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Beqari J, Powell J, Hurd J, Potter AL, McCarthy M, Srinivasan D, Wang D, Cranor J, Zhang L, Webster K, Kim J, Rosenstein A, Zheng Z, Lin TH, Li J, Fang Z, Zhang Y, Anderson A, Madsen J, Anderson J, Clark A, Yang ME, Nurko A, El-Jawahri AR, Sundt TM, Melnitchouk S, Jassar AS, D'Alessandro D, Panda N, Schumacher-Beal LY, Wright CD, Auchincloss HG, Sachdeva UM, Lanuti M, Colson YL, Langer N, Osho A, Yang CFJ, Li X. A Pilot Study Using Machine Learning Algorithms and Wearable Technology for the Early Detection of Postoperative Complications After Cardiothoracic Surgery. Ann Surg 2024:00000658-990000000-00809. [PMID: 38482684 DOI: 10.1097/sla.0000000000006263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To evaluate whether a machine learning algorithm (i.e. the "NightSignal" algorithm) can be used for the detection of postoperative complications prior to symptom onset after cardiothoracic surgery. SUMMARY BACKGROUND DATA Methods that enable the early detection of postoperative complications after cardiothoracic surgery are needed. METHODS This was a prospective observational cohort study conducted from July 2021 to February 2023 at a single academic tertiary care hospital. Patients aged 18 years or older scheduled to undergo cardiothoracic surgery were recruited. Study participants wore a Fitbit watch continuously for at least 1 week preoperatively and up to 90-days postoperatively. The ability of the NightSignal algorithm-which was previously developed for the early detection of Covid-19-to detect postoperative complications was evaluated. The primary outcomes were algorithm sensitivity and specificity for postoperative event detection. RESULTS A total of 56 patients undergoing cardiothoracic surgery met inclusion criteria, of which 24 (42.9%) underwent thoracic operations and 32 (57.1%) underwent cardiac operations. The median age was 62 (IQR: 51-68) years and 30 (53.6%) patients were female. The NightSignal algorithm detected 17 of the 21 postoperative events a median of 2 (IQR: 1-3) days prior to symptom onset, representing a sensitivity of 81%. The specificity, negative predictive value, and positive predictive value of the algorithm for the detection of postoperative events were 75%, 97%, and 28%, respectively. CONCLUSIONS Machine learning analysis of biometric data collected from wearable devices has the potential to detect postoperative complications-prior to symptom onset-after cardiothoracic surgery.
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Affiliation(s)
- Jorind Beqari
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Joseph Powell
- Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, OH
| | - Jacob Hurd
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Meghan McCarthy
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Danny Wang
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - James Cranor
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Lizi Zhang
- Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, OH
| | - Kyle Webster
- Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, OH
| | - Joshua Kim
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Zeyuan Zheng
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Tung Ho Lin
- Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, OH
| | - Jing Li
- Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, OH
| | - Zhengyu Fang
- Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, OH
| | - Yuhang Zhang
- Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, OH
| | - Alex Anderson
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - James Madsen
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Jacob Anderson
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Anne Clark
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Margaret E Yang
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Andrea Nurko
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Thoralf M Sundt
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | | | | | - Nikhil Panda
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Cameron D Wright
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Uma M Sachdeva
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Michael Lanuti
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Yolonda L Colson
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Nathaniel Langer
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Asishana Osho
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Xiao Li
- Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, OH
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Jassar AS. Care of patients with acute aortic syndromes: till death do us part. Eur J Cardiothorac Surg 2023; 64:ezad359. [PMID: 37882759 DOI: 10.1093/ejcts/ezad359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- Arminder S Jassar
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, USA
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Yucel E, Patel NK, Crousillat DR, Baliyan V, Jassar AS, Palacios I, Inglessis I, Smith RN. Case 32-2023: A 62-Year-Old Woman with Recurrent Hemorrhagic Pericardial Effusion. N Engl J Med 2023; 389:1511-1520. [PMID: 37851878 DOI: 10.1056/nejmcpc2115845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Affiliation(s)
- Evin Yucel
- From the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - Nilay K Patel
- From the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - Daniela R Crousillat
- From the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - Vinit Baliyan
- From the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - Arminder S Jassar
- From the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - Igor Palacios
- From the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - Ignacio Inglessis
- From the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - R Neal Smith
- From the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
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Potz BA, Andrawes MN, Sakhuja R, Jassar AS. Direct implantation of balloon expandable transcatheter aortic valve to treat intraoperative homograft valve dysfunction. JTCVS Tech 2023; 20:40-44. [PMID: 37555040 PMCID: PMC10405301 DOI: 10.1016/j.xjtc.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 08/10/2023] Open
Affiliation(s)
- Brittany A. Potz
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Mass
| | - Michael N. Andrawes
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Mass
| | - Rahul Sakhuja
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Mass
| | - Arminder S. Jassar
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Mass
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Maraboto Gonzalez C, Butala N, Patel NK, Inglessis-Azuaje I, Jassar AS, Yucel E. Transesophageal Echocardiography Guidance for Percutaneous Closure of Ascending Aortic Pseudoaneurysm. CASE (Phila) 2023; 7:21-26. [PMID: 36704489 PMCID: PMC9871350 DOI: 10.1016/j.case.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
• Percutaneous closure of ascending aortic pseudoaneurysms is feasible in selected patients. • Procedural planning with multimodality imaging and multidisciplinary discussion is key. • TEE can be instrumental for intraprocedural guidance. • TEE guidance minimizes the amount of iodinated contrast and ionizing radiation used.
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Affiliation(s)
- Carola Maraboto Gonzalez
- Echocardiography Laboratory, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Neel Butala
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Nilay K. Patel
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Arminder S. Jassar
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Evin Yucel
- Echocardiography Laboratory, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
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Paneitz DC, Hedgire S, Jassar AS. Role of advanced imaging techniques in cardiac surgery: Aortic dissection. J Card Surg 2022; 37:4165-4171. [PMID: 36183405 DOI: 10.1111/jocs.16995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Collaboration among cardiac surgeons and radiologists is essential to fully leverage advanced imaging technologies and improve the care of cardiac surgery patients. In this review, a cardiac surgeon and cardiovascular radiologist discuss imaging pearls and considerations in aortic dissection cases. METHODS The surgeon and the radiologist discuss imaging considerations in two aortic dissection cases. RESULTS It is essential to obtain and review all phases of a CTA when diagnosing acute aortic pathology. Optimizing scan parameters and careful multiplanar image review is necessary for adept interpretation. Current CT technology allows ECG gating to eliminate motion artifact and allow for dynamic assessment of the aortic pathology. Concurrent evaluation of thoracic aorta and coronary arteries is feasible. A systematic review of the scan using landmarks is critical for appropriate diagnosis and reporting. As TEVAR is increasingly used for arch repair, collaboration with radiologists is essential for preoperative planning in redo cases. CONCLUSIONS Collaboration among cardiac surgeons and radiologists is mutually beneficial for surgeons, radiologists, and their patients.
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Affiliation(s)
- Dane C Paneitz
- Division of Cardiac Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sandeep Hedgire
- Department of Radiology, Division of Cardiovascular Imaging, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Arminder S Jassar
- Division of Cardiac Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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7
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Wolfe SB, Sundt TM, Isselbacher EM, Cameron DE, Trimarchi S, Bekeredjian R, Leshnower B, Bavaria JE, Brinster DR, Sultan I, Pai CW, Kachroo P, Ouzounian M, Coselli JS, Myrmel T, Pacini D, Eagle K, Patel HJ, Jassar AS. Survival after operative repair of acute type A aortic dissection varies according to the presence and type of preoperative malperfusion. J Thorac Cardiovasc Surg 2022:S0022-5223(22)01024-8. [PMID: 36333247 DOI: 10.1016/j.jtcvs.2022.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/07/2022] [Accepted: 09/20/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Approximately one-quarter of patients with acute type A aortic dissection (TAAD) present with concomitant malperfusion of coronary arteries, mesenteric circulation, lower extremities, kidneys, brain, and/or coma. It is generally accepted that TAAD patients who present with malperfusion experience higher mortality rates than patients without, although how specific malperfusion syndromes, alone or in combination, affect mortality is not well described. METHODS The International Registry of Acute Aortic Dissection database was queried for patients who underwent surgical repair of TAAD. Patients were stratified according to the presence/absence of malperfusion at presentation. Multivariable logistic regression was used to evaluate in-hospital mortality according to malperfusion type. Kaplan-Meier estimates were used to estimate 30-day postoperative survival. RESULTS Six thousand four hundred thirty-seven patients underwent surgical repair of acute TAAD, of whom 2642 (41%) had 1 or more preoperative malperfusion syndromes. Mesenteric malperfusion (adjusted odds ratio [AOR], 4.84; P < .001) was associated with the highest odds of in-hospital mortality, followed by coma (AOR, 1.88; P = .007), limb ischemia (AOR, 1.73; P = .008), and coronary malperfusion (AOR, 1.51; P = .02). Renal malperfusion (AOR, 1.37; P = .24) and neurologic deficit (AOR, 1.35; P = .28) were not associated with increased in-hospital mortality. In patients who survived to discharge, there was no difference in 1-year postdischarge survival in the malperfusion and no malperfusion cohorts (P = .36). CONCLUSIONS Survival during the index admission after TAAD repair varies according to the presence and type of malperfusion syndromes, with mesenteric malperfusion being associated with the highest odds of in-hospital death. Not only the presence of malperfusion but rather specific malperfusion syndromes should be considered when assessing a patient's risk of undergoing TAAD repair.
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Affiliation(s)
- Stanley B Wolfe
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Mass
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Mass
| | - Eric M Isselbacher
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Mass
| | - Duke E Cameron
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Mass
| | - Santi Trimarchi
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan, University of Milan, Milan, Italy
| | - Raffi Bekeredjian
- Department of Internal Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Bradley Leshnower
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Derek R Brinster
- Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Center for Thoracic Aortic Disease, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Chih-Wen Pai
- International Registry of Acute Aortic Dissection, University of Michigan, Ann Arbor, Mich
| | - Puja Kachroo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Mo
| | - Maral Ouzounian
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Truls Myrmel
- Department of Thoracic and Cardiovascular Surgery, Tromso University Hospital, Tromso, Norway
| | - Davide Pacini
- Division of Cardiac-Surgery, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda-Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Kim Eagle
- Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Mich
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Mich
| | - Arminder S Jassar
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Mass.
