1
|
Outcomes of Concomitant Maze Procedure in Tricuspid Repair for Severe Tricuspid Regurgitation. J Korean Med Sci 2024; 39:e143. [PMID: 38651225 PMCID: PMC11035715 DOI: 10.3346/jkms.2024.39.e143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND We aimed to analyze the impact of concomitant Maze procedure on the clinical and rhythm outcomes, and echocardiographic parameters in tricuspid repair for patients with severe tricuspid regurgitation (TR) and persistent atrial fibrillation (AF). METHODS Patients who had severe TR and persistent AF and underwent tricuspid valve (TV) repair were included in the study. Both primary TR and secondary TR were included in the current study. The study population was stratified according to Maze procedure. The primary outcome was major adverse cardiovascular and cerebrovascular event (MACCE) at 15 years post-surgery. Propensity-score matching analyses was performed to adjust baseline differences. RESULTS Three hundred seventy-one patients who underwent tricuspid repair for severe TR and persistent AF from 1994 to 2021 were included, and 198 patients (53.4%) underwent concomitant Maze procedure. The maze group showed 10-year sinus rhythm (SR) restoration rate of 55%. In the matched cohort, the maze group showed a lower cumulative incidence of cardiac death (4.6% vs. 14.4%, P = 0.131), readmission for heart failure (8.1% vs. 22.2%, P = 0.073), and MACCE (21.1% vs. 42.1%, P = 0.029) at 15 years compared to the non-maze group. Left atrial (LA) diameter significantly decreased in the maze group at 5 years (53.3 vs. 59.6 mm, P < 0.001) after surgery compared to preoperative level, and there was a significant difference in the change of LA diameter over time between the two groups (P = 0.013). CONCLUSION The Maze procedure during TV repair in patients with severe TR and persistent AF showed acceptable SR rates and lower MACCE rates compared to those without the procedure, while also promoting LA reverse remodeling.
Collapse
|
2
|
Pericardial Window Operation in Oncology Patients: Analysis of Long-Term Survival and Prognostic Factors. J Chest Surg 2024; 57:169-177. [PMID: 38228497 DOI: 10.5090/jcs.23.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/25/2023] [Accepted: 11/28/2023] [Indexed: 01/18/2024] Open
Abstract
Background Pericardial effusion (PE) is a serious condition in cancer patients, primarily arising from malignant dissemination. Pericardial window formation is a surgical intervention for refractory PE. However, the long-term outcomes and factors associated with postoperative survival remain unclear. Methods We retrospectively analyzed data from 166 oncology patients who underwent pericardial window formation at Samsung Medical Center between 2011 and 2023. We analyzed survival and PE recurrence regarding surgical approach, cancer type, and cytopathological findings. To identify factors associated with survival, we utilized Cox proportional-hazards regression. Results All patients had tumors documented in accordance with the American Joint Committee on Cancer staging manual, including lung (61.4%), breast (9.6%), gastrointestinal (9.0%), hematologic (3.6%), and other cancers (16.4%). Surgical approaches included mini-thoracotomy (67.5%) and thoracoscopy (32.5%). Postsurgical cytopathology confirmed malignancy in 94 cases (56.6%). Over a median follow-up duration of 50.0 months, 142 deaths and 16 PE recurrences occurred. The 1-year overall and PE recurrence-free survival rates were 31.4% and 28.6%, respectively. One-year survival rates were significantly higher for thoracoscopy recipients (43.7% vs. 25.6%, p=0.031) and patients with negative cytopathology results (45.1% vs. 20.6%, p<0.001). No significant survival difference was observed between lung cancer and other types (p=0.129). Multivariate analysis identified New York Heart Association class, cancer stage, and cytopathology as independent prognostic factors. Conclusion This series is the largest to date concerning window formation among cancer patients with PE. Patients' long-term survival after surgery was generally unfavorable. However, cases with negative cytopathology or earlier tumor stage demonstrated comparatively high survival rates.
Collapse
|
3
|
Surgical Correction of Left Ventricular Assist Device Outflow Graft Obstruction Caused by a Wrapped Expanded Polytetrafluoroethylene Graft: A Case Report. J Chest Surg 2024:jcs.23.133. [PMID: 38325905 DOI: 10.5090/jcs.23.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/23/2023] [Accepted: 12/10/2023] [Indexed: 02/09/2024] Open
Abstract
A 70-year-old man with dilated cardiomyopathy underwent left ventricular assist device (LVAD) implantation, using a HeartWare ventricular assist device, as a bridge to candidacy. After 26 months, computed tomography (CT) angiography indicated stenosis in the LVAD outflow graft; however, the patient was asymptomatic, prompting a decision to manage his condition with close monitoring. Ten months later, the patient presented with dizziness and low-flow alerts. Subsequent CT angiography revealed a critical obstruction involving the entire LVAD outflow graft. The patient underwent emergency surgery, during which an organized seroma causing the graft obstruction was found between a wrapped expanded polytetrafluoroethylene (ePTFE) graft and a Dacron outflow graft. The covering of the outflow graft was removed, along with the organized seroma. Following removal of the ePTFE wrap and decompression of the outflow graft, normal LVAD flow was reestablished. The practice of wrapping the outflow graft with synthetic material, commonly done to facilitate later redo sternotomy, may pose a risk for outflow graft obstruction.
Collapse
|
4
|
Phase Angle as a Reliable Biomarker of Frailty to Predict Postoperative Outcomes in Patients Undergoing Off-Pump Coronary Artery Grafting: A Prospective Observational Study. J Cardiothorac Vasc Anesth 2024; 38:109-117. [PMID: 37858381 DOI: 10.1053/j.jvca.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To elucidate the association between phase angle (PA) and a composite adverse outcome in patients requiring off-pump coronary artery bypass grafting (OPCAB). DESIGN A prospective observational study. SETTING High-volume single center. PARTICIPANTS A total of 229 adult patients who underwent OPCAB from May 2019 to October 2020. INTERVENTIONS Each patient underwent bioelectrical impedance analysis, including PA assessment before surgery (PApre), immediately postoperatively (PApost), and 1 day postoperatively (PAPOD1), using an Inbody S10. Frailty index and nutritional assessments also were obtained before surgery. MEASUREMENTS AND MAIN RESULTS Patient outcomes were assessed using a composite adverse outcome comprising death, myocardial infarction, revascularization, new-onset atrial fibrillation, acute kidney injury, stroke, postoperative pulmonary complications, wound complications, sepsis, reoperation, and/or delirium occurring during hospitalization and over the following year. Patients for whom composite adverse outcomes were reported had lower PApre than those without complications (5.4 ± 0.9 v 6.0 ± 0.9, p < 0.001). The PA was significantly associated with in-hospital and 1-year composite postoperative outcomes. The odds ratios (OR, [95% confidence interval]) for PApre by time were in-hospital complications (0.435 [0.314, 0.604], p < 0.001; 1-year complications: 0.459 [0.330, 0.638], p < 0.001) and PAPOD1 (OR, in-hospital complications: 0.400 [0.277, 0.576], 1-year complications: 0.429 [0.298, 0.619], p < 0.001). The PApre was significantly associated with days alive and out of hospital until 1 year. The cut-off value of PApre for optimal prediction of in-hospital complications was 6.0 (area under the curve: 0.691 [0.623-0.758], p < 0.001). CONCLUSION Low PA as an indicator of frailty is associated with adverse postoperative outcomes after OPCAB. Low PA may be employed as a noninvasive and practical tool for the prediction of prognosis in patients with coronary artery disease.
Collapse
|
5
|
Early stroke after left ventricular assist device implantation: role of right heart failure. J Thorac Dis 2023; 15:6730-6740. [PMID: 38249868 PMCID: PMC10797350 DOI: 10.21037/jtd-23-1194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/10/2023] [Indexed: 01/23/2024]
Abstract
Background Both stroke and right heart failure (RHF) are common and serious complications after left ventricular assist device (LVAD) implantation. The objective of this study was to evaluate relation between stroke and RHF early after LVAD implantation. Methods This is a retrospective observational cohort study. From January 2012 to December 2020, patients who underwent LVAD implantation in a single-center were enrolled. Patients with a non-dischargeable LVAD or without follow-up data were excluded. Early stroke was defined as a stroke event within 6 months after implantation. Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) definition was used for the diagnosis of RHF. Results A total of 70 patients underwent LVAD implantation. Sixty-seven patients (95.7%) were successfully discharged and 16 patients (22.9%) died during follow-up. 14 patients (20.0%) experienced a stroke within 6 months after implantation, and 0.28 stroke events per patient-year occurred during follow-up. Postoperative RHF was more common in the stroke group (64.3% vs. 23.2%, P=0.008) and the median time from implantation to RHF was 1 day. In the Cox multivariable analysis, postoperative RHF [hazard ratio (HR): 5.063; 95% confidence interval (CI): 1.682-15.245; P=0.004], and cerebral perfusion pressure (CPP) on postoperative day (POD) 1 (HR: 0.923; 95% CI: 0.858-0.992; P=0.030) were independent predictors for early stroke. A CPP of 62 mmHg (sensitivity, 71.4%; specificity, 59.3%) was the cutoff value for early stroke according to the receiver operating characteristic (ROC) analysis. Conclusions RHF after LVAD implantation may be a risk factor for early stroke. Prevention and management of postoperative RHF with adequate CPP could prevent early stroke after LVAD implantation.
