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Brener MI, Hamandi M, Hong E, Pizano A, Harloff MT, Garner EF, El Sabbagh A, Kaple RK, Geirsson A, Deaton DW, Islam AM, Veeregandham R, Bapat V, Khalique OK, Ning Y, Kurlansky PA, Grayburn PA, Nazif TM, Kodali SK, Leon MB, Borger MA, Lee R, Kohli K, Yoganathan AP, Colli A, Guerrero ME, Davies JE, Eudailey KW, Kaneko T, Nguyen TC, Russell H, Smith RL, George I. Early outcomes following transatrial transcatheter mitral valve replacement in patients with severe mitral annular calcification. J Thorac Cardiovasc Surg 2024; 167:1263-1275.e3. [PMID: 36153166 DOI: 10.1016/j.jtcvs.2022.07.038] [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: 03/08/2022] [Revised: 06/29/2022] [Accepted: 07/22/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Implantation of a transcatheter valve-in-mitral annular calcification (ViMAC) has emerged as an alternative to traditional surgical mitral valve (MV) replacement. Previous studies evaluating ViMAC aggregated transseptal, transapical, and transatrial forms of the procedure, leaving uncertainty about each technique's advantages and disadvantages. Thus, we sought to evaluate clinical outcomes specifically for transatrial ViMAC from the largest multicenter registry to-date. METHODS Patients with symptomatic MV dysfunction and severe MAC who underwent ViMAC were enrolled from 12 centers across the United States and Europe. Clinical characteristics, procedural details, and clinical outcomes were abstracted from the electronic record. The primary end point was all-cause mortality. RESULTS We analyzed 126 patients who underwent ViMAC (median age 76 years [interquartile range {IQR}, 70-82 years], 28.6% female, median Society of Thoracic Surgeons score 6.8% [IQR, 4.0-11.4], and median follow-up 89 days [IQR, 16-383.5]). Sixty-one (48.4%) had isolated mitral stenosis, 25 (19.8%) had isolated mitral regurgitation (MR), and 40 (31.7%) had mixed MV disease. Technical success was achieved in 119 (94.4%) patients. Thirty (23.8%) patients underwent concurrent septal myectomy, and 8 (6.3%) patients experienced left ventricular outflow tract obstruction (7/8 did not undergo myectomy). Five (4.2%) patients of 118 with postprocedure echocardiograms had greater than mild paravalvular leak. Thirty-day and 1-year all-cause mortality occurred in 16 and 33 patients, respectively. In multivariable models, moderate or greater MR at baseline was associated with increased risk of 1-year mortality (hazard ratio, 2.31; 95% confidence interval, 1.07-4.99, P = .03). CONCLUSIONS Transatrial ViMAC is safe and feasible in this selected, male-predominant cohort. Patients with significant MR may derive less benefit from ViMAC than patients with mitral stenosis only.
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Affiliation(s)
- Michael I Brener
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Mohanad Hamandi
- Division of Cardiothoracic Surgery, Baylor Scott and White Health, Plano, Tex
| | - Estee Hong
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY
| | - Alejandro Pizano
- Division of Cardiothoracic Surgery, University of Texas Health Science Center, Houston, Tex
| | - Morgan T Harloff
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Evan F Garner
- Division of Cardiothoracic Surgery, University of Alabama-Birmingham, Birmingham, Ala
| | | | - Ryan K Kaple
- Division of Cardiology, Yale University School of Medicine, New Haven, Conn
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Conn
| | - David W Deaton
- Baystate Heart and Vascular Program, Baystate Medical Center, Springfield, Mass
| | - Ashequl M Islam
- Baystate Heart and Vascular Program, Baystate Medical Center, Springfield, Mass
| | | | - Vinayak Bapat
- Division of Cardiothoracic Surgery, Minneapolis Heart Institute Foundation, Minneapolis, Minn
| | - Omar K Khalique
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Yuming Ning
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY
| | - Paul A Kurlansky
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY
| | - Paul A Grayburn
- Division of Cardiology, Baylor Scott and White Health, Plano, Tex
| | - Tamim M Nazif
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Susheel K Kodali
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Martin B Leon
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Michael A Borger
- Division of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Raymond Lee
- Division of Cardiothoracic Surgery, Keck University of Southern California, Los Angeles, Calif
| | - Keshav Kohli
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga
| | - Ajit P Yoganathan
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga
| | - Andrea Colli
- Department of Cardio-Thoracic-Vascular Surgery, University of Pisa, Pisa, Italy
| | - Mayra E Guerrero
- Division of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minn
| | - James E Davies
- Division of Cardiothoracic Surgery, University of Alabama-Birmingham, Birmingham, Ala
| | - Kyle W Eudailey
- Division of Cardiothoracic Surgery, University of Alabama-Birmingham, Birmingham, Ala
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Tom C Nguyen
- Division of Cardiothoracic Surgery, University of California-San Francisco, San Francisco, Calif
| | - Hyde Russell
- Division of Cardiothoracic Surgery, Northshore University HealthSystem, Evanston, Ill
| | - Robert L Smith
- Division of Cardiothoracic Surgery, Baylor Scott and White Health, Plano, Tex
| | - Isaac George
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY.