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Flannery L, Etiwy M, Camacho A, Liu R, Patel N, Tavil-Shatelyan A, Tanguturi VK, Dal-Bianco JP, Yucel E, Sakhuja R, Jassar AS, Langer NB, Inglessis I, Passeri JJ, Hung J, Elmariah S. Patient- and Process-Related Contributors to the Underuse of Aortic Valve Replacement and Subsequent Mortality in Ambulatory Patients With Severe Aortic Stenosis. J Am Heart Assoc 2022; 11:e025065. [PMID: 35621198 PMCID: PMC9238693 DOI: 10.1161/jaha.121.025065] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Many patients with severe aortic stenosis (AS) and an indication for aortic valve replacement (AVR) do not undergo treatment. The reasons for this have not been well studied in the transcatheter AVR era. We sought to determine how patient‐ and process‐specific factors affected AVR use in patients with severe AS. Methods and Results We identified ambulatory patients from 2016 to 2018 demonstrating severe AS, defined by aortic valve area ≤1.0 cm2. Propensity scoring analysis with inverse probability of treatment weighting was used to evaluate associations between predictors and the odds of undergoing AVR at 365 days and subsequent mortality at 730 days. Of 324 patients with an indication for AVR (79.3±9.7 years, 57.4% men), 140 patients (43.2%) did not undergo AVR. The odds of AVR were reduced in patients aged >90 years (odds ratio [OR], 0.24 [95% CI, 0.08–0.69]; P=0.01), greater comorbid conditions (OR, 0.88 per 1‐point increase in Combined Comorbidity Index [95% CI, 0.79–0.97]; P=0.01), low‐flow, low‐gradient AS with preserved left ventricular ejection fraction (OR, 0.11 [95% CI, 0.06–0.21]), and low‐gradient AS with reduced left ventricular ejection fraction (OR, 0.18 [95% CI, 0.08–0.40]) and were increased if the transthoracic echocardiogram ordering provider was a cardiologist (OR, 2.46 [95% CI, 1.38–4.38]). Patients who underwent AVR gained an average of 85.8 days of life (95% CI, 40.9–130.6) at 730 days. Conclusions The proportion of ambulatory patients with severe AS and an indication for AVR who do not receive AVR remains significant. Efforts are needed to maximize the recognition of severe AS, especially low‐gradient subtypes, and to encourage patient referral to multidisciplinary heart valve teams.
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Affiliation(s)
- Laura Flannery
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Muhammad Etiwy
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Alexander Camacho
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Ran Liu
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Nilay Patel
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Arpi Tavil-Shatelyan
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Varsha K Tanguturi
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Jacob P Dal-Bianco
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Evin Yucel
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Rahul Sakhuja
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Arminder S Jassar
- Division of Cardiac Surgery Department of Surgery Massachusetts General HospitalHarvard Medical School Boston MA
| | - Nathaniel B Langer
- Division of Cardiac Surgery Department of Surgery Massachusetts General HospitalHarvard Medical School Boston MA
| | - Ignacio Inglessis
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Jonathan J Passeri
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Judy Hung
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Sammy Elmariah
- Cardiology Division Department of Medicine Massachusetts General HospitalHarvard Medical School Boston MA
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Li SX, Patel NK, Flannery LD, Selberg A, Kandanelly RR, Morrison FJ, Kim J, Tanguturi VK, Crousillat DR, Shaqdan AW, Inglessis I, Shah PB, Passeri JJ, Kaneko T, Jassar AS, Langer NB, Turchin A, Elmariah S. Trends in Utilization of Aortic Valve Replacement for Severe Aortic Stenosis. J Am Coll Cardiol 2022; 79:864-877. [PMID: 35241220 DOI: 10.1016/j.jacc.2021.11.060] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/19/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Despite the rapid growth of aortic valve replacement (AVR) for aortic stenosis (AS), limited data suggest symptomatic severe AS remains undertreated. OBJECTIVES This study sought to investigate temporal trends in AVR utilization among patients with a clinical indication for AVR. METHODS Patients with severe AS (aortic valve area <1 cm2) on transthoracic echocardiograms from 2000 to 2017 at 2 large academic medical centers were classified based on clinical guideline indications for AVR and divided into 4 AS subgroups: high gradient with normal left ventricular ejection fraction (LVEF) (HG-NEF), high gradient with low LVEF (HG-LEF), low gradient with normal LVEF (LG-NEF), and low gradient with low LVEF (LG-LEF). Utilization of AVR was examined and predictors identified. RESULTS Of 10,795 patients, 6,150 (57%) had an indication or potential indication for AVR, of whom 2,977 (48%) received AVR. The frequency of AVR varied by AS subtype with LG groups less likely to receive an AVR (HG-NEF: 70%, HG-LEF: 53%, LG-NEF: 32%, LG-LEF: 38%, P < 0.001). AVR volumes grew over the 18-year study period but were paralleled by comparable growth in the number of patients with an indication for AVR. In patients with a Class I indication, younger age, coronary artery disease, smoking history, higher hematocrit, outpatient index transthoracic echocardiogram, and LVEF ≥0.5 were independently associated with an increased likelihood of receiving an AVR. AVR was associated with improved survival in each AS-subgroup. CONCLUSIONS Over an 18-year period, the proportion of patients with an indication for AVR who did not receive AVR has remained substantial despite the rapid growth of AVR volumes.
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Affiliation(s)
- Shawn X Li
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. https://twitter.com/ShawnXLiMD
| | - Nilay K Patel
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura D Flannery
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra Selberg
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ritvik R Kandanelly
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Fritha J Morrison
- Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joonghee Kim
- Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Varsha K Tanguturi
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniela R Crousillat
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ayman W Shaqdan
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ignacio Inglessis
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pinak B Shah
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan J Passeri
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Arminder S Jassar
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nathaniel B Langer
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Turchin
- Division of Endocrinology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sammy Elmariah
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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10
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Sylvin EA, Jassar AS, Kucharczuk JC, Vallabhajosyula P. Pericardial–Esophageal Fistula: A Rare but Increasing Complication of Cardiac Ablation. Thorac Cardiovasc Surg Rep 2022; 11:e27-e29. [PMID: 35265452 PMCID: PMC8901371 DOI: 10.1055/s-0041-1736209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/16/2021] [Indexed: 11/26/2022] Open
Abstract
Pericardial–esophageal fistula and/or atrial–esophageal fistula after cardiac ablation is nearly universally fatal if not detected and treated expeditiously. This condition should be assumed and ruled out in anyone with a recent history of cardiac ablation presenting with signs of sepsis, pneumomediastinum, pneumopericardium, or chest pain. Computed tomography scan of the chest is a rapid and a sensitive diagnostic modality. Tenets of treatment and repair consist of preventing an air embolism, repairing the esophageal perforation and atrial defect, and interposing autologous tissue between the esophagus and heart.
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Affiliation(s)
- Erik A. Sylvin
- Division of Cardiothoracic Surgery, JFK Medical Center, University of Miami Miller School of Medicine, Atlantis, Florida, United States
| | - Arminder S. Jassar
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - John C. Kucharczuk
- Division of Thoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Prashanth Vallabhajosyula
- Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
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11
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Vyas DA, Marinacci L, Bearnot B, Wakeman SE, Sundt TM, Jassar AS, Triant VA, Nelson SB, Dudzinski DM, Paras ML. Creation of a Multidisciplinary Drug Use Endocarditis Treatment (DUET) Team: Initial Patient Characteristics, Outcomes, and Future Directions. Open Forum Infect Dis 2022; 9:ofac047. [PMID: 35252467 PMCID: PMC8890495 DOI: 10.1093/ofid/ofac047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/30/2022] [Indexed: 11/17/2022] Open
Abstract
Background Consensus guidelines recommend multidisciplinary models to manage infective endocarditis, yet often do not address the unique challenges of treating people with drug use–associated infective endocarditis (DUA-IE). Our center is among the first to convene a Drug Use Endocarditis Treatment (DUET) team composed of specialists from Infectious Disease, Cardiothoracic Surgery, Cardiology, and Addiction Medicine. Methods The objective of this study was to describe the demographics, infectious characteristics, and clinical outcomes of the first cohort of patients cared for by the DUET team. This was a retrospective chart review of patients referred to the DUET team between August 2018 and May 2020 with DUA-IE. Results Fifty-seven patients were presented to the DUET team between August 2018 and May 2020. The cohort was young, with a median age of 35, and injected primarily opioids (82.5% heroin/fentanyl), cocaine (52.6%), and methamphetamine (15.8%). Overall, 14 individuals (24.6%) received cardiac surgery, and the remainder (75.4%) were managed with antimicrobial therapy alone. Nearly 65% of individuals were discharged on medication for opioid use disorder, though less than half (36.8%) were discharged with naloxone and only 1 patient was initiated on HIV pre-exposure prophylaxis. Overall, the cohort had a high rate of readmission (42.1%) within 90 days of discharge. Conclusions Multidisciplinary care models such as the DUET team can help integrate nuanced decision-making from numerous subspecialties. They can also increase the uptake of addiction medicine and harm reduction tools, but further efforts are needed to integrate harm reduction strategies and improve follow-up in future iterations of the DUET team model.
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Affiliation(s)
- Darshali A Vyas
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lucas Marinacci
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Benjamin Bearnot
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah E Wakeman
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thoralf M Sundt
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Arminder S Jassar
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Virginia A Triant
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of General Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sandra B Nelson
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David M Dudzinski
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Molly L Paras
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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12
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Wolfe S, Langer NB, Hedgire SS, Passeri JJ, Yucel E, Dal-Bianco J, Inglessis-Azuaje I, Kolte DS, Patel NK, Michel E, Sakhuja R, Elmariah S, Jassar AS. TRANSCATHETER AORTIC VALVE REPLACEMENT IS SAFE IN PATIENTS WITH ANOMALOUS ORIGIN OF CORONARY ARTERIES. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01773-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Osho AA, Langer NB, Jassar AS. Transcatheter Aortic Valve Implantation in Low and Intermediate Surgical Risk Patients: a Critical Appraisal of Seminal Studies. Curr Treat Options Cardio Med 2022. [DOI: 10.1007/s11936-022-00960-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Naar L, Dorken Gallastegi A, Kongkaewpaisan N, Kokoroskos N, Tolis G, Melnitchouk S, Villavicencio-Theoduloz M, Mendoza AE, Velmahos GC, Kaafarani HMA, Jassar AS. Risk factors for ischemic gastrointestinal complications in patients undergoing open cardiac surgical procedures: A single-center retrospective experience. J Card Surg 2022; 37:808-817. [PMID: 35137981 DOI: 10.1111/jocs.16294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/18/2021] [Accepted: 01/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ischemic gastrointestinal complications (IGIC) following cardiac surgery are associated with high morbidity and mortality and remain difficult to predict. We evaluated perioperative risk factors for IGIC in patients undergoing open cardiac surgery. METHODS All patients that underwent an open cardiac surgical procedure at a tertiary academic center between 2011 and 2017 were included. The primary outcome was IGIC, defined as acute mesenteric ischemia necessitating a surgical intervention or postoperative gastrointestinal bleeding that was proven to be of ischemic etiology and necessitated blood product transfusion. A backward stepwise regression model was constructed to identify perioperative predictors of IGIC. RESULTS Of 6862 patients who underwent cardiac surgery during the study period, 52(0.8%) developed IGIC. The highest incidence of IGIC (1.9%) was noted in patients undergoing concomitant coronary artery, valvular, and aortic procedures. The multivariable regression identified hypertension (odds ratio [OR] = 5.74), preoperative renal failure requiring dialysis (OR = 3.62), immunocompromised status (OR = 2.64), chronic lung disease (OR = 2.61), and history of heart failure (OR = 2.03) as independent predictors for postoperative IGIC. Pre- or intraoperative utilization of intra-aortic balloon pump or catheter-based assist devices (OR = 4.54), intraoperative transfusion requirement of >4 RBC units(OR = 2.47), and cardiopulmonary bypass > 180 min (OR = 2.28) were also identified as independent predictors for the development of IGIC. CONCLUSIONS We identified preoperative and intraoperative risk factors that independently increase the risk of developing postoperative IGIC after cardiac surgery. A high index of suspicion must be maintained and any deviation from the expected recovery course in patients with the above-identified risk factors should trigger an immediate evaluation with the involvement of the acute care surgical team.