Collapse
|
6
|
Full-Color Generation via Phototunable Mono Ink for Fast and Elaborate Printings. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2307165. [PMID: 37945054 DOI: 10.1002/adma.202307165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/23/2023] [Indexed: 11/12/2023]
Abstract
Unlike pigment-based colors, which are determined by their molecular structure, diverse colors can be expressed by a regular arrangement of nanomaterials. However, existing techniques for constructing such nanostructures have struggled to combine high precision and speed, resulting in a narrow gamut, and prolonged color fabrication time. Here, this work reports a phototunable mono ink that can generate a wide range of colors by controlling regularly arranged nanostructure. Core-shell growth controlled by polymerization time precisely regulates the distance between arranged particles at a nanometer-scale, enabling the generation of various colors. Moreover, the wide and thin arrangement induces constrained out-of-plane growth, thus facilitating the intricate color generation at the desired location via photopolymerization. Upon terminating polymerization by oxygen gas, the generated colors are readily fixed and kept stable. Utilizing programmed ultraviolet illumination, large-scale and high-resolution (≈1 µm) full-color printings are demonstrated at high speed (100 mm2 s-1 ).
Collapse
|
7
|
Phase I dose escalation and expansion study of golidocitinib, a highly selective JAK1 inhibitor, in relapsed or refractory peripheral T-cell lymphomas. Ann Oncol 2023; 34:1055-1063. [PMID: 37673210 DOI: 10.1016/j.annonc.2023.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/09/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Relapsed or refractory peripheral T-cell lymphomas (r/r PTCLs) are a group of rare and aggressive diseases that lack effective therapies. Constitutive activation of the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway is reported to be associated with PTCLs. Golidocitinib is an oral, potent JAK1 selective inhibitor evaluated in a phase I/II multinational study in patients with r/r PTCLs. PATIENTS AND METHODS Patients with r/r PTCLs were eligible. The primary objectives were to assess safety and tolerability of golidocitinib and to define its recommended phase II dose (RP2D). The secondary objectives were to evaluate its antitumor activity and pharmacokinetics (PK). RESULTS A total of 51 patients were enrolled and received golidocitinib treatment at 150 or 250 mg once daily (QD). The median prior lines of therapies were 2 (range: 1-8). Golidocitinib was tolerated at both doses tested, while a higher incidence of serious adverse events and dose modifications at 250 mg were observed. The most common grade ≥3 drug-related treatment-emergent adverse events were neutropenia (27.5%) and thrombocytopenia (11.8%). An objective response rate of 39.2% and a complete response rate of 21.6% were observed. With median follow-up time of 14.7 and 15.9 months, the median duration of response (DoR) and progression-free survival were 8.0 and 3.3 months, respectively. Based on these data, 150 mg QD was defined as the RP2D. Golidocitinib demonstrated a favorable PK profile as an oral agent. Biomarker analysis suggested a potential correlation between JAK/STAT pathway aberrations and clinical activity of golidocitinib. CONCLUSIONS In this phase I study, golidocitinib demonstrated an acceptable safety profile and encouraging antitumor efficacy in heavily pretreated patients with r/r PTCLs. These results support the initiation of the multinational pivotal study in patients with r/r PTCLs.
Collapse
|
8
|
Total arch replacement versus hybrid operation for aortic arch aneurysm in elderly patients: a retrospective cohort analysis. J Thorac Dis 2023; 15:4357-4366. [PMID: 37691665 PMCID: PMC10482621 DOI: 10.21037/jtd-23-331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/30/2023] [Indexed: 09/12/2023]
Abstract
Background There is not sufficient evidence of the superiority of hybrid procedures over total arch replacement (TAR) for the aortic arch aneurysm of an elderly patients. This retrospective study aimed to compare total arch replacement and hybrid procedures for treatment of aortic arch aneurysms in patients aged ≥75. Methods This study was a multicenter retrospective investigation of peri-operative outcomes of patients undergoing aortic arch aneurysm repair using either TAR or hybrid procedures between January 2012 and May 2021. Risk factors for mortality were evaluated using multivariate analyses. Results This study included 90 patients, of which 28 underwent hybrid procedures (hybrid group: frozen elephant trunk =9, zone 0 =6, zone 1 =1, zone 2 =12), and 62 underwent TAR (TAR group), and the mean duration of follow-up was 27.0±28.8 months. In patient characteristics, the incidence of chronic obstructive lung disease and chronic kidney disease in the TAR group was significantly higher than in the hybrid group, and other operative risk factors were not significantly different in both groups. No significant differences in the incidence of post-operative complications and mortality on hospitalization. Survival rates of both groups were not significantly different (P=0.31). However, re-intervention rates after aortic arch aneurysm repair were significantly higher in the hybrid group compared to the TAR group (freedom from re-intervention rates at 1, 3, 5 years: 100%, 93%, 93% in the TAR group, and 90%, 80%, 80% in the hybrid group, P=0.04). Conclusions There was no definitive evidence of the superiority of hybrid procedures over TAR, although the risk of re-intervention was higher in the former group. The surgical strategy for aortic arch aneurysms should be selected based on the patient's demographic and anatomical characteristics.
Collapse
|
9
|
HeartMate 3 Implantation via Only Left Thoracotomy: A Case Report. J Chest Surg 2023; 56:224-227. [PMID: 36792945 PMCID: PMC10165426 DOI: 10.5090/jcs.22.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 02/17/2023] Open
Abstract
Median sternotomy is a standard surgical technique used for left ventricular assist device (LVAD) implantation. However, if sternotomy has a prohibitive surgical risk, LVAD implantation can be performed through only left thoracotomy. We managed a patient with endstage heart failure who had recently undergone coronary artery bypass grafting (CABG) elsewhere. The patient also had a deep sternal wound infection and bacteremia. Because of refractory cardiogenic shock, we performed extracorporeal membrane oxygenation (ECMO). After multiple mediastinal washouts and omental flap placement, ECMO was converted to extracorporeal LVAD (from the left ventricular apex to the descending aorta) through a left thoracotomy. The extracorporeal LVAD was maintained for 18 days and replaced by the HeartMate 3 LVAD. The patient was discharged in good condition 115 days after CABG.
Collapse
|
10
|
Aortic Valve Replacement and Concomitant Multi-Vessel Coronary Artery Bypass: The Impact of Using the Bilateral Internal Thoracic Arteries on Early and Late Clinical Outcomes. J Chest Surg 2023; 56:197-203. [PMID: 36792942 PMCID: PMC10165424 DOI: 10.5090/jcs.22.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/02/2022] [Accepted: 12/22/2022] [Indexed: 02/17/2023] Open
Abstract
Background The survival benefit of coronary artery bypass grafting (CABG) using the bilateral internal thoracic arteries (BITA) is well known; however, the role of BITA in concomitant aortic valve replacement (AVR) and CABG has not been studied. Methods We retrospectively reviewed patients who underwent concomitant AVR and CABG. Cases not using an internal thoracic artery and less than 2 bypass grafts were excluded. We enrolled 114 patients in this study. The mean follow-up duration was 61.5±43.5 months. Results Forty patients (35.1%) underwent CABG with a single internal thoracic artery (SITA) and 74 patients (64.9%) underwent CABG with BITA. The preoperative clinical characteristics were not significantly different between the 2 groups, with the exception of a higher prevalence of atrial fibrillation in the SITA group. Postoperative mortality and morbidity were not significantly higher in the BITA group than in the SITA group. In the univariable analysis, the survival of the BITA group was similar to that of the SITA group (p=0.157). Multivariable analysis showed that only mean age was a predictor of death (p=0.042), but using BITA was not an independent predictor (p=0.094). In low-risk patients whose preoperative ejection fraction was >45%, the survival of the BITA group was significantly better than that of the SITA group (p=0.043). Conclusion BITA use in concomitant AVR and CABG showed no difference in mortality compared to using SITA. Although its impact on long-term survival was inconclusive, BITA use can be considered for low-risk patients.
Collapse
|
11
|
Impact of Interatrial Septal Reconstruction on Atrial Tachyarrhythmia after Surgical Resection of Myxoma. J Chest Surg 2023; 56:186-193. [PMID: 36710578 PMCID: PMC10165435 DOI: 10.5090/jcs.22.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 01/31/2023] Open
Abstract
Background Complete surgical excision is the only curative treatment for primary cardiac tumors. For wide excision, interatrial septal reconstruction (ISR) is commonly performed. We hypothesized that ISR may increase the risk of postoperative atrial tachyarrhythmia (AT) after surgical resection of cardiac myxoma. Methods After excluding patients with a history of cardiac surgery and concomitant procedures unrelated to tumor resection and those with AT or permanent pacemakers, we finally enrolled 272 adult patients who underwent benign cardiac tumor surgery from 1995 to 2021 at our institution. They were divided into the ISR (n=184) and non-ISR (n=88) groups. The primary outcome was postoperative new-onset AT. Results The study cohort predominantly consisted of women (66.2%), with a mean age of 57.2±13.6 years. The incidence of postoperative new-onset AT was 15.4%. No 30-day mortality or recurrence was observed. The cardiopulmonary bypass time and aortic cross-clamping time were significantly longer in the ISR group than in the non-ISR group (p<0.001). The median duration of hospital stay of all patients was 6.0 days (interquartile range, 5.0-7.0 days), and no significant difference was observed between the 2 groups (p=0.329). ISR was not an independent predictor of new-onset AT (p=0.248). Male sex and hypertension were found to be independent predictors of new-onset AT. Conclusion ISR was not a significant predictor of postoperative new-onset AT. ISR might be a feasible and safe procedure for surgical resection of cardiac myxoma and should be considered if needed.