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Ebra G, Traad EA, Kurlansky PA. Long-Term Survival Benefits of Porcine versus Pericardial Bioprostheses in Elderly Patients Undergoing Isolated Aortic Valve Replacement: A 32-Year Study. Heart Surg Forum 2023; 26:E869-E879. [PMID: 38178341 DOI: 10.59958/hsf.6917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/19/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND The elderly population is growing at an unprecedented rate. Aortic valve disease increases with age. Bioprostheses are the valves of choice for older patients; however, the optimal tissue valve remains undetermined. The purpose of this investigation was to perform a life-of-patient survival comparison of the prototypical porcine and pericardial prostheses in elderly patients. METHODS The study population (N = 1480) consisted of patients 65 years of age and older who underwent isolated aortic valve replacement from 1990 through 2005 with a Carpentier-Edwards Porcine (n = 650) or Pericardial (n = 830) bioprosthesis. Propensity score-matched groups were created. RESULTS Valve selection was not associated with operative mortality. Survival estimates at 10 years were better for Pericardial (41.8%; 95% CI: 37.9 to 45.7) than Porcine (32.6%; 95% CI: 28.8 to 36.3); and 5.2% (95% CI: 3.2 to 7.1) versus 2.0%; (95% CI: 0.8 to 3.2) at 20 years (p < 0.001). E-value analysis found minimal influence of unknown study confounders. Factors associated with long-term mortality were porcine valve (p < 0.001), age (p < 0.001), diabetes mellitus (p < 0.001), preop renal insufficiency (p < 0.001), peripheral artery disease (p = 0.011), congestive heart failure (p = 0.003), New York Heart Association Class III or IV (p = 0.004), surgical history-reoperation (p = 0.012), transient ischemic attack (p = 0.009), prolonged ventilation (p = 0.010), postop renal insufficiency (p < 0.001), and atrial fibrillation (p = 0.009). The indexed Effective Orifice Area (EOAi) was assessed and did not influence observed long-term survival differences. CONCLUSIONS This unusual lifetime study provided substantial evidence for the superiority of the pericardial over the porcine bioprosthesis in the aortic position in elderly patients. It demonstrated enhanced long-term survival benefits for elderly patients without any increase in perioperative mortality. It is intended to inform future investigation into aortic valve design.
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Affiliation(s)
- George Ebra
- Premier Cardiovascular Surgeons, Tampa, FL 33607, USA; Cardiac Thoracic Vascular Surgical Associates, Miami, FL 33140, USA.
| | - Ernest A Traad
- Cardiac Thoracic Vascular Surgical Associates, Miami, FL 33140, USA.
| | - Paul A Kurlansky
- Cardiac Thoracic Vascular Surgical Associates, Miami, FL 33140, USA; Division of Cardiac Surgery, Columbia University, New York, NY 10032, USA; Center for Innovation and Outcomes Research, Department of Surgery, Columbia University, New York, NY 10032, USA.
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Kurlansky PA. Failure to Rescue in Cardiac Surgery: Where Do We Go From Here? Ann Thorac Surg 2023; 116:1309-1310. [PMID: 37285949 DOI: 10.1016/j.athoracsur.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/13/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Paul A Kurlansky
- Department of Surgery, Columbia University Irving Medical Center, Neurological Institute 554, 710 W 168th St, New York, NY 10032.
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Kurlansky PA, Bittl JA. Learning From Machines to Predict Mortality After Surgical or Percutaneous Revascularization. J Am Coll Cardiol 2023; 82:2125-2127. [PMID: 37993204 DOI: 10.1016/j.jacc.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Paul A Kurlansky
- Division of Cardiothoracic and Vascular Surgery, Columbia University Irving Medical Center, New York, New York, USA.
| | - John A Bittl
- Scientific Publications Committee, American College of Cardiology, Washington, DC, USA
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Corpuz GS, Premaratne ID, Toyoda Y, Ning Y, Kurlansky PA, Rohde CH. Correlating state-specific and national trends in breast reconstruction after Medicaid expansion: A decade-long update on the Affordable Care Act's impact. J Plast Reconstr Aesthet Surg 2023; 85:344-351. [PMID: 37543023 DOI: 10.1016/j.bjps.2023.07.031] [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: 03/22/2023] [Revised: 07/13/2023] [Accepted: 07/16/2023] [Indexed: 08/07/2023]
Abstract
While disparities in access to reconstruction persist, a comprehensive analysis comparing state-based outcomes and national patterns in breast reconstruction as a result of Medicaid expansion has never been examined. In this study, we investigated how breast reconstruction rates changed as a result of Medicaid expansion and compared these state-based findings to national counterparts. Patient data from the Healthcare Cost and Utilization Project among states that chose to expand Medicaid were compared with those from states that did not expand. The difference-in-differences estimate of expansion to nonexpansion states was 7.05 (p = 0.10) for implant-based reconstruction, -11.56 (p = 0.01) for autologous reconstruction, and -7.08 (p = 0.18) for overall reconstruction. Comparing rates of nonexpansion states to national trends yielded estimates of -0.06 (p = 0.04), 0.06 (p = 0.01), and 0.004 (p = 0.90) for implant-based, autologous, and overall breast reconstruction, respectively. Similarly, comparing rates of expansion states to national trends yielded estimates of 0.02 (p = 0.38), -0.05 (p = 0.03), and -0.02 (p = 0.44) for implant-based, autologous, and overall breast reconstruction, respectively. In this study on national health policy, Medicaid expansion was associated with a significant increase in autologous rates while state-specific trends alone did not appear to predict the national outcomes of sweeping legislative changes that were differentially applied among states.
