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK (W.B.); Kings College Hospital, London, UK (P.A.M., O.W.); National Institute for Cardiovascular Outcome Research, London, UK (D.C., D.M.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (D.H.-S., U.T.); St. Thomas's Hospital, London, UK (C.P.Y.); Leicester Cardiovascular Biomedical Research Unit, University Hospital NHS Trust, Leicester, UK (J.K., T.S.); Royal Infirmary of Edinburgh, Edinburgh, UK (N.G.U.); West Midlands Public Health England Centre, Birmingham, UK (J.H.); and University Hospital Southampton, Southampton, UK (H.G.)
| | - Winston Banya
- From Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); Royal Brompton and Harefield Hospital, London, UK (N.M., A.D.); James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Leeds Teaching Hospitals, Leeds, UK (D.J.B.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK (W.B.); Kings College Hospital, London, UK (P.A.M., O.W.); National Institute for Cardiovascular Outcome Research, London, UK (D.C., D.M.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (D.H.-S., U.T.); St. Thomas's Hospital, London, UK (C.P.Y.); Leicester Cardiovascular Biomedical Research Unit, University Hospital NHS Trust, Leicester, UK (J.K., T.S.); Royal Infirmary of Edinburgh, Edinburgh, UK (N.G.U.); West Midlands Public Health England Centre, Birmingham, UK (J.H.); and University Hospital Southampton, Southampton, UK (H.G.)
| | - Philip A MacCarthy
- From Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); Royal Brompton and Harefield Hospital, London, UK (N.M., A.D.); James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Leeds Teaching Hospitals, Leeds, UK (D.J.B.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK (W.B.); Kings College Hospital, London, UK (P.A.M., O.W.); National Institute for Cardiovascular Outcome Research, London, UK (D.C., D.M.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (D.H.-S., U.T.); St. Thomas's Hospital, London, UK (C.P.Y.); Leicester Cardiovascular Biomedical Research Unit, University Hospital NHS Trust, Leicester, UK (J.K., T.S.); Royal Infirmary of Edinburgh, Edinburgh, UK (N.G.U.); West Midlands Public Health England Centre, Birmingham, UK (J.H.); and University Hospital Southampton, Southampton, UK (H.G.)
| | - David Cunningham
- From Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); Royal Brompton and Harefield Hospital, London, UK (N.M., A.D.); James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Leeds Teaching Hospitals, Leeds, UK (D.J.B.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK (W.B.); Kings College Hospital, London, UK (P.A.M., O.W.); National Institute for Cardiovascular Outcome Research, London, UK (D.C., D.M.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (D.H.-S., U.T.); St. Thomas's Hospital, London, UK (C.P.Y.); Leicester Cardiovascular Biomedical Research Unit, University Hospital NHS Trust, Leicester, UK (J.K., T.S.); Royal Infirmary of Edinburgh, Edinburgh, UK (N.G.U.); West Midlands Public Health England Centre, Birmingham, UK (J.H.); and University Hospital Southampton, Southampton, UK (H.G.)
| | - Olaf Wendler
- From Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); Royal Brompton and Harefield Hospital, London, UK (N.M., A.D.); James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Leeds Teaching Hospitals, Leeds, UK (D.J.B.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK (W.B.); Kings College Hospital, London, UK (P.A.M., O.W.); National Institute for Cardiovascular Outcome Research, London, UK (D.C., D.M.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (D.H.-S., U.T.); St. Thomas's Hospital, London, UK (C.P.Y.); Leicester Cardiovascular Biomedical Research Unit, University Hospital NHS Trust, Leicester, UK (J.K., T.S.); Royal Infirmary of Edinburgh, Edinburgh, UK (N.G.U.); West Midlands Public Health England Centre, Birmingham, UK (J.H.); and University Hospital Southampton, Southampton, UK (H.G.)