Collapse
|
12
|
Impact of diabetes mellitus on long-term clinical and graft outcomes after off-pump coronary artery bypass grafting with pure bilateral skeletonized internal thoracic artery grafts. Cardiovasc Diabetol 2022; 21:243. [PMID: 36380349 PMCID: PMC9667562 DOI: 10.1186/s12933-022-01687-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/05/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The effect of diabetes mellitus (DM) on the long-term outcomes of coronary artery bypass graft (CABG) remained debatable and various strategies exist for CABG; hence, clarifying the effects of DM on CABG outcomes is difficult. The current study aimed to evaluate the effect of DM on clinical and graft-related outcomes after CABG with bilateral internal thoracic artery (BITA) grafts. METHODS From January 2001 to December 2017, 3395 patients who underwent off-pump CABG (OPCAB) with BITA grafts were enrolled. The study population was stratified according to preoperative DM. The primary endpoint was cardiac death and the secondary endpoints were myocardial infarction (MI), revascularization, graft failure, stroke, postoperative wound infection, and a composite endpoint of cardiac death, MI, and revascularization. Multiple sensitivity analyses, including Cox proportional hazard regression and propensity-score matching analyses, were performed to adjust baseline differences. RESULTS After CABG, the DM group showed similar rates of cardiac death, MI, or revascularization and lower rates of graft failure at 10 years (DM vs. non-DM, 19.0% vs. 24.3%, hazard ratio [HR] 0.711, 95% confidence interval [CI] 0.549-0.925; P = 0.009) compared to the non-DM group. These findings were consistent after multiple sensitivity analyses. In the subgroup analysis, the well-controlled DM group, which is defined as preoperative hemoglobin A1c (HbA1c) of < 7%, showed lower postoperative wound infection rates (well-controlled DM vs. poorly controlled DM, 3.7% vs. 7.3%, HR 0.411, 95% CI 0.225-0.751; P = 0.004) compared to the poorly controlled DM group, which was consistent after propensity-score matched analysis. CONCLUSIONS OPCAB with BITA grafts showed excellent and comparable long-term clinical outcomes in patients with and without DM. DM might have a protective effect on competition and graft failure of ITA. Strict preoperative hyperglycemia control with target HbA1c of < 7% might reduce postoperative wound infection and facilitate the use of BITA in CABG.
Collapse
|
13
|
Joint Statement of the Korean Society for Thoracic and Cardiovascular Surgery and the Korean Society for Coronary Artery Surgery on Chapter 7.1 in the 2021 American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions Guideline for Coronary Artery Revascularization. J Chest Surg 2022; 55:361-363. [PMID: 36097819 PMCID: PMC9579840 DOI: 10.5090/jcs.22.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 11/22/2022] Open
|
14
|
Comparison of long-term cardiovascular and renal outcomes between percutaneous coronary intervention and coronary artery bypass grafting in multi-vessel disease with chronic kidney disease. Front Cardiovasc Med 2022; 9:951113. [PMID: 36172577 PMCID: PMC9510652 DOI: 10.3389/fcvm.2022.951113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/19/2022] [Indexed: 12/01/2022] Open
Abstract
Objective This study aims to analyze cardiac and renal outcomes of chronic kidney disease (CKD) patients with multi-vessel disease who have undergone coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Materials and methods Chronic kidney disease patients with multi-vessel disease who underwent CABG or PCI were retrospectively selected from our database and divided into the PCI group [further stratified into PCI with complete revascularization (PCI-CR) and PCI with incomplete revascularization (PCI-IR) groups] and the CABG group. The primary endpoint was the composite of all-cause death, myocardial infarction (MI), or stroke at 5 years. The key secondary endpoint was the 5-year rate of the renal composite outcome, defined as >40% glomerular filtration rate decrease, initiation of dialysis, and/or kidney transplant. Outcomes were compared using Cox proportional hazards regression analysis, and the results were further adjusted by multivariable analyses and inverse probability weighting. Results Among the study population (n = 798), 443 (55.5%) patients received CABG and 355 (44.5%) patients received PCI. Compared with the CABG group, the PCI group had similar risk of the primary endpoint (CABG vs. PCI, 19.3% vs. 24.0%, HR: 1.28, 95% CI: 0.95–1.73, p = 0.11) and a lower risk of the renal composite outcome (36.6% vs. 31.2%, HR: 0.74, 95% CI 0.58–0.94, p = 0.03). In addition, PCI-IR was associated with a significantly higher risk of the primary endpoint than CABG (HR: 1.54, 95% CI: 1.11–2.13, p = 0.009) or PCI-CR (HR: 1.78, 95% CI: 1.09–2.89, p = 0.02). However, PCI-CR had a comparable 5-year death, MI, or stroke rate to CABG (HR: 0.86, 95% CI 0.54–1.38, p = 0.54). Conclusion Coronary artery bypass grafting showed an incidence of death, MI, or stroke similar to PCI but was associated with a higher risk of renal injury. PCI-CR had a prognosis comparable with that of CABG, while PCI-IR had worse prognosis. If PCI is chosen for revascularization in patients with CKD, achieving CR should be attempted to ensure favorable outcomes. Clinical trial registration [clinicaltrials.gov], identifier [NCT 03870815].
Collapse
|
15
|
Search for Subsolar-Mass Binaries in the First Half of Advanced LIGO's and Advanced Virgo's Third Observing Run. PHYSICAL REVIEW LETTERS 2022; 129:061104. [PMID: 36018635 DOI: 10.1103/physrevlett.129.061104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/18/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
We report on a search for compact binary coalescences where at least one binary component has a mass between 0.2 M_{⊙} and 1.0 M_{⊙} in Advanced LIGO and Advanced Virgo data collected between 1 April 2019 1500 UTC and 1 October 2019 1500 UTC. We extend our previous analyses in two main ways: we include data from the Virgo detector and we allow for more unequal mass systems, with mass ratio q≥0.1. We do not report any gravitational-wave candidates. The most significant trigger has a false alarm rate of 0.14 yr^{-1}. This implies an upper limit on the merger rate of subsolar binaries in the range [220-24200] Gpc^{-3} yr^{-1}, depending on the chirp mass of the binary. We use this upper limit to derive astrophysical constraints on two phenomenological models that could produce subsolar-mass compact objects. One is an isotropic distribution of equal-mass primordial black holes. Using this model, we find that the fraction of dark matter in primordial black holes in the mass range 0.2 M_{⊙}<m_{PBH}<1.0 M_{⊙} is f_{PBH}≡Ω_{PBH}/Ω_{DM}≲6%. This improves existing constraints on primordial black hole abundance by a factor of ∼3. The other is a dissipative dark matter model, in which fermionic dark matter can collapse and form black holes. The upper limit on the fraction of dark matter black holes depends on the minimum mass of the black holes that can be formed: the most constraining result is obtained at M_{min}=1 M_{⊙}, where f_{DBH}≡Ω_{DBH}/Ω_{DM}≲0.003%. These are the first constraints placed on dissipative dark models by subsolar-mass analyses.
Collapse
|
16
|
Liquid crystal-powered Mie resonators for electrically tunable photorealistic color gradients and dark blacks. LIGHT, SCIENCE & APPLICATIONS 2022; 11:118. [PMID: 35487908 PMCID: PMC9054757 DOI: 10.1038/s41377-022-00806-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 04/11/2022] [Accepted: 04/18/2022] [Indexed: 05/20/2023]
Abstract
Taking inspiration from beautiful colors in nature, structural colors produced from nanostructured metasurfaces have shown great promise as a platform for bright, highly saturated, and high-resolution colors. Both plasmonic and dielectric materials have been employed to produce static colors that fulfil the required criteria for high-performance color printing, however, for practical applications in dynamic situations, a form of tunability is desirable. Combinations of the additive color palette of red, green, and blue enable the expression of further colors beyond the three primary colors, while the simultaneous intensity modulation allows access to the full color gamut. Here, we demonstrate an electrically tunable metasurface that can represent saturated red, green, and blue pixels that can be dynamically and continuously controlled between on and off states using liquid crystals. We use this to experimentally realize ultrahigh-resolution color printing, active multicolor cryptographic applications, and tunable pixels toward high-performance full-color reflective displays.
Collapse
|
17
|
The ECHELON-2 Trial: 5-year results of a randomized, phase 3 study of brentuximab vedotin with chemotherapy for CD30-positive peripheral T-cell lymphoma. Ann Oncol 2021; 33:288-298. [PMID: 34921960 PMCID: PMC9447792 DOI: 10.1016/j.annonc.2021.12.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/12/2021] [Accepted: 12/07/2021] [Indexed: 01/18/2023] Open
Abstract
Background: For patients with peripheral T-cell lymphoma (PTCL), outcomes using frontline treatment with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP-like therapy are typically poor. The ECHELON-2 study demonstrated that brentuximab vedotin plus cyclophosphamide, doxorubicin, and prednisone (A+CHP) exhibited statistically superior progression-free survival (PFS) per independent central review and improvements in overall survival versus CHOP for the frontline treatment of patients with systemic anaplastic large cell lymphoma or other CD30-positive PTCL. Patients and methods: ECHELON-2 is a double-blind, double-dummy, randomized, placebo-controlled, active-comparator phase III study. We present an exploratory update of the ECHELON-2 study, including an analysis of 5-year PFS per investigator in the intent-to-treat analysis group. Results: A total of 452 patients were randomized (1 : 1) to six or eight cycles of A+CHP (N = 226) or CHOP (N = 226). At median follow-up of 47.6 months, 5-year PFS rates were 51.4% [95% confidence interval (CI): 42.8% to 59.4%] with A+CHP versus 43.0% (95% CI: 35.8% to 50.0%) with CHOP (hazard ratio = 0.70; 95% CI: 0.53–0.91), and 5-year overall survival (OS) rates were 70.1% (95% CI: 63.3% to 75.9%) with A+CHP versus 61.0% (95% CI: 54.0% to 67.3%) with CHOP (hazard ratio = 0.72; 95% CI: 0.53–0.99). Both PFS and OS were generally consistent across key subgroups. Peripheral neuropathy was resolved or improved in 72% (84/117) of patients in the A+CHP arm and 78% (97/124) in the CHOP arm. Among patients who relapsed and subsequently received brentuximab vedotin, the objective response rate was 59% with brentuximab vedotin retreatment after A+CHP and 50% with subsequent brentuximab vedotin after CHOP. Conclusions: In this 5-year update of ECHELON-2, frontline treatment of patients with PTCL with A+CHP continues to provide clinically meaningful improvement in PFS and OS versus CHOP, with a manageable safety profile, including continued resolution or improvement of peripheral neuropathy.