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Affiliation(s)
- George S Corpuz
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, United States; Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY, United States
| | - Ishani D Premaratne
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY, United States; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, United States
| | - Yoshiko Toyoda
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY, United States; Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Yuming Ning
- Center for Innovation and Outcomes Research, Department of Surgery, Columbia University Medical Center, New York, NY, United States
| | - Paul A Kurlansky
- Center for Innovation and Outcomes Research, Department of Surgery, Columbia University Medical Center, New York, NY, United States
| | - Christine H Rohde
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, NY, United States.
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Kurlansky PA, Traad EA, Ebra G. Mitral Repair vs Replacement for Degenerative Mitral Regurgitation in Patients Aged ≥65 Years. Ann Thorac Surg 2023; 116:736-742. [PMID: 37308067 DOI: 10.1016/j.athoracsur.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/11/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND The benefits of mitral valve repair vs replacement are well documented. However, survival benefits in the elderly population are more controversial. In this novel lifetime analysis, we hypothesize that survival benefits for valve repair vs replacement in the elderly are sustained throughout the patient's lifetime. METHODS From January 1985 through December 2005, 663 patients, aged ≥65 years with myxomatous degenerative mitral valve disease underwent primary isolated mitral valve repair (n = 434) or replacement (n = 229). Propensity score matching was used to balance variables potentially related to outcome. RESULTS Follow-up was complete in 99.1% of mitral repair and 99.6% of mitral replacement patients. In matched patients, perioperative mortality was 3.9% (9 of 229) for repair and 10.9% (25 of 229) for replacement (P = .004). Survival estimates (95% confidence limits) from 29-year follow-up for matched patients were 54.6% (48.0%, 61.1%) and 11.0% (6.8%, 15.2%) at 10 years and 20 years for repair patients, and 34.2% (27.7%, 40.7%) and 3.7% (1%, 6.4%) for replacement patients, respectively. Median survival (95% confidence limits) was 11.3 years (9.6, 12.2 years) for repair patients compared with 6.9 years (6.3, 8.0 years) for replacement patients (P < .001). CONCLUSIONS This study demonstrates that although the elderly population is prone to multiple comorbidities, survival benefits of isolated mitral valve repair vs replacement are sustained throughout the patient's lifetime.
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Affiliation(s)
- Paul A Kurlansky
- Division of Cardiac Surgery, Columbia University, New York, New York; Center for Innovation and Outcomes Research, Department of Surgery, Columbia University, New York, New York.
| | - Ernest A Traad
- Cardiac Thoracic Vascular Surgical Associates, Miami, Florida
| | - George Ebra
- Cardiac Thoracic Vascular Surgical Associates, Miami, Florida; Premier Cardiovascular Surgeons, Tampa, Florida
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Feng I, Kurlansky PA, Ning Y, Sun J, Naka Y, Topkara VK, Latif F, Sayer G, Uriel NY, Takeda K. Do age and functional dependence affect outcomes of simultaneous heart-kidney transplantation? JTCVS Open 2023; 15:262-289. [PMID: 37808044 PMCID: PMC10556940 DOI: 10.1016/j.xjon.2023.05.016] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/26/2023] [Accepted: 05/18/2023] [Indexed: 10/10/2023]
Abstract
Objective This study assessed characteristics and outcomes of younger (18-65) versus older (>65) recipients of simultaneous heart-kidney (SHK) transplantation with varying functional dependence. Methods This study retrospectively analyzed 1398 patients from the United Network for Organ Sharing database who received SHK between 2010 and 2021. Patients who were <18 year old, underwent transplant of additional organs simultaneously, or had previous heart transplant were excluded. The primary end point was all-cause mortality, and secondary end points included adverse events and cause of death. Outcomes were also evaluated by propensity score-matched comparison. Results The number of annual SHK transplantation in the United States has significantly increased among both age groups over the past 2 decades (P < .0001). After propensity score matching of recipients aged 18 to 65 years (n = 1162) versus age >65 years (n = 236), baseline characteristics were similar and well-balanced between the 2 cohorts. Between matched cohorts, older recipients did not have increased posttransplant mortality compared with younger recipients (90-day survival, P = .85; 7-year survival, P = .61). Multivariable Cox regression analysis found that age (hazard ratio [HR], 1.039 [0.975-1.106], P = .2415) and pretransplant functional status with interaction term for age (some assistance, HR, 0.965 [0.902-1.033], P = .3079; total assistance, HR, 0.976 [0.914-1.041], P = .4610) were not significant risk factors for 7-year post-SHK transplantation mortality. Conclusions Older and more functionally dependent recipients in this study did not have increased post-SHK transplantation mortality. These findings have important implications for organ allocation among elderly patients, as they support the need for thorough assessment of SHK candidates in terms of comorbidities, rather than exclusion solely based on age and functional dependence.