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Affiliation(s)
- Leon Naar
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ander Dorken Gallastegi
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Napaporn Kongkaewpaisan
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nikolaos Kokoroskos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - George Tolis
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Serguei Melnitchouk
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mauricio Villavicencio-Theoduloz
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - April E Mendoza
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - George C Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Arminder S Jassar
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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15
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Paras ML, Jassar AS. Vegetation size in patients with infective endocarditis: does size matter? J Am Soc Echocardiogr 2022; 35:576-578. [DOI: 10.1016/j.echo.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 11/26/2022]
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16
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Shi WY, Jassar AS. Use of the angioscope for aortic endovascular repair. Ann Cardiothorac Surg 2021; 10:801-803. [PMID: 34926185 DOI: 10.21037/acs-2021-taes-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/05/2021] [Indexed: 11/06/2022]
Affiliation(s)
- William Y Shi
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
| | - Arminder S Jassar
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
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17
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Ong CS, Reinertsen E, Moonsamy P, Young K, Song S, Axtell AL, Wolfe SB, Mohan N, Jassar AS, Aguirre AD, Sundt TM. Late onset atrial fibrillation in patients undergoing surgical aortic valve replacement. J Card Surg 2021; 37:285-289. [PMID: 34699088 DOI: 10.1111/jocs.16093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Aortic valve disease is a risk factor for atrial fibrillation (AF), and AF is associated with increased late mortality and morbidity after cardiac surgery. The evolution of alternative approaches to AF prophylaxis, including less invasive technologies and medical therapies, has altered the balance between risk and potential benefit for prophylactic intervention at the time of surgical aortic valve replacement (SAVR). Such interventions impose incremental risk, however, making an understanding of predictors of new onset AF that persists beyond the perioperative episode relevant. METHODS We conducted a retrospective single-institution cohort analysis of patients undergoing SAVR with no history of preoperative AF (n = 1014). These patients were cross-referenced against an institutional electrocardiogram (ECG) database to identify those with ECGs 3-12 months after surgery. Logistic regression was used to identify predictors of late AF. RESULTS Among the 401 patients (40%), who had ECGs in our institution 3-12 months after surgery, 16 (4%) had late AF. Patients with late AF were older than patients without late AF (73 vs. 65, p = .025), and underwent procedures that were more urgent/emergent (38% vs. 15%, p = .015), with higher predicted risk of mortality (2.2% vs. 1.3%, p = .012). Predictors associated with the development of late AF were advanced age, higher preoperative creatinine level and urgent/emergent surgery. CONCLUSIONS The incidence of late AF 3-12 months after SAVR, is low. Prophylactic AF interventions at the time of SAVR may not be warranted.
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Affiliation(s)
- Chin Siang Ong
- Division of Cardiac Surgery, Massachusetts General Hospital and Corrigan Minehan Heart Center, Boston, Massachusetts, USA
| | - Erik Reinertsen
- Division of Cardiology, Massachusetts General Hospital and Corrigan Minehan Heart Center, Boston, Massachusetts, USA.,Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Research Laboratory for Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Philicia Moonsamy
- Division of Cardiac Surgery, Massachusetts General Hospital and Corrigan Minehan Heart Center, Boston, Massachusetts, USA
| | - Katherine Young
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, Massachusetts, USA
| | - Steven Song
- Division of Cardiology, Massachusetts General Hospital and Corrigan Minehan Heart Center, Boston, Massachusetts, USA.,Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrea L Axtell
- Division of Cardiac Surgery, Massachusetts General Hospital and Corrigan Minehan Heart Center, Boston, Massachusetts, USA
| | - Stanley B Wolfe
- Division of Cardiac Surgery, Massachusetts General Hospital and Corrigan Minehan Heart Center, Boston, Massachusetts, USA
| | - Navyatha Mohan
- Division of Cardiac Surgery, Massachusetts General Hospital and Corrigan Minehan Heart Center, Boston, Massachusetts, USA
| | - Arminder S Jassar
- Division of Cardiac Surgery, Massachusetts General Hospital and Corrigan Minehan Heart Center, Boston, Massachusetts, USA
| | - Aaron D Aguirre
- Division of Cardiology, Massachusetts General Hospital and Corrigan Minehan Heart Center, Boston, Massachusetts, USA.,Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital and Corrigan Minehan Heart Center, Boston, Massachusetts, USA
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18
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19
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Bloom JP, Attia RQ, Sundt TM, Cameron DE, Hedgire SS, Bhatt AB, Isselbacher EM, Srivastava SD, Kwolek CJ, Eagleton MJ, Mohebali J, Jassar AS. Outcomes of open and endovascular repair of Kommerell diverticulum. Eur J Cardiothorac Surg 2021; 60:305-311. [PMID: 33582760 DOI: 10.1093/ejcts/ezab072] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/20/2020] [Accepted: 01/13/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Kommerell diverticulum (KD) is a rare congenital vascular anomaly often associated with an aberrant subclavian artery (ASCA). Definitive indications for intervention remain unclear. We present open and endovascular (EV) operative outcomes in a large contemporary series and propose a management algorithm. METHODS Between 2004 and 2020, 224 patients presented with ASCA and associated KD to our institution. Of the 43 (19.2%) patients who underwent operative repair, 31 (72.1%) had open surgical (OS) repair via thoracotomy and 12 (27.9%) had EV repair. Univariable and bivariable statistical analyses were conducted stratified by approach. The median follow-up time was 5.4 years (IQR, 2.9-9.7). RESULTS Patients in EV group were older (68 years vs 47 years, P < 0.001) and had larger aneurysms (base diameter 3.2 cm vs 21.5 cm, P = 0.007). All patients with dysphagia lusoria were treated with open surgery (n = 20). Asymptomatic patients with incidentally detected KD (50% vs 16.1%), those with chest or back pain (50% vs 19.4%) and patients who presented with an aortic emergency (25% vs 6.5%) were more likely to be treated endovascularly (P = 0.001). Carotid-to-subclavian bypass was used in 38 (88.4%) patients. There were no operative mortalities. In-hospital mortality was similar between groups (3.2% vs 16.7%, P = 0.121). Mid-term mortality was higher in the EV group [4 (33.8%) vs 0, P < 0.001]. There were 2 (15.4%) postoperative strokes in the EV group. There were no statistically significant differences in other postoperative complications or hospital length of stay between groups. CONCLUSIONS KD can be managed using open or EV approaches with low morbidity and mortality. Treatment strategy should depend on clinical presentation and patient factors.
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Affiliation(s)
- Jordan P Bloom
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rizwan Q Attia
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Duke E Cameron
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sandeep S Hedgire
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ami B Bhatt
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric M Isselbacher
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sunita D Srivastava
- Division of Vascular and Endovascular Surgery, Fireman Vascular Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher J Kwolek
- Division of Vascular and Endovascular Surgery, Fireman Vascular Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew J Eagleton
- Division of Vascular and Endovascular Surgery, Fireman Vascular Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jahan Mohebali
- Division of Vascular and Endovascular Surgery, Fireman Vascular Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Arminder S Jassar
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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20
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Czerny M, Gottardi R, Puiu P, Bernecker OY, Citro R, Corte AD, di Marco L, Fink M, Gosslau Y, Haldenwang PL, Heijmen RH, Hugas-Mallorqui M, Iesu S, Jacobsen O, Jassar AS, Juraszek A, Kolowca M, Lepidi S, Marrocco-Trischitta MM, Matsuda H, Meisenbacher K, Micari A, Minatoya K, Park KH, Peterss S, Petrich M, Piffaretti G, Probst C, Reutersberg B, Rosati F, Schachner B, Schachner T, Sorokin VA, Szeberin Z, Szopinski P, Di Tommaso L, Trimarchi S, Verhoeven ELG, Vogt F, Voetsch A, Walter T, Weiss G, Yuan X, Benedetto F, De Bellis A, D'Oria M, Discher P, Zierer A, Rylski B, van den Berg JC, Wyss TR, Bossone E, Schmidli J, Nienaber C, Accarino G, Baldascino F, Böckler D, Corazzari C, D'Alessio I, de Beaufort H, De Troia C, Dumfarth J, Galbiati D, Gorgatti F, Hagl C, Hamiko M, Huber F, Hyhlik-Duerr A, Ianelli G, Iesu I, Jung JC, Kainz FM, Katsargyris A, Koter S, Kusmierczyk M, Kolsut P, Lengyel B, Lomazzi C, Muneretto C, Nava G, Nolte T, Pacini D, Pleban E, Rychla M, Sakamoto K, Shijo T, Yokawa K, Siepe M, Sirch J, Strauch J, Sule JA, Tobler EL, Walter C, Weigang E. Corrigendum to 'Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions'. Eur J Cardiothorac Surg 2021; 60:724-725. [PMID: 34378028 PMCID: PMC8385948 DOI: 10.1093/ejcts/ezab314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Martin Czerny
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Roman Gottardi
- Department of Cardiovascular and Thoracic Surgery, MediClin Heart Institute Lahr/Baden, Lahr, Germany.,Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Paul Puiu
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Oliver Y Bernecker
- Department of Cardiac Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Rodolfo Citro
- Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d_Aragona, Salerno, Italy
| | - Alessandro Della Corte
- Cardiac Surgery Unit, Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Luca di Marco
- Department of Cardiac Surgery, Hospital Santa Orsola, University of Bologna, Bologna, Italy
| | - Martina Fink
- Department of Vascular Surgery, HGZ Bad Bevensen, Bad Bevensen, Germany
| | - Yvonne Gosslau
- Department for Vascular and Endovascular Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Peter Lukas Haldenwang
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil Bochum, Ruhr University of Bochum, Bochum, Germany
| | - Robin H Heijmen
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Maria Hugas-Mallorqui
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Severino Iesu
- Cardiac Surgery Unit, University Hospital San Giovanni di Dio e Ruggi d_Aragona, Salerno, Italy
| | - Oyvind Jacobsen
- Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, Oslo, Norway
| | - Arminder S Jassar
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrzej Juraszek
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Maciej Kolowca
- Cardiac Surgery Department, University State Hospital No 2, University of Rzesznow, Rzesznow, Poland
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | | | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kay-Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Michael Petrich
- Department of Vascular and Endovascular Surgery, Hubertus Hospital Berlin, Berlin, Germany
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, University of Insubria, School of Medicine and ASST Settelaghi University Teaching Hospital, Varese, Italy
| | - Chris Probst
- Department of Cardiac Surgery, University of Bonn, Bonn, Germany
| | - Benedikt Reutersberg
- Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Fabrizio Rosati
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Bruno Schachner
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Thomas Schachner
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Vitaly A Sorokin
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Zoltan Szeberin
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Piotr Szopinski
- Department of Vascular Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Luigi Di Tommaso
- Department of Cardiac Surgery, School of Medicine, University Federico II, Naples, Italy
| | - Santi Trimarchi
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Eric L G Verhoeven
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Ferdinand Vogt
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Andreas Voetsch
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Tim Walter
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | | | - Xun Yuan
- Cardiology and Aortic Centre, The Royal Brompton & Harefield NHS Foundation Trust; National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, London, UK
| | | | - Antonio De Bellis
- Cardiac Surgery Unit, Heart and Vessels Department, Casa di Cura San Michele, Maddaloni, Italy
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | - Philipp Discher
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Andreas Zierer
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Bartosz Rylski
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Jos C van den Berg
- Centro Vasolare Ticino, Ospedale Regionale di Lugano, Lugano, Switzerland.,Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas R Wyss
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Vascular Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Jürg Schmidli
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Nienaber
- Cardiology and Aortic Centre, The Royal Brompton & Harefield NHS Foundation Trust; National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, London, UK
| | | | - Giulio Accarino
- Cardiac Surgery Unit, University Hospital San Giovanni di Dio e Ruggi d_Aragona, Salerno, Italy
| | | | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Claudio Corazzari
- Department of Cardiac Surgery, Department of Medicine and Surgery, University of Insubria, School of Medicine and ASST Settelaghi University Teaching, Hospital, Varese, Italy
| | - Ilenia D'Alessio
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Hector de Beaufort
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | | | - Julia Dumfarth
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Denise Galbiati
- Cardiac Surgery Unit, Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Filippo Gorgatti
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Marwan Hamiko
- Department of Cardiac Surgery, University of Bonn, Bonn, Germany
| | - Florian Huber
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Alexander Hyhlik-Duerr
- Department for Vascular and Endovascular Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Gabriele Ianelli
- Department of Cardiac Surgery, School of Medicine, University Federico II, Naples, Italy
| | - Ivana Iesu
- Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d_Aragona, Salerno, Italy
| | - Joon-Chui Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Frieda-Maria Kainz
- Department of Cardiac Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Athanasios Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Stephan Koter
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Mariusz Kusmierczyk
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Piotr Kolsut
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Balazs Lengyel
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Chiara Lomazzi
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Claudio Muneretto
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Giovanni Nava
- Cardiovascular Department, IRCCS-Policlinico San Donato, Milan, Italy
| | - Thomas Nolte
- Department of Vascular Surgery, HGZ Bad Bevensen, Bad Bevensen, Germany
| | - Davide Pacini
- Department of Cardiac Surgery, Hospital Santa Orsola, University of Bologna, Bologna, Italy
| | - Eliza Pleban
- Department of Vascular Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Miriam Rychla
- Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Kazuhisa Sakamoto
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayuki Shijo
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koki Yokawa
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Matthias Siepe
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Joachim Sirch
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil Bochum, Ruhr University of Bochum, Bochum, Germany
| | - Jai Ajitchandra Sule
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Eva-Luca Tobler
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Ernst Weigang
- Department of Vascular and Endovascular Surgery, Hubertus Hospital Berlin, Berlin, Germany
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21
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Czerny M, Gottardi R, Puiu P, Bernecker OY, Citro R, Della Corte A, di Marco L, Fink M, Gosslau Y, Haldenwang PL, Heijmen RH, Hugas-Mallorqui M, Iesu S, Jacobsen O, Jassar AS, Juraszek A, Kolowca M, Lepidi S, Marrocco-Trischitta MM, Matsuda H, Meisenbacher K, Micari A, Minatoya K, Park KH, Peterss S, Petrich M, Piffaretti G, Probst C, Reutersberg B, Rosati F, Schachner B, Schachner T, Sorokin VA, Szeberin Z, Szopinski P, Di Tommaso L, Trimarchi S, Verhoeven ELG, Vogt F, Voetsch A, Walter T, Weiss G, Yuan X, Benedetto F, De Bellis A, D Oria M, Discher P, Zierer A, Rylski B, van den Berg JC, Wyss TR, Bossone E, Schmidli J, Nienaber C, Accarino G, Baldascino F, Böckler D, Corazzari C, D Alessio I, de Beaufort H, De Troia C, Dumfarth J, Galbiati D, Gorgatti F, Hagl C, Hamiko M, Huber F, Hyhlik-Duerr A, Ianelli G, Iesu I, Jung JC, Kainz FM, Katsargyris A, Koter S, Kusmierczyk M, Kolsut P, Lengyel B, Lomazzi C, Muneretto C, Nava G, Nolte T, Pacini D, Pleban E, Rychla M, Sakamoto K, Shijo T, Yokawa K, Siepe M, Sirch J, Strauch J, Sule JA, Tobler EL, Walter C, Weigang E. Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions. Eur J Cardiothorac Surg 2021; 59:1096-1102. [PMID: 33394040 PMCID: PMC7799089 DOI: 10.1093/ejcts/ezaa452] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/30/2020] [Accepted: 11/16/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on acute and elective thoracic and abdominal aortic procedures. METHODS Forty departments shared their data on acute and elective thoracic and abdominal aortic procedures between January and May 2020 and January and May 2019 in Europe, Asia and the USA. Admission rates as well as delay from onset of symptoms to referral were compared. RESULTS No differences in the number of acute thoracic and abdominal aortic procedures were observed between 2020 and the reference period in 2019 [incidence rates ratio (IRR): 0.96, confidence interval (CI) 0.89-1.04; P = 0.39]. Also, no difference in the time interval from acute onset of symptoms to referral was recorded (<12 h 32% vs > 12 h 68% in 2020, < 12 h 34% vs > 12 h 66% in 2019 P = 0.29). Conversely, a decline of 35% in elective procedures was seen (IRR: 0.81, CI 0.76-0.87; P < 0.001) with substantial differences between countries and the most pronounced decline in Italy (-40%, P < 0.001). Interestingly, in Switzerland, an increase in the number of elective cases was observed (+35%, P = 0.02). CONCLUSIONS There was no change in the number of acute thoracic and abdominal aortic cases and procedures during the initial wave of the COVID-19 pandemic, whereas the case load of elective operations and procedures decreased significantly. Patients with acute aortic syndromes presented despite COVID-19 and were managed according to current guidelines. Further analysis is required to prove that deferral of elective cases had no impact on premature mortality.
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Affiliation(s)
- Martin Czerny
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Roman Gottardi
- Department of Cardiovascular and Thoracic Surgery, MediClin Heart Institute Lahr/Baden, Lahr, Germany.,Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Paul Puiu
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Oliver Y Bernecker
- Department of Cardiac Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Rodolfo Citro
- Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d´Aragona, Salerno, Italy
| | - Alessandro Della Corte
- Cardiac Surgery Unit, Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Luca di Marco
- Department of Cardiac Surgery, Hospital Santa Orsola, University of Bologna, Bologna, Italy
| | - Martina Fink
- Department of Vascular Surgery, HGZ Bad Bevensen, Bad Bevensen, Germany
| | - Yvonne Gosslau
- Department for Vascular and Endovascular Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Peter Lukas Haldenwang
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil Bochum, Ruhr University of Bochum, Bochum, Germany
| | - Robin H Heijmen
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Maria Hugas-Mallorqui
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Severino Iesu
- Cardiac Surgery Unit, University Hospital San Giovanni di Dio e Ruggi d´Aragona, Salerno, Italy
| | - Oyvind Jacobsen
- Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, Oslo, Norway
| | - Arminder S Jassar
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrzej Juraszek
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Maciej Kolowca
- Cardiac Surgery Department, University State Hospital No 2, University of Rzesznow, Rzesznow, Poland
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | | | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kay-Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Michael Petrich
- Department of Vascular and Endovascular Surgery, Hubertus Hospital Berlin, Berlin, Germany
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, University of Insubria, School of Medicine and ASST Settelaghi University Teaching Hospital, Varese, Italy
| | - Chris Probst
- Department of Cardiac Surgery, University of Bonn, Bonn, Germany
| | - Benedikt Reutersberg
- Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Fabrizio Rosati
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Bruno Schachner
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Thomas Schachner
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Vitali A Sorokin
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Zoltan Szeberin
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Piotr Szopinski
- Department of Vascular Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Luigi Di Tommaso
- Department of Cardiac Surgery, School of Medicine, University Federico II, Naples, Italy
| | - Santi Trimarchi
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Eric L G Verhoeven
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Ferdinand Vogt
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Andreas Voetsch
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Tim Walter
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | | | - Xun Yuan
- Cardiology and Aortic Centre, The Royal Brompton & Harefield NHS Foundation Trust; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | | | - Antonio De Bellis
- Cardiac Surgery Unit, Heart and Vessels Department, Casa di Cura San Michele, Maddaloni, Italy
| | - Mario D Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | - Philipp Discher
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Andreas Zierer
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Bartosz Rylski
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Jos C van den Berg
- Centro Vasolare Ticino, Ospedale Regionale di Lugano, Lugano, Switzerland.,Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas R Wyss
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Vascular Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | - Jürg Schmidli
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Nienaber
- Cardiology and Aortic Centre, The Royal Brompton & Harefield NHS Foundation Trust; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | | | - Giulio Accarino
- Cardiac Surgery Unit, University Hospital San Giovanni di Dio e Ruggi d´Aragona, Salerno, Italy
| | | | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Claudio Corazzari
- Department of Cardiac Surgery, Department of Medicine and Surgery, University of Insubria, School of Medicine and ASST Settelaghi University Teaching Hospital, Varese, Italy
| | - Ilenia D Alessio
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Hector de Beaufort
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | | | - Julia Dumfarth
- Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Denise Galbiati
- Cardiac Surgery Unit, Department of Translational Medical Sciences, University of Campania "L.Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Filippo Gorgatti
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | - Marwan Hamiko
- Department of Cardiac Surgery, University of Bonn, Bonn, Germany
| | - Florian Huber
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Alexander Hyhlik-Duerr
- Department for Vascular and Endovascular Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Gabriele Ianelli
- Department of Cardiac Surgery, School of Medicine, University Federico II, Naples, Italy
| | - Ivana Iesu
- Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d´Aragona, Salerno, Italy
| | - Joon-Chui Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Frieda-Maria Kainz
- Department of Cardiac Surgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Athanasios Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Stephan Koter
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Mariusz Kusmierczyk
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Piotr Kolsut
- Department of Cardiac Surgery and Transplantation, The Cardinal Stefan Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Balazs Lengyel
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Chiara Lomazzi
- Unita Operativa di Chirurgia Vascolare, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Claudio Muneretto
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Giovanni Nava
- Cardiovascular Department, IRCCS-Policlinico San Donato, Milan, Italy
| | - Thomas Nolte
- Department of Vascular Surgery, HGZ Bad Bevensen, Bad Bevensen, Germany
| | - Davide Pacini
- Department of Cardiac Surgery, Hospital Santa Orsola, University of Bologna, Bologna, Italy
| | - Eliza Pleban
- Department of Vascular Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Miriam Rychla
- Department for Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Kazuhisa Sakamoto
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayuki Shijo
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Koki Yokawa
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Matthias Siepe
- Department for Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany.,Faculty of Medicine, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Joachim Sirch
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil Bochum, Ruhr University of Bochum, Bochum, Germany
| | - Jai Ajitchandra Sule
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Eva-Luca Tobler
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Ernst Weigang
- Department of Vascular and Endovascular Surgery, Hubertus Hospital Berlin, Berlin, Germany
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22
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Jassar AS. Outcomes after concomitant aortic root and aortic arch replacement: what came first-the root or the arch? Eur J Cardiothorac Surg 2021; 60:631-632. [PMID: 33990835 DOI: 10.1093/ejcts/ezab211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/06/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Arminder S Jassar
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, USA
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23
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Jassar AS. Temperature management during circulatory arrest - we have the ingredients, but what is the recipe? Ann Thorac Surg 2021; 112:1899-1900. [PMID: 33529604 DOI: 10.1016/j.athoracsur.2020.08.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Arminder S Jassar
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital 55 Fruit Street Boston, MA 02114-2696.
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24
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Zavriyev AI, Kaya K, Farzam P, Farzam PY, Sunwoo J, Jassar AS, Sundt TM, Carp SA, Franceschini MA, Qu JZ. The role of diffuse correlation spectroscopy and frequency-domain near-infrared spectroscopy in monitoring cerebral hemodynamics during hypothermic circulatory arrests. JTCVS Tech 2021; 7:161-177. [PMID: 34318236 PMCID: PMC8311503 DOI: 10.1016/j.xjtc.2021.01.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives Real-time noninvasive monitoring of cerebral blood flow (CBF) during surgery is key to reducing mortality rates associated with adult cardiac surgeries requiring hypothermic circulatory arrest (HCA). We explored a method to monitor cerebral blood flow during different brain protection techniques using diffuse correlation spectroscopy (DCS), a noninvasive optical technique which, combined with frequency-domain near-infrared spectroscopy (FDNIRS), also provides a measure of oxygen metabolism. Methods We used DCS in combination with FDNIRS to simultaneously measure hemoglobin oxygen saturation (SO2), an index of cerebral blood flow (CBFi), and an index of cerebral metabolic rate of oxygen (CMRO2i) in 12 patients undergoing cardiac surgery with HCA. Results Our measurements revealed that a negligible amount of blood is delivered to the cerebral cortex during HCA with retrograde cerebral perfusion, indistinguishable from HCA-only cases (median CBFi drops of 93% and 95%, respectively) with consequent similar decreases in SO2 (mean decrease of 0.6 ± 0.1% and 0.9 ± 0.2% per minute, respectively); CBFi and SO2 are mostly maintained with antegrade cerebral perfusion; the relationship of CMRO2i to temperature is given by CMRO2i = 0.052e0.079T. Conclusions FDNIRS-DCS is able to detect changes in CBFi, SO2, and CMRO2i with intervention and can become a valuable tool for optimizing cerebral protection during HCA.
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Key Words
- ACP, antegrade cerebral perfusion
- CBFi, cerebral blood flow (index)
- CMRO2i, cerebral metabolic rate of oxygen (index)
- CPB, cardiopulmonary bypass
- DCS, diffuse correlation spectroscopy
- EEG, electroencephalography
- FDNIRS, frequency-domain near-infrared spectroscopy
- HCA, hypothermic circulatory arrest
- NIRS, near-infrared spectroscopy
- RCP, retrograde cerebral perfusion
- SO2, hemoglobin oxygen saturation
- TCD, transcranial Doppler ultrasound
- antegrade cerebral perfusion
- brain imaging
- cerebral blood flow
- diffuse correlation spectroscopy
- hypothermic circulatory arrest
- near-infrared spectroscopy
- rSO2, regional oxygen saturation
- retrograde cerebral perfusion
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Affiliation(s)
- Alexander I. Zavriyev
- Department of Radiology, Optics at Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
- Address for reprints: Alexander I. Zavriyev, BS, 149 13th St, Charlestown, MA 02129.
| | - Kutlu Kaya
- Department of Radiology, Optics at Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Parisa Farzam
- Department of Radiology, Optics at Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Parya Y. Farzam
- Department of Radiology, Optics at Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - John Sunwoo
- Department of Radiology, Optics at Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Arminder S. Jassar
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Thoralf M. Sundt
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Stefan A. Carp
- Department of Radiology, Optics at Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Maria Angela Franceschini
- Department of Radiology, Optics at Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Jason Z. Qu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
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25
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Al-Bawardy R, Vemulapalli S, Thourani VH, Mack M, Dai D, Stebbins A, Palacios I, Inglessis I, Sakhuja R, Ben-Assa E, Passeri JJ, Dal-Bianco JP, Yucel E, Melnitchouk S, Vlahakes GJ, Jassar AS, Elmariah S. Association of Pulmonary Hypertension With Clinical Outcomes of Transcatheter Mitral Valve Repair. JAMA Cardiol 2021; 5:47-56. [PMID: 31746963 DOI: 10.1001/jamacardio.2019.4428] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Pulmonary hypertension (pHTN) is associated with increased risk of mortality after mitral valve surgery for mitral regurgitation. However, its association with clinical outcomes in patients undergoing transcatheter mitral valve repair (TMVr) with a commercially available system (MitraClip) is unknown. Objective To assess the association of pHTN with readmissions for heart failure and 1-year all-cause mortality after TMVr. Design, Setting, and Participants This retrospective cohort study analyzed 4071 patients who underwent TMVr with the MitraClip system from November 4, 2013, through March 31, 2017, across 232 US sites in the Society of Thoracic Surgery/American College of Cardiology Transcatheter Valve Therapy registry. Patients were stratified into the following 4 groups based on invasive mean pulmonary arterial pressure (mPAP): 1103 with no pHTN (mPAP, <25 mm Hg [group 1]); 1399 with mild pHTN (mPAP, 25-34 mm Hg [group 2]); 1011 with moderate pHTN (mPAP, 35-44 mm Hg [group 3]); and 558 with severe pHTN (mPAP, ≥45 mm Hg [group 4]). Data were analyzed from November 4, 2013, through March 31, 2017. Interventions Patients were stratified into groups before TMVr, and clinical outcomes were assessed at 1 year after intervention. Main Outcomes and Measures Primary end point was a composite of 1-year mortality and readmissions for heart failure. Secondary end points were 30-day and 1-year mortality and readmissions for heart failure. Linkage to Centers for Medicare & Medicaid Services administrative claims was performed to assess 1-year outcomes in 2381 patients. Results Among the 4071 patients included in the analysis, the median age was 81 years (interquartile range, 73-86 years); 1885 (46.3%) were women and 2186 (53.7%) were men. The composite rate of 1-year mortality and readmissions for heart failure was 33.6% (95% CI, 31.6%-35.7%), which was higher in those with pHTN (27.8% [95% CI, 24.2%-31.5%] in group 1, 32.4% [95% CI, 29.0%-35.8%] in group 2, 36.0% [95% CI, 31.8%-40.2%] in group 3, and 45.2% [95% CI, 39.1%-51.0%] in group 4; P < .001). Similarly, 1-year mortality (16.3% [95% CI, 13.4%-19.5%] in group 1, 19.8% [95% CI, 17.0%-22.8%] in group 2, 22.4% [95% CI, 18.8%-26.1%] in group 3, and 27.8% [95% CI, 22.6%-33.3%] in group 4; P < .001) increased across pHTN groups. The association of pHTN with mortality persisted despite multivariable adjustment (hazard ratio per 5-mm Hg mPAP increase, 1.05; 95% CI, 1.01-1.09; P = .02). Conclusions and Relevance These findings suggest that pHTN is associated with increased mortality and readmission for heart failure in patients undergoing TMVr using the MitraClip system for severe mitral regurgitation. Further efforts are needed to determine whether earlier intervention before pHTN develops will improve clinical outcomes.
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Affiliation(s)
- Rasha Al-Bawardy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Vinod H Thourani
- Marcus Valve Center, Department of Cardiac Surgery, Piedmont Heart and Vascular Institute, Atlanta, Georgia
| | - Michael Mack
- Department of Cardiology, Baylor Scott and White Heart Hospital Plano, Plano, Texas
| | - David Dai
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Amanda Stebbins
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Igor Palacios
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ignacio Inglessis
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Rahul Sakhuja
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Eyal Ben-Assa
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jonathan J Passeri
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jacob P Dal-Bianco
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Evin Yucel
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Serguei Melnitchouk
- Cardiac Surgery Division, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Gus J Vlahakes
- Cardiac Surgery Division, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Arminder S Jassar
- Cardiac Surgery Division, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Sammy Elmariah
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
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Abstract
The global pandemic of coronavirus 2019 (COVID‐19) caused by coronavirus has had a profound impact on the delivery of health care in the United States and globally. Boston was among the earliest hit cities in the United States, and within Boston, the Massachusetts General Hospital provided care for more patients with COVID‐19 than any other hospital in the region. This necessitated a massive reallocation of resources and priorities, with a near doubling of intensive care bed capacity and a halt in all deferrable surgical cases. During this crisis, the Division of Cardiac Surgery responded in a unified manner, dealing honestly with the necessity to reduce Intensive Care Unit resource utilization for the benefit of both the institution and our community by deferring nonemergent cases while also continuing to efficiently care for those patients in urgent or emergent need of surgery. Many of the interventions that we instituted have continued to support teamwork as we adapt to the remarkably fluid changes in resource availability during the recovery phase. We believe that the culture of our division and the structure of our practice facilitated our ability to contribute to the mission of our hospital to support the community in this crisis, and now to its recovery. We describe here the challenge we faced in Boston and some of the details of the structure and function of our division.