Collapse
|
18
|
Non-Surgical Resolution of Inflow Cannula Obstruction of a Left Ventricular Assist Device: A Case Report. J Chest Surg 2021; 54:543-546. [PMID: 34815371 PMCID: PMC8646067 DOI: 10.5090/jcs.21.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/06/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
A 55-year-old woman who had received an implantable left ventricular assist device 3 months earlier presented with dyspnea and a low-flow alarm of the device. Computed tomography and log-file analysis of the device system suggested inflow cannula obstruction. Since the patient had cardiogenic shock due to pump failure, venoarterial extracorporeal membrane oxygenation (ECMO) was initiated. With ECMO, surgical exchange of the pump was considered. However, the obstruction spontaneously resolved without surgical intervention. It turned out that an obstructive thrombus was washed out by rebooting the pump. Moreover, the thrombus was embolized in the patient’s left subclavian artery. The patient underwent heart transplantation 4 months after the pump obstruction accident and continued to do well.
Collapse
|
19
|
Effects of Statin Intensity on Long-Term Outcomes after Coronary Artery Bypass Grafting. Ann Thorac Surg 2021; 114:1705-1714. [PMID: 34555373 DOI: 10.1016/j.athoracsur.2021.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/08/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The current study sought to investigate the association between statin intensity and long-term clinical outcomes according to initial clinical presentation following CABG. METHODS A total of 6,531 patients who underwent CABG were finally included in this study, and the study population was classified into four groups according to statin intensity (no or low[atorvastatin<10mg,n=731], lower-moderate[atorvastatin 10mg equivalent,n=2310], higher-moderate [atorvastatin 20mg equivalent,n=2404], and high-intensity [atorvastatin≥40mg equivalent, n=1086]). The primary endpoint was MACCE at 5-years. Multivariable Cox and inverse-probability-weighting methods were performed to adjust for baseline differences. RESULTS At least moderate-intensity statin use was associated with significantly lower risk of 5-year MACCE compared with no or low-intensity statin use(HR 0.694,95%CI:0.493-0.977,p=0.036). Among patients who were taken at-least moderate-intensity statin, both higher moderate-intensity(HR:0.622,95%CI:0.479-0.807,p<0.001) and high-intensity statin(HR:0.613,95%CI:0.421-0.894,p=0.011) groups showed significantly lower risks of MACCE than lower-moderate intensity statin group at 5-years after CABG. There was no significant difference in the risk of MACCE between higher-moderate intensity and high-intensity statin groups(HR:0.987,95%CI:0.661-1.475,p=0.950). Multivariable Cox and inverse-probability-weighting methods yielded similar results. In subgroup analysis, compared with the use of a lower-moderate intensity statin, the use of a higher-moderate or high-intensity statin(equivalent dose with atorvastatin≥20mg) was associated with a significantly lower risk of MACCE among CABG patients who presented with ACS, but not in those who presented with stable ischemic heart disease(interaction-p=0.001). CONCLUSIONS The use of a lower-moderate intensity statin(atorvastatin 10mg equivalent) was associated with relatively poorer long-term clinical outcomes than the use of higher-moderate or high-intensity statin, especially in ACS patients following CABG.
Collapse
|
20
|
Comprehensive assessment of heart failure in patients with preserved ejection fraction undergoing coronary bypass grafting. J Thorac Cardiovasc Surg 2021; 165:2063-2073.e2. [PMID: 34217536 DOI: 10.1016/j.jtcvs.2021.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Although coronary artery bypass grafting is expected to improve the outcomes of patients with advanced coronary artery disease, whether prognosis is different according to preoperative diastolic function remains unclear. This study sought to evaluate the prognostic implications of preoperative heart failure with preserved ejection fraction in patients undergoing coronary artery bypass grafting. METHODS A total of 3593 consecutive patients with preserved ejection fraction (≥50%) who underwent coronary artery bypass grafting between January 1, 2001, and December 31, 2017, were evaluated. According to Heart Failure Association Pretest Assessment, Echocardiography and Natriuretic Peptide, Functional Testing, Final Etiology score, they were stratified into 3 groups: (1) non-heart failure with preserved ejection fraction (low-risk); (2) indeterminate (intermediate risk); and (3) heart failure with preserved ejection fraction (high risk). The primary outcome was all-cause death at 5 years after surgery. RESULTS Among the study population, 984 patients (27.4%) had preoperative heart failure with preserved ejection fraction. After coronary artery bypass grafting, 30-day survival in the heart failure with preserved ejection fraction group did not differ significantly from that in the non-heart failure with preserved ejection fraction group. The 5-year survival of the heart failure with preserved ejection fraction group was significantly lower than that of the non-heart failure with preserved ejection fraction group (91.9% vs 97.0%; adjusted hazard ratio, 2.41; 95% confidence interval, 1.29-4.50; P = .006). Follow-up echocardiography for the heart failure with preserved ejection fraction group showed no significant changes in early diastolic mitral annular velocity or left ventricular filling pressure compared with preoperative values. CONCLUSIONS On the basis of noninvasive assessment using Heart Failure Association Pretest Assessment, Echocardiography and Natriuretic Peptide, Functional Testing, Final Etiology score, a substantial proportion of patients with coronary artery disease who underwent coronary artery bypass grafting had preoperative heart failure with preserved ejection fraction. Preoperative heart failure with preserved ejection fraction was significantly associated with a decrease in the 5-year survival after successful coronary artery bypass grafting.
Collapse
|
21
|
Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run. PHYSICAL REVIEW LETTERS 2021; 126:241102. [PMID: 34213926 DOI: 10.1103/physrevd.97.102002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/31/2021] [Accepted: 05/23/2021] [Indexed: 05/21/2023]
Abstract
We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.
Collapse
|
22
|
Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run. PHYSICAL REVIEW LETTERS 2021; 126:241102. [PMID: 34213926 DOI: 10.1103/physrevlett.126.241102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/31/2021] [Accepted: 05/23/2021] [Indexed: 06/13/2023]
Abstract
We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.
Collapse
|
23
|
Reappraisal of mechanical tricuspid valve replacement in the current era: a single center retrospective study. J Thorac Dis 2021; 13:3359-3368. [PMID: 34277032 PMCID: PMC8264679 DOI: 10.21037/jtd-20-3027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/08/2021] [Indexed: 11/17/2022]
Abstract
Background This study aimed to investigate the early and late outcomes of mechanical tricuspid valve replacement (mTVR). Methods We evaluated 113 patients (82 women; median age, 53 years) who underwent mTVR between 1995 and 2017. Based on a history of cardiac surgery, patients were divided into primary (n=42) and reoperative mTVR (n=71) groups. The median follow-up duration was 12.7 years in primary and 9.3 years in reoperative mTVR, respectively (P=0.045). Results Patients in the reoperative group were older (54 vs. 46 years; P=0.007) and showed higher central venous pressure (16±6 vs. 13±6 mmHg; P=0.002) than the primary group. Early mortality occurred in 2 patients in the reoperative group (2 vs. 0; P=0.529). There was no significant difference in overall survival between the primary and reoperation groups (15-year survival rate: 86% vs. 78%; P=0.215). The independent risk factors of overall survival were age [P<0.001; hazard ratio (HR), 1.11; 95% confidential interval (CI), 1.05–1.18], left ventricular ejection fraction of less than 40% (P=0.001; HR, 5.1; 95% CI, 2.21–28.2), and central venous pressure over 20 mmHg (P=0.016; HR, 3.7; 95% CI, 1.28–10.7). Overall survival did not differ between the age groups (<60 vs. 60–70 years) in the reoperative group (P=0.772). Tricuspid valve thrombosis occurred in 8 patients (7 primary, 1 reoperative; P=0.004). Conclusions The incidence of tricuspid valve thrombosis was significantly higher in the primary mTVR group compared with the reoperative mTVR group. The patients who underwent mTVR at a relatively young age showed good early and late outcomes in both groups.
Collapse
|
24
|
Paradoxical darkening following picosecond laser and successful treatment. Clin Exp Dermatol 2021; 46:1128-1129. [PMID: 33774841 DOI: 10.1111/ced.14661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/28/2022]
|
25
|
Intractable Coronary Spasm Requiring Percutaneous Coronary Intervention after Coronary Artery Bypass Grafting in a Patient with Moyamoya Disease. J Chest Surg 2021; 54:150-153. [PMID: 33262315 PMCID: PMC8038879 DOI: 10.5090/jcs.20.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 11/18/2022] Open
Abstract
Moyamoya disease (MMD) is characterized by progressive steno-occlusive lesions of the distal or proximal branch of the internal carotid arteries, and cerebrovascular symptoms are its major complications. Extracranial vascular involvement including the coronary artery has been reported, and some case reports have described variant angina or myocardial infarction. However, no report has yet described a case of myocardial infarction after coronary artery bypass grafting (CABG). Here, we present a patient with MMD who suffered cardiac arrest caused by myocardial infarction due to a coronary spasm after off-pump CABG and who was discharged successfully after treatment with a veno-arterial extracorporeal membrane oxygenator and percutaneous coronary intervention.