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Affiliation(s)
- Iris Feng
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Paul A. Kurlansky
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
- Department of Surgery, Center of Innovation and Outcomes Research, Columbia University, New York, NY
| | - Yuming Ning
- Department of Surgery, Center of Innovation and Outcomes Research, Columbia University, New York, NY
| | - Jocelyn Sun
- Department of Surgery, Center of Innovation and Outcomes Research, Columbia University, New York, NY
| | - Yoshifumi Naka
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Veli K. Topkara
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Farhana Latif
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Gabriel Sayer
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Nir Y. Uriel
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Koji Takeda
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
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Melehy A, Sanchez JE, Nemeth SK, Kurlansky PA, Uriel N, Sayer GT, Naka Y, Takeda K. National outcomes of bridge to multiorgan cardiac transplantation using mechanical circulatory support. J Thorac Cardiovasc Surg 2023; 165:168-182.e11. [PMID: 33678503 DOI: 10.1016/j.jtcvs.2021.01.114] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 01/11/2021] [Accepted: 01/23/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Little is known regarding the profile of patients with multiorgan failure listed for simultaneous cardiac transplantation and secondary organ. In addition, few studies have reported how these patients are bridged with mechanical circulatory support (MCS). In this study, we examined national data of patients listed for multiorgan transplantation and their outcomes after bridging with or without MCS. METHODS United Network for Organ Sharing data were reviewed for adult multiorgan transplantations from 1986 to 2019. Post-transplant patients and total waitlist listings were examined and stratified according to MCS status. Survival was assessed via Cox regression in the post-transplant cohort and Fine-Gray competing risk regression with transplantation as a competing risk in the waitlist cohort. RESULTS There were 4534 waitlist patients for multiorgan transplant during the study period, of whom 2117 received multiorgan transplants. There was no significant difference in post-transplant survival between the MCS types and those without MCS in the whole cohort and heart-kidney subgroup. Fine-Gray competing risk regression showed that patients bridged with extracorporeal membrane oxygenation had significantly greater waitlist mortality compared with those without MCS when controlling for preoperative characteristics (subdistribution hazard ratio, 2.27; 95% confidence interval, 1.48-3.47; P < .001), whereas those bridged with a ventricular assist device had a decreased incidence of death compared with those without MCS (subdistribution hazard ratio, 0.78; 95% confidence interval, 0.63-0.96; P = .017). CONCLUSIONS MCS, as currently applied, does not appear to compromise the survival of multiorgan heart transplant patients. Waitlist data show that extracorporeal membrane oxygenation patients have profoundly worse survival irrespective of preoperative factors including organ type listed. Survival on the waitlist for multiorgan transplant has improved across device eras.
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Affiliation(s)
- Andrew Melehy
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Joseph E Sanchez
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Samantha K Nemeth
- Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, NY
| | - Paul A Kurlansky
- Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, NY
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Gabriel T Sayer
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY.
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Yamabe T, Zhao Y, Kurlansky PA, Patel V, George I, Smith CR, Takayama H. Extent of aortic replacement and operative outcome in open proximal thoracic aortic aneurysm repair. JTCVS Open 2022; 12:1-12. [PMID: 36590741 PMCID: PMC9801234 DOI: 10.1016/j.xjon.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 01/04/2023]
Abstract
Objectives There are few data to delineate the risk differences among open aortic procedures. We aimed to investigate the influence of the procedural types on the outcomes of proximal thoracic aortic aneurysm repair. Methods Among 1900 patients who underwent aortic replacement in our institution between 2005 and 2019, 1132 patients with aortic aneurysm who underwent a graft replacement of proximal thoracic aorta were retrospectively reviewed. Patients were divided into 4 groups based on the extent of the aortic replacement: isolated ascending aortic replacement (n = 52); ascending aortic replacement with distal extension with hemiarch, partial arch, or total arch replacement (n = 126); ascending aortic replacement with proximal extension with aortic valve or root replacement (n = 620); and ascending aortic replacement with distal and proximal extension (n = 334). "Eventful recovery," defined as occurrence of any key complications, was used as the primary end point. Odds ratios for inability to achieve uneventful recovery in each procedure were calculated using ascending aortic replacement as a reference. Results Overall, in-hospital mortality and stroke occurred in 16 patients (1.4%) and 24 patients (2.1%). Eventful recovery was observed in 19.7% of patients: 11.5% in those with ascending aortic replacement, 36.5% in those with partial arch or total arch replacement, 16.6% in those with proximal extension with aortic valve or root replacement, and 20.4% in those with distal and proximal extension (P < .001). With ascending aortic replacement as the reference, a multivariable logistic regression revealed partial arch or total arch replacement (odds ratio, 10.0; 95% confidence interval, 1.8-189.5) was an independent risk factor of inability to achieve uneventful recovery. Conclusions Open proximal aneurysm repair in the contemporary era resulted in satisfactory in-hospital outcomes. Distal extension was associated with a higher risk for postoperative complications.