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Affiliation(s)
- Arminder S Jassar
- Division of Cardiac Surgery, Harvard Medical School, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Katy E Perkins
- Division of Cardiac Surgery, Harvard Medical School, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Harvard Medical School, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
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Axtell AL, Xue Y, Qu JZ, Zhou Q, Pan J, Cao H, Pan T, Jassar AS, Wang D, Sundt TM, Cameron DE. Type A aortic dissection in the East and West: A comparative study between two hospitals from China and the US. J Card Surg 2020; 35:2168-2174. [PMID: 32652637 DOI: 10.1111/jocs.14766] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND In this study, we compare the clinical characteristics, intraoperative management, and postoperative outcomes of patients with acute type A aortic dissection (ATAAD) between two academic medical hospitals in the United States and China. METHODS From January 2011 to December 2017, 641 and 150 patients from Nanjing Drum Tower Hospital (NDTH) and Massachusetts General Hospital (MGH) were enrolled. Patient demographics, clinical features, surgical techniques, and postoperative outcomes were compared. RESULTS The annual number of patients presenting with ATAAD at MGH remained relatively stable, while the number at NDTH increased significantly over the study period. The average age was 51 years at NDTH and 61 years at MGH (P < .001). The percentage of patients with known hypertension at the two centers was similar. The time interval from onset of symptoms to diagnosis was significantly longer at NDTH than MGH (11 vs 3.5 hours; P < .001). Associated complications at presentation were more common at NDTH than MGH. More than 90% of patients (91% NDTH and 92% MGH) underwent surgery. The postoperative stroke rate was higher at MGH (12% vs 4%; P < .001); however, the 30-day mortality rate was lower (7% vs 16%; P = .006). CONCLUSIONS There was a significant increase in the number of ATAAD at NDTH during the study period while the number at MGH remained stable. Hypertension was a common major risk factor; however, the onset of ATAAD at NDTH was nearly one decade earlier than MGH. Chinese patients tended to have more complicated preoperative pathophysiology at presentation and underwent more extensive surgical repair.
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Affiliation(s)
- Andrea L Axtell
- Department of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Yunxing Xue
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Nanjing, China
| | - Jason Z Qu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Qing Zhou
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Nanjing, China
| | - Jun Pan
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Nanjing, China
| | - Hailong Cao
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Nanjing, China
| | - Tuo Pan
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Nanjing, China
| | - Arminder S Jassar
- Department of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Dongjin Wang
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Nanjing, China
| | - Thoralf M Sundt
- Department of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Duke E Cameron
- Department of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Jassar AS, Vlahakes GJ. Management of diabetic patients with aortic intramural hematoma: There may be more involved besides MMP-9. J Card Surg 2020; 35:1822-1823. [PMID: 32652666 DOI: 10.1111/jocs.14824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Arminder S Jassar
- Division of Cardiac Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Gus J Vlahakes
- Division of Cardiac Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
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Jassar AS. "Real World" Results of Open Descending Thoracic and Thoracoabdominal Aortic Replacement. Ann Thorac Surg 2020; 110:1949-1950. [PMID: 32565087 DOI: 10.1016/j.athoracsur.2020.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/16/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Arminder S Jassar
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, 55 Fruit St, Cox 630, Boston, MA 02114-2696.
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Axtell AL, Moonsamy P, Melnitchouk S, Jassar AS, Villavicencio MA, D'Alessandro DA, Tolis G, Cameron DE, Sundt TM. Starting elective cardiac surgery after 3 pm does not impact patient morbidity, mortality, or hospital costs. J Thorac Cardiovasc Surg 2020; 159:2314-2321.e2. [DOI: 10.1016/j.jtcvs.2019.06.125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 11/25/2022]
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Sheriff F, Shelton K, Jassar AS, Patel AB, Leslie-Mazwi TM. Reply to author: Further expansion on the horizon? Thrombectomy for stroke after cardiothoracic surgery. J Thorac Cardiovasc Surg 2020; 160:e49-e50. [PMID: 32312536 DOI: 10.1016/j.jtcvs.2020.02.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Faheem Sheriff
- Department of Neurosurgery, University at Texas Houston Health Science Center, Houston, Tex
| | - Kenneth Shelton
- Department of Anesthesia, Massachusetts General Hospital, Boston, Mass
| | | | - Aman B Patel
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Mass
| | - Thabele M Leslie-Mazwi
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Mass; Department of Neurology, Massachusetts General Hospital, Boston, Mass
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32
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Axtell AL, Moonsamy P, Melnitchouk S, Tolis G, Jassar AS, D'Alessandro DA, Villavicencio MA, Cameron DE, Sundt TM. Preoperative predictors of new-onset prolonged atrial fibrillation after surgical aortic valve replacement. J Thorac Cardiovasc Surg 2020; 159:1407-1414. [DOI: 10.1016/j.jtcvs.2019.04.077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 10/26/2022]
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Mori M, Bin Mahmood SU, Schranz AJ, Sultan I, Axtell AL, Sarsour N, Hiesinger W, Boskovski MT, Hirji S, Kaneko T, Woo J, Tang P, Jassar AS, Atluri P, Whitson BA, Gleason T, Geirsson A. Risk of reoperative valve surgery for endocarditis associated with drug use. J Thorac Cardiovasc Surg 2020; 159:1262-1268.e2. [PMID: 31420136 PMCID: PMC6952585 DOI: 10.1016/j.jtcvs.2019.06.055] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 06/09/2019] [Accepted: 06/19/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND We aimed to quantify incidence and operative risks associated with reoperative valve surgeries (RVS) in patients with drug-associated infective endocarditis in a multi-center setting. METHODS We formed a registry of patients with drug-associated infective endocarditis who underwent valve surgeries at 8 US centers between 2011 and 2017. Outcomes of first-time valve surgery (FVS) and RVS were compared. Multivariable logistic regression models related RVS to 30-day mortality. Poisson regression models were fitted to evaluate temporal trends in overall case volume and proportions of patients undergoing RVS. RESULTS The cohort consisted of 925 patients with drug-associated infective endocarditis who underwent a valve surgery, of which 652 were FVS and 273 were RVS. Patients undergoing FVS had fewer comorbidities than those undergoing RVS. Overall case volume increased from 108 in 2012 to 229 cases in 2017 (P < .001). The proportion of redo valve cases increased from 19% in 2012 to 28% in 2017 (P < .001). The 30-day mortality in RVS was higher compared with FVS (8.1% vs 4.8%; P = .049). An increase in unadjusted mortality rates were observed as the number of prior cardiac surgeries increased, from 4.8% in FVS to 11.8% in ≥3 RVS. Multivariable model demonstrated that RVS was associated with an increased risk of 30-day mortality (odds ratio, 2.22; 95% confidence interval, 1.22-4.06; P = .010). CONCLUSIONS An increasing proportion of valve surgery for drug-associated infective endocarditis is for RVS. Despite being young and harboring few comorbidities, the RVS cohort is still susceptible to increased risk of 30-day mortality compared with those undergoing FVS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Paul Tang
- University of Michigan Medical School
| | | | - Pavan Atluri
- University of Pennsylvania- Perelman School of Medicine
| | | | | | - Arnar Geirsson
- Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Conn.
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Levack MM, Mecozzi G, Jainandunsing JS, Bouma W, Jassar AS, Pouch AM, Yushkevich PA, Mariani MA, Jackson BM, Gorman JH, Gorman RC. Quantitative three-dimensional echocardiographic analysis of the bicuspid aortic valve and aortic root: A single modality approach. J Card Surg 2019; 35:375-382. [PMID: 31794089 DOI: 10.1111/jocs.14387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with bicuspid aortic valves (BAV) are heterogeneous with regard to patterns of root remodeling and valvular dysfunction. Two-dimensional echocardiography is the standard surveillance modality for patients with aortic valve dysfunction. However, ancillary computed tomography or magnetic resonance imaging is often necessary to characterize associated patterns of aortic root pathology. Conversely, the pairing of three-dimensional (3D) echocardiography with novel quantitative modeling techniques allows for a single modality description of the entire root complex. We sought to determine 3D aortic valve and root geometry with this quantitative approach. METHODS Transesophageal real-time 3D echocardiography was performed in five patients with tricuspid aortic valves (TAV) and in five patients with BAV. No patient had evidence of valvular dysfunction or aortic root pathology. A customized image analysis protocol was used to assess 3D aortic annular, valvular, and root geometry. RESULTS Annular, sinus and sinotubular junction diameters and areas were similar in both groups. Coaptation length and area were higher in the TAV group (7.25 ± 0.98 mm and 298 ± 118 mm2 , respectively) compared to the BAV group (5.67 ± 1.33 mm and 177 ± 43 mm2 ; P = .07 and P = .01). Cusp surface area to annular area, coaptation height, and the sub- and supravalvular tenting indices did not differ significantly between groups. CONCLUSIONS Single modality 3D echocardiography-based modeling allows for a quantitative description of the aortic valve and root geometry. This technique together with novel indices will improve our understanding of normal and pathologic geometry in the BAV population and may help to identify geometric predictors of adverse remodeling and guide tailored surgical therapy.
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Affiliation(s)
- Melissa M Levack
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gianclaudio Mecozzi
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jayant S Jainandunsing
- Department of Anesthesiology and Pain Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wobbe Bouma
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arminder S Jassar
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alison M Pouch
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul A Yushkevich
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Benjamin M Jackson
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph H Gorman
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert C Gorman
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Affiliation(s)
- Sarah N Bernstein
- From the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Harvard Medical School - both in Boston
| | - Gaston A Cudemus-Deseda
- From the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Harvard Medical School - both in Boston
| | - Vilma E Ortiz
- From the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Harvard Medical School - both in Boston
| | - Annekathryn Goodman
- From the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Harvard Medical School - both in Boston
| | - Arminder S Jassar
- From the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Harvard Medical School - both in Boston
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Axtell AL, Fiedler AG, Melnitchouk S, D'Alessandro DA, Villavicencio MA, Jassar AS, Sundt TM. Correlation of cardiopulmonary bypass duration with acute renal failure after cardiac surgery. J Thorac Cardiovasc Surg 2019; 159:170-178.e2. [PMID: 30826102 DOI: 10.1016/j.jtcvs.2019.01.072] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 01/04/2019] [Accepted: 01/19/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Prolonged cardiopulmonary bypass (CPB) is recognized as a risk factor for acute renal failure (ARF), but the dose effect of time on bypass is unknown. We therefore examined the risk of ARF associated with increasing CPB time stratified by preoperative renal function. METHODS A retrospective analysis was performed on 3889 patients undergoing cardiac surgery on CPB without circulatory arrest between 2011 and 2017 excluding those with a diagnosis of dialysis-dependent renal failure and those who had an intra-aortic balloon pump. Postoperative ARF was defined as a 3-fold increase in creatinine level, creatinine level > 4 mg/dL, or requirement for dialysis. A logistic regression model was built to identify predictors of ARF and to determine the probability of ARF. RESULTS Postoperative ARF occurred in 72 patients (2%) overall. Of 100 patients with an estimated glomerular filtration rate <30 mL/min/1.73 m2, 22% developed ARF, of which 16 required dialysis. Thirty-day mortality was 31% for those with ARF compared with <1% for those without ARF (P < .01). Risk factors for ARF included obesity (odds ratio, 3.03; P < .01), increasing preoperative creatinine level (odds ratio, 4.21; P < .01), CPB time scaled by a factor of 10 minutes (odds ratio, 1.06; P = .04), and postoperative transfusion (odds ratio, 11.94; P < .01). The adjusted probability of ARF as a function of CPB time was determined and stratified by preoperative glomerular filtration rate. CONCLUSIONS Increasing CPB duration is associated with postoperative ARF, particularly among those with preoperative renal impairment. For patients with an estimated glomerular filtration rate <30 mL/min/1.73 m2 the risk increases exponentially with time.
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Affiliation(s)
- Andrea L Axtell
- Corrigan Minehan Heart Center and Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Amy G Fiedler
- Corrigan Minehan Heart Center and Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Serguei Melnitchouk
- Corrigan Minehan Heart Center and Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - David A D'Alessandro
- Corrigan Minehan Heart Center and Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Mauricio A Villavicencio
- Corrigan Minehan Heart Center and Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Arminder S Jassar
- Corrigan Minehan Heart Center and Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Thoralf M Sundt
- Corrigan Minehan Heart Center and Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass.
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37
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Axtell AL, Chang DC, Melnitchouk S, Jassar AS, Tolis G, Villavicencio MA, Sundt TM, D'Alessandro DA. Early structural valve deterioration and reoperation associated with the mitroflow aortic valve. J Card Surg 2018; 33:778-786. [DOI: 10.1111/jocs.13953] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea L. Axtell
- Corrigan Minehan Heart Center and Division of Cardiac Surgery; Massachusetts General Hospital; Boston Massachusetts
- Minehan Outcomes Fellow; Minehan Heart Center; Boston Massachusetts
| | - David C. Chang
- Codman Center for Clinical Effectiveness; Department of Surgery; Massachusetts General Hospital; Boston Massachusetts
| | - Serguei Melnitchouk
- Corrigan Minehan Heart Center and Division of Cardiac Surgery; Massachusetts General Hospital; Boston Massachusetts
| | - Arminder S. Jassar
- Corrigan Minehan Heart Center and Division of Cardiac Surgery; Massachusetts General Hospital; Boston Massachusetts
| | - George Tolis
- Corrigan Minehan Heart Center and Division of Cardiac Surgery; Massachusetts General Hospital; Boston Massachusetts
| | - Mauricio A. Villavicencio
- Corrigan Minehan Heart Center and Division of Cardiac Surgery; Massachusetts General Hospital; Boston Massachusetts
| | - Thoralf M. Sundt
- Corrigan Minehan Heart Center and Division of Cardiac Surgery; Massachusetts General Hospital; Boston Massachusetts
| | - David A. D'Alessandro
- Corrigan Minehan Heart Center and Division of Cardiac Surgery; Massachusetts General Hospital; Boston Massachusetts
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Jassar AS, Sundt TM. How should we manage type A aortic dissection? Gen Thorac Cardiovasc Surg 2018; 67:137-145. [DOI: 10.1007/s11748-018-0957-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/08/2018] [Indexed: 02/06/2023]
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Abstract
Aortic coarctation is one of the most common congenital cardiac pathologies. Repair of native aortic coarctation is nowadays a common and safe procedure. However, late complications, including re-coarctation and aneurysm formation, are not uncommon. The incidence of these complications is dependent on the type of the initial operation. Both endovascular and conventional open repair play important roles in the treatment of late complications after previous coarctation repair. This article will review the incidence of late complications after coarctation repair and will discuss the treatment options for redo coarctation repair in adult patients.
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Affiliation(s)
- Erik Beckmann
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Arminder S Jassar
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Lino Cardenas CL, Kessinger CW, MacDonald C, Jassar AS, Isselbacher EM, Jaffer FA, Lindsay ME. Inhibition of the methyltranferase EZH2 improves aortic performance in experimental thoracic aortic aneurysm. JCI Insight 2018. [PMID: 29515022 DOI: 10.1172/jci.insight.97493] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Loss-of-function mutations in genes encoding contractile proteins have been observed in thoracic aortic aneurysms (TAA). To gain insight into the contribution of contractile protein deficiency in the pathogenesis of TAA, we examined human aneurysm samples. We found multiple contractile gene products deficient in TAA samples, and in particular, expression of SM22α was inversely correlated with aneurysm size. SM22α-deficient mice demonstrated pregnancy-induced aortic dissection, and SM22α deficiency worsened aortic aneurysm in Fbn1C1039G/+ (Marfan) mice, validating this gene product as a TAA effector. We found that repression of SM22α was enforced by increased activity of the methyltransferase EZH2. TGF-β effectors such as SMAD3 were excluded from binding SM22α-encoding chromatin (TAGLN) in TAA samples, while treatment with the EZH2 inhibitor GSK343 improved cytoskeletal architecture and restored SM22α expression. Finally, inhibition of EZH2 improved aortic performance in Fbn1C1039G/+ mice, in association with restoration of contractile protein expression (including SM22α). Together, these data inform our understanding of contractile protein deficiency in TAA and support the pursuit of chromatin modifying factors as therapeutic targets in aortic disease.
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Affiliation(s)
| | | | - Carolyn MacDonald
- Thoracic Aortic Center.,Cardiovascular Research Center.,Cardiology, Department of Medicine
| | - Arminder S Jassar
- Thoracic Aortic Center.,Division of Cardiothoracic Surgery, Department of Surgery, and
| | - Eric M Isselbacher
- Thoracic Aortic Center.,Cardiovascular Research Center.,Cardiology, Department of Medicine
| | - Farouc A Jaffer
- Cardiovascular Research Center.,Cardiology, Department of Medicine
| | - Mark E Lindsay
- Thoracic Aortic Center.,Cardiovascular Research Center.,Cardiology, Department of Medicine.,Pediatric Cardiology, Department of Pediatrics, Massachusetts General Hospital (MGH), Harvard Medical School, Boston, Massachusetts, USA
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Jassar AS, Kim JB, Sundt TM. The more I learn the less I know. J Thorac Cardiovasc Surg 2017; 153:282-283. [PMID: 28104193 DOI: 10.1016/j.jtcvs.2016.09.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 09/23/2016] [Indexed: 11/28/2022]
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Jassar AS, Szeto WY. Early reperfusion for acute type A dissection complicated with distal malperfusion. J Thorac Cardiovasc Surg 2016; 151:e113-4. [PMID: 26952928 DOI: 10.1016/j.jtcvs.2016.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 02/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Arminder S Jassar
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
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Affiliation(s)
- Arminder S Jassar
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
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Jassar AS, Desai ND, Kobrin D, Pochettino A, Vallabhajosyula P, Milewski RK, McCarthy F, Maniaci J, Szeto WY, Bavaria JE. Outcomes of aortic root replacement after previous aortic root replacement: the "true" redo root. Ann Thorac Surg 2015; 99:1601-8; discussion 1608-9. [PMID: 25754965 DOI: 10.1016/j.athoracsur.2014.12.038] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 11/30/2014] [Accepted: 12/08/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Aortic reoperations are technically challenging. This study evaluated outcomes after "true" redo root replacement (previous full root replacement) stratified by cause of prosthesis failure. METHODS Data were compared for 793 patients who underwent a first-time sternotomy (de novo group) and 120 patients who had previously undergone full aortic root replacement (redo group), of which 76 underwent reoperation due to structural valve deterioration (degenerative group), and 44 due to endocarditis (infection group). RESULTS Overall mortality was 4% (n = 28) in the de novo group and 5% (n = 6) in the redo group (p = 0.43) (degenerative group, 3%, infection group, 9%; p = 0.19). The infection group had an increased incidence of renal failure, sternal infection, prolonged ventilation, reoperation for bleeding, multisystem failure, and sepsis, and an increased hospital length of stay. The degenerative group and the de novo group had a similar risk of perioperative death and major complications. The 5-year survival was 86.3% ± 1.3% for the de novo group and 77.3% ± 4.6% for the redo group (p ≤ 0.01; degenerative, 86.3% ± 5%; infection, 65.3% ± 7.7%; p < 0.01; p = 0.98 for de novo vs degenerative). Multivariate analysis demonstrated that reoperation for degenerative failure did not increase the risk of perioperative or late death. CONCLUSIONS Redo aortic root replacement can be performed with low perioperative morbidity and death. The presence of infection increases the risk of complications and worsens survival. However, redo root replacement for degenerative failure can be performed with similar short-term complication risk and midterm survival as de novo root replacement.
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Affiliation(s)
- Arminder S Jassar
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dale Kobrin
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alberto Pochettino
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Rita K Milewski
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fenton McCarthy
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jon Maniaci
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
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Jassar AS, Levack MM, Solorzano RD, Pouch AM, Ferrari G, Cheung AT, Ferrari VA, Gorman JH, Gorman RC, Jackson BM. Feasibility of in vivo human aortic valve modeling using real-time three-dimensional echocardiography. Ann Thorac Surg 2014; 97:1255-8. [PMID: 24518577 DOI: 10.1016/j.athoracsur.2013.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 12/04/2013] [Accepted: 12/18/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Surgical techniques for aortic valve (AV) repair are directed toward restoring normal structural relationships in the aortic root and rely on detailed assessment of root and valve anatomy. Noninvasive three-dimensional (3D) imaging and modeling may assist in patient selection and operative planning. METHODS Transesophageal real-time 3D echocardiographic images of 5 patients with normal AVs were acquired. The aortic root and the annulus were manually segmented at end diastole using a 36-point rotational template. The AV leaflets and the coaptation zone were manually segmented in parallel 1-mm cross sections. Quantitative 3D models of the AV and root were generated and used to measure standard anatomic parameters and were compared to conventional two-dimensional echocardiographic measurements. All measurements are given as mean±SD. RESULTS Annular, sinus, and sinotubular junction areas were 4.1±0.6 cm2, 7.5±1.2 cm2, and 3.9±1.0 cm2, respectively. Root diameters (measured in three locations) by 3D model inspection and two-dimensional echocardiography measurement correlated (R2=0.75). Noncoapted areas of the left, right, and noncoronary leaflets were 1.9±0.2 cm2, 1.6±0.3 cm2, and 1.6±0.3 cm2, respectively. Mean coaptation areas for the left-right, left-noncoronary, and right-noncoronary coaptation zones were 87.7±36.9 mm2, 69.9±20.7 mm2, and 114.2±23.0 mm2, respectively. The mean ratio of noncoapted leaflet area to annular area was 1.3±0.2. CONCLUSIONS High-resolution 3D models of the in vivo normal human aortic root and valve were generated using 3D echocardiography. Quantitative 3D models and analysis may assist in characterization of pathology and decision making for AV repair.
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Affiliation(s)
- Arminder S Jassar
- Gorman Cardiovascular Research Group, University of Pennsylvania, Glenolden, Pennsylvania; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Melissa M Levack
- Gorman Cardiovascular Research Group, University of Pennsylvania, Glenolden, Pennsylvania
| | - Ricardo D Solorzano
- Gorman Cardiovascular Research Group, University of Pennsylvania, Glenolden, Pennsylvania
| | - Alison M Pouch
- Gorman Cardiovascular Research Group, University of Pennsylvania, Glenolden, Pennsylvania
| | - Giovanni Ferrari
- Gorman Cardiovascular Research Group, University of Pennsylvania, Glenolden, Pennsylvania; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Albert T Cheung
- Department of Anesthesiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Victor A Ferrari
- Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph H Gorman
- Gorman Cardiovascular Research Group, University of Pennsylvania, Glenolden, Pennsylvania; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert C Gorman
- Gorman Cardiovascular Research Group, University of Pennsylvania, Glenolden, Pennsylvania; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin M Jackson
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
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Ramakrishna H, Kohl BA, Jassar AS, Augoustides JGT. Incidental moderate mitral regurgitation in patients undergoing aortic valve replacement for aortic stenosis: review of guidelines and current evidence. J Cardiothorac Vasc Anesth 2014; 28:417-22. [PMID: 24508019 DOI: 10.1053/j.jvca.2013.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Indexed: 11/11/2022]
Abstract
Recent evidence has shown that moderate mitral regurgitation is common and clinically relevant in patients presenting for surgical and transcatheter aortic valve replacement for aortic stenosis. Prospective multicenter clinical trials are now indicated to resolve the clinical equipoise about whether or not mitral valve intervention also is indicated at the time of aortic valve intervention. Advances in three-dimensional transesophageal echocardiography, transcatheter mitral interventions, and surgical aortic valve replacement, including the advent of sutureless valves, likely will expand the therapeutic possibilities for moderate mitral regurgitation in the setting of aortic valve interventions for severe aortic stenosis.
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Affiliation(s)
| | - Benjamin A Kohl
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Arminder S Jassar
- Department of Surgery, Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G T Augoustides
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Jassar AS, Vergnat M, Jackson BM, McGarvey JR, Cheung AT, Ferrari G, Woo YJ, Acker MA, Gorman RC, Gorman JH. Regional annular geometry in patients with mitral regurgitation: implications for annuloplasty ring selection. Ann Thorac Surg 2013; 97:64-70. [PMID: 24070698 DOI: 10.1016/j.athoracsur.2013.07.048] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 07/08/2013] [Accepted: 07/11/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The saddle shape of the normal mitral annulus has been quantitatively described by several groups. There is strong evidence that this shape is important to valve function. A more complete understanding of regional annular geometry in diseased valves may provide a more educated approach to annuloplasty ring selection and design. We hypothesized that mitral annular shape is markedly distorted in patients with diseased valves. METHODS Real-time 3-dimensional echocardiography was performed in 20 patients with normal mitral valves, 10 with ischemic mitral regurgitation, and 20 with myxomatous mitral regurgitation (MMR). Thirty-six annular points were defined to generate a 3-dimensional model of the annulus. Regional annular parameters were measured from these renderings. Left ventricular inner diameter was obtained from 2-dimensional echocardiographic images. RESULTS Annular geometry was significantly different among the three groups. The annuli were larger in the MMR and in the ischemic mitral regurgitation groups. The annular enlargement was greater and more pervasive in the MMR group. Both diseases were associated with annular flattening, although though the regional distribution of that flattening was different between groups. Left ventricular inner diameter was increased in both groups. However, relative to the Left ventricular inner diameter, the annulus was disproportionately dilated in the MMR group. CONCLUSIONS Patients with MMR and ischemic mitral regurgitation have enlarged and flattened annuli. In the case of MMR, annular distortions may be the driving factor leading to valve incompetence. These data suggest that the goal of annuloplasty should be the restoration of normal annular saddle shape and that the use of flexible, partial, and flat rings may be ill advised.
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Affiliation(s)
- Arminder S Jassar
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mathieu Vergnat
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin M Jackson
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy R McGarvey
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Albert T Cheung
- Department of Anesthesia University of Pennsylvania, Philadelphia, Pennsylvania
| | - Giovanni Ferrari
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Y Joseph Woo
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael A Acker
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert C Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph H Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, Pennsylvania.
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Levack MM, Jassar AS, Shang EK, Vergnat M, Woo YJ, Acker MA, Jackson BM, Gorman JH, Gorman RC. Three-dimensional echocardiographic analysis of mitral annular dynamics: implication for annuloplasty selection. Circulation 2012; 126:S183-8. [PMID: 22965981 DOI: 10.1161/circulationaha.111.084483] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Proponents of flexible annuloplasty rings have hypothesized that such devices maintain annular dynamics. This hypothesis is based on the supposition that annular motion is relatively normal in patients undergoing mitral valve repair. We hypothesized that mitral annular dynamics are impaired in ischemic mitral regurgitation and myxomatous mitral regurgitation. METHODS AND RESULTS A Philips iE33 echocardiographic module and X7-2t probe were used to acquire full-volume real-time 3-dimensional transesophageal echocardiography loops in 11 normal subjects, 11 patients with ischemic mitral regurgitation and 11 patients with myxomatous mitral regurgitation. Image analysis was performed using Tomtec Image Arena, 4D-MV Assessment, 2.1 (Munich, Germany). A midsystolic frame was selected for the initiation of annular tracking using the semiautomated program. Continuous parameters were normalized in time to provide for uniform systolic and diastolic periods. Both ischemic mitral regurgitation (9.98 ± 155 cm(2)) and myxomatous mitral regurgitation annuli (13.29 ± 3.05 cm(2)) were larger in area than normal annuli (7.95 ± 1.40 cm(2)) at midsystole. In general, ischemic mitral regurgitation annuli were less dynamic than controls. In myxomatous mitral regurgitation, annular dynamics were also markedly abnormal with the mitral annulus dilating rapidly in early systole in response to rising ventricular pressure. CONCLUSIONS In both ischemic mitral regurgitation and myxomatous mitral regurgitation, annular dynamics and anatomy are abnormal. Flexible annuloplasty devices used in mitral valve repair are, therefore, unlikely to result in either normal annular dynamics or normal anatomy.
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Jassar AS, Minakawa M, Shuto T, Robb JD, Koomalsingh KJ, Levack MM, Vergnat M, Eperjesi TJ, Jackson BM, Gorman JH, Gorman RC. Posterior leaflet augmentation in ischemic mitral regurgitation increases leaflet coaptation and mobility. Ann Thorac Surg 2012; 94:1438-45. [PMID: 22795059 DOI: 10.1016/j.athoracsur.2012.05.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 05/02/2012] [Accepted: 05/03/2012] [Indexed: 01/09/2023]
Abstract
BACKGROUND Restoring leaflet coaptation is the primary objective in repair of ischemic mitral regurgitation (IMR). The common practice of placing an undersized annuloplasty ring partially achieves this goal by correcting annular dilation; however, annular reduction has been demonstrated to exacerbate posterior leaflet tethering. Using a sheep model of IMR, we tested the hypothesis that posterior leaflet augmentation (PLA) combined with standard annuloplasty sizing increases leaflet coaptation more effectively than undersized annuloplasty alone. METHODS Eight weeks after posterobasal myocardial infarction, 15 sheep with 2+ or greater IMR underwent annuloplasty with either a 24-mm annuloplasty ring (24-mm group, n = 5), 30-mm ring (30-mm group, n = 5), or 30-mm ring with concomitant augmentation of the posterior leaflet (PLA group, n = 5). Using three-dimensional echocardiography, postrepair coaptation zone and posterior leaflet mobility were assessed. RESULTS Leaflet coaptation length after repair was greater in the PLA group (4.1 ± 0.3 mm) and the 24-mm group (3.8 ± 0.5 mm) as compared with the 30-mm group (2.7 ± 0.6 mm, p < 0.01). Leaflet coaptation area was significantly greater in the PLA group (121.5 ± 6.6 mm(2)) as compared with the 30-mm group (77.5 ± 17.0 mm(2)) or the 24-mm group (92.5 ± 17.9 mm(2), p < 0.01). Posterior leaflet mobility was significantly greater in the PLA group as compared with the 30-mm group or the 24-mm group. CONCLUSIONS Posterior leaflet augmentation combined with standard-sized annuloplasty enhances leaflet coaptation more effectively than either standard-sized annuloplasty or undersized annuloplasty alone. Increased leaflet coaptation after PLA provides redundancy to IMR repair, and may decrease incidence of both recurrent IMR and mitral stenosis.
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Affiliation(s)
- Arminder S Jassar
- Department of Surgery, University of Pennsylvania, Philadelphia, PA 19036, USA
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Pouch AM, Yushkevich PA, Jackson BM, Jassar AS, Vergnat M, Gorman JH, Gorman RC, Sehgal CM. Development of a semi-automated method for mitral valve modeling with medial axis representation using 3D ultrasound. Med Phys 2012; 39:933-50. [PMID: 22320803 DOI: 10.1118/1.3673773] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Precise 3D modeling of the mitral valve has the potential to improve our understanding of valve morphology, particularly in the setting of mitral regurgitation (MR). Toward this goal, the authors have developed a user-initialized algorithm for reconstructing valve geometry from transesophageal 3D ultrasound (3D US) image data. METHODS Semi-automated image analysis was performed on transesophageal 3D US images obtained from 14 subjects with MR ranging from trace to severe. Image analysis of the mitral valve at midsystole had two stages: user-initialized segmentation and 3D deformable modeling with continuous medial representation (cm-rep). Semi-automated segmentation began with user-identification of valve location in 2D projection images generated from 3D US data. The mitral leaflets were then automatically segmented in 3D using the level set method. Second, a bileaflet deformable medial model was fitted to the binary valve segmentation by Bayesian optimization. The resulting cm-rep provided a visual reconstruction of the mitral valve, from which localized measurements of valve morphology were automatically derived. The features extracted from the fitted cm-rep included annular area, annular circumference, annular height, intercommissural width, septolateral length, total tenting volume, and percent anterior tenting volume. These measurements were compared to those obtained by expert manual tracing. Regurgitant orifice area (ROA) measurements were compared to qualitative assessments of MR severity. The accuracy of valve shape representation with cm-rep was evaluated in terms of the Dice overlap between the fitted cm-rep and its target segmentation. RESULTS The morphological features and anatomic ROA derived from semi-automated image analysis were consistent with manual tracing of 3D US image data and with qualitative assessments of MR severity made on clinical radiology. The fitted cm-reps accurately captured valve shape and demonstrated patient-specific differences in valve morphology among subjects with varying degrees of MR severity. Minimal variation in the Dice overlap and morphological measurements was observed when different cm-rep templates were used to initialize model fitting. CONCLUSIONS This study demonstrates the use of deformable medial modeling for semi-automated 3D reconstruction of mitral valve geometry using transesophageal 3D US. The proposed algorithm provides a parametric geometrical representation of the mitral leaflets, which can be used to evaluate valve morphology in clinical ultrasound images.
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Affiliation(s)
- Alison M Pouch
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA.
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