1
|
Bozso SJ, Nagendran J, Chu MWA, Kiaii B, El-Hamamsy I, Ouzounian M, Forcillo J, Kempfert J, Starck C, Moon MC. Three-year outcomes of the Dissected Aorta Repair Through Stent Implantation trial. J Thorac Cardiovasc Surg 2024; 167:1661-1669.e3. [PMID: 36220703 DOI: 10.1016/j.jtcvs.2022.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/11/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study objective was to evaluate the clinical and radiographic outcomes of the Ascyrus Medical Dissection Stent in a prospective, nonrandomized, international study (Dissected Aorta Repair Through Stent Implantation) of patients with acute DeBakey type I aortic dissection. METHODS The Ascyrus Medical Dissection Stent was used in combination with the standard surgical management of acute DeBakey type I aortic dissection I to treat patients with (56.5%, 26/46) and without (43.5%, 20/46) preoperative clinical and radiographic malperfusion. All patients had a primary entry tear in the ascending aorta, and 97.8% (45/46) were treated with a hemiarch repair. Median follow-up was 3 years. RESULTS All 47 patients underwent emergency surgical repair with successful Ascyrus Medical Dissection Stent implantation. One patient was excluded from analysis due to use in iatrogenic dissection. Overall mortality at 30 days and 3 years was 13.0% (6/46) and 21.7% (10/46), respectively. Overall new stroke rate at 30 days was 15.2% (7/46). No devices were explanted at any time during the 3-year median follow-up. At 3 years, the total aortic diameter in zones 0, 1, and 2 decreased or remained stable in 91.7%, 72.7%, and 75.0%, respectively. The false lumen was completely or partially thrombosed in 90.5% in zone 0, 60.0% in zone 1, and 68.2% in zone 2 at 3 years. CONCLUSIONS The use of the Ascyrus Medical Dissection Stent in the treatment of acute DeBakey type I aortic dissection I holds promise as a simple technology that enables repair of the aortic arch and proximal descending aorta, while promoting positive aortic remodeling. Ongoing follow-up of the Dissected Aorta Repair Through Stent Implantation trial will provide long-term, prospective, clinical outcomes and radiographic data on positive remodeling of the aortic arch.
Collapse
Affiliation(s)
- Sabin J Bozso
- Division of Cardiac Surgery, University of Alberta, Edmonton, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, University of Alberta, Edmonton, Canada
| | - Michael W A Chu
- Division of Cardiac Surgery, Western University, Edmonton, Canada
| | - Bob Kiaii
- Division of Cardiac Surgery, Western University, Edmonton, Canada
| | - Ismail El-Hamamsy
- Division of Cardiac Surgery, Montreal Heart Institute, Montreal, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, University of Toronto, Toronto, Canada
| | - Jessica Forcillo
- Centre Hospitalière de L Université de Montréal (CHUM), Montreal, Canada
| | | | | | - Michael C Moon
- Division of Cardiac Surgery, University of Alberta, Edmonton, Canada.
| |
Collapse
|
2
|
Kleiman NS, Van Mieghem NM, Reardon MJ, Gada H, Mumtaz M, Olsen PS, Heiser J, Merhi W, Chetcuti S, Deeb GM, Chawla A, Kiaii B, Teefy P, Chu MWA, Yakubov SJ, Windecker S, Althouse AD, Baron SJ. Quality of Life 5 Years Following Transfemoral TAVR or SAVR in Intermediate Risk Patients. JACC Cardiovasc Interv 2024; 17:979-988. [PMID: 38658126 DOI: 10.1016/j.jcin.2024.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 01/12/2024] [Accepted: 02/04/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Symptomatic patients with severe aortic stenosis (AS) at high risk for surgical aortic valve replacement (SAVR) sustain comparable improvements in health status over 5 years after transcatheter aortic valve replacement (TAVR) or SAVR. Whether a similar long-term benefit is observed among intermediate-risk AS patients is unknown. OBJECTIVES The purpose of this study was to assess health status outcomes through 5 years in intermediate risk patients treated with a self-expanding TAVR prosthesis or SAVR using data from the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial. METHODS Intermediate-risk patients randomized to transfemoral TAVR or SAVR in the SURTAVI trial had disease-specific health status assessed at baseline, 30 days, and annually to 5 years using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Health status was compared between groups using fixed effects repeated measures modelling. RESULTS Of the 1,584 patients (TAVR, n = 805; SAVR, n = 779) included in the analysis, health status improved more rapidly after TAVR compared with SAVR. However, by 1 year, both groups experienced large health status benefits (mean change in KCCQ-Overall Summary Score (KCCQ-OS) from baseline: TAVR: 20.5 ± 22.4; SAVR: 20.5 ± 22.2). This benefit was sustained, albeit modestly attenuated, at 5 years (mean change in KCCQ-OS from baseline: TAVR: 15.4 ± 25.1; SAVR: 14.3 ± 24.2). There were no significant differences in health status between the cohorts at 1 year or beyond. Similar findings were observed in the KCCQ subscales, although a substantial attenuation of benefit was noted in the physical limitation subscale over time in both groups. CONCLUSIONS In intermediate-risk AS patients, both transfemoral TAVR and SAVR resulted in comparable and durable health status benefits to 5 years. Further research is necessary to elucidate the mechanisms for the small decline in health status noted at 5 years compared with 1 year in both groups. (Safety and Efficacy Study of the Medtronic CoreValve® System in the Treatment of Severe, Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement [SURTAVI]; NCT01586910).
Collapse
Affiliation(s)
- Neal S Kleiman
- Department of Interventional Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
| | | | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Hemal Gada
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleysburg, Pennsylvania, USA
| | - Mubashir Mumtaz
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pinnacle Health, Harrisburg, Pennsylvania, USA
| | - Peter Skov Olsen
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - John Heiser
- Department of Interventional Cardiology, Corewell Health, Grand Rapids, Michigan, USA
| | - William Merhi
- Department of Cardiothoracic Surgery, Corewell Health, Grand Rapids, Michigan, USA
| | - Stanley Chetcuti
- Interventional Cardiology, University of Michigan, Ann Arbor, Michigan, USA
| | - G Michael Deeb
- Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Atul Chawla
- Department of Cardiology, Iowa Heart Center, Des Moines, Iowa, USA
| | - Bob Kiaii
- Division of Cardiac Surgery, University of California-Davis Health, Sacramento, California, USA
| | - Patrick Teefy
- Divisions of Cardiology and Cardiac Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Michael W A Chu
- Divisions of Cardiology and Cardiac Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Steven J Yakubov
- Interventional Cardiology, OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Stephan Windecker
- Department of Cardiology, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Suzanne J Baron
- Massachusetts General Hospital, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Anastasiadis K, Antonitsis P, Murkin J, Serrick C, Gunaydin S, El-Essawi A, Bennett M, Erdoes G, Liebold A, Punjabi P, Theodoropoulos KC, Kiaii B, Wahba A, de Somer F, Bauer A, Kadner A, van Boven W, Argiriadou H, Deliopoulos A, Baker RΑ, Breitenbach I, Ince C, Starinieri P, Jenni H, Popov V, Moorjani N, Moscarelli M, Di Eusanio M, Cale A, Shapira O, Baufreton C, Condello I, Merkle F, Stehouwer M, Schmid C, Ranucci M, Angelini G, Carrel T. 2021 MiECTiS focused update on the 2016 position paper for the use of minimal invasive extracorporeal circulation in cardiac surgery. Perfusion 2023; 38:1360-1383. [PMID: 35961654 DOI: 10.1177/02676591221119002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The landmark 2016 Minimal Invasive Extracorporeal Technologies International Society (MiECTiS) position paper promoted the creation of a common language between cardiac surgeons, anesthesiologists and perfusionists which led to the development of a stable framework that paved the way for the advancement of minimal invasive perfusion and related technologies. The current expert consensus document offers an update in areas for which new evidence has emerged. In the light of published literature, modular minimal invasive extracorporeal circulation (MiECC) has been established as a safe and effective perfusion technique that increases biocompatibility and ultimately ensures perfusion safety in all adult cardiac surgical procedures, including re-operations, aortic arch and emergency surgery. Moreover, it was recognized that incorporation of MiECC strategies advances minimal invasive cardiac surgery (MICS) by combining reduced surgical trauma with minimal physiologic derangements. Minimal Invasive Extracorporeal Technologies International Society considers MiECC as a physiologically-based multidisciplinary strategy for performing cardiac surgery that is associated with significant evidence-based clinical benefit that has accrued over the years. Widespread adoption of this technology is thus strongly advocated to obtain additional healthcare benefit while advancing patient care.
Collapse
Affiliation(s)
- Kyriakos Anastasiadis
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Polychronis Antonitsis
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - John Murkin
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Cyril Serrick
- Department of Perfusion, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Serdar Gunaydin
- Department of Cardiovascular Surgery, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Aschraf El-Essawi
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Mark Bennett
- Department of Anesthesia, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Gabor Erdoes
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Andreas Liebold
- Department of Cardio-thoracic Surgery, University Hospital Ulm, Ulm, Germany
| | - Prakash Punjabi
- Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | - Bob Kiaii
- Division of Cardiothoracic Surgery, UC Davis Health, Sacramento, CA, USA
| | - Alexander Wahba
- Department of Cardio-Thoracic Surgery, St Olav's University Hospital, Trondheim, Norway and Department of Circulation and Medical Imaging, University of Science and Technology, Trondheim, Norway
| | - Filip de Somer
- Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
| | - Adrian Bauer
- Department of Cardiovascular Perfusion, MediClin Heart Center, Coswig, Saxony-Anhalt, Germany
| | - Alexander Kadner
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, Switzerland
| | | | - Helena Argiriadou
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Apostolos Deliopoulos
- Cardiothoracic Department, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Robert Α Baker
- Cardiothoracic Surgery Quality and Outcomes, and Perfusion, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
| | - Ingo Breitenbach
- Department of Thoracic and Cardiovascular Surgery, Braunschweig Clinic, Braunschweig, Germany
| | - Can Ince
- Department of Intensive Care, Laboratory of Translational Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Hansjoerg Jenni
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, Switzerland
| | - Vadim Popov
- Department of Cardio-Vascular Surgery, Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - Narain Moorjani
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, University of Cambridge, Cambridge, UK
| | - Marco Moscarelli
- Cardiac Surgery, Anthea Hospital Gvm Care & Research, Bari, Italy
| | - Marco Di Eusanio
- Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Alex Cale
- Department of Cardiac Surgery, Hull and East Yorkshire Hospitals NHS Trust, UK
| | - Oz Shapira
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Ignazio Condello
- Cardiac Surgery, Anthea Hospital Gvm Care & Research, Bari, Italy
| | - Frank Merkle
- Academy for Perfusion, German Heart Institute Berlin, Berlin, Germany
| | - Marco Stehouwer
- Department of Clinical Perfusion, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Marco Ranucci
- Department of Cardiovascular Anesthesia and Intensive Care Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gianni Angelini
- Bristol Heart Institute, Bristol Royal Infirmary, University of Bristol, Bristol, UK
| | - Thierry Carrel
- Department of Cardiac Surgery, University Hospital Zürich, Zurich, Switzerland
| |
Collapse
|
4
|
Balkhy HH, Grossi EA, Kiaii B, Murphy SME, Kitahara H, Guy TS, Lewis C. Cost and Clinical Outcomes Evaluation Between the Endoaortic Balloon and External Aortic Clamp in Cardiac Surgery. Innovations (Phila) 2023; 18:338-345. [PMID: 37458243 DOI: 10.1177/15569845231185311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
OBJECTIVE Endoaortic balloon occlusion facilitates cardioplegic arrest during minimally invasive surgery (MIS). Studies have shown endoclamping to be as safe as traditional aortic clamping. We compared outcomes and hospital costs of endoclamping versus external aortic occlusion in a large administrative database. METHODS There were 52,882 adults undergoing eligible cardiac surgery (October 2015 to March 2020) identified in the Premier Healthcare Database. Endoclamp procedures (n = 419) were 1:3 propensity score matched to similar procedures using external aortic occlusion (n = 1,244). Generalized linear modeling measured differences in in-hospital complications (major adverse renal and cardiac events, including mortality, new-onset atrial fibrillation, acute kidney injury [AKI], myocardial infarction [MI], postcardiotomy syndrome, stroke/transient ischemic attack [TIA], and aortic dissection) and length of stay (LOS). RESULTS The mean age was 63 years, and 53% were male (n = 882). The majority (93%, n = 1,543) were mitral valve procedures, and 17% of procedures (n = 285) were robot-assisted. Total hospitalization costs were not statistically significantly different between the 2 groups ($52,158 vs $49,839, P = 0.06). The median LOS was significantly shorter in the endoclamp group (incident rate ratio = 0.87, P < 0.001). Mortality, atrial fibrillation, AKI, and stroke/TIA were similar between the 2 groups. MI and postcardiotomy syndrome were lower in the endoclamp group (odds ratio [OR] = 0.14, P = 0.006, and OR = 0.27, P = 0.005). There were no aortic dissections in the endoclamp group. CONCLUSIONS Aortic endoclamping in MIS was associated with similar costs, shorter LOS, no dissections, and comparably low mortality and stroke rates when compared with external clamping in this hospital billing dataset. These results demonstrate the clinical safety and efficacy of endoaortic balloon clamping in a real-world setting. Further studies are warranted.