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Affiliation(s)
- Tsuyoshi Yamabe
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY,Department of Cardiovascular Surgery, Shonan-Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Yanling Zhao
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Paul A. Kurlansky
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Virendra Patel
- Division of Aortic Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Isaac George
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Craig R. Smith
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Hiroo Takayama
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY,Address for reprints: Hiroo Takayama, MD, PhD, Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, 177 Fort Washington Ave, New York, NY 10032.
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10
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Kainuma A, Ning Y, Kurlansky PA, Wang AS, Latif F, Sayer GT, Uriel N, Kaku Y, Naka Y, Takeda K. Predictors of one-year outcome after cardiac re-transplantation: Machine learning analysis. Clin Transplant 2022; 36:e14761. [PMID: 35730923 DOI: 10.1111/ctr.14761] [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: 12/23/2021] [Revised: 06/02/2022] [Accepted: 06/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND As cardiac re-transplantation is associated with inferior outcomes compared with primary transplantation, allocating scarce resources to appropriate re-transplant candidates is important. The aim of this study is to elucidate the factors associated with 1-year mortality in cardiac re-transplantation using the random forests algorithm for survival analysis. METHODS We retrospectively reviewed the United Network for Organ Sharing registry and identified all adult (>17 years old) recipients who underwent cardiac re-transplantation between January 2000 and March 2020. The random forest algorithm on Cox modeling was used to calculate the variable importance (VIMP) of independent variables for contributing to one-year mortality. RESULTS A total of 1294 patients underwent cardiac re-transplantation. Of these, 137 patients were re-transplanted within one year of their first transplant, while 1157 patients were re-transplanted more than one year after their first transplant. One-year mortality was significantly higher for patients receiving early transplantation compared with those receiving late transplantation (Early 40.6% vs. Late 13.6%, log-rank P<0.001). Machine learning analysis showed that total bilirubin (>2 mg/dl) (VIMP, 2.99%) was an independent predictor of one-year mortality after early re-transplant. High BMI (>30.0 kg/m2) (VIMP, 1.43%) and ventilator dependence (VIMP, 1.47%) were independent predictors of one-year mortality for the late re-transplantation group. CONCLUSION Machine learning showed that optimal one-year survival following cardiac re-transplantation was significantly related to liver function in early re-transplantation, and to obesity and preoperative ventilator dependence in late re-transplantation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Atsushi Kainuma
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Yuming Ning
- Center for Innovation and Outcomes Research, Columbia University, New York, NY, USA
| | - Paul A Kurlansky
- Center for Innovation and Outcomes Research, Columbia University, New York, NY, USA.,Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Amy S Wang
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Farhana Latif
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Gabriel T Sayer
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Nir Uriel
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Yuji Kaku
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
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11
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Kainuma A, Ning Y, Kurlansky PA, Wang AS, Latif F, Farr MA, Sayer GT, Uriel N, Takayama H, Naka Y, Takeda K. Deep vein thrombosis and pulmonary embolism after heart transplantation. Clin Transplant 2022; 36:e14705. [PMID: 35545895 DOI: 10.1111/ctr.14705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 04/22/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Venous thromboembolism (VTE), such as deep vein thrombosis (DVT) and pulmonary embolism (PE), is an important and serious postoperative complication after heart transplantation. We sought to characterize in-hospital VTE after heart transplantation and its association with clinical outcomes. METHOD Adult (≧18 years) patients undergoing heart transplantation from 2015 to 2019 at our center were retrospectively reviewed. Post-transplant VTE was defined as newly diagnosed venous system thrombus by imaging studies. RESULTS There were 254 patients. The cohort's median age was 55 years. A total of 61 patients were diagnosed with VTE, including 1 with right atrial thrombus, 54 with upper extremity DVT in which one patient subsequently developed PE, 4 with lower extremity DVT, and 2 with upper and lower extremity DVT. The cumulative incidence of VTE was 42% at 60-days of post heart transplant. Patients with VTE had longer hospital stay (p<0.001), higher in-hospital mortality (p = 0.010), and worse 5-year survival (p = 0.009). On the multivariable Cox analysis, history of DVT/PE and intubation for more than 3 days were associated with an increased risk of in hospital VTE. CONCLUSION The incidence of VTE in heart transplant recipients is high. Post-transplant surveillance, and appropriate preventive measures and treatment strategies after diagnosis are warranted. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Atsushi Kainuma
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Yuming Ning
- Center for Innovation and Outcomes Research, Columbia University, New York, New York, USA
| | - Paul A Kurlansky
- Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York, New York, USA.,Center for Innovation and Outcomes Research, Columbia University, New York, New York, USA
| | - Amy S Wang
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Farhana Latif
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Maryjane A Farr
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Gabriel T Sayer
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Nir Uriel
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Hiroo Takayama
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Yoshifumi Naka
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Koji Takeda
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
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12
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Don CW, Zwischenberger BA, Kurlansky PA, Rao SV, Sharma G, Lawton JS, Tamis-Holland JE. 2021 ACC/AHA/SCAI Coronary Artery Revascularization Guidelines for Managing the Nonculprit Artery in STEMI. JACC Case Rep 2022; 4:377-384. [PMID: 35693904 PMCID: PMC9175203 DOI: 10.1016/j.jaccas.2022.02.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/26/2022] [Accepted: 02/15/2022] [Indexed: 11/23/2022]
Abstract
The 2021 Coronary Artery Disease revascularization guidelines of the American College of Cardiology (ACC), the American Heart Association (AHA), and the Society for Cardiovascular Angiography and Interventions (SCAI) provide recommendations for managing nonculprit arteries in ST-segment elevation myocardial infarction (STEMI). Although staged revascularization is preferred, at times same-setting intervention, coronary artery bypass surgery, or medical therapy may be preferable. These cases exemplify clinical scenarios for treating nonculprit arteries in STEMI. (Level of Difficulty: Intermediate.)