Collapse
|
26
|
Impact of a Multidisciplinary Team Approach on Extracorporeal Circulatory Life Support-Bridged Heart Transplantation. J Chest Surg 2021; 54:99-105. [PMID: 33767029 PMCID: PMC8038881 DOI: 10.5090/jcs.20.115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 11/16/2022] Open
Abstract
Background The number of heart transplantations (HTx) is increasing annually. Due to advances in medical and surgical support, the outcomes of HTx are also improving. Extracorporeal circulatory life support (ECLS) provides patients with decompensated heart failure a chance to undergo HTx. A medical approach involving collaboration among experienced experts in different fields should improve the outcomes and prognosis of ECLS-bridged HTx. Methods From December 2003 to December 2018, 1,465 patients received ECLS at Samsung Medical Center. We excluded patients who had not undergone HTx or underwent repeated transplantations. Patients younger than 18 years were excluded. We also excluded patients who received an implantable durable left ventricular assist device before HTx. In total, 91 patients were included in this study. A multidisciplinary team approach began in March 2013 at our hospital. We divided the patients into 2 groups depending on whether they were treated before or after implementation of the team approach. Results The 30-day mortality rate was significantly higher in the pre-ECLS team group than in the post-ECLS team group (n=5, 18.5% vs. n=2, 3.1%; p=0.023). The 1-year survival rate was better in the post-ECLS team group than in the pre-ECLS team group (n=57, 89.1% vs. n=19, 70.4%; p=0.023). Conclusion We found that implementing a multidisciplinary team approach improved the outcomes of ECLS-bridged HTx. Team-based care should be adapted at HTx centers that perform high-risk HTx.
Collapse
|
27
|
Implementation of Venoarterial Extracorporeal Membrane Oxygenation in Nonintubated Patients. J Chest Surg 2021; 54:17-24. [PMID: 33203803 PMCID: PMC7946527 DOI: 10.5090/kjtcs.20.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 11/24/2022] Open
Abstract
Background Although extracorporeal membrane oxygenation (ECMO) is generally performed percutaneously, the technology is deployed under sedation and necessitates endotracheal intubation. However, in some patients, the use of venoarterial (VA) ECMO without intubation may be beneficial. Herein, we describe our experiences with VA ECMO performed without prior endotracheal intubation. Methods A total of 783 patients treated with VA ECMO at a single center between January 2013 and July 2018 were reviewed retrospectively. We included patients who underwent successful VA ECMO implementation without prior endotracheal intubation, and excluded those who were younger than 18 years, had ongoing cardiopulmonary resuscitation status, and had poor quality of the vessels needed for percutaneous cannulation. The primary study outcome was in-hospital survival. Results In total, 50 patients were included in this study, 94% of whom showed cardiogenic shock. The mean age of the study participants was 56.3±14.5 years. The median VA ECMO support time was 7 days (range, 2–13 days). Twenty-one patients (42%) did not receive ventilator care during the VA ECMO support period, while 29 patients (58%) progressed to intubation after VA ECMO implementation. The rates of survival at discharge and weaning success were 82% (n=41) and 92% (n=46), respectively, and 80% (n=40) of patients presented good Glasgow–Pittsburgh Cerebral Performance Categories scores at discharge. Conclusion Even in patients with cardiogenic shock, percutaneous VA ECMO can be introduced safely without prior endotracheal intubation by an experienced care team. The application of nonintubated VA ECMO might be a feasible strategy in selected cases.
Collapse
|
28
|
Self-Regulation of Infrared Using a Liquid Crystal Mixture Doped with Push-Pull Azobenzene for Energy-Saving Smart Windows. ACS APPLIED MATERIALS & INTERFACES 2021; 13:5028-5033. [PMID: 33472366 DOI: 10.1021/acsami.0c19015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A self-regulating liquid crystal (LC) smart window whose reflectance changes with ambient conditions is demonstrated. Thermally or optically induced switching between the transparent state and a near-infrared (NIR) reflective state can be used for energy-saving windows. Reflection of NIR can reduce the energy used for cooling, while remaining transparent to visible light. By changing the initial alignment of LCs, the window can be switched between hazy-opaque and IR-reflective states to be used for privacy windows.
Collapse
|
29
|
Association between depression and hostile attribution bias in hostile and non-hostile individuals: An ERP study. J Affect Disord 2020; 276:1077-1083. [PMID: 32771859 DOI: 10.1016/j.jad.2020.06.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 05/31/2020] [Accepted: 06/23/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hostility and aggression have been found to be highly prevalent among depressed patients and are associated with higher comorbidity and illness severity levels. Although negative interpretation biases are a fundamental element of cognitive models of depression, few studies have examined the specific biases in information processing, mainly the hostile attribution bias, found in hostile individuals who present depressive symptoms. METHOD Using pre-collected data from a sample of 72 (male=41,6%, female=58,3%) undergraduate and community-based hostile (n = 26) and non-hostile (n = 46) adult participants, the authors aimed to examine the association between depression and the hostile attribution bias by determining whether depression level scores were uniquely related to electrophysiological measures of the hostile attribution bias. RESULTS The hostile group showed higher measured levels of depression and reactive aggression compared to the non-hostile group. Also, depression scores were significant predictors of the N400 effect in the non-hostile task condition, while reactive aggression was not, whereas in the hostile condition, the overall model was significant, with depression and reactive aggression levels both showing strong trends towards significance. LIMITATIONS A small sample size limited the scope of our conclusions. Also, sample selection prevented us from examining specific group differences regarding the hostile attribution bias in depressed and non-depressed groups. CONCLUSION Clinical and research implications include the necessity to apply cognitive restructuring techniques to counter biased interpretation processes in settings where depression and aggression intersect, and the need to consider alternatives to self-evaluative methodologies.
Collapse
|
30
|
Left Ventricular Assist Device Implantation via Dual Left Thoracotomy in an Adult Patient with Congenitally Corrected Transposition of the Great Arteries. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:306-309. [PMID: 33020348 PMCID: PMC7553819 DOI: 10.5090/kjtcs.19.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 11/29/2022]
Abstract
A 59-year-old man presented for possible durable ventricular assist device (VAD) implantation. He had previously been diagnosed with congenitally corrected transposition of the great arteries, a ventricular septal defect, an atrial septal defect, pulmonary valve stenosis, and aortic valve regurgitation. In the previous 22 years, he had undergone palliative cardiac surgery 3 times. VAD implantation as a bridge to transplantation was planned. Owing to severe adhesions, mesocardia, a left ascending aorta, and moderate aortic regurgitation, we performed VAD implantation and aortic valve closure via a dual left thoracotomy and partial sternotomy.
Collapse
|
31
|
Is Prophylactic Tricuspid Annuloplasty Beneficial for Degenerative Mitral Valve Repair? Ann Thorac Surg 2020; 111:1502-1511. [PMID: 33002510 DOI: 10.1016/j.athoracsur.2020.07.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 06/29/2020] [Accepted: 07/22/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study aimed to evaluate the long-term clinical impacts of prophylactic tricuspid annuloplasty (TAP) in patients with mild tricuspid regurgitation (TR) who underwent mitral valve repair. METHODS One hundred fifty-one patients with mild TR who underwent mitral valve repair for degenerative mitral regurgitation between 1997 and 2013 were categorized into the TAP (n = 85) or no TAP (n = 66) groups. The indications for TAP were atrial fibrillation and tricuspid annular dilatation. The mean follow-up duration was 115.5 ± 48.6 months. Inverse probability of treatment weighting analysis and propensity score matching with 53 patients in each group were used to adjust for the baseline differences between the 2 groups. RESULTS There were no early mortalities in either group, and early morbidities, including heart block, were not different between the groups. Inverse probability of treatment weighting-adjusted survival analysis did not reveal any difference in overall survival (P = .862), freedom from cardiac-related mortality (P = .535), or major adverse valve-related events (P = .972) between the groups. There was no difference in late TR progression (moderate or greater) between the groups (P = .316). These results were consistent in the matched analysis. CONCLUSIONS Prophylactic TAP in mild TR may not have a beneficial effect on TR progress in degenerative mitral regurgitation. Further large studies are necessary to define the role of prophylactic TAP in mild TR.
Collapse
|
32
|
GW190521: A Binary Black Hole Merger with a Total Mass of 150 M_{⊙}. PHYSICAL REVIEW LETTERS 2020; 125:101102. [PMID: 32955328 DOI: 10.1103/physrevlett.125.101102] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/19/2020] [Accepted: 07/09/2020] [Indexed: 06/08/2023]
Abstract
On May 21, 2019 at 03:02:29 UTC Advanced LIGO and Advanced Virgo observed a short duration gravitational-wave signal, GW190521, with a three-detector network signal-to-noise ratio of 14.7, and an estimated false-alarm rate of 1 in 4900 yr using a search sensitive to generic transients. If GW190521 is from a quasicircular binary inspiral, then the detected signal is consistent with the merger of two black holes with masses of 85_{-14}^{+21} M_{⊙} and 66_{-18}^{+17} M_{⊙} (90% credible intervals). We infer that the primary black hole mass lies within the gap produced by (pulsational) pair-instability supernova processes, with only a 0.32% probability of being below 65 M_{⊙}. We calculate the mass of the remnant to be 142_{-16}^{+28} M_{⊙}, which can be considered an intermediate mass black hole (IMBH). The luminosity distance of the source is 5.3_{-2.6}^{+2.4} Gpc, corresponding to a redshift of 0.82_{-0.34}^{+0.28}. The inferred rate of mergers similar to GW190521 is 0.13_{-0.11}^{+0.30} Gpc^{-3} yr^{-1}.