Collapse
Affiliation(s)
| | | | - Bob Kiaii
- University of California Davis Health, Sacramento, CA, USA
| | | | | | - T Sloane Guy
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Clifton Lewis
- University of Alabama School of Medicine, Birmingham, AL, USA
| |
Collapse
|
5
|
Kiaii B. President's Message: The Pursuit of Connecting the Dots. Innovations (Phila) 2023; 18:2S. [PMID: 37078737 DOI: 10.1177/15569845221146369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
|
6
|
Balkhy HH, Grossi EA, Kiaii B, Murphy D, Geirsson A, Guy S, Lewis C. A Retrospective Evaluation of Endo-Aortic Balloon Occlusion Compared to External Clamping in Minimally Invasive Mitral Valve Surgery. Semin Thorac Cardiovasc Surg 2023; 36:27-36. [PMID: 36921680 DOI: 10.1053/j.semtcvs.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 03/16/2023]
Abstract
We compare outcomes of endo-aortic balloon occlusion (EABO) vs external aortic clamping (EAC) in patients undergoing minimally invasive mitral valve surgery (MIMVS) in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database. Adults undergoing mitral valve surgery (July 2017-December 2018) were identified within the STS database (N = 60,607). Total 7,978 patients underwent a minimally invasive approach (including robotically assisted). About 1,163 EABO patients were 1:1 propensity-matched to EAC patients using exact matching on age, sex, and type of mitral procedure, and propensity score average matching for 16 other risk indicators. Early outcomes were compared. Categorical variables were compared using logistic regression; hospital and intensive care unit length of stay were compared using negative binomial regression. In the matched cohort, mean age was 62 years; 35.9% were female, and 86% underwent mitral valve repair. Cardiopulmonary bypass time was shorter for EABO vs EAC group (125.0 ± 53.0 vs 134.0 ± 67.0 minutes, P = 0.0009). There was one aortic dissection in the EAC group and none in the EABO group (P value > 0.31), and no statistically significant differences in cross-clamp time, major intraoperative bleeding, perioperative mortality, stroke, new onset of atrial fibrillation, postoperative acute kidney injury, success of repair. Median hospital LOS was shorter for EABO vs EAC procedures (4 vs 5 days, P < 0.0001). In this large, retrospective, STS database propensity-matched analysis ofpatients undergoing MIMVS, we observed similar safety outcomes for EABO and EAC, including no aortic dissections in the EABO group. The EABO group showed slightly shorter CPB times and hospital LOS.
Collapse
Affiliation(s)
- Husam H Balkhy
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Eugene A Grossi
- New York University Medical Center, Cardiac Surgery, New York, New York
| | - Bob Kiaii
- Department of Surgery, UC Davis Health, Sacramento, California
| | - Douglas Murphy
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Sloane Guy
- Minimally Invasive & Robotic Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Clifton Lewis
- Adult Cardiac Surgery, University of Alabama School of Medicine, Birmingham, Alabama
| |
Collapse
|
7
|
Anderson D, Xue A, Wong S, Kiaii B, Catrip-Torres J. Large Ascending Aortic Pseudoaneurysm with Focal Dissection after Coronary Artery Bypass Surgery. Thorac Cardiovasc Surg Rep 2023; 12:e60-e62. [PMID: 37954493 PMCID: PMC10637853 DOI: 10.1055/a-2192-5909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/24/2023] [Indexed: 11/14/2023] Open
Abstract
Background There are many known complications that occur after surgical revascularization for patients with significant left main coronary artery disease. Case Description This case report highlights the preoperative workup, surgical approach, and postoperative management of a patient who presents with an aortic pseudoaneurysm and dissection 2 years after the index CABG. Conclusion The development of an aortic pseudoaneurysm in combination with an ascending aortic dissection after prior coronary artery bypass grafting (CABG) is a rare compilation of complications that has scarcely been reported in the literature.
Collapse
Affiliation(s)
- Devon Anderson
- Department of Surgery, University of California Davis Medical Center, Sacramento, California, United States
| | - Anna Xue
- Division of Cardiothoracic Surgery, Department of Surgery, University of California Davis Medical Center, Sacramento, California, United States
| | - Samantha Wong
- Department of Surgery, University of California Davis School of Medicine, Sacramento, California, United States
| | - Bob Kiaii
- Division of Cardiothoracic Surgery, Department of Surgery, University of California Davis Medical Center, Sacramento, California, United States
| | - Jorge Catrip-Torres
- Division of Cardiothoracic Surgery, Department of Surgery, University of California Davis Medical Center, Sacramento, California, United States
| |
Collapse
|
8
|
Verma A, Sanaiha Y, Hadaya J, Maltagliati AJ, Tran Z, Ramezani R, Shemin RJ, Benharash P, Benharash P, Shemin RJ, Satou N, Nguyen T, Clary C, Madani M, Higgins J, Steltzner D, Kiaii B, Young JN, Behan K, Houston H, Matsumoto C, Sun JC, Flavin L, Fopiano P, Cabrera M, Khaki R, Washabaugh P. Parsimonious machine learning models to predict resource use in cardiac surgery across a statewide collaborative. JTCVS Open 2022; 11:214-228. [PMID: 36172420 PMCID: PMC9510828 DOI: 10.1016/j.xjon.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/18/2022] [Accepted: 04/12/2022] [Indexed: 11/03/2022]
Abstract
Objective Methods Results Conclusions
Collapse
|
9
|
Xue A, Chen S, Ranade A, Smith K, Kasten J, Catrip J, Kiaii B. How to implement a clinical robotic mitral valve surgery program. Ann Cardiothorac Surg 2022; 11:504-509. [PMID: 36237591 PMCID: PMC9551378 DOI: 10.21037/acs-2022-rmvs-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/24/2022] [Indexed: 11/06/2022]
Abstract
Minimally invasive, specifically, robot-assisted mitral valve surgery has evolved as a method to intervene on mitral valve disease without a median sternotomy while providing the advantages of excellent visualization and allowing for precise technical movements in a small space with the goal to decrease surgical invasiveness, post-operative pain, and hospital length of stay. As patient interest in minimally invasive cardiac procedures become more prevalent and patients seek the opportunity to undergo robotic valve surgery, institutions worldwide are exploring the potential of establishing a robotic mitral valve surgery program. While robust existing experience in open surgical mitral valve repair, careful patient selection, a dedicated team, and institution support are fundamental factors to implement a new robotic mitral valve surgery program, we believe that simulation team training prior to transitioning to live cases is also crucial and should be incorporated to establish a successful mitral valve surgery program.
Collapse
Affiliation(s)
- Anna Xue
- Division of Cardiac Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Sarah Chen
- Division of Cardiac Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Alison Ranade
- Division of Cardiac Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Kimberly Smith
- Division of Cardiac Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Jeff Kasten
- Division of Cardiac Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Jorge Catrip
- Division of Cardiac Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Bob Kiaii
- Division of Cardiac Surgery, University of California Davis Health, Sacramento, CA, USA
| |
Collapse
|
10
|
Kiaii B, Johnston SS, Jang SR, Elangovanraaj N, Tewari P, Chen BPH. Clinical and economic outcomes after sternotomy for cardiac surgery with skin closure through 2-octyl cyanoacrylate plus polymer mesh tape versus absorbable sutures plus waterproof wound dressings: a retrospective cohort study. J Cardiothorac Surg 2022; 17:212. [PMID: 36031599 PMCID: PMC9420285 DOI: 10.1186/s13019-022-01956-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To compare clinical and economic outcomes after sternotomy for cardiac surgery with skin closure through 2-octyl cyanoacrylate plus polymer mesh tape (2OPMT) versus conventional absorbable sutures plus waterproof wound dressings (CSWWD).
Methods
Retrospective study using the Premier Healthcare Database. Patients undergoing a cardiac surgery requiring sternotomy with 2OPMT or CSWWD were included. Primary outcome was 60-day cumulative incidence of diagnosis for wound complications (infection, dehiscence). Secondary outcomes were index admission hospital length of stay (LOS), total hospital-borne costs, discharge status, and 60-day cumulative incidences of inpatient readmission and reoperation. After propensity score matching, outcomes were compared between the 2OPMT and CSWWD groups using bivariate multilevel mixed-effects generalized linear models.
Results
Overall, 7,901 2OPMT patients and 10,775 CSWWD patients were eligible for study. After propensity score matching on 68 variables, each group comprised 5,338 patients (total study N = 10,676). The 2OPMT and CSWWD groups did not differ significantly in terms of the 60-day cumulative incidences of wound complication (3.47% vs 3.47%, p = 0.996), inpatient readmission (12.6% vs. 13.6%, p = 0.354), and reoperation (10.3% vs 10.1%, p = 0.808), as well as discharge to home versus non-home setting (77.2% vs. 75.1%), p = 0.254. However, the 2OPMT group had significantly lower LOS (9.2 days vs 10.6 days, p < 0.001) and total hospital-borne costs ($50,174 vs $60,526, p < 0.001).
Conclusions
This large observational study provides evidence that sternotomy skin closure with 2OPMT is associated with nearly identical 60-day cumulative incidence of wound complication as compared with CSWWD, while exhibiting a significant association with lower LOS and total hospital-borne costs.
Trial registration Not applicable.
Collapse
|
11
|
Anderson D, Chen S, Southard J, Catrip-Torres JM, Kiaii B. Multidisciplinary approach to coronary artery revascularization: Optimal strategy for high-risk patients. J Card Surg 2022; 37:2900-2902. [PMID: 35701995 DOI: 10.1111/jocs.16685] [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: 03/23/2022] [Revised: 05/27/2022] [Accepted: 06/04/2022] [Indexed: 11/28/2022]
Abstract
High-risk patients that are not candidates for conventional coronary artery bypass grafting surgery can undergo coronary artery revascularization through less invasive procedures. Hybrid approaches have emerged to address coronary artery disease in this subset of patients. This case report highlights the successful application of a multidisciplinary heart team approach for hybrid coronary revascularization in a very high-risk patient with complex coronary anatomy, who would not otherwise be a candidate for conventional modalities of revascularization. The optimal workup, selection criteria based on anatomy, anticoagulation strategies, and timing of intervention of hybrid coronary revascularization are outlined in this case report.
Collapse
Affiliation(s)
- Devon Anderson
- Division of Cardiothoracic Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Sarah Chen
- Division of Cardiothoracic Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Jeffrey Southard
- Division of Cardiology, University of California Davis Medical Center, Sacramento, California, USA
| | - Jorge Manuel Catrip-Torres
- Division of Cardiothoracic Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Bob Kiaii
- Division of Cardiothoracic Surgery, University of California Davis Medical Center, Sacramento, California, USA
| |
Collapse
|
12
|
Sherazee EA, Chen SA, Li D, Li D, Frank P, Kiaii B. Pain Management Strategies for Minimally Invasive Cardiothoracic Surgery. Innovations (Phila) 2022; 17:167-176. [PMID: 35521910 DOI: 10.1177/15569845221091779] [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] [Indexed: 11/15/2022]
Affiliation(s)
- Elan A Sherazee
- Department of Surgery, 8789UC Davis Medical Center, Sacramento, CA, USA
| | - Sarah A Chen
- Division of Cardiac Surgery, 8789UC Davis Medical Center, Sacramento, CA, USA
| | - David Li
- Department of Anesthesiology and Pain Medicine, 8789UC Davis Medical Center, Sacramento, CA, USA
| | - David Li
- Department of Pharmacy Services, 8789UC Davis Medical Center, Sacramento, CA, USA
| | - Paul Frank
- Department of Anesthesiology and Pain Medicine, 8789UC Davis Medical Center, Sacramento, CA, USA
| | - Bob Kiaii
- Division of Cardiac Surgery, 8789UC Davis Medical Center, Sacramento, CA, USA
| |
Collapse
|
13
|
Shi C, Zhang Z, Goldhammer J, Li D, Kiaii B, Rudriguez V, Boyd D, Lubarsky D, Applegate R, Liu H. Effect of lipid-lowering medications in patients with coronary artery bypass grafting surgery outcomes. BMC Anesthesiol 2022; 22:122. [PMID: 35473580 PMCID: PMC9040242 DOI: 10.1186/s12871-022-01675-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increased life expectancy and improved medical technology allow increasing numbers of elderly patients to undergo cardiac surgery. Elderly patients may be at greater risk of postoperative morbidity and mortality. Complications can lead to worsened quality of life, shortened life expectancy and higher healthcare costs. Reducing perioperative complications, especially severe adverse events, is key to improving outcomes in patients undergoing cardiac surgery. The objective of this study is to determine whether perioperative lipid-lowering medication use is associated with a reduced risk of complications and mortality after coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). METHODS After IRB approval, we reviewed charts of 9,518 patients who underwent cardiac surgery with CPB at three medical centers between July 2001 and June 2015. The relationship between perioperative lipid-lowering treatment and postoperative outcome was investigated. 3,988 patients who underwent CABG met inclusion criteria and were analyzed. Patients were divided into lipid-lowering or non-lipid-lowering treatment groups. RESULTS A total of 3,988 patients were included in the final analysis. Compared to the patients without lipid-lowering medications, the patients with lipid-lowering medications had lower postoperative neurologic complications and overall mortality (P < 0.05). Propensity weighted risk-adjustment showed that lipid-lowering medication reduced in-hospital total complications (odds ratio (OR) = 0.856; 95% CI 0.781-0.938; P < 0.001); all neurologic complications (OR = 0.572; 95% CI 0.441-0.739; P < 0.001) including stroke (OR = 0.481; 95% CI 0.349-0.654; P < 0.001); in-hospital mortality (OR = 0.616; 95% CI 0.432-0.869; P = 0.006; P < 0.001); and overall mortality (OR = 0.723; 95% CI 0.634-0.824; P < 0.001). In addition, the results indicated postoperative lipid-lowering medication use was associated with improved long-term survival in this patient population. CONCLUSIONS Perioperative lipid-lowering medication use was associated with significantly reduced postoperative adverse events and improved overall outcome in elderly patients undergoing CABG surgery with CPB.