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13
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Jacobs JP, Shahian DM, Badhwar V, Thibault DP, Thourani VH, Rankin JS, Kurlansky PA, Bowdish ME, Cleveland JC, Furnary AP, Kim KM, Lobdell KW, Vassileva C, Wyler von Ballmoos MC, Antman MS, Feng L, O'Brien SM. The Society of Thoracic Surgeons 2021 Adult Cardiac Surgery Risk Models for Multiple Valve Operations. Ann Thorac Surg 2022; 113:511-518. [PMID: 33844993 DOI: 10.1016/j.athoracsur.2021.03.089] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 12/16/2020] [Revised: 03/17/2021] [Accepted: 03/30/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND The Society of Thoracic Surgeons (STS) Quality Measurement Task Force has developed risk models and composite performance measures for isolated coronary artery bypass grafting (CABG), isolated aortic valve replacement (AVR), isolated mitral valve replacement or repair (MVRR), AVR+CABG, and MVRR+CABG. To further enhance its portfolio of risk-adjusted performance metrics, STS has developed new risk models for multiple valve operations ± CABG procedures. METHODS Using July 2011 to June 2019 STS Adult Cardiac Surgery Database data, risk models for AVR+MVRR (n = 31,968) and AVR+MVRR+CABG (n = 12,650) were developed with the following endpoints: Operative Mortality, major morbidity (any 1 or more of the following: cardiac reoperation, deep sternal wound infection/mediastinitis, stroke, prolonged ventilation, and renal failure), and combined mortality and/or major morbidity. Data were divided into development (July 2011 to June 2017; n = 35,109) and validation (July 2017 to June 2019; n = 9509) samples. Predictors were selected by assessing model performance and clinical face validity of full and progressively more parsimonious models. Performance of the resulting models was evaluated by assessing discrimination and calibration. RESULTS C-statistics for the overall population of multiple valve ± CABG procedures were 0.7086, 0.6734, and 0.6840 for mortality, morbidity, and combined mortality and/or morbidity in the development sample, and 0.6953, 0.6561, and 0.6634 for the same outcomes, respectively, in the validation sample. CONCLUSIONS New STS Adult Cardiac Surgery Database risk models have been developed for multiple valve ± CABG operations, and these models will be used in subsequent STS performance metrics.
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Affiliation(s)
- Jeffrey P Jacobs
- Congenital Heart Center, Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida.
| | - David M Shahian
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Dylan P Thibault
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart Institute, Atlanta, Georgia
| | - J Scott Rankin
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Paul A Kurlansky
- Division of Cardiac Surgery, Columbia University, New York, New York
| | - Michael E Bowdish
- University of Southern California Keck School of Medicine, Los Angeles, California
| | - Joseph C Cleveland
- Division of Cardiothoracic Surgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado
| | | | - Karen M Kim
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Kevin W Lobdell
- Atrium Health, Cardiovascular and Thoracic Surgery, Charlotte, North Carolina
| | - Christina Vassileva
- Division of Cardiac Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | | | - Liqi Feng
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Sean M O'Brien
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
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14
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Reif de Paula T, Nemeth SK, Kurlansky PA, Simon HL, Miller LK, Keller DS. A Randomized Controlled Trial Examining the Impact of an Anorectal Surgery Multimodal Enhanced Recovery Program on Opioid Use. Ann Surg 2022; 275:e22-e29. [PMID: 33351458 DOI: 10.1097/sla.0000000000004701] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anorectal cases may be a common gateway to the opioid epidemic. Opioid reduction is inherent in enhanced recovery after surgery (ERAS) protocols, but little work has evaluated ERAS in these cases. OBJECTIVE To determine if ERAS could reduce postoperative opioid utilization in ambulatory anorectal surgery without sacrificing patient pain or satisfaction. METHODS A randomized controlled trial assigned ambulatory anorectal patients to ERAS (experimental) or routine care (surgeon's choice) for pain management (control) over 30-days postoperatively. Primary outcome was overall days of opioid use. Secondary outcomes included pain and satisfaction scores over multiple time points and new persistent opioid use. The Visual Analog Scale, Functional Pain Scale, and EQ-5D-3L measured patient-reported pain and satisfaction. Univariate analysis compared outcomes overall and at individual time points. Two-way mixed ANOVA evaluated pain and satisfaction measures between groups and over time. RESULTS Thirty-two patients were randomized into each arm (64 total). The control group consumed significantly more opioids after discharge (median 121.3MME vs 23.5MME, P < 0.001). Significantly more control patients requested additional narcotics (P = 0.004), made unplanned calls (P = 0.009), and had unplanned clinic visits (P = 0.003). The control group had significantly more days on opioids (mean 14.4 vs 2.2, P < 0.001). Three control patients (9.4%) versus no experimental patients had new persistent opioid use. The mean global health, EQ5D-3L, Visual Analog Scale, and Functional Pain scores were comparable between groups over time. CONCLUSIONS An ERAS protocol in ambulatory anorectal surgery is feasible, and resulted in reduced opioid use, and healthcare utilization, with no difference in pain or patient satisfaction. This challenges the paradigm that extended opioids are needed for effective postoperative pain management.