Collapse
|
33
|
Optimal Timing of Venoarterial-Extracorporeal Membrane Oxygenation in Acute Myocardial Infarction Patients Suffering From Refractory Cardiogenic Shock. Circ J 2020; 84:1502-1510. [PMID: 32684541 DOI: 10.1253/circj.cj-20-0259] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although there is an increase in the use of mechanical circulatory support devices to rescue patients with acute myocardial infarction (AMI) complicated by refractory cardiogenic shock (CS), the optimal timing of the application remains controversial. Therefore, this study aimed to compare the clinical outcomes between venoarterial-extracorporeal membrane oxygenation (VA-ECMO) insertion before and after coronary revascularization in AMI patients with refractory CS.Methods and Results:A total of 253 patients with AMI who underwent revascularization therapy with VA-ECMO were included. The study population was stratified into extracorporeal cardiopulmonary resuscitation (E-CPR) before revascularization (N=106, reference cohort) and refractory CS without E-CPR before revascularization (n=147, comparison cohort). Patients with refractory CS but without E-CPR before revascularization were further divided into VA-ECMO before revascularization (N=50) and VA-ECMO after revascularization (n=97). The primary endpoint was a composite of in-hospital mortality, left ventricular assist device implantation, and heart transplantation. The primary endpoint occurred in 60 patients (40.8%) of the comparison cohort and 51 patients (48.1%) of the reference cohort. Among the comparison cohort, the primary endpoint was significantly lower in VA-ECMO before revascularization than in VA-ECMO after revascularization (32.0% vs. 49.5%, OR 0.480, 95% CI 0.235-0.982, P=0.045). A similar trend was observed after a 1-year follow up. CONCLUSIONS Early initiation of VA-ECMO before revascularization therapy might improve clinical outcomes in patients with AMI complicated by refractory CS.
Collapse
|
34
|
Differential effects of dual antiplatelet therapy in patients presented with acute coronary syndrome vs. stable ischaemic heart disease after coronary artery bypass grafting. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:517-526. [DOI: 10.1093/ehjcvp/pvaa080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/05/2020] [Accepted: 06/27/2020] [Indexed: 12/14/2022]
Abstract
AbstractAimsThe current study sought to evaluate whether long-term clinical outcomes according to the use of dual antiplatelet therapy (DAPT) or single antiplatelet therapy (SAPT) differed between acute coronary syndrome (ACS) and stable ischaemic heart disease (SIHD) patients who underwent coronary artery bypass grafting surgery (CABG).Methods and resultsBetween January 2001 and December 2017, 3199 patients with ACS (55.3%) and 2583 with SIHD (44.7%) who underwent isolated CABG were enrolled. The study population was stratified using DAPT or SAPT in ACS patients and SIHD patients. The primary outcome was a cardiovascular death or myocardial infarction (MI) at 5 years. After CABG, DAPT was more frequently used in patients with ACS than in those with SIHD [n = 1960 (61.3%) vs. n = 1313 (50.8%), P < 0.001]. Among patients with ACS, the DAPT group showed a significantly lower risk of cardiovascular death or MI at 5 years than the SAPT group [DAPT vs. SAPT, 4.0% vs. 7.8%, hazard ratio (HR) 0.521, 95% confidence interval (CI) 0.339–0.799; P = 0.003]. In contrast, among patients with SIHD, there was no significant difference in the rate of cardiovascular death or MI at 5 years between the use of DAPT and SAPT (4.0% vs. 4.0%, HR 0.991, 95% CI 0.604–1.626; P = 0.971). These findings were robust to multiple sensitivity analyses and competing risk analysis. In the subgroup analysis, the use of DAPT was associated with a significantly lower risk of cardiovascular death or MI among SIHD patients with a previous percutaneous coronary intervention (PCI), with a significant interaction between the use of DAPT and PCI history (interaction P = 0.011).ConclusionAmong ACS patients who underwent CABG, the use of DAPT was associated with lower cardiovascular death or MI than the use of SAPT, but this was not the case in SIHD patients.Trial registrationClinicalTrials.gov, NCT03870815.
Collapse
|
35
|
Abstract
Background Although many patients with coronary artery disease are using statins before off‐pump coronary artery bypass grafting (OPCAB) following current guidelines, recent studies have raised concerns regarding adverse effects of preoperative statins on postoperative kidney function. We evaluated the effects of preoperative statins on acute kidney injury (AKI) after OPCAB. Methods and Results We enrolled 1783 consecutive OPCAB patients in either a statin or nonstatin group based on preoperative use of statins. Propensity scores were used to adjust the differences between the groups. The primary outcome was incidence of postoperative AKI according to Kidney Disease: Improving Global Outcomes criteria. To evaluate the dose‐related renal effects of statins, the statin group was divided into low‐ and moderate‐ or higher dose groups based on preoperative statin dose. The incidence of postoperative AKI was 15.7% and 13.5% in the nonstatin and statin groups, respectively, and preoperative statins did not increase the incidence of postoperative AKI (odds ratio: 0.84; 95% CI, 0.61–1.15; P=0.27). In dose‐related analysis, the moderate‐ or higher dose group showed lower incidence of postoperative AKI in comparison with the nonstatin group (odds ratio: 0.61; 95% CI, 0.39–0.95; P=0.03). However, no difference was found between low‐dose and nonstatin groups (odds ratio: 1.17; 95% CI, 0.75–1.84; P=0.49) or between moderate‐ or higher dose and low‐dose statin groups (odds ratio: 0.84; 95% CI, 0.5–1.41; P=0.51) in the incidence of postoperative AKI. Conclusions Neither preoperative statin use nor statin dose increased the risk of AKI after OPCAB. Preoperative statin therapy is not harmful in patients receiving OPCAB.
Collapse
|
36
|
Association Between β-Blockers and Outcome of Coronary Artery Bypass Grafting: Before and After 1 Year. Ann Thorac Surg 2020; 111:69-75. [PMID: 32565089 DOI: 10.1016/j.athoracsur.2020.04.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/07/2020] [Accepted: 04/23/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND We evaluated the long-term outcomes of coronary artery bypass grafting (CABG) according to β-blocker therapy using landmark analysis. Although β-blockers have been shown to improve outcomes for ischemic heart disease, the long-term effects and optimal treatment duration of use after CABG remain unknown. METHODS From January 2001 to December 2014, 5382 CABG patients were stratified into 2 groups according to β-blocker therapy at discharge (β-blocker group: 3677 [68.3%], no β-blocker group: 1705 [31.7%]). RESULTS The primary outcome was all-cause death during 48 months of follow-up. Using propensity score-matched analysis, β-blocker therapy was associated with all-cause death during the 48-month follow-up (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.41-0.95; P = .03). The landmark analysis demonstrated that the effect of β-blockers on all-cause death was particularly significant within the first 12 months of therapy (HR, 0.37; 95% CI, 0.19-0.80; P = .01) but not after 12 months (HR, 0.92; 95% CI, 0.56-1.53; P = .77). CONCLUSIONS The benefits of postdischarge β-blockers may be limited to 1 year after CABG, but further studies are required to confirm this finding.
Collapse
|
37
|
Mild Ischemic Mitral Regurgitation: Is Revascularization Enough for Every Patient? Heart Surg Forum 2020; 23:E370-E375. [PMID: 32524986 DOI: 10.1532/hsf.2759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 04/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The progress of mild ischemic mitral regurgitation (MR) after isolated coronary artery bypass is not clear. We aimed to determine the proportion of patients with mild ischemic MR undergoing isolated coronary artery bypass grafting (CABG) presenting with regression of or persistent MR one year after CABG and to identify the significantly different echocardiographic variables between regressing and persistent MR. METHODS Sixty-three patients with preoperative mild ischemic MR were categorized into an MR- regression or an MR-persistence group one year after isolated CABG. The echocardiographic indices, indicating mitral leaflet configuration and remodeling of the left ventricle (LV), were measured before and one year after the surgery. RESULTS One year after CABG, MR regressed in 60% (38/63) and persisted in 40% (25/63) of the patients. The left ventricular diameter, volume, and sphericity and anteroposterior diameter of the mitral annulus improved only in the MR-regression group, while the ejection fraction improved in both groups (47.7% ± 12.4% from 40.1% ± 11.3%, P < .001 in the regression group and 43.2% ± 14.0% from 39.3% ± 11.6%, P = .035 in the persistence group). A >15% decrease in the LV end-systolic volume was noted more frequently in the MR-regression group (60.5% versus 30%, P = .027). The leaflet angle did not show asymmetry or significant changes in both groups. CONCLUSIONS Isolated CABG improved mild MR in most patients with mild ischemic MR. These patients showed greater reverse remodeling after revascularization than the patients with persistent MR after isolated CABG. Additional tests, which can predict LV reverse remodeling, are needed to predict persistent MR.
Collapse
|
38
|
Clinically-defined preoperative serum phosphorus abnormalities and outcomes of coronary artery bypass grafting: Retrospective analysis using inverse probability weighting adjustment. PLoS One 2019; 14:e0225720. [PMID: 31851672 PMCID: PMC6919634 DOI: 10.1371/journal.pone.0225720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/10/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Serum phosphorus is a well-known marker of vascular calcification, but the effects of serum phosphorus abnormalities defined by clinical criteria on the outcomes of coronary artery bypass grafting (CABG) remain unclear. We aimed to evaluate whether preoperative serum phosphorus abnormalities defined based on clinical criteria are associated with outcomes of CABG using a relatively new statistical technique, inverse probability weighting (IPW) adjustment. METHODS From January 2001 to December 2014, 4,989 consecutive patients who underwent CABG were stratified into normal (2.5-4.5 mg/dl; n = 4,544), hypophosphatemia (<2.5 mg/dl; n = 238), or hyperphophatemia (>4.5 mg/dl; n = 207) groups depending on preoperative serum phosphorus level. RESULTS The primary outcome was all-cause death during a median follow-up of 48 months. Secondary outcomes were cardiovascular death, graft failure, myocardial infarction, repeat revascularization, and stroke. In multivariate Cox analysis, preoperative hypophosphatemia was significantly associated with all-cause death (hazard ratio [HR] 1.76; 95% confidence interval [CI] 1.13-2.76; P = 0.01). However, this association varied depending on chronic kidney disease and emergent operation (p for interaction = 0.05 and 0.03, respectively). In addition, analysis after IPW adjustment demonstrated that preoperative serum phosphorus abnormalities were not significantly associated with all-cause death (P = 0.08) or any secondary outcomes except graft failure. Graft failure was significantly associated with preoperative hypophosphatemia (HR 2.51; 95% CI 1.37-4.61; P = 0.003). CONCLUSION Our study showed that preoperative serum phosphorus abnormalities in clinical criteria were not associated with outcomes after CABG except for graft failure. And, the association of hypophosphatemia with graft failure remains to be evaluated.
Collapse
|
39
|
Late clinical outcomes of aortic valve replacement with Carpentier-Edwards pericardial valves. J Thorac Dis 2019; 11:5372-5381. [PMID: 32030255 DOI: 10.21037/jtd.2019.11.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The present study aimed to compare the long-term clinical and hemodynamic outcomes of aortic valve replacement using Carpentier-Edwards Perimount (Perimount) or Perimount Magna (Magna) valves. Methods We enrolled 430 patients who underwent aortic valve replacements with Perimount (n=58) or Magna (n=372) valves [1998-2013]. Multivariable and inverse probability of treatment weight (IPTW) analyses were performed. Results Before IPTW analysis, the overall 8-year survival rate differed significantly between the groups [Perimount 90%±4% vs. Magna 76%±4%; P=0.02; hazard ratio (HR): 0.37 for the Perimount group; 95% confidence interval (CI): 0.17-0.83]. Multivariable analysis of the overall survival identified Perimount valve use as a protective factor (P=0.009; HR: 0.32; 95% CI: 0.14-0.75). Independent risk factors of overall survival were older age, male sex, higher preoperative left ventricular mass index, lower ejection fraction, lower aortic valve pressure gradient, and lower haemoglobin. After applying IPTW, overall survival was again found to be significantly longer in the Perimount group (P=0.04; HR: 0.43; 95% CI: 0.20-0.93). Event-free survival was also better in the Perimount group (P=0.006; HR: 0.38; 95% CI: 0.19-0.75). However, the Magna group had significantly lower aortic valve pressure gradients at one year and five years postoperative. Conclusions Although Magna use led to decreased aortic valve pressure gradients at follow-up, overall and event-free survival rates were significantly better with use of the Perimount valve. Additional and larger studies are needed to confirm these results.
Collapse
|
40
|
Association between high-sensitivity cardiac troponin I measured at emergency department and complications of emergency coronary artery bypass grafting. Sci Rep 2019; 9:16933. [PMID: 31729415 PMCID: PMC6858436 DOI: 10.1038/s41598-019-53047-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 10/23/2019] [Indexed: 12/27/2022] Open
Abstract
High-sensitivity cardiac troponin I (hs-cTnI) is a widely used biomarker to identify ischemic chest pain in the Emergency Department (ED), but the clinical impact on emergency coronary artery bypass grafting (eCABG) remains undetermined. We aimed to evaluate the clinical impact of hs-cTnI measured at the ED by comparing outcomes of eCABG in patients with non–ST-segment–elevation acute coronary syndrome (NSTE-ACS) which comprises unstable angina (UA) and non–ST-segment–elevation myocardial infarction (NSTEMI). From January 2012 to March 2016, 242 patients undergoing eCABG were grouped according to serum hs-cTnI level in the ED. The primary endpoint was major cardiovascular cerebral event (MACCE) defined as a composite of all-cause death, myocardial infarction, repeat revascularization, and stroke. The incidence of each MACCE composite, in addition to postoperative complications such as acute kidney injury, reoperation, atrial fibrillation, and hospital stay duration were also compared. Patients were divided into two groups: UA [<0.04 ng/mL, n = 102] and NSTEMI [≥0.04 ng/mL, n = 140]. The incidence of MACCE did not differ between the two groups. Postoperative acute kidney injury was more frequent in the NSTEMI group after adjusting for confounding factors (6.9% vs. 23.6%; odds ratio, 2.76; 95% confidence interval, 1.09–6.99; p-value = 0.032). In-hospital stay was also longer in the NSTEMI group (9.0 days vs. 15.4 days, p-value = 0.008). ECABG for UA and NSTEMI patients showed comparable outcomes, but hs-cTnI elevation at the ED may be associated with immediate postoperative complications.
Collapse
|
41
|
Search for Subsolar Mass Ultracompact Binaries in Advanced LIGO's Second Observing Run. PHYSICAL REVIEW LETTERS 2019; 123:161102. [PMID: 31702344 DOI: 10.1103/physrevlett.123.161102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Indexed: 06/10/2023]
Abstract
We present a search for subsolar mass ultracompact objects in data obtained during Advanced LIGO's second observing run. In contrast to a previous search of Advanced LIGO data from the first observing run, this search includes the effects of component spin on the gravitational waveform. We identify no viable gravitational-wave candidates consistent with subsolar mass ultracompact binaries with at least one component between 0.2 M_{⊙}-1.0 M_{⊙}. We use the null result to constrain the binary merger rate of (0.2 M_{⊙}, 0.2 M_{⊙}) binaries to be less than 3.7×10^{5} Gpc^{-3} yr^{-1} and the binary merger rate of (1.0 M_{⊙}, 1.0 M_{⊙}) binaries to be less than 5.2×10^{3} Gpc^{-3} yr^{-1}. Subsolar mass ultracompact objects are not expected to form via known stellar evolution channels, though it has been suggested that primordial density fluctuations or particle dark matter with cooling mechanisms and/or nuclear interactions could form black holes with subsolar masses. Assuming a particular primordial black hole (PBH) formation model, we constrain a population of merging 0.2 M_{⊙} black holes to account for less than 16% of the dark matter density and a population of merging 1.0 M_{⊙} black holes to account for less than 2% of the dark matter density. We discuss how constraints on the merger rate and dark matter fraction may be extended to arbitrary black hole population models that predict subsolar mass binaries.
Collapse
|
42
|
Clinical Outcome of Extraanatomic Bypass for Midaortic Syndrome Caused by Takayasu Arteritis. Ann Thorac Surg 2019; 109:1419-1425. [PMID: 31557481 DOI: 10.1016/j.athoracsur.2019.08.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/08/2019] [Accepted: 08/08/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND We investigated long-term outcomes and cardiac function after extraanatomic bypass surgery for Takayasu arteritis and midaortic syndrome. METHODS Between 2007 and 2016, 14 patients underwent extraanatomic bypass for Takayasu arteritis. Median age was 56.6 years. Median systolic pressure gradient in the stenotic lesion was 79 mm Hg. Nine patients underwent bypass surgery from the ascending aorta to the infrarenal aorta, 2 from the ascending aorta to the distal descending thoracic aorta, 1 from the ascending aorta to the supraceliac abdominal aorta, 1 from the descending thoracic aorta to the infrarenal abdominal aorta, and 1 from the descending thoracic aorta to the descending thoracic aorta. Five underwent additional 6 peripheral bypass procedures, and 6 underwent concomitant heart surgery. RESULTS There were no early deaths. Median hospital stay was 10.5 days. Median follow-up duration was 36.3 months, and late death occurred in 2 patients. One died at 1 year postoperatively because of an infection due to pancreatic injury and mediastinitis. The other was lost to follow-up, and death was confirmed through the national insurance database. No anastomotic site stenosis or aneurysmal change occurred. The number of antihypertensive medications was reduced significantly in all but 1 patient, and organ ischemia symptoms, including dizziness, visual disturbance, and claudication, improved in all patients. Interventricular septal diameter and left ventricular mass index decreased significantly. Serum creatinine level also decreased. Overall estimated 5-year survival was 79% ± 13%. CONCLUSIONS Extraanatomic bypass for Takayasu arteritis is safe and effective and can be useful for left ventricular unloading and reduction of organ ischemia.
Collapse
|
43
|
Tests of General Relativity with GW170817. PHYSICAL REVIEW LETTERS 2019; 123:011102. [PMID: 31386391 DOI: 10.1103/physrevlett.123.011102] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/21/2019] [Indexed: 06/10/2023]
Abstract
The recent discovery by Advanced LIGO and Advanced Virgo of a gravitational wave signal from a binary neutron star inspiral has enabled tests of general relativity (GR) with this new type of source. This source, for the first time, permits tests of strong-field dynamics of compact binaries in the presence of matter. In this Letter, we place constraints on the dipole radiation and possible deviations from GR in the post-Newtonian coefficients that govern the inspiral regime. Bounds on modified dispersion of gravitational waves are obtained; in combination with information from the observed electromagnetic counterpart we can also constrain effects due to large extra dimensions. Finally, the polarization content of the gravitational wave signal is studied. The results of all tests performed here show good agreement with GR.
Collapse
|
44
|
Erratum: Graft Strategy for Coronary Artery Bypass Grafting in Patients with Severe Left Ventricular Dysfunction. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:189. [PMID: 31263670 PMCID: PMC6559188 DOI: 10.5090/kjtcs.2019.52.3.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
45
|
Comparison of Off-Pump Coronary Artery Bypass between Octogenarians and Septuagenarians: A Propensity Score Analysis. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:155-161. [PMID: 31236375 PMCID: PMC6559184 DOI: 10.5090/kjtcs.2019.52.3.155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 11/16/2022]
Abstract
Background Coronary artery bypass grafting (CABG) is being offered increasingly frequently to octogenarians. However, old age is known to be an independent risk factor in CABG. The aim of this study was to compare the outcomes of off-pump coronary artery bypass (OPCAB) between octogenarians and septuagenarians. Methods We retrospectively reviewed the data of 1,289 consecutive patients aged ≥70 years who underwent OPCAB at a single institution between 2001 and 2016. We compared the outcomes of 115 octogenarians and 1,174 septuagenarians. Using propensity score matching, based on preoperative clinical characteristics, 114 octogenarians were matched with 338 septuagenarians. Results Propensity score analysis revealed that the incidence of acute kidney injury (14.9% vs. 7.9%, p=0.028) and respiratory complications (8.8% vs. 4.2%, p=0.040) was significantly higher in octogenarians. The early mortality rate (2.6% vs. 1.0%, p=0.240) and 1-year survival rate (89.5% vs. 94.4%, p=0.097) were not statistically significant between the groups. However, the 5-year survival rate (67.3% vs. 79.9%, p<0.001) was significantly lower in octogenarians. Previous myocardial infarction and a left ventricular ejection fraction ≤35% were associated with a poor 1-year survival rate. Conclusion Early and 1-year outcomes of OPCAB in octogenarians were tolerable when compared with those in septuagenarians. OPCAB could be a suitable option for octogenarians.
Collapse
|
46
|
Temporary Right Ventricular Assist Device Insertion via Left Thoracotomy after Left Ventricular Assist Device Implantation. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:105-108. [PMID: 31089448 PMCID: PMC6493264 DOI: 10.5090/kjtcs.2019.52.2.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/05/2018] [Accepted: 11/14/2018] [Indexed: 11/23/2022]
Abstract
Right heart failure is a relatively common complication after left ventricular assist device (LVAD) implantation. Severe right heart failure can be managed by temporary right ventricular assist device (RVAD) implantation. However, trans-sternal RVAD insertion requires a subsequent third sternotomy for cannula removal. Herein, we present a case of RVAD insertion via a left anterior mini-thoracotomy after LVAD implantation in a patient with alcohol-induced cardiomyopathy.
Collapse
|
47
|
Outcomes of Coronary Artery Bypass Grafting after Extracorporeal Life Support in Patients with Cardiac Arrest or Cardiogenic Shock. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:70-77. [PMID: 31089443 PMCID: PMC6493258 DOI: 10.5090/kjtcs.2019.52.2.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/28/2022]
Abstract
Background Extracorporeal life support (ECLS) is used as a bridge to revascularization in high-risk patients with ischemic heart disease. We reviewed our experiences of coronary artery bypass grafting (CABG) after ECLS in patients with cardiac arrest or refractory cardiogenic shock. Methods We retrospectively reviewed 4,616 patients who underwent CABG at our institution between May 2006 and February 2017. We identified patients who underwent CABG following ECLS for cardiogenic shock or cardiac arrest. Twenty-three patients (0.5% of all CABG cases) were enrolled in the analysis. Their median age was 65 years (Q1-Q3, 58-77 years). Nine patients (39.1%) were diagnosed with ST-elevation myocardial infarction. Mechanical complications after acute myocardial infarction, including acute mitral regurgitation, left ventricular rupture, and ventricular septal defect, occurred in 9 patients (39.1%). Results The median time from cardiopulmonary resuscitation to ECLS initiation was 25 minutes (Q1-Q3, 18.5-28.5 minutes). Conventional CABG was performed in 10 patients (43.5%) who underwent concomitant intracardiac procedures. Postoperative ECLS was required in 16 patients (69.5%). The rate of successful ECLS weaning was 91.3% (n=21). There were 6 early mortalities (26.1%). Conclusion CABG after ECLS was very rare in real-world circumstances. Although the early mortality rate was high, the risk of mortality may be acceptable under such devastating circumstances.
Collapse
|
48
|
Graft Strategy for Coronary Artery Bypass Grafting in Patients with Severe Left Ventricular Dysfunction. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:16-24. [PMID: 30834213 PMCID: PMC6383854 DOI: 10.5090/kjtcs.2019.52.1.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 01/06/2023]
Abstract
Background Optimal graft selection for coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) dysfunction remains debatable. We report an analysis of our experiences of isolated CABG in patients with severe LV dysfunction and the impact of graft strategy on long-term outcomes. Methods We analyzed 209 patients with severe LV dysfunction (ejection fraction [EF] <30%) who underwent primary isolated CABG. Of these, 169 were revascularized with a bilateral internal thoracic arterial (ITA) graft (BITA group) and 40 were revascularized with a single ITA graft (SITA group). The mean follow-up duration was 22±32 months. Results There were 18 early deaths (8.6%). Overall survival at 5 years was 66.7%. The rate of freedom from cardiac-related death at 5 years was 74.1%, and was significantly higher in patients who underwent off-pump CABG (p=0.005) and in the BITA group (p=0.023). Multivariate analysis demonstrated that old age (hazard ratio [HR], 2.548; 95% confidence interval [CI], 1.134–5.762; p=0.024), off-pump CABG (HR, 0.245; 95% CI, 0.090–0.661; p=0.006), and BITA grafts (HR, 0.333; 95% CI, 0.146–0.757; p=0.009) were correlated with cardiac mortality. Conclusion CABG in patients with severe LV dysfunction (EF <30%) showed reasonable long-term outcomes. The rate of freedom from cardiac-related death was significantly higher in patients who underwent off-pump CABG and in the BITA group. Off-pump BITA grafting strategies can be accepted as a viable primary option in patients with severe LV dysfunction if performed by an experienced surgeon.
Collapse
|
49
|
Constraining the p-Mode-g-Mode Tidal Instability with GW170817. PHYSICAL REVIEW LETTERS 2019; 122:061104. [PMID: 30822067 DOI: 10.1103/physrevlett.122.061104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/30/2018] [Indexed: 06/09/2023]
Abstract
We analyze the impact of a proposed tidal instability coupling p modes and g modes within neutron stars on GW170817. This nonresonant instability transfers energy from the orbit of the binary to internal modes of the stars, accelerating the gravitational-wave driven inspiral. We model the impact of this instability on the phasing of the gravitational wave signal using three parameters per star: an overall amplitude, a saturation frequency, and a spectral index. Incorporating these additional parameters, we compute the Bayes factor (lnB_{!pg}^{pg}) comparing our p-g model to a standard one. We find that the observed signal is consistent with waveform models that neglect p-g effects, with lnB_{!pg}^{pg}=0.03_{-0.58}^{+0.70} (maximum a posteriori and 90% credible region). By injecting simulated signals that do not include p-g effects and recovering them with the p-g model, we show that there is a ≃50% probability of obtaining similar lnB_{!pg}^{pg} even when p-g effects are absent. We find that the p-g amplitude for 1.4 M_{⊙} neutron stars is constrained to less than a few tenths of the theoretical maximum, with maxima a posteriori near one-tenth this maximum and p-g saturation frequency ∼70 Hz. This suggests that there are less than a few hundred excited modes, assuming they all saturate by wave breaking. For comparison, theoretical upper bounds suggest ≲10^{3} modes saturate by wave breaking. Thus, the measured constraints only rule out extreme values of the p-g parameters. They also imply that the instability dissipates ≲10^{51} erg over the entire inspiral, i.e., less than a few percent of the energy radiated as gravitational waves.
Collapse
|
50
|
Randomized Trial of Concomitant Maze Procedure Using Nitrous Oxide- Versus Argon-Based Cryoablation. Ann Thorac Surg 2019; 108:30-36. [PMID: 30716291 DOI: 10.1016/j.athoracsur.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 11/09/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Currently, two types of cryoprobes are available: nitrous oxide (N2O)-based and argon gas-based. However, few studies have compared the outcomes obtained with these two cryoprobe types. The aim of this study was to compare the early outcomes of a concomitant maze procedure using N2O-based cryoablation (the N2O group) versus argon gas-based cryoablation (the argon group) in patients with persistent atrial fibrillation (AF). METHODS This study was a single-center, prospective, randomized controlled clinical trial. Sixty patients were randomly assigned to receive a concomitant maze procedure using N2O-based cryoablation (n = 30) or argon gas-based cryoablation (n = 30) for persistent AF. Patients were followed up at 3, 6, and 12 months by electrocardiography, 24-hour Holter monitoring, and transthoracic echocardiography. RESULTS No important intergroup differences were observed in terms of preoperative variables, morbidity, or mortality. During 1 year of follow-up, normal sinus rhythm was maintained in 26 patients in the N2O group and 26 patients in the argon group (86.7% versus 86.7%, p = 1.000). Freedom from atrial arrhythmia events at 12 months was observed in 84.5% ± 4.7% without intergroup differences. Early AF episode before discharge was correlated with atrial arrhythmia events during follow-up (hazard ratio 7.89, 95% confidence interval: 1.75 to 35, p = 0.007). The N2O group showed earlier recovery of left atrial activity compared with the argon group (p = 0.043); however, this difference disappeared after 6 months. CONCLUSIONS Both procedures have similar 1-year sinus rhythm maintenance rates. Left atrial contractile activity tends to return earlier in the N2O group.
Collapse
|