Collapse
Affiliation(s)
- Chunxia Shi
- Department of Anesthesiology, Peking University International Hospital, Beijing, China.,Department of Anesthesiology and Pain Medicine, University of California Davis Health, 4150 V Street, Suite 1200, Sacramento, CA, 95817, USA
| | - Zugui Zhang
- Institute for Research On Equality and Community Health, Christiana Care, Newark, DE, USA
| | - Jordan Goldhammer
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - David Li
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, 4150 V Street, Suite 1200, Sacramento, CA, 95817, USA
| | - Bob Kiaii
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Victor Rudriguez
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Douglas Boyd
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
| | - David Lubarsky
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, 4150 V Street, Suite 1200, Sacramento, CA, 95817, USA
| | - Richard Applegate
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, 4150 V Street, Suite 1200, Sacramento, CA, 95817, USA
| | - Hong Liu
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, 4150 V Street, Suite 1200, Sacramento, CA, 95817, USA.
| |
Collapse
|
14
|
Tuttle MK, Kiaii B, Van Mieghem NM, Laham RJ, Deeb GM, Windecker S, Chetcuti S, Yakubov SJ, Chawla A, Hockmuth D, Teefy P, Li S, Reardon MJ. Functional Status After Transcatheter and Surgical Aortic Valve Replacement: 2-Year Analysis From the SURTAVI Trial. JACC Cardiovasc Interv 2022; 15:728-738. [PMID: 35393106 DOI: 10.1016/j.jcin.2022.01.284] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 03/03/2021] [Revised: 01/06/2022] [Accepted: 01/14/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to evaluate patient-centered metrics in intermediate-surgical-risk aortic stenosis patients enrolled in the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial treated with self-expanding transcatheter aortic valve replacement (TAVR) or surgery. BACKGROUND Studies have shown TAVR to be an alternative to surgery in patients with severe symptomatic aortic stenosis but have focused on "hard endpoints," including all-cause mortality and stroke, rather than on comparative patient-centered metrics, such as functional status and symptom burden. METHODS The study analyzed functional status (6-minute walk test [6MWT]) and symptom burden (Kansas City Cardiomyopathy Questionnaire) in 1,492 patients from the SURTAVI trial at baseline, 30 days, 1 year, and 2 years. Patients were categorized by baseline functional status into tertiles of slow, medium, and fast walkers. RESULTS Patients with lowest capacity baseline functional status were commonly women, had higher Society of Thoracic Surgeons scores, and had more New York Heart Association functional class III or IV symptoms; reduced baseline functional status was associated with higher aortic valve- and heart failure-related hospitalization at 2 years. There was greater improvement in 6MWT distance in TAVR compared with surgery patients at 30 days (P < 0.001) and 1 year (P = 0.012), but at 2 years, both groups had similar improvement (P = 0.091). The percentage of patients with large improvement in 6MWT was greatest in patients categorized as slow walkers and lowest in fast walkers. Symptom burden improved after TAVR at 30 days and after both procedures at 1 and 2 years. CONCLUSIONS In this substudy of patients from the SURTAVI trial, patients receiving TAVR demonstrated a more rapid improvement in functional status and symptom burden compared with patients undergoing surgery; however, both groups had similar improvements in long-term follow-up. (Safety and Efficacy Study of the Medtronic CoreValve® System in the Treatment of Severe, Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement [SURTAVI]; NCT01586910).
Collapse
Affiliation(s)
- Mark K Tuttle
- CardioVascular Institute of North Colorado, Banner Health, Greeley, Colorado, USA.
| | - Bob Kiaii
- Department of Cardiothoracic Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Roger J Laham
- CardioVascular Institute of North Colorado, Banner Health, Greeley, Colorado, USA
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Stanley Chetcuti
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven J Yakubov
- Department of Cardiac Surgery, Riverside Methodist Hospital, Columbus, Ohio, USA; Department of Interventional Cardiology, Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Atul Chawla
- Department of Cardiology, Iowa Heart Center, Des Moines, Iowa, USA
| | - David Hockmuth
- Department of Cardiology, Iowa Heart Center, Des Moines, Iowa, USA
| | - Patrick Teefy
- Department of Medicine, Cardiology Division, London Health Sciences Centre, London, Ontario, Canada
| | - Shuzhen Li
- Coronary and Structural Heart, Medtronic, Minneapolis, Minnesota, USA
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA; Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| |
Collapse
|
15
|
Sherazee EA, Guenther TM, Kiaii B. Systematic Review of Graft Patency after Robotically Assisted Coronary Artery Bypass Grafting Surgery. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
16
|
Bonatti J, Kiaii B, Alhan C, Cerny S, Torregrossa G, Bisleri G, Komlo C, Guy TS. The role of robotic technology in minimally invasive surgery for mitral valve disease. Expert Rev Med Devices 2021; 18:955-970. [PMID: 34325594 DOI: 10.1080/17434440.2021.1960506] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Robotic mitral valve surgery has developed for more than 20 years. The main purpose of robotic assistance is to use multiwristed instruments for surgical endothoracic maneuvers on the mitral valve without opening the chest. The surgeon controls the instruments remotely from a console but is virtually immersed into the operative field. AREAS COVERED This review outlines indications and contraindication for the procedure. Intra- and postoperative results as available in the literature are reported. Further areas focus on the technological development, advances in surgical techniques, training methods, and learning curves. Finally we give an outlook on the potential future of this operation. EXPERT OPINION Robotic assistance allows for the surgically least invasive form of mitral valve operations. All variations of robotic mitral valve repair and replacement are feasible and indications have recently been broadened. Improved dexterity of instrumentation, 3D and HD vision, introduction of a robotic left atrial retractor, and adjunct technology enable most complex forms of minimally invasive mitral valve interventions through ports on the patient's right chest wall. Application of robotics results in significantly reduced surgical trauma while maintaining safety and outcome standards in mitral valve surgery.
Collapse
Affiliation(s)
- Johannes Bonatti
- UPMC Heart and Vascular Institute and Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bob Kiaii
- Department of Cardiothoracic Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Cem Alhan
- Department of Cardiovascular Surgery, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Stepan Cerny
- Department of Cardiac Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Main Line Health - Lankenau Heart Institute, Wynnewood, PA, USA
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Caroline Komlo
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - T Sloane Guy
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
17
|
de Jong R, Jacob K, Jalali A, Moharrem Y, Buijsrogge M, Gianoli M, Teefy P, Kiaii B. Five-Year Outcomes After Hybrid Coronary Revascularization: A Single Center Experience. Innovations (Phila) 2021; 16:456-462. [PMID: 34318730 DOI: 10.1177/15569845211031498] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Hybrid coronary revascularization (HCR) combines both surgical and percutaneous coronary revascularization procedures. It offers a minimally invasive strategy for multivessel coronary artery disease and combines the advantages of both. However, quantitative long-term patency and clinical outcomes remain understudied. The objective of this study was to assess clinical outcomes and graft and stent patency at 5-year follow-up. METHODS From January 2004 to January 2015, 120 patients were enrolled in this study. They underwent robotically assisted minimally invasive coronary artery bypass grafting of left internal thoracic artery (LITA) to the left descending artery (LAD) and percutaneous coronary intervention of non-LAD vessels. Primary outcome was graft (LITA-LAD) patency determined at 5 years of follow-up, assessed by computed tomography angiography and rest and stress myocardial perfusion scintigraphy (MPS-MIBI). Secondary outcomes were stent patency and major adverse major cardiac and cerebrovascular events (MACCE). Also, freedom from recurrence of angina was assessed. RESULTS At follow-up, 18 of 120 patients (15%) had died (in 5 patients the cause of death was cardiovascular). Among survivors, follow-up was achieved in 83 of 102 (81%). In 76 of 83 patients (92%) there was a patent LITA-LAD graft and in 75 of 83 (90%) a patent stent was demonstrated. MACCE occurred in 36 of 120 patients (30%). Freedom from recurrence of angina occurred in 92 of 120 patients (77%). CONCLUSIONS HCR is a safe and a promising procedure. It provides a minimally invasive approach and results in complete revascularization with good 5-year patency and clinical outcomes.
Collapse
Affiliation(s)
- Roos de Jong
- London Health Sciences Center, Ontario, Canada.,569601 University Medical Center Utrecht, The Netherlands
| | - Kirolos Jacob
- 569601 University Medical Center Utrecht, The Netherlands
| | | | | | | | - Monica Gianoli
- 569601 University Medical Center Utrecht, The Netherlands
| | | | - Bob Kiaii
- London Health Sciences Center, Ontario, Canada.,907798789 University of California Davis Medical Center, Sacramento, CA, USA
| |
Collapse
|
18
|
Abazid R, Romsa J, Akincioglu C, Warrington J, Bureau Y, Kiaii B, Vezina W. Coronary Artery Calcium Progression After Coronary Artery Bypass Graft Surgery. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.235] [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: 10/20/2022]
|
19
|
Abazid RM, Romsa JG, Akincioglu C, Warrington JC, Bureau Y, Kiaii B, Vezina WC. Coronary artery calcium progression after coronary artery bypass grafting surgery. Open Heart 2021; 8:openhrt-2021-001684. [PMID: 34127533 PMCID: PMC8204154 DOI: 10.1136/openhrt-2021-001684] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/31/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Accelerated atherosclerosis is a well-established phenomenon after coronary artery bypass grafting surgery (CABG). In this study, we analysed coronary artery calcium (CCS) progression after CABG. METHODS We retrospectively measured the CCS Agatston score (AS), volume score (VS) and mass score (MS) of 39 patients before and after CABG. The annualised CCS change and annualised CCS percent change of each coronary artery, coronary artery segments proximal and distal to anastomosis were analysed. RESULTS Mean age at the time of the surgery was 59.8±8.5 years. Follow-up period between the first and second CT scans was 6.7±2.8 (range, 1.1-12.8) years. Annualised CCS percent change (AS, VS and MS) of the coronary segments proximal-to-anastomosis did not differ from that of the non-grafted coronary arteries as follow: segments proximal-to-anastomosis: median (Q1-Q3) 12.8 (5.0-37.4), 13.7 (6.1-41.1) and 14.9 (5.4-53.7), left main coronary artery 12.6 (7.4-43.8), 22.0 (8.1-44.4) and 18.2 (7.3-57.4), non-grafted left circumflex artery: 13.5 (4.4-38.1), 10.5 (2.9-45.2) and 11.5 (7.1-47.9) and non-grafted right coronary artery: 31.4 (14.4-74.5), 25.2 (16.7-62.0) and 31.3 (23.8-85.6), respectively. Likewise, annualised percent change (AS, VS and MS) was similar between the native coronary arteries. Multivariate regression analysis showed that diabetes mellitus was the only predictor of annualised percent progression of the total CCS of >15% (HR, 8.12; 95% CI, 1.05 to 26.6; p=0.04). CONCLUSION The CCS post-CABG did not follow an accelerated progression process. Among coronary artery disease risk factors, diabetes mellitus is the only predictor of annualised CCS percent progression of >15% post-CABG.