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Affiliation(s)
- Thais Reif de Paula
- Division of Colorectal Surgery, Department of Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York
| | - Samantha K Nemeth
- Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, New York
| | - Paul A Kurlansky
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, New York
| | - Hillary L Simon
- Division of Colorectal Surgery, Department of Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, NY
| | - Lydia K Miller
- Department of Anesthesia, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York
| | - Deborah S Keller
- Division of Colorectal Surgery, Department of Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York
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15
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 145:e18-e114. [PMID: 34882435 DOI: 10.1161/cir.0000000000001038] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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16
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 145:e4-e17. [PMID: 34882436 DOI: 10.1161/cir.0000000000001039] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM The executive summary of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions coronary artery revascularization guideline provides the top 10 items readers should know about the guideline. In the full guideline, the recommendations replace the 2011 coronary artery bypass graft surgery guideline and the 2011 and 2015 percutaneous coronary intervention guidelines. This summary offers a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization, as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Recommendations from the earlier percutaneous coronary intervention and coronary artery bypass graft surgery guidelines have been updated with new evidence to guide clinicians in caring for patients undergoing coronary revascularization. This summary includes recommendations, tables, and figures from the full guideline that relate to the top 10 take-home messages. The reader is referred to the full guideline for graphical flow charts, supportive text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in the development of this guideline.
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17
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 79:e21-e129. [PMID: 34895950 DOI: 10.1016/j.jacc.2021.09.006] [Citation(s) in RCA: 455] [Impact Index Per Article: 151.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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18
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Nishikawa M, Willey J, Takayama H, Kaku Y, Ning Y, Kurlansky PA, Brodie D, Masoumi A, Fried J, Takeda K. Stroke patterns and cannulation strategy during veno-arterial extracorporeal membrane support. J Artif Organs 2021; 25:231-237. [PMID: 34751886 DOI: 10.1007/s10047-021-01300-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/22/2021] [Indexed: 11/27/2022]
Abstract
Stroke has potentially devastating consequences for patients receiving veno-arterial extracorporeal membrane support (VA-ECMO). Arterial cannulation sites for VA-ECMO include the ascending aorta, axillary artery, and femoral artery. However, the influence of cannulation site on stroke risk has not been well described. The purpose of this study was to investigate the association between occurrence and patterns of stroke with ECMO arterial cannulation sites. We retrospectively reviewed 414 consecutive patients who received VA-ECMO support for cardiogenic shock between March 2007 and May 2018. Patients were categorized by cannulation strategy. The rates, subtype and location of strokes as assessed by neuroimaging during and after VA-ECMO support were analyzed. Median age was 61 years (IQR 50-69); 67% were men. 77 patients were cannulated via the ascending aorta (17%), 31 via the axillary artery (7%), and 306 (69%) via the femoral artery. In total, 26 patients (6.3%) developed 30 stroke lesions at a median of 6.0 (IQR 3.1-8.7) days after ECMO cannulation. Ischemic stroke was the most common subtype (64%), followed by hemorrhagic transformation (20%) and hemorrhagic stroke (16%). Location by CT was right hemispheric in 38%, left hemispheric in 24%, bilateral in 21%, and vertebrobasilar in 17%. The incidence of stroke was similar across cannulation strategies: aorta (n = 5, 6.5%), axillary artery (n = 2, 6.5%), and femoral artery (n = 19, 6.2%), (p = 0.99). Incidence of stroke does not appear to differ among patients cannulated via the ascending aorta, axillary artery, or femoral artery. Ischemic stroke was the most common subtype of stroke.
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Affiliation(s)
- Mia Nishikawa
- Department of Surgery, Division of Cardiothoracic Surgery, 177 Fort Washington Avenue, New York, NY, 10032, USA.