| | - Damian Marlee
- From Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); Royal Brompton and Harefield Hospital, London, UK (N.M., A.D.); James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Leeds Teaching Hospitals, Leeds, UK (D.J.B.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK (W.B.); Kings College Hospital, London, UK (P.A.M., O.W.); National Institute for Cardiovascular Outcome Research, London, UK (D.C., D.M.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (D.H.-S., U.T.); St. Thomas's Hospital, London, UK (C.P.Y.); Leicester Cardiovascular Biomedical Research Unit, University Hospital NHS Trust, Leicester, UK (J.K., T.S.); Royal Infirmary of Edinburgh, Edinburgh, UK (N.G.U.); West Midlands Public Health England Centre, Birmingham, UK (J.H.); and University Hospital Southampton, Southampton, UK (H.G.)
| | - David Hildick-Smith
- From Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); Royal Brompton and Harefield Hospital, London, UK (N.M., A.D.); James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Leeds Teaching Hospitals, Leeds, UK (D.J.B.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK (W.B.); Kings College Hospital, London, UK (P.A.M., O.W.); National Institute for Cardiovascular Outcome Research, London, UK (D.C., D.M.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (D.H.-S., U.T.); St. Thomas's Hospital, London, UK (C.P.Y.); Leicester Cardiovascular Biomedical Research Unit, University Hospital NHS Trust, Leicester, UK (J.K., T.S.); Royal Infirmary of Edinburgh, Edinburgh, UK (N.G.U.); West Midlands Public Health England Centre, Birmingham, UK (J.H.); and University Hospital Southampton, Southampton, UK (H.G.)
| | - Christopher P Young
- From Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); Royal Brompton and Harefield Hospital, London, UK (N.M., A.D.); James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Leeds Teaching Hospitals, Leeds, UK (D.J.B.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK (W.B.); Kings College Hospital, London, UK (P.A.M., O.W.); National Institute for Cardiovascular Outcome Research, London, UK (D.C., D.M.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (D.H.-S., U.T.); St. Thomas's Hospital, London, UK (C.P.Y.); Leicester Cardiovascular Biomedical Research Unit, University Hospital NHS Trust, Leicester, UK (J.K., T.S.); Royal Infirmary of Edinburgh, Edinburgh, UK (N.G.U.); West Midlands Public Health England Centre, Birmingham, UK (J.H.); and University Hospital Southampton, Southampton, UK (H.G.)
| | - Jan Kovac
- From Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); Royal Brompton and Harefield Hospital, London, UK (N.M., A.D.); James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Leeds Teaching Hospitals, Leeds, UK (D.J.B.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK (W.B.); Kings College Hospital, London, UK (P.A.M., O.W.); National Institute for Cardiovascular Outcome Research, London, UK (D.C., D.M.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (D.H.-S., U.T.); St. Thomas's Hospital, London, UK (C.P.Y.); Leicester Cardiovascular Biomedical Research Unit, University Hospital NHS Trust, Leicester, UK (J.K., T.S.); Royal Infirmary of Edinburgh, Edinburgh, UK (N.G.U.); West Midlands Public Health England Centre, Birmingham, UK (J.H.); and University Hospital Southampton, Southampton, UK (H.G.)
| | - Neal G Uren
- From Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); Royal Brompton and Harefield Hospital, London, UK (N.M., A.D.); James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Leeds Teaching Hospitals, Leeds, UK (D.J.B.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK (W.B.); Kings College Hospital, London, UK (P.A.M., O.W.); National Institute for Cardiovascular Outcome Research, London, UK (D.C., D.M.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (D.H.-S., U.T.); St. Thomas's Hospital, London, UK (C.P.Y.); Leicester Cardiovascular Biomedical Research Unit, University Hospital NHS Trust, Leicester, UK (J.K., T.S.); Royal Infirmary of Edinburgh, Edinburgh, UK (N.G.U.); West Midlands Public Health England Centre, Birmingham, UK (J.H.); and University Hospital Southampton, Southampton, UK (H.G.)
| | - Tomasz Spyt
- From Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); Royal Brompton and Harefield Hospital, London, UK (N.M., A.D.); James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Leeds Teaching Hospitals, Leeds, UK (D.J.B.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK (W.B.); Kings College Hospital, London, UK (P.A.M., O.W.); National Institute for Cardiovascular Outcome Research, London, UK (D.C., D.M.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (D.H.-S., U.T.); St. Thomas's Hospital, London, UK (C.P.Y.); Leicester Cardiovascular Biomedical Research Unit, University Hospital NHS Trust, Leicester, UK (J.K., T.S.); Royal Infirmary of Edinburgh, Edinburgh, UK (N.G.U.); West Midlands Public Health England Centre, Birmingham, UK (J.H.); and University Hospital Southampton, Southampton, UK (H.G.)
| | - Uday Trivedi
- From Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); Royal Brompton and Harefield Hospital, London, UK (N.M., A.D.); James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Leeds Teaching Hospitals, Leeds, UK (D.J.B.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK (W.B.); Kings College Hospital, London, UK (P.A.M., O.W.); National Institute for Cardiovascular Outcome Research, London, UK (D.C., D.M.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (D.H.-S., U.T.); St. Thomas's Hospital, London, UK (C.P.Y.); Leicester Cardiovascular Biomedical Research Unit, University Hospital NHS Trust, Leicester, UK (J.K., T.S.); Royal Infirmary of Edinburgh, Edinburgh, UK (N.G.U.); West Midlands Public Health England Centre, Birmingham, UK (J.H.); and University Hospital Southampton, Southampton, UK (H.G.)
| | - Jonathan Howell
- From Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); Royal Brompton and Harefield Hospital, London, UK (N.M., A.D.); James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Leeds Teaching Hospitals, Leeds, UK (D.J.B.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK (W.B.); Kings College Hospital, London, UK (P.A.M., O.W.); National Institute for Cardiovascular Outcome Research, London, UK (D.C., D.M.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (D.H.-S., U.T.); St. Thomas's Hospital, London, UK (C.P.Y.); Leicester Cardiovascular Biomedical Research Unit, University Hospital NHS Trust, Leicester, UK (J.K., T.S.); Royal Infirmary of Edinburgh, Edinburgh, UK (N.G.U.); West Midlands Public Health England Centre, Birmingham, UK (J.H.); and University Hospital Southampton, Southampton, UK (H.G.)
| | - Huon Gray
- From Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); Royal Brompton and Harefield Hospital, London, UK (N.M., A.D.); James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Leeds Teaching Hospitals, Leeds, UK (D.J.B.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK (W.B.); Kings College Hospital, London, UK (P.A.M., O.W.); National Institute for Cardiovascular Outcome Research, London, UK (D.C., D.M.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (D.H.-S., U.T.); St. Thomas's Hospital, London, UK (C.P.Y.); Leicester Cardiovascular Biomedical Research Unit, University Hospital NHS Trust, Leicester, UK (J.K., T.S.); Royal Infirmary of Edinburgh, Edinburgh, UK (N.G.U.); West Midlands Public Health England Centre, Birmingham, UK (J.H.); and University Hospital Southampton, Southampton, UK (H.G.)
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Ferro CJ, Chue CD, de Belder MA, Moat N, Wendler O, Trivedi U, Ludman P, Townend JN. Impact of renal function on survival after transcatheter aortic valve implantation (TAVI): an analysis of the UK TAVI registry. Heart 2015; 101:546-52. [DOI: 10.1136/heartjnl-2014-307041] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wynne DG, Rampat R, Trivedi U, de Belder A, Hill A, Hutchinson N, Hildick-Smith D. Transradial Secondary Arterial Access for Transcatheter Aortic Valve Implantation: Experience and Limitations. Heart Lung Circ 2014; 24:682-5. [PMID: 25637250 DOI: 10.1016/j.hlc.2014.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 12/05/2014] [Accepted: 12/09/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The transradial approach limits vascular complications in coronary interventions. The same may be true for transcatheter aortic valve implantation (TAVI). We present our experience using secondary transradial arterial access. METHODS Secondary transradial arterial access has been our default strategy for TAVI since 2007. Procedural data is collected prospectively. We assessed procedural success and complications. RESULTS Data from 282 patients aged 81±5.2 yrs was examined. Secondary arterial access was transradial (74%), femoral (24%) and none (2%). Secondary femoral access was reserved for failed radial access (3%), anatomical anomalies (4%), operator preference (7%), trial requirements (6%) or proctor preference (4%). The principal pathology was aortic stenosis (90.8%), aortic regurgitation (6.7%) or a combination (2.5%). CoreValve (91.4%), Edwards (7%) or Lotus valves (1.7%) were delivered via transfemoral (88.6%), direct aortic (5.3%), subclavian (3.9%) or transapical approaches (1.8%). Significant vascular complications occurred in 25 cases (9.4%), including surgical repair of a failed percutaneous closure device (n=16), ilio-femoral dissection (n=3), iliac perforations (n=3), plaque disruption (n=1) and false aneurysm (n=2), one of which was from the secondary femoral access site. There was no local vascular complication from the secondary radial site. CONCLUSIONS The transradial secondary access route for TAVI is safe and effective. The transradial route may limit vascular access complications from secondary transfemoral access.
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Affiliation(s)
- Dylan G Wynne
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, East Sussex BN25BE, United Kingdom
| | - Rajiv Rampat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, East Sussex BN25BE, United Kingdom.
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, East Sussex BN25BE, United Kingdom
| | - Adam de Belder
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, East Sussex BN25BE, United Kingdom
| | - Andrew Hill
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, East Sussex BN25BE, United Kingdom
| | - Nevil Hutchinson
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, East Sussex BN25BE, United Kingdom
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, East Sussex BN25BE, United Kingdom
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Dworakowski R, Wendler O, Halliday B, Ludman P, DeBelder M, Ray S, Moat N, Kovac J, Spyt T, Trivedi U, Hildick-Smith D, Blackman D, Marlee D, Cunningham D, MacCarthy PA. Device-dependent association between paravalvar aortic regurgitation and outcome after TAVI. Heart 2014; 100:1939-45. [DOI: 10.1136/heartjnl-2013-305390] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Blackman DJ, Baxter PD, Gale CP, Moat NE, Maccarthy PA, Hildick-Smith D, Trivedi U, Cunningham D, DE Belder MA, Ludman PF. Do outcomes from transcatheter aortic valve implantation vary according to access route and valve type? The UK TAVI Registry. J Interv Cardiol 2013; 27:86-95. [PMID: 24373048 DOI: 10.1111/joic.12084] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To determine whether outcomes from transcatheter aortic valve implantation (TAVI) vary according to access route and valve type in a real-world population. BACKGROUND Registry and uncontrolled trial data have found that patients undergoing nonfemoral TAVI have higher early and late mortality. It is not clear whether worse outcomes relate directly to access route. There have been no direct comparisons of outcomes according to valve type. METHODS Data were collected prospectively on 1,620 patients undergoing TAVI in the UK and compared in 4 groups: SAPIEN transfemoral (TF); SAPIEN transapical (TA); CoreValve TF, CoreValve subclavian. Univariable and multivariable regression analysis was performed to identify independent predictors of mortality. RESULTS Mortality in patients undergoing SAPIEN TAVI via a TA approach was higher than with TF at 30 days (11.2% vs. 4.4%, P < 0.01), 1 year (28.7% vs. 18.1%, P = 0.01), and 2 years (56.0% vs. 43.5%, P = 0.01). Logistic EuroSCORE was higher in TA patients (22.5 ± 12.9% vs. 17.7 ± 11.1%, P < 0.0001). After multivariable analysis TA access was associated with increased mortality at 30 days (OR 2.56, 95% CI 1.46-4.48, P < 0.01) and 2 years (OR 1.75, 1.08-2.74, P = 0.02). There was no significant difference in mortality at any time-point between patients treated with SAPIEN (n = 812) and CoreValve (n = 808) prostheses. CoreValve-treated patients had a higher rate of permanent pacemaker implantation (23.1% vs. 7.2%, P < 0.0001), and grade ≥2 aortic regurgitation on postprocedure echocardiography (13.0% vs. 7.3%, P < 0.01). CONCLUSIONS Patients undergoing TA TAVI experienced increased early and late mortality compared to a TF approach. Survival was not influenced by valve type.
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