Collapse
Affiliation(s)
- Rami M Abazid
- London Health Sciences Centre, London, Ontario, Canada
| | | | | | - James C Warrington
- Nuclear Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Yves Bureau
- London Health Sciences Centre, London, Ontario, Canada
| | - Bob Kiaii
- Division of Cardiac Surgery, University of California Davis, Davis, California, USA
| | | |
Collapse
|
20
|
Luc JGY, Ad N, Nguyen TC, Arora RC, Balkhy HH, Bender EM, Bethencourt DM, Bisleri G, Boyd D, Chu MWA, de la Cruz KI, DeAnda A, Engelman DT, Farkas EA, Fedoruk LM, Fiocco M, Forcillo J, Fradet G, Fremes SE, Gammie JS, Geirsson A, Gerdisch MW, Girard LN, Kaiser CA, Kaneko T, Kent WDT, Khabbaz KR, Khoynezhad A, Kiaii B, Lee R, Legare JF, Lehr EJ, MacArthur RGG, McCarthy PM, Mehall JR, Merrill WH, Moon MR, Ouzounian M, Peltz M, Perrault LP, Preventza O, Ramchandani M, Ramlawi B, Salenger R, Sekela ME, Sellke FW, Stulak JM, Sutter FP, Timek TA, Whitman G, Williams JB, Wong DR, Yanagawa B, Ye J, Zeigler SM. Cardiac surgeons' concerns, perceptions, and responses during the COVID-19 pandemic. J Card Surg 2021; 36:3040-3051. [PMID: 34118080 PMCID: PMC8447333 DOI: 10.1111/jocs.15681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/21/2021] [Accepted: 02/27/2021] [Indexed: 01/31/2023]
Abstract
Background The coronavirus disease 2019 (COVID‐19) pandemic has had an unprecedented impact on health care and cardiac surgery. We report cardiac surgeons' concerns, perceptions, and responses during the COVID‐19 pandemic. Methods A detailed survey was sent to recruit participating adult cardiac surgery centers in North America. Data regarding cardiac surgeons' perceptions and changes in practice were analyzed. Results Our study comprises 67 institutions with diverse geographic distribution across North America. Nurses were most likely to be redeployed (88%), followed by advanced care practitioners (69%), trainees (28%), and surgeons (25%). Examining surgeon concerns in regard to COVID‐19, they were most worried with exposing their family to COVID‐19 (81%), followed by contracting COVID‐19 (68%), running out of personal protective equipment (PPE) (28%), and hospital resources (28%). In terms of PPE conservation strategies among users of N95 respirators, nearly half were recycling via decontamination with ultraviolet light (49%), followed by sterilization with heat (13%) and at home or with other modalities (13%). Reuse of N95 respirators for 1 day (22%), 1 week (21%) or 1 month (6%) was reported. There were differences in adoption of methods to conserve N95 respirators based on institutional pandemic phase and COVID‐19 burden, with higher COVID‐19 burden institutions more likely to resort to PPE conservation strategies. Conclusions The present study demonstrates the impact of COVID‐19 on North American cardiac surgeons. Our study should stimulate further discussions to identify optimal solutions to improve workforce preparedness for subsequent surges, as well as facilitate the navigation of future healthcare crises.
Collapse
Affiliation(s)
- Jessica G Y Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Niv Ad
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Adventist White Oak Medical Center, Silver Spring, Maryland, USA
| | - Tom C Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, Texas, USA
| | | | - Rakesh C Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Husam H Balkhy
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Illinois, USA
| | - Edward M Bender
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California, USA
| | - Daniel M Bethencourt
- Division of Cardiac Surgery, Orange Coast Memorial Medical Centers, Fountain Valley, California, USA
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
| | - Douglas Boyd
- Division of Cardiothoracic Surgery, East Carolina University, Brody School of Medicine, Greenville, North Carolina, USA
| | - Michael W A Chu
- Division of Cardiac Surgery, Western University, London, Ontario, Canada
| | - Kim I de la Cruz
- Division of Cardiothoracic Surgery, Methodist Heart Hospital San Antonio, San Antonio, Texas, USA
| | - Abe DeAnda
- Division of Cardiovascular and Thoracic Surgery, UTMB-Galveston, Galveston, Texas, USA
| | - Daniel T Engelman
- Heart and Vascular Program, Baystate Health, Springfield, Massachusetts, USA
| | - Emily A Farkas
- Division of Cardiac Surgery, ThedaCare Appleton Heart Institute, Appleton, Wisconsin, USA
| | - Lynn M Fedoruk
- Division of Cardiac Surgery, Royal Jubilee Hospital, Vancouver Island Health Authority, University of British Columbia, Victoria, British Columbia, Canada
| | - Michael Fiocco
- Division of Cardiac Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Jessica Forcillo
- Division of Cardiac Surgery, Université de Montréal, Department of Cardiac Surgery- Montréal University Hospital Centre (CHUM), Montreal, Quebec, Canada
| | - Guy Fradet
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Kelowna General Hospital, Kelowna, British Columbia, Canada
| | - Stephen E Fremes
- Schulich Heart Centre Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - James S Gammie
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Arnar Geirsson
- Department of Surgery, Yale University, New Haven, Connecticut, USA
| | - Marc W Gerdisch
- Department of Cardiothoracic Surgery, Franciscan Health Heart Center, Indianapolis, IN, USA
| | - Leonard N Girard
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Clayton A Kaiser
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William D T Kent
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kamal R Khabbaz
- Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Khoynezhad
- Department of Cardiovascular Surgery, Memorial Heart and Vascular Institute, Memorial Care Long Beach Medical Center, Long Beach, California, USA
| | - Bob Kiaii
- Division of Cardiothoracic Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Richard Lee
- Division of Cardiothoracic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Jean-Francois Legare
- Division of Cardiac Surgery, New Brunswick Heart Center, Dalhousie University, Saint John, New Brunswick, Canada
| | - Eric J Lehr
- Division of Cardiac Surgery, Swedish Heart and Vascular Institute, Seattle, Washington, USA
| | - Roderick G G MacArthur
- Division of Cardiac Surgery, Department of Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick M McCarthy
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| | - John R Mehall
- Division of Cardiac Surgery, Penrose-St Francis Health Services, Colorado Springs, Colorado, USA
| | - Walter H Merrill
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri, USA
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Matthias Peltz
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Louis P Perrault
- Division of Cardiac Surgery, Institut de Cardiologie de Montreal, Universite de Montreal, Montreal, Quebec, Canada
| | - Ourania Preventza
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA.,Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Mahesh Ramchandani
- Department of Cardiothoracic Surgery, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Basel Ramlawi
- Department of Cardiothoracic Surgery, Valley Health System - Heart and Vascular Center, Winchester Medical Center, Winchester, VA, USA
| | - Rawn Salenger
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael E Sekela
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Frank W Sellke
- Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Francis P Sutter
- Division of Cardiac Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Tomasz A Timek
- Division of Cardiothoracic Surgery, Spectrum Health, Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Glenn Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Judson B Williams
- Department of Cardiovascular and Thoracic Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
| | - Daniel R Wong
- Division of Cardiac Surgery, Department of Surgery, University of British Columbia, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jian Ye
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Sanford M Zeigler
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
21
|
Peng K, Shen YP, Ying YY, Kiaii B, Rodriguez V, Boyd D, Applegate RL, Lubarsky DA, Zhang Z, Xia Z, Feng XM, Yang JP, Liu H, Ji FH. Perioperative dexmedetomidine and 5-year survival in patients undergoing cardiac surgery. Br J Anaesth 2021; 127:215-223. [PMID: 34082896 DOI: 10.1016/j.bja.2021.03.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 03/08/2021] [Accepted: 03/31/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Dexmedetomidine sedation has been associated with favourable outcomes after surgery. We aimed to assess whether perioperative dexmedetomidine use is associated with improved survival after cardiac surgery. METHODS This retrospective cohort study included 2068 patients undergoing on-pump coronary artery bypass grafting and/or valve surgery. Among them, 1029 patients received dexmedetomidine, and 1039 patients did not. Intravenous dexmedetomidine infusion of 0.007 μg kg-1 min-1 was initiated before or immediately after cardiopulmonary bypass and lasted for < 24 h. The primary outcome was 5-year survival after cardiac surgery. The propensity scores matching (PSM), inverse probability of treatment weighting (IPTW), and overlap weighting approaches were used to minimise bias. Survival analyses were performed with Cox proportional-hazard models. RESULTS The median age was 63 yr old and the male to female ratio was 71:29 in both groups. Baseline covariates were balanced between groups after adjustment using PSM, IPTW, or overlap weighting. Patients receiving dexmedetomidine in cardiac surgical procedures had higher survival during postoperative 5 yr in unadjusted analysis (hazard ratio [HR]=0.63; 95% confidence interval [CI], 0.51-0.78; P<0.001), and after adjustment with PSM (HR=0.63; 95% CI, 0.45-0.89; P=0.009), IPTW (HR=0.70; 95% CI, 0.51-0.95; P=0.023), or overlap weighting (HR=0.67; 95% CI, 0.51-0.89; P=0.006). The 5-yr mortality rate after cardiac surgery was 13% and 20% in the dexmedetomidine and non-dexmedetomidine groups, respectively (PSM adjusted odds ratio=0.61; 95% CI, 0.42-0.89; P=0.010). CONCLUSION Perioperative dexmedetomidine infusion was associated with improved 5-yr survival in patients undergoing cardiac surgery.
Collapse
Affiliation(s)
- Ke Peng
- Department of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Department of Anaesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Yue-Ping Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Yao-Yu Ying
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Bob Kiaii
- Department of Cardiothoracic Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Victor Rodriguez
- Department of Cardiothoracic Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Douglas Boyd
- Department of Cardiothoracic Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Richard L Applegate
- Department of Anaesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA
| | - David A Lubarsky
- Department of Anaesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Zugui Zhang
- Value Institute, Christiana Care Health System, Newark, DE, USA
| | - Zhengyuan Xia
- Department of Anaesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA; Department of Anaesthesiology, University of Hong Kong, Hong Kong, China
| | - Xiao-Mei Feng
- Department of Anaesthesiology, University of Utah Health, Salt Lake City, UT, USA
| | - Jian-Ping Yang
- Department of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hong Liu
- Department of Anaesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA.
| | - Fu-Hai Ji
- Department of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
| |
Collapse
|
22
|
Li Z, Dawson E, Moodie J, Martin J, Bagur R, Cheng D, Kiaii B, Hashi A, Bi R, Yeschin M, John-Baptiste A. Measurement and prognosis of frail patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis. BMJ Open 2021; 11:e040459. [PMID: 33664067 PMCID: PMC7934784 DOI: 10.1136/bmjopen-2020-040459] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/09/2020] [Accepted: 12/22/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Our objectives were to review the literature to identify frailty instruments in use for transcatheter aortic valve implantation (TAVI) recipients and synthesise prognostic data from these studies, in order to inform clinical management of frail patients undergoing TAVI. METHODS We systematically reviewed the literature published in 2006 or later. We included studies of patients with aortic stenosis, diagnosed as frail, who underwent a TAVI procedure that reported mortality or clinical outcomes. We categorised the frailty instruments and reported on the prevalence of frailty in each study. We summarised the frequency of clinical outcomes and pooled outcomes from multiple studies. We explored heterogeneity and performed subgroup analysis, where possible. We also used Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to assess the overall certainty of the estimates. RESULTS Of 49 included studies, 21 used single-dimension measures to assess frailty, 3 used administrative data-based measures, and 25 used multidimensional measures. Prevalence of frailty ranged from 5.67% to 90.07%. Albumin was the most commonly used single-dimension frailty measure and the Fried or modified Fried phenotype were the most commonly used multidimensional measures. Meta-analyses of studies that used either the Fried or modified Fried phenotype showed a 30-day mortality of 7.86% (95% CI 5.20% to 11.70%) and a 1-year mortality of 26.91% (95% CI 21.50% to 33.11%). The GRADE system suggests very low certainty of the respective estimates. CONCLUSIONS Frailty instruments varied across studies, leading to a wide range of frailty prevalence estimates for TAVI recipients and substantial heterogeneity. The results provide clinicians, patients and healthcare administrators, with potentially useful information on the prognosis of frail patients undergoing TAVI. This review highlights the need for standardisation of frailty measurement to promote consistency. PROSPERO REGISTRATION NUMBER CRD42018090597.
Collapse
Affiliation(s)
- Zhe Li
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
| | - Emily Dawson
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
| | - Jessica Moodie
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
| | - Janet Martin
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
| | - Rodrigo Bagur
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Davy Cheng
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
- Department of Medicine, Division of Critical Care Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Bob Kiaii
- Department of Surgery, Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Adam Hashi
- Faculty of Sciences, Western University, London, Ontario, Canada
| | - Ran Bi
- Schulich Interfaculty Program in Public Health, Western University, London, Ontario, Canada
| | - Michelle Yeschin
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Ava John-Baptiste
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
- Schulich Interfaculty Program in Public Health, Western University, London, Ontario, Canada
| |
Collapse
|
23
|
Abazid RM, Khatami A, Romsa JG, Warrington JC, Akincioglu C, Stodilka RZ, Fox S, Kiaii B, Vezina WC. Hiatal hernia after robotic-assisted coronary artery bypass graft surgery. J Thorac Dis 2021; 13:575-581. [PMID: 33717530 PMCID: PMC7947528 DOI: 10.21037/jtd-20-2557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The aim of the present study is to determine the incidence/progression of hiatal hernia (HH) after robotic-assisted coronary artery bypass grafting (RA-CABG) surgery. Methods We reviewed the pre- and post-operative computed tomography (CT) of 491 patients who underwent RA-CABG between 2000 and 2017. Post-operative CT was acquired prospectively in a research protocol. CT was reviewed to assess the presence and the size of HH. Results We found 444/491 (90.4%) had pre-operative CT, while 201/491 (40.9%) had post-operative CT. In total, 155/491 (31.6%) had both pre- and long-term post-operative CT with a mean follow-up of 6.2 (±3.5) years. HH was more prevalent on post-operative CT, 64/155 (41.3%) compared to pre-operative CT, 44/155 (28.4%), P<0.0001. The diameter of pre-existing HH 2.8 (±1.8) cm was significantly greater after surgery 3.9 (±2.5) cm, P<0.0001. As well the volume of the pre-existing HH 5.8 (4.4-9.2) mL (quartile) was significantly greater after surgery 14.1 (7.2-64.9) mL, P<0.0001. 20/155 (12.9%) had a newly developed HH after RA-CABG. A binary multivariate regression including HH risk factors showed that male gender is a predictor of developing a HH after RA-CABG with Hazard Ratio of 3.038, confidence interval (1.10-8.43), P=0.033. Conclusions RA-CABG is associated with an increased risk of developing HH and increases the size of pre-existing HH.
Collapse
Affiliation(s)
- Rami M Abazid
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, Canada
| | - Alireza Khatami
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, Canada
| | - Jonathan G Romsa
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, Canada
| | - James C Warrington
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, Canada
| | - Cigdem Akincioglu
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, Canada
| | - Robert Z Stodilka
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, Canada
| | - Stephanie Fox
- Division of Cardiac Surgery, London Health Sciences Centre, London, Canada
| | - Bob Kiaii
- Division of Cardiac Surgery, London Health Sciences Centre, London, Canada.,Division of Cardiac Surgery, University of California, Davis Medical Center, Sacramento, CA, USA
| | - William C Vezina
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, London, Canada
| |
Collapse
|
24
|
Thourani VH, Edelman JJ, Holmes SD, Nguyen TC, Carroll J, Mack MJ, Kapadia S, Tang GHL, Kodali S, Kaneko T, Meduri CU, Forcillo J, Ferdinand FD, Fontana G, Suwalski P, Kiaii B, Balkhy H, Kempfert J, Cheung A, Borger MA, Reardon M, Leon MB, Popma JJ, Ad N. The International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on Transcatheter and Surgical Aortic Valve Replacement in Low- and Intermediate-Risk Patients: A Meta-Analysis of Randomized and Propensity-Matched Studies. Innovations (Phila) 2021; 16:3-16. [PMID: 33491539 DOI: 10.1177/1556984520978316] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE There is an increasing amount of evidence supporting use of transcatheter aortic valve replacement (TAVR) for treatment of aortic stenosis in patients at low or intermediate risk for surgical aortic valve replacement (SAVR). TAVR is now approved for use in all patient cohorts. Despite this, there remains debate about the relative efficacy of TAVR compared with SAVR in lower-risk cohorts and various subgroups of patients. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and propensity-matched trials to guide a consensus among expert cardiologists and surgeons. METHODS Studies comparing TAVR and SAVR in low- and intermediate-risk patients were identified by a thorough search of the major databases. Mortality, stroke, and other perioperative outcomes were assessed at 30 days and 1 year. RESULTS Early mortality was lower in TAVR compared to SAVR in RCTs, but not propensity-matched studies in low-risk cohorts (0.66% vs 1.5%; odds ratio [OR] = 0.44, 95% confidence interval [CI] 0.20 to 0.98, I2 = 0%). No difference in mortality between TAVR and SAVR was identified in intermediate-risk patients at early or later time points. Incidence of perioperative stroke in 3 low-risk RCTs was significantly lower in TAVR (0.4%) than SAVR (1.4%; OR = 0.33, 95% CI 0.13 to 0.81, I2 = 0%). There was no difference in stroke for intermediate-risk patients between TAVR and SAVR. The expert panel of cardiologists and cardiac surgeons provided recommendations for TAVR and SAVR in various clinical scenarios. CONCLUSIONS In RCTs comparing TAVR and SAVR in low-risk patients, early mortality and stroke were lower in TAVR, but did not differ at 1 year. There was no difference in mortality and stroke in intermediate-risk patients. The Multidisciplinary Heart Team must consider individual patient characteristics and preferences when recommending TAVR or SAVR. The decision must consider the long-term management of each patient's aortic valve disease.
Collapse
Affiliation(s)
- Vinod H Thourani
- 165591 Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart and Vascular Institute, Atlanta, GA, USA
| | - J James Edelman
- 2720 Department of Cardiac Surgery, Fiona Stanley Hospital, University of Western Australia, Perth, Australia
| | - Sari D Holmes
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tom C Nguyen
- Division of Adult Cardiothoracic Surgery, University of California, San Francisco, CA, USA
| | - John Carroll
- 1878 Division of Cardiology, University of Colorado, Denver, CO, USA
| | - Michael J Mack
- 384526 Department of Cardiology, Baylor Health Care System, Heart Hospital Baylor Plano, Dallas, TX, USA
| | - Samir Kapadia
- 2569 Department of Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Gilbert H L Tang
- 5944 Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Susheel Kodali
- 5798 Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Tsuyoshi Kaneko
- 1861 Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Christopher U Meduri
- 165591 Division of Cardiology, Marcus Heart and Vascular Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Jessica Forcillo
- 5622 Department of Cardiac Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada
| | - Francis D Ferdinand
- 6595 Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine & UPMC Hamot Heart and Vascular Institute, University of Pittsburgh Medical Center, PA, USA
| | - Gregory Fontana
- Cardiovascular Institute, Los Robles Hospital and Medical Center, Thousand Oaks, CA, USA
| | - Piotr Suwalski
- 359917 Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Bob Kiaii
- 8789 Cardiothoracic Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Husam Balkhy
- 12246 Section of Cardiac Surgery, University of Chicago Medicine, IL, USA
| | - Joerg Kempfert
- Department of Cardiac Surgery, German Heart Institute, Berlin, Germany
| | - Anson Cheung
- Department of Cardiac Surgery, The University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | | | - Michael Reardon
- Department of Cardiac Surgery, Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Martin B Leon
- 5798 Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Jeffrey J Popma
- 1859 Department of Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Niv Ad
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.,Cardiovascular Surgery, Adventist White Oak Medical Center, Silver Spring, MD, USA
| |
Collapse
|
25
|
Singh GD, Kiaii B. Direct annuloplasty: where are we at and where are we heading? Ann Cardiothorac Surg 2021; 10:170-171. [PMID: 33575190 DOI: 10.21037/acs-2020-mv-23] [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] [Indexed: 11/06/2022]
Affiliation(s)
- Gagan D Singh
- Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, CA, USA
| | - Bob Kiaii
- Division of Cardiothoracic Surgery, UC Davis Medical Center, Sacramento, CA, USA
| |
Collapse
|
26
|
Guenther TM, Chen SA, Gustafson JD, Wozniak CJ, Kiaii B. Development of a porcine model of emergency resternotomy at a low-volume cardiac surgery centre. Interact Cardiovasc Thorac Surg 2020; 31:803-805. [PMID: 33155046 DOI: 10.1093/icvts/ivaa191] [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: 05/11/2020] [Revised: 07/07/2020] [Accepted: 08/06/2020] [Indexed: 11/12/2022] Open
Abstract
Emergency resternotomy in the intensive care unit (ICU) is a rarely performed, yet potentially life-saving intervention. Success relies on recognition of a deteriorating clinical condition, timely deployment of equipment/personnel and rapid execution. Given how infrequently it is performed, we sought to develop a large animal model of resternotomy to prepare ICU nurses and technicians at our low-volume cardiac surgery military centre. A porcine model of resternotomy was developed at the end of an already-scheduled trauma lab. Participants worked their way through a pre-planned simulation scenario, culminating in the need for resternotomy. Pre-simulation surveys assessing knowledge and comfort level with aspects of resternotomy were compared to post-simulation surveys. Participants improved their knowledge of resternotomy by 20.4% (P < 0.0001; 14.7% for nurses and 26.9% for technicians). Improvements were seen in all aspects assessed relating to subjective comfort/preparedness of resternotomy. The model was an effective and realistic method to augment training of ICU staff about resternotomy. Costs associated with this model can be reduced when used in conjunction with large animal labs. This model should be used together with mannequin-based methods of resternotomy training to provide a realistic training environment and assessment of skills at capable institutions.
Collapse
Affiliation(s)
- Timothy M Guenther
- Department of Surgery, University of California Davis, Sacramento, CA, USA.,Department of Cardiothoracic Surgery, David Grant USAF Medical Center, Fairfield, CA, USA
| | - Sarah A Chen
- Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Joshua D Gustafson
- Department of Cardiothoracic Surgery, David Grant USAF Medical Center, Fairfield, CA, USA.,Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Curtis J Wozniak
- Department of Surgery, University of California Davis, Sacramento, CA, USA.,Department of Cardiothoracic Surgery, David Grant USAF Medical Center, Fairfield, CA, USA.,Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Bob Kiaii
- Department of Surgery, University of California Davis, Sacramento, CA, USA
| |
Collapse
|
27
|
Abazid RM, Goha A, Romsa JG, Warrington JC, Akincioglu C, Stodilka RZ, Kiaii B, Vezina WC. Coronary sinus to left atrium fistula on computed tomography angiography: Differentiation from unroofed coronary sinus with literature review. J Cardiovasc Comput Tomogr 2020; 15:e15-e17. [PMID: 33229304 DOI: 10.1016/j.jcct.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/09/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Rami M Abazid
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, 800 Commissioners Road East, PO Box 5010, Ontario, N6A 5W9, Canada and Western University, London, Canada.
| | - Ahmed Goha
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, 800 Commissioners Road East, PO Box 5010, Ontario, N6A 5W9, Canada and Western University, London, Canada
| | - Jonathan G Romsa
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, 800 Commissioners Road East, PO Box 5010, Ontario, N6A 5W9, Canada and Western University, London, Canada
| | - James C Warrington
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, 800 Commissioners Road East, PO Box 5010, Ontario, N6A 5W9, Canada and Western University, London, Canada
| | - Cigdem Akincioglu
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, 800 Commissioners Road East, PO Box 5010, Ontario, N6A 5W9, Canada and Western University, London, Canada
| | - Robert Z Stodilka
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, 800 Commissioners Road East, PO Box 5010, Ontario, N6A 5W9, Canada and Western University, London, Canada
| | - Bob Kiaii
- Division of Cardiac Surgery, University of California Davis Medical Center, Sacramento, CA, 95817, USA
| | - William C Vezina
- Division of Nuclear Medicine, London Health Sciences Centre, Victoria Hospital, 800 Commissioners Road East, PO Box 5010, Ontario, N6A 5W9, Canada and Western University, London, Canada
| |
Collapse
|
28
|
Vriesendorp MD, Deeb GM, Reardon MJ, Kiaii B, Bapat V, Labrousse L, Rao V, Sabik JF, Gearhart E, Klautz RJM. Why the categorization of indexed effective orifice area is not justified for the classification of prosthesis-patient mismatch. J Thorac Cardiovasc Surg 2020; 164:822-829.e6. [PMID: 33339597 DOI: 10.1016/j.jtcvs.2020.10.123] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 06/07/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Although the impact of prosthesis-patient mismatch (PPM) on survival has been widely studied, there has been little debate about whether the current definition of PPM truly reflects hemodynamic obstruction. This study aimed to validate the categorization of indexed effective orifice area (EOAi) for the classification of PPM. METHODS In total, 2171 patients who underwent aortic valve replacement with a surgical stented bioprosthesis in 5 trials (CoreValve US High-Risk, SURTAVI [Surgical Replacement and Transcatheter Aortic Valve Implantation Trial], Evolut Low Risk, PERIGON [PERIcardial SurGical AOrtic Valve ReplacemeNt] Pivotal Trial for the Avalus valve, and PERIGON Japan) were used for this analysis. The echocardiographic images at the 1-year follow-up visit were evaluated to explore the association between EOAi and mean aortic gradient and its interaction with other patient characteristics, including obesity. In addition, different criteria of PPM were compared with reflect elevated mean aortic gradients (≥20 mm Hg). RESULTS A relatively smaller exponential decay in mean aortic gradient was found for increasing EOAi, as the slope on the log scale was -0.83 versus -2.5 in the publication from which the current cut-offs for PPM originate. The accuracy of the American Society of Echocardiography, Valve Academic Research Consortium-2, and European Association of Cardiovascular Imaging definitions of PPM to reflect elevated mean aortic gradients was 49%, 57%, and 57%, respectively. The relation between EOAi and mean aortic gradient was not significantly different between obese and non-obese patients (P = .20). CONCLUSIONS The use of EOAi thresholds to classify patients with PPM is undermined by a less-pronounced exponential relationship between EOAi and mean aortic gradient than previously demonstrated. Moreover, recent adjustment for obesity in the definition of PPM is not supported by these data.
Collapse
Affiliation(s)
- Michiel D Vriesendorp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan Health System-University Hospital, Ann Arbor, Mich
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex
| | - Bob Kiaii
- Department of Cardiovascular and Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Vinayak Bapat
- Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Louis Labrousse
- Medico-Surgical Department of Valvulopathies, CHU Hospital of Bordeaux, Bordeaux, France
| | - Vivek Rao
- Department of Cardiovascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Joseph F Sabik
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
29
|
Makhdom F, Hage A, Manian U, Ginty O, Losenno KL, Kiaii B, Chu MWA. Echocardiographic Method to Determine the Length of Neochordae Reconstruction for Mitral Repair. Ann Thorac Surg 2020; 111:519-528. [PMID: 32698022 DOI: 10.1016/j.athoracsur.2020.05.129] [Citation(s) in RCA: 5] [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: 10/30/2019] [Revised: 03/28/2020] [Accepted: 05/11/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND We evaluated a novel formula using preoperative transesophageal echocardiographic measurements to determine neochordae length for repair of degenerative mitral regurgitation (MR). METHODS The formula is based on measuring the distance from the adjacent papillary head to the intended coaptation zone of the flail/prolapsing leaflet segment and subtracting the redundant leaflet length. Between 2008 and 2017, 264 consecutive patients underwent mitral valve repair (82.2% endoscopic, minimally invasive approach and 17.8% sternotomy) with neochordae loop reconstruction (68.6% posterior, 6.4% anterior, and 25% bileaflet repair). Mean patient age was 63 ± 13.6 years, 73.5% were men, and mean left ventricular ejection fraction was 63.1% ± 6.7%. RESULTS Mitral valve repair was successful in 100% of patients, with no patient requiring conversion to replacement. Neochordae length measurement was accurate in 259 patients (98%), with 4 patients requiring conversion to resection and 1 patient requiring longer anterior leaflet neochordae. Median anterior and posterior neochordae lengths were 27 mm (range, 18-32) and 17 mm (range, 9-27), respectively. Intraoperative transesophageal echocardiography demonstrated no or trace residual MR in 254 patients and mild residual MR in 10 patients. In-hospital mortality occurred in 1 patient, and complications included respiratory failure (2.7%) and renal failure (1.8%). At the median follow-up of 12.6 months (interquartile range, 11.1), 98.9% of patients remained free from ≥2+ MR, whereas freedom from reoperation was 100%. CONCLUSIONS Preoperative transesophageal echocardiographic measurements can accurately and reproducibly predict the required length of neochordae loop reconstruction for degenerative mitral valve repair with good results. Longer-term follow-up is necessary.
Collapse
Affiliation(s)
- Fahd Makhdom
- Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada; Division of Cardiac Surgery, Department of Surgery, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Ali Hage
- Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Usha Manian
- Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Olivia Ginty
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Katie L Losenno
- Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Bob Kiaii
- Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Michael W A Chu
- Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada.
| |
Collapse
|
30
|
Bozso SJ, Nagendran J, Chu MWA, Kiaii B, El-Hamamsy I, Ouzounian M, Kempfert J, Starck C, Moon MC. Midterm Outcomes of the Dissected Aorta Repair Through Stent Implantation Trial. Ann Thorac Surg 2020; 111:463-470. [PMID: 32673661 DOI: 10.1016/j.athoracsur.2020.05.090] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 02/12/2020] [Revised: 04/14/2020] [Accepted: 05/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The intimal flap at the distal aortic anastomosis after standard aortic dissection repair creates distal anastomotic new entry, leading to false lumen (FL) pressurization and true lumen (TL) collapse and resulting in increased mortality, malperfusion, aortic growth, and reinterventions. The Ascyrus Medical Dissection Stent (AMDS; Ascyrus Medical, Boca Raton, FL) is a hybrid prosthesis that seals and depressurizes the FL at the distal anastomosis while expanding and pressurizing the TL. METHODS The Dissected Aorta Repair Through Stent Implantation trial is a prospective, nonrandomized, international type A dissection trial where patients with acute DeBakey I dissections were enrolled between March 2017 and January 2019. Forty-seven patients were enrolled (median age, 62.5; 67.4% men) with a median follow-up of 631 days. RESULTS All patients underwent emergent surgical repair with successful AMDS implantation. One patient was excluded because of use in iatrogenic dissection. Overall mortality at 30 days and 1 year was 13.0% (6/46) and 19.6% (9/46), whereas new strokes occurred in 6.5% (3/46). Over 95% of vessel malperfusions resolved because of AMDS-induced TL expansion, including 3 patients with preoperative paralysis. Positive remodeling of the aortic arch occurred in 100% of cases with complete obliteration or thrombosis of the FL in 74%. In the proximal descending thoracic aorta positive remodeling occurred in 77% and complete obliteration or FL thrombosis in 53% of cases. CONCLUSIONS AMDS facilitates single-stage management of malperfusion and induces positive remodeling of the aortic arch through effective sealing of the distal anastomotic FL, depressurization of the FL with expansion, and pressurization of the TL. Importantly the use of AMDS is safe and reproducible.
Collapse
Affiliation(s)
- Sabin J Bozso
- Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Michael W A Chu
- Division of Cardiac Surgery, Western University, Edmonton, Alberta, Canada
| | - Bob Kiaii
- Division of Cardiac Surgery, Western University, Edmonton, Alberta, Canada
| | - Ismail El-Hamamsy
- Division of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Michael C Moon
- Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
31
|
Affiliation(s)
- Timothy M. Guenther
- Division of Cardiothoracic Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
- Department of Surgery, David Grant USAF Medical Center, Fairfield, CA, USA
| | - Sarah A. Chen
- Division of Cardiothoracic Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Husam H. Balkhy
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, IL, USA
| | - Bob Kiaii
- Division of Cardiothoracic Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| |
Collapse
|
32
|
Abazid RM, Akincioglu C, Warrington JC, Romsa JG, Stodilka RZ, Kiaii B, Fox S, Vezina WC. Boot-Shaped Heart After Robotic Coronary Assist Bypass Surgery. JACC Cardiovasc Imaging 2020; 13:2430-2434. [PMID: 32305475 DOI: 10.1016/j.jcmg.2020.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Rami M Abazid
- Department of Nuclear Medicine, London Health Sciences Centre, London, Ontario, Canada.
| | - Cigdem Akincioglu
- Department of Nuclear Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - James C Warrington
- Department of Nuclear Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Jonathan G Romsa
- Department of Nuclear Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Robert Z Stodilka
- Department of Nuclear Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Bob Kiaii
- Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Stephanie Fox
- Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - William C Vezina
- Department of Nuclear Medicine, London Health Sciences Centre, London, Ontario, Canada
| |
Collapse
|
33
|
Li Z, Habbous S, Thain J, Hall DE, Nagpal AD, Bagur R, Kiaii B, John-Baptiste A. Cost-Effectiveness Analysis of Frailty Assessment in Older Patients Undergoing Coronary Artery Bypass Grafting Surgery. Can J Cardiol 2020; 36:490-499. [DOI: 10.1016/j.cjca.2019.09.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/07/2019] [Accepted: 09/19/2019] [Indexed: 12/21/2022] Open
|
34
|
Nagaoka E, Gelinas J, Vola M, Kiaii B. Early Clinical Experiences of Robotic Assisted Aortic Valve Replacement for Aortic Valve Stenosis with Sutureless Aortic Valve. Innovations�(Phila) 2020; 15:88-92. [DOI: 10.1177/1556984519894298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Robotic assisted aortic valve surgery is still challenging and debatable. We retrospectively reviewed our cases of robotic assisted aortic valve replacement utilizing sutureless aortic valve with following surgical technique: 3 ports, 1 for endoscope and 2 for the robotic arms were inserted in the right chest and da Vinci Si robotic system (Intuitive Surgical, Sunnyvale, CA, USA) was adapted to these ports. Cardiopulmonary bypass was initiated through peripheral cannulations. A vent cannula was placed through the right superior pulmonary vein and a cardioplegia cannula in the ascending aorta. After cardioplegic arrest following aortic cross-clamp, the aortic valve was exposed through a clam shell aortotomy. Valvectomy along with decalcification was performed. Next using 3 guiding sutures the Perceval S valve (LivaNova, London, UK) was parachuted down and deployed. After confirming valve position, the aortotomy was closed. There were no major complications during the procedures and no conversion to sternotomy. Exposure of aortic valve was of high quality. Valvectomy required assistance with long scissors by the bedside surgeon for excision of the severely calcified valve cusps and effective decalcification of annulus. Postoperative convalescence was uncomplicated except for postoperative atrial fibrillation in 1 patient. Robotic assistance in aortic valve procedure enabled excellent exposure of the aortic valve and improved manipulation and suturing of the aortic annulus and aorta. There needs to be improvement of instrumentation for valve debridement and removal of calcium from the annulus. In addition, the sutureless valve technology contributes to the feasibility and the efficacy of this procedure.
Collapse
Affiliation(s)
- Eiki Nagaoka
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
| | - Jill Gelinas
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
| | - Marco Vola
- Department of Cardiac Surgery, University Hospital of Lyon, France
| | - Bob Kiaii
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
| |
Collapse
|
35
|
Affiliation(s)
- Ali Hage
- Division of Cardiac Surgery (Hage, Kiaii), Department of Surgery; Division of Hematology (Louzada), Department of Medicine, Western University, London Health Sciences Centre, London, Ont
| | - Martha Louzada
- Division of Cardiac Surgery (Hage, Kiaii), Department of Surgery; Division of Hematology (Louzada), Department of Medicine, Western University, London Health Sciences Centre, London, Ont
| | - Bob Kiaii
- Division of Cardiac Surgery (Hage, Kiaii), Department of Surgery; Division of Hematology (Louzada), Department of Medicine, Western University, London Health Sciences Centre, London, Ont.
| |
Collapse
|
36
|
Hage A, Giambruno V, Jones P, Chu MW, Fox S, Teefy P, Lavi S, Bainbridge D, Harle C, Iglesias I, Dobkowski W, Kiaii B. Hybrid Coronary Revascularization Versus Off-Pump Coronary Artery Bypass Grafting: Comparative Effectiveness Analysis With Long-Term Follow-up. J Am Heart Assoc 2019; 8:e014204. [PMID: 31826727 PMCID: PMC6951054 DOI: 10.1161/jaha.119.014204] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Hybrid coronary revascularization (HCR) involves the integration of coronary artery bypass grafting (CABG) and percutaneous coronary intervention to treat multivessel coronary artery disease. Our objective was to perform a comparative analysis with long-term follow-up between HCR and conventional off-pump CABG. Methods and Results We compared all double off-pump CABG (n=216) and HCR (n=147; robotic-assisted minimally invasive direct CABG of the left internal thoracic artery to the left anterior descending artery and percutaneous coronary intervention to one of the non-left anterior descending vessels) performed at a single institution between March 2004 and November 2015. To adjust for the selection bias of receiving either off-pump CABG or HCR, we performed a propensity score analysis using inverse-probability weighting. Both groups had similar results in terms of re-exploration for bleeding, perioperative myocardial infarction, stroke, blood transfusion, in-hospital mortality, and intensive care unit length of stay. HCR was associated with a higher in-hospital reintervention rate (CABG 0% versus HCR 3.4%; P=0.03), lower prolonged mechanical ventilation (>24 hours) rate (4% versus 0.7%; P=0.02), and shorter hospital length of stay (8.1±5.8 versus 4.5±2.1 days; P<0.001). After a median follow-up of 81 (48-113) months for the off-pump CABG and 96 (53-115) months for HCR, the HCR group of patients had a trend toward improved survival (85% versus 96%; P=0.054). Freedom from any form of revascularization was similar between the 2 groups (92% versus 91%; P=0.80). Freedom from angina was better in the HCR group (73% versus 90%; P<0.001). Conclusions HCR seems to provide, in selected patients, a shorter postoperative recovery, with similar excellent short- and long-term outcomes when compared with standard off-pump CABG.
Collapse
Affiliation(s)
- Ali Hage
- Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada
| | - Vincenzo Giambruno
- Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada
| | - Philip Jones
- Department of Anesthesia and Perioperative Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Michael W Chu
- Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada
| | - Stephanie Fox
- Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada
| | - Patrick Teefy
- Division of Cardiology Department of Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Shahar Lavi
- Division of Cardiology Department of Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Daniel Bainbridge
- Department of Anesthesia and Perioperative Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Christopher Harle
- Department of Anesthesia and Perioperative Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Ivan Iglesias
- Department of Anesthesia and Perioperative Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Woijtecj Dobkowski
- Department of Anesthesia and Perioperative Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Bob Kiaii
- Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada
| |
Collapse
|
37
|
Choudhury T, Bakar SN, Kiaii B, Teefy P. Emergent Percutaneous Rotational Atherectomy to Bailout Surgical Transapical Aortic Valve Implantation: A Successful Case of Heart Team Turnaround. Arq Bras Cardiol 2019; 113:1151-1154. [PMID: 31800691 PMCID: PMC7021259 DOI: 10.5935/abc.20190235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 12/19/2018] [Indexed: 11/20/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis (AS) in patients with elevated surgical risk. Concomitant coronary artery disease affects 55-70% of patients with severe AS. Percutaneous coronary intervention in patients with TAVI can be challenging. We report a case of acute coronary obstruction immediately following transapical TAVI deployment requiring emergent rotational atherectomy.
Collapse
Affiliation(s)
- Tawfiq Choudhury
- London Health Sciences Centre - Interventional Cardiology, London, Ontario - Canada
| | - Shahrukh N Bakar
- London Health Sciences Centre - Interventional Cardiology, London, Ontario - Canada
| | - Bob Kiaii
- London Health Sciences Centre - Interventional Cardiology, London, Ontario - Canada
| | - Patrick Teefy
- London Health Sciences Centre - Interventional Cardiology, London, Ontario - Canada
| |
Collapse
|
38
|
Bozso SJ, Nagendran J, Chu MW, Kiaii B, El-Hamamsy I, Ouzounian M, Kempfert J, Starck C, Shahriari A, Moon MC. Single-Stage Management of Dynamic Malperfusion Using a Novel Arch Remodeling Hybrid Graft. Ann Thorac Surg 2019; 108:1768-1775. [DOI: 10.1016/j.athoracsur.2019.04.121] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/06/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
|
39
|
Søndergaard L, Popma JJ, Reardon MJ, Van Mieghem NM, Deeb GM, Kodali S, George I, Williams MR, Yakubov SJ, Kappetein AP, Serruys PW, Grube E, Schiltgen MB, Chang Y, Engstrøm T, Sorajja P, Sun B, Agarwal H, Langdon T, den Heijer P, Bentala M, O’Hair D, Bajwa T, Byrne T, Caskey M, Paulus B, Garrett E, Stoler R, Hebeler R, Khabbaz K, Scott Lim D, Bladergroen M, Fail P, Feinberg E, Rinaldi M, Skipper E, Chawla A, Hockmuth D, Makkar R, Cheng W, Aji J, Bowen F, Schreiber T, Henry S, Hengstenberg C, Bleiziffer S, Harrison JK, Hughes C, Joye J, Gaudiani V, Babaliaros V, Thourani V, Dauerman H, Schmoker J, Skelding K, Casale A, Kovac J, Spyt T, Seshiah P, Smith JM, McKay R, Hagberg R, Matthews R, Starnes V, O’Neill W, Paone G, García JMH, Such M, de la Tassa CM, Cortina JCL, Windecker S, Carrel T, Whisenant B, Doty J, Resar J, Conte J, Aharonian V, Pfeffer T, Rück A, Corbascio M, Blackman D, Kaul P, Kliger C, Brinster D, Teefy P, Kiaii B, Leya F, Bakhos M, Sandhu G, Pochettino A, Piazza N, de Varennes B, van Boven A, Boonstra P, Waksman R, Bafi A, Asgar A, Cartier R, Kipperman R, Brown J, Lin L, Rovin J, Sharma S, Adams D, Katz S, Hartman A, Al-Jilaihawi H, Crestanello J, Lilly S, Ghani M, Bodenhamer RM, Rajagopal V, Kauten J, Mumtaz M, Bachinsky W, Nickenig G, Welz A, Olsen P, Watson D, Chhatriwalla A, Allen K, Teirstein P, Tyner J, Mahoney P, Newton J, Merhi W, Keiser J, Yeung A, Miller C, Berg JT, Heijmen R, Petrossian G, Robinson N, Brecker S, Jahangiri M, Davis T, Batra S, Hermiller J, Heimansohn D, Radhakrishnan S, Fremes S, Maini B, Bethea B, Brown D, Ryan W, Kleiman N, Spies C, Lau J, Herrmann H, Bavaria J, Horlick E, Feindel C, Neumann FJ, Beyersdorf F, Binder R, Maisano F, Costa M, Markowitz A, Tadros P, Zorn G, de Marchena E, Salerno T, Chetcuti S, Labinz M, Ruel M, Lee JS, Gleason T, Ling F, Knight P, Robbins M, Ball S, Giacomini J, Burdon T, Applegate R, Kon N, Schwartz R, Schubach S, Forrest J, Mangi A. Comparison of a Complete Percutaneous Versus Surgical Approach to Aortic Valve Replacement and Revascularization in Patients at Intermediate Surgical Risk: Results From the Randomized SURTAVI Trial. Circulation 2019; 140:1296-1305. [PMID: 31476897 DOI: 10.1161/circulationaha.118.039564] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND For patients with severe aortic stenosis and coronary artery disease, the completely percutaneous approach to aortic valve replacement and revascularization has not been compared with the standard surgical approach. METHODS The prospective SURTAVI trial (Safety and Efficiency Study of the Medtronic CoreValve System in the Treatment of Severe, Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement) enrolled intermediate-risk patients with severe aortic stenosis from 87 centers in the United States, Canada, and Europe between June 2012 and June 2016. Complex coronary artery disease with SYNTAX score (Synergy Between PCI with Taxus and Cardiac Surgery Trial) >22 was an exclusion criterion. Patients were stratified according to the need for revascularization and then randomly assigned to treatment with transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). Patients assigned to revascularization in the TAVR group underwent percutaneous coronary intervention, whereas those in the SAVR group had coronary artery bypass grafting. The primary end point was the rate of all-cause mortality or disabling stroke at 2 years. RESULTS Of 1660 subjects with attempted aortic valve implants, 332 (20%) were assigned to revascularization. They had a higher Society of Thoracic Surgeons risk score for mortality (4.8±1.7% versus 4.4±1.5%; P<0.01) and were more likely to be male (65.1% versus 54.2%; P<0.01) than the 1328 patients not assigned to revascularization. After randomization to treatment, there were 169 patients undergoing TAVR and percutaneous coronary intervention, 163 patients undergoing SAVR and coronary artery bypass grafting, 695 patients undergoing TAVR, and 633 patients undergoing SAVR. No significant difference in the rate of the primary end point was found between TAVR and percutaneous coronary intervention and SAVR and coronary artery bypass grafting (16.0%; 95% CI, 11.1-22.9 versus 14.0%; 95% CI, 9.2-21.1; P=0.62), or between TAVR and SAVR (11.9%; 95% CI, 9.5-14.7 versus 12.3%; 95% CI, 9.8-15.4; P=0.76). CONCLUSIONS For patients at intermediate surgical risk with severe aortic stenosis and noncomplex coronary artery disease (SYNTAX score ≤22), a complete percutaneous approach of TAVR and percutaneous coronary intervention is a reasonable alternative to SAVR and coronary artery bypass grafting. CLINICAL TRIAL REGISTRATION URL: https://www. CLINICALTRIALS gov. Unique identifier: NCT01586910.
Collapse
Affiliation(s)
- Lars Søndergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (L.S., T.E.)
| | - Jeffrey J. Popma
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Michael J. Reardon
- Department of Cardiovascular Surgery, Methodist DeBakey Heart and Vascular Center, Houston, TX (M.J.R.)
| | - Nicolas M. Van Mieghem
- Departments of Cardiology and Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands (N.M.V.M., A.P.K.)
| | - G. Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor (G.M.D.)
| | - Susheel Kodali
- Department of Surgery, Columbia University Medical Center, New York (S.K., I.G.)
| | - Isaac George
- Department of Surgery, Columbia University Medical Center, New York (S.K., I.G.)
| | - Mathew R. Williams
- Departments of Medicine (Cardiology) and Cardiothoracic Surgery, NYU-Langone Medical Center, New York (M.R.W.)
| | - Steven J. Yakubov
- Department of Cardiology, OhioHealth Riverside Methodist Hospital, Columbus (S.J.Y.)
| | - Arie P. Kappetein
- Departments of Cardiology and Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands (N.M.V.M., A.P.K.)
- Structural Heart, Medtronic plc, Minneapolis, MN (A.P.K., M.B.S., Y.C.)
| | - Patrick W. Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Eberhard Grube
- Department of Medicine II, Heart Center Bonn, Germany (E.G.)
| | | | - Yanping Chang
- Structural Heart, Medtronic plc, Minneapolis, MN (A.P.K., M.B.S., Y.C.)
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (L.S., T.E.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Nagaoka E, Sato K, Hage A, Bagur R, Harle C, Asopa S, Kiaii B. Rescue Balloon Aortic Valvuloplasty After Sutureless Aortic Valve Replacement for Severe Paravalvular Leak. Innovations (Phila) 2019; 14:476-479. [PMID: 31570026 DOI: 10.1177/1556984519864938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sutureless aortic valve replacement (AVR) is a wide-spreading new technology that provides short clamping time and excellent hemodynamic outcomes. However, among its possible complications is the risk of paravalvular leak. We present the case of a 63-year-old woman who underwent minimally invasive right mini-thoracotomy AVR) with Perceval S sutureless valve (LivaNova, London, UK). Intraoperative transesophageal echocardiography revealed severe paravalvular leak with stent distortion. Rescue balloon valvuloplasty was performed through the right femoral artery, and resulted in the resolution of the paravalvular leak. This case illustrates the utility and feasibility of balloon valvuloplasty in trouble-shooting sutureless aortic valve stent distortion, thus avoiding a repeat aortic cross-clamp and valve replacement.
Collapse
Affiliation(s)
- Eiki Nagaoka
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, Ontario, Canada
| | - Keita Sato
- Department of Anesthesia and Perioperative Medicine, Western University, London Health Sciences Centre, Ontario, Canada
| | - Ali Hage
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, Ontario, Canada
| | - Rodrigo Bagur
- Division of Cardiology, Department of Medicine, Western University, London Health Sciences Centre, Ontario, Canada
| | - Christopher Harle
- Department of Anesthesia and Perioperative Medicine, Western University, London Health Sciences Centre, Ontario, Canada
| | - Sanjay Asopa
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, Ontario, Canada
| | - Bob Kiaii
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, Ontario, Canada
| |
Collapse
|
41
|
Alboom M, Browne A, Dagenais F, Noiseux N, Kieser T, Légaré J, Brown C, Kiaii B, Eikelboom J, Lamy A. PICK YOUR CONDUIT WISELY TO DECREASE GRAFT FAILURE AFTER CABG SURGERY. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
42
|
Abstract
OBJECTIVE The role of hybrid coronary revascularization (HCR), which utilizes the combination of minimally invasive surgical coronary artery bypass grafting of the left anterior descending artery and percutaneous coronary intervention (PCI) of non-left anterior descending vessels to treat multivessel coronary artery disease, is expanding. We set out to provide a review of this technology. METHODS We conducted a retrospective analysis of all minimally invasive hybrid operations performed at our institution from September 2004 to December 2018. An effective analysis comparing patients undergoing HCR vs off-pump or on-pump surgical coronary artery revascularization was undertaken using an adjusted analysis with inverse-probability weighting based on the propensity score. Outcomes that were assessed include death, myocardial infarction, stroke, atrial fibrillation, renal failure, requirement of blood transfusion, conversion to open procedure (in the hybrid group), length of stay in intensive care unit, and total length of stay in hospital. Intention-to-treat analysis was performed. An up-to-date literature review of HCR complements this study. RESULTS Since 2004 a total of 191 consecutive patients (61.4±11.1 years; 142 males and 49 females) underwent HCR (robotic-assisted coronary artery bypass graft of the left internal thoracic artery to the left anterior descending coronary artery (LAD) and PCI of a non-LAD vessel) in a single- or double-stage fashion. Successful HCR occurred in 183 of the 191 patients (8 patients required intraoperative conversion to conventional coronary bypass). From our comparative analysis and literature review we found no significant difference between HCR and coronary artery bypass grafting groups with respect to in-hospital and 1-year follow-up. CONCLUSIONS Current evidences suggest that HCR is a feasible, safe, and effective coronary artery revascularization strategy in selected patients with multivessel coronary artery disease.
Collapse
Affiliation(s)
- Bob Kiaii
- Department of Cardiac Surgery, London Health Sciences Centre, London, ON, Canada
| | - Patrick Teefy
- Department of Cardiology, London Health Sciences Centre, London, ON, Canada
| |
Collapse
|
43
|
Hage A, Hage F, Sridhar K, Kiaii B, Chu MWA. A Novel Hybrid Approach to Iatrogenic Circumflex Artery Injury After Mitral Repair. Semin Thorac Cardiovasc Surg 2019; 32:486-489. [PMID: 31306765 DOI: 10.1053/j.semtcvs.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/02/2019] [Accepted: 07/05/2019] [Indexed: 11/11/2022]
Abstract
Iatrogenic coronary injury after mitral repair is related to blind annuloplasty suture ligation or kinking of the circumflex artery (CxA) and can present with early ST segment changes, malignant ventricular arrhythmias, and segmental wall motion abnormalities. Corrective treatment is imperative to avoid myocardial infarction and can include removal of the annuloplasty ring or CxA bypass. We present a novel hybrid approach for the rapid diagnosis and management of iatrogenic CxA injury after mitral repair.
Collapse
Affiliation(s)
- Ali Hage
- Division of Cardiac Surgery, Western University, London, Ontario, Canada
| | - Fadi Hage
- Division of Cardiac Surgery, Western University, London, Ontario, Canada
| | - Kumar Sridhar
- Division of Cardiology, Western University, London, Ontario, Canada
| | - Bob Kiaii
- Division of Cardiac Surgery, Western University, London, Ontario, Canada
| | - Michael W A Chu
- Division of Cardiac Surgery, Western University, London, Ontario, Canada.
| |
Collapse
|
44
|
Manian U, Sheyin O, Bagur R, Kiaii B, Tzemos N. High Prevalence of Subclinical Infarction in Asymptomatic Patients With Silent Left-Sided Cardiac Masses. J Am Coll Cardiol 2019; 73:2236-2237. [PMID: 31047012 DOI: 10.1016/j.jacc.2019.02.019] [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: 12/10/2018] [Revised: 02/08/2019] [Accepted: 02/12/2019] [Indexed: 10/26/2022]
|
45
|
Bozso SJ, Nagendran J, MacArthur RG, Chu MW, Kiaii B, El-Hamamsy I, Cartier R, Shahriari A, Moon MC. Dissected Aorta Repair Through Stent Implantation trial: Canadian results. J Thorac Cardiovasc Surg 2019; 157:1763-1771. [DOI: 10.1016/j.jtcvs.2018.09.120] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/08/2018] [Accepted: 09/04/2018] [Indexed: 11/15/2022]
|
46
|
Cheung A, Denti P, Kiaii B, Bagur R, Webb J, Latib A, Alfieri O. Mitral Valve-in-Ring Implantation With a Dedicated Transcatheter Mitral Valve Replacement System. JACC Cardiovasc Interv 2019; 10:2012-2014. [PMID: 28982565 DOI: 10.1016/j.jcin.2017.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 08/01/2017] [Indexed: 10/18/2022]
|
47
|
Guo MH, Wells GA, Glineur D, Fortier J, Davierwala PM, Kikuchi K, Lemma MG, Mishra YK, McGinn J, Ramchandani M, Rabindra P, Nambala S, Chiu KM, Kiaii B, Gibson S, Ruel M. Minimally Invasive coronary surgery compared to STernotomy coronary artery bypass grafting: The MIST trial. Contemp Clin Trials 2019; 78:140-145. [PMID: 30634037 DOI: 10.1016/j.cct.2019.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/18/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
Abstract
RATIONALE Minimally invasive cardiac surgery has emerged as a safe alternative to standard cardiac surgery. Minimally invasive coronary surgery (MICS CABG) was developed to allow adequate exposure and complete revascularization in CABG from a small thoracotomy incision without cardiopulmonary bypass. Multiple studies have reported significant shorter length of hospital stay and earlier postoperative physical recovery for MICS CABG patients when compared to sternotomy CABG patients. However, there have been no convincing clinical trials that demonstrate improvement in post-operative quality of life for patients who undergo MICS CABG. STUDY DESIGN The Minimally Invasive Coronary Surgery compared to Sternotomy Coronary Artery Bypass Grafting (MIST) trial is a multi-centered, prospective randomized controlled trial that compares the quality of life and recovery in the early post-operative period between patients undergoing MICS CABG versus patients undergoing sternotomy CABG. Patients will be randomized either to the MICS CABG group or the sternotomy CABG group, and the target enrollment is 88 patients per group. The primary outcome is quality of life assessment performed by SF-36 questionnaire at 1 month. CONCLUSION The MIST trial is the first prospective study that compares the quality of life between MICS CABG and sternotomy CABG patients. The results of this trial may enhance the procedural desirability of MICS CABG by patients and provide an incentive for surgeons and institutions to increase the availability of MICS CABG in suitable patients.
Collapse
Affiliation(s)
- Ming Hao Guo
- Division of cardiac surgery, University of Ottawa Heart Institute, Ottawa, Canada
| | - George A Wells
- Department of Epidemiology, University of Ottawa, Ottawa, Canada
| | - David Glineur
- Division of cardiac surgery, University of Ottawa Heart Institute, Ottawa, Canada
| | - Jacqueline Fortier
- Division of cardiac surgery, University of Ottawa Heart Institute, Ottawa, Canada
| | | | - Keita Kikuchi
- Division of cardiac surgery, Wuhan Asian Heart Hospital, Wuhan, China
| | - Massimo G Lemma
- Division of cardiac surgery, Jilin Heart Hospital, Jilin, China
| | - Yugal K Mishra
- Division of cardiac surgery, Fortis Escorts Heart Institute, New Delhi, India
| | - Joseph McGinn
- Division of cardiothoracic surgery, Carolinas Medical Center, Charlotte, United States
| | - Mahesh Ramchandani
- Division of cardiothoracic surgery, Houston Methodist, Houston, United States
| | - Prem Rabindra
- Division of cardiothoracic surgery, Gundersen Lutheran Medical Center, La Crosse, United States
| | | | - Kuan Ming Chiu
- Division of cardiac surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Bob Kiaii
- Division of cardiac surgery, London Health Sciences Center, London, Canada
| | - Sarah Gibson
- Division of cardiac surgery, University of Ottawa Heart Institute, Ottawa, Canada
| | - Marc Ruel
- Division of cardiac surgery, University of Ottawa Heart Institute, Ottawa, Canada.
| |
Collapse
|
48
|
Li Z, Dawson E, Moodie J, Martin J, Bagur R, Cheng D, Kiaii B, John-Baptiste A. Frailty in patients undergoing transcatheter aortic valve implantation: a protocol for a systematic review. BMJ Open 2019; 9:e024163. [PMID: 30782896 PMCID: PMC6377546 DOI: 10.1136/bmjopen-2018-024163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/25/2018] [Accepted: 10/05/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Aortic stenosis is a significant cause of morbidity and mortality in older patients. The advent of transcatheter aortic valve implantation (TAVI) offers an alternative to surgical aortic valve replacement for patients with severe symptomatic aortic stenosis who are at high or intermediate risk of adverse events. Existing evidence highlights the importance of frailty as a predictor of poor outcomes post-TAVI. The objective of this study is to review the operationalisation of frailty instruments for TAVI recipients and determine clinical outcomes and the change in quality of life in frail patients undergoing TAVI. METHODS AND ANALYSIS Methods are reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist. We will search relevant databases to identify published, completed but unpublished and ongoing studies. We will include studies of patients with aortic stenosis, diagnosed as frail and who underwent a TAVI procedure that report mortality, clinical outcomes or health-related quality of life. Retrospective or prospective cohort studies, randomised controlled trials and non-randomised controlled trials will be eligible for inclusion. Two researchers will independently screen articles for inclusion, with disagreements resolved by a third reviewer. One researcher will extract data with audit by a second researcher. The risk of bias in studies will be evaluated using the Quality in Prognosis Studies tool. Meta-analysis of mortality, survival curve and the change in quality of life will be performed if appropriate. Subgroup analysis, sensitivity analysis and meta-regression will be performed if necessary. ETHICS AND DISSEMINATION Due to the nature of this study, no ethical issues are foreseen. We will disseminate the results of our systematic review through a peer-reviewed journal. TRIAL REGISTRATION NUMBER CRD42018090597.
Collapse
Affiliation(s)
- Zhe Li
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Emily Dawson
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
| | - Jessica Moodie
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
| | - Janet Martin
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Rodrigo Bagur
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Davy Cheng
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Critical Care Medicine, Department of Medicine, Western University, London, Ontario, Canada
| | - Bob Kiaii
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Ava John-Baptiste
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Interfaculty Program in Public Health, Western University, London, Ontario, Canada
| |
Collapse
|
49
|
Sullivan R, Randhawa VK, Stokes A, Wu D, Lalonde T, Kiaii B, Luyt L, Wisenberg G, Dhanvantari S. Dynamics of the Ghrelin/Growth Hormone Secretagogue Receptor System in the Human Heart Before and After Cardiac Transplantation. J Endocr Soc 2019; 3:748-762. [PMID: 30937420 PMCID: PMC6438351 DOI: 10.1210/js.2018-00393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/11/2019] [Indexed: 12/14/2022] Open
Abstract
Currently, the early preclinical detection of left ventricular dysfunction is difficult because biomarkers are not specific for the cardiomyopathic process. The underlying molecular mechanisms leading to heart failure remain elusive, highlighting the need for identification of cardiac-specific markers. The growth hormone secretagogue receptor (GHSR) and its ligand ghrelin are present in cardiac tissue and are known to contribute to myocardial energetics. Here, we examined tissue ghrelin-GHSR levels as specific markers of cardiac dysfunction in patients who underwent cardiac transplantation. Samples of cardiac tissue were obtained from 10 patients undergoing cardiac transplant at the time of organ harvesting and during serial posttransplant biopsies. Quantitative fluorescence microscopy using a fluorescent ghrelin analog was used to measure levels of GHSR, and immunofluorescence was used to measure levels of ghrelin, B-type natriuretic peptide (BNP), and tissue markers of cardiomyocyte contractility and growth. GHSR and ghrelin expression levels were highly variable in the explanted heart, less in the grafted heart biopsies. GHSR and ghrelin were strongly positively correlated, and both markers were negatively correlated with left ventricular ejection fraction. Ghrelin had stronger positive correlations than BNP with the signaling markers for contractility and growth. These data suggest that GHSR-ghrelin have potential use as an integrated marker of cardiac dysfunction. Interestingly, tissue ghrelin appeared to be a more sensitive indicator than BNP to the biochemical processes that are characteristic of heart failure. This work allows for further use of ghrelin-GHSR to interrogate cardiac-specific biochemical mechanisms in preclinical stages of heart failure (HF).
Collapse
Affiliation(s)
- Rebecca Sullivan
- Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Varinder K Randhawa
- Cardiac Imaging Research, Lawson Health Research Institute, London, Ontario, Canada
| | - Anne Stokes
- Metabolism and Diabetes, Lawson Health Research Institute, London, Ontario, Canada
| | - Derek Wu
- Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Tyler Lalonde
- Chemistry, Western University, London, Ontario, Canada
| | - Bob Kiaii
- Cardiac Surgery, Western University, London, Ontario, Canada
| | - Leonard Luyt
- Chemistry, Western University, London, Ontario, Canada.,Imaging Program, Lawson Health Research Institute, London, Ontario, Canada.,Department of Oncology, London Regional Cancer Program, Western University, London, Ontario, Canada
| | - Gerald Wisenberg
- Imaging Program, Lawson Health Research Institute, London, Ontario, Canada.,Medical Biophysics, Western University, London, Ontario, Canada
| | - Savita Dhanvantari
- Pathology and Laboratory Medicine, Western University, London, Ontario, Canada.,Imaging Program, Lawson Health Research Institute, London, Ontario, Canada.,Metabolism and Diabetes, Lawson Health Research Institute, London, Ontario, Canada.,Medical Biophysics, Western University, London, Ontario, Canada
| |
Collapse
|
50
|
Chu MW, Losenno KL, Dubois LA, Jones PM, Ouzounian M, Whitlock R, Dagenais F, Boodhwani M, Bhatnagar G, Poostizadeh A, Pozeg Z, Moon M, Kiaii B, Peterson MD. Early Clinical Outcomes of Hybrid Arch Frozen Elephant Trunk Repair With the Thoraflex Hybrid Graft. Ann Thorac Surg 2019; 107:47-53. [DOI: 10.1016/j.athoracsur.2018.07.091] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/27/2018] [Accepted: 07/30/2018] [Indexed: 12/01/2022]
|