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY, USA.
| | - Joshua Willey
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Hiroo Takayama
- Department of Surgery, Division of Cardiothoracic Surgery, 177 Fort Washington Avenue, New York, NY, 10032, USA
| | - Yuji Kaku
- Department of Surgery, Division of Cardiothoracic Surgery, 177 Fort Washington Avenue, New York, NY, 10032, USA
| | - Yuming Ning
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, NY, USA
| | - Paul A Kurlansky
- Department of Surgery, Division of Cardiothoracic Surgery, 177 Fort Washington Avenue, New York, NY, 10032, USA
| | - Daniel Brodie
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA
| | - Amirali Masoumi
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Justin Fried
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Koji Takeda
- Department of Surgery, Division of Cardiothoracic Surgery, 177 Fort Washington Avenue, New York, NY, 10032, USA.
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19
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Malick A, Ning Y, Kurlansky PA, Melehy A, Yuzefpolskaya M, Colombo PC, Sayer G, Uriel N, Naka Y, Takeda K. Development of De Novo Aortic Insufficiency in Patients with HeartMate 3. Ann Thorac Surg 2021; 114:450-456. [PMID: 34624263 DOI: 10.1016/j.athoracsur.2021.08.074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 07/21/2021] [Accepted: 08/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND De novo aortic insufficiency (AI) is a common adverse event following continuous flow left ventricular assist device (LVAD) placement and is associated with morbidity and mortality. This study aims to compare the development of de novo AI between HeartMate 3 and HeartMate II LVAD recipients. METHODS A retrospective review was conducted of clinical characteristics and serial echocardiograms (1 month, 6 months, and 1 year post-implantation) of HeartMate 3 patients implanted between November 2014 and March 2019, and of HeartMate II patients implanted between April 2004 and December 2015 at Columbia University Irving Medical Center. Patients (n=122) were excluded from analysis for a history of aortic valve surgery, concomitant aortic valve surgery with LVAD implant, or more than trace preoperative AI left untreated. De novo AI was defined as development of more than mild AI following LVAD implant. RESULTS There were 121 HeartMate 3 patients and 270 HeartMate II patients included in the study. After accounting for competing risks of death and transplantation, there was no significant difference in the development of de novo AI by 1 year post-implantation between HeartMate II and HeartMate 3 patients (p = 0.68). There was no significant difference in severity between HeartMate II and HeartMate 3 among those patients who developed AI up to 1 year post-implantation. CONCLUSIONS Development of de novo AI is comparable between HeartMate 3 and HeartMate II patients. There is no significant difference in severity of AI between HM II and HM 3 patients.
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Affiliation(s)
- Alyyah Malick
- Department of Surgery, Division of Cardiac, Thoracic & Vascular Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Yuming Ning
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York, NY, USA
| | - Paul A Kurlansky
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York, NY, USA
| | - Andrew Melehy
- Department of Surgery, Division of Cardiac, Thoracic & Vascular Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Gabriel Sayer
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Nir Uriel
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Yoshifumi Naka
- Department of Surgery, Division of Cardiac, Thoracic & Vascular Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Koji Takeda
- Department of Surgery, Division of Cardiac, Thoracic & Vascular Surgery, Columbia University Irving Medical Center, New York, NY, USA.
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20
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Kainuma A, Sanchez J, Ning Y, Kurlansky PA, Axsom K, Farr M, Sayer G, Uriel N, Takayama H, Naka Y, Takeda K. Outcomes of Heart Transplantation in Adult Congenital Heart Disease With Prior Intracardiac Repair. Ann Thorac Surg 2021; 112:846-853. [DOI: 10.1016/j.athoracsur.2020.06.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/10/2020] [Accepted: 06/29/2020] [Indexed: 12/13/2022]
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21
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Kainuma A, Ning Y, Kurlansky PA, Wang AS, Axom K, Farr M, Sayer G, Uriel N, Naka Y, Takeda K. Changes in waitlist and posttransplant outcomes in patients with adult congenital heart disease after the new heart transplant allocation system. Clin Transplant 2021; 35:e14458. [PMID: 34398487 DOI: 10.1111/ctr.14458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/14/2021] [Accepted: 08/11/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE In 2018, the United Network for Organ Sharing (UNOS) introduced new criteria for heart allocation. This study sought to assess the impact of this change on waitlist and posttransplant outcomes in adult congenital heart disease (ACHD) recipients. METHODS Between January 2010 and March 2020, we extracted first heart transplant ACHD patients listed from the UNOS database. We compared waitlist and post-transplant outcomes before and after the policy change. RESULTS A total of 1206 patients were listed, 951 under the old policy and 255 under the new policy. Prior to transplant, recipients under the new policy era were more likely to be treated with extracorporeal membrane oxygenation (P = .018), and have intra-aortic balloon pumps (P < .001), and less likely to have left ventricular assist devices (P = .027).Compared to patients waitlisted in the pre-policy change era, those waitlisted in the post policy change era were more likely to receive transplants (P = .001) with no significant difference in waiting list mortality (P = .267) or delisting (P = .915). There was no difference in 1-year survival post-transplant between the groups (P = .791). CONCLUSION The new policy altered the heart transplant cohort in the ACHD group, allowing them to receive transplants earlier with no changes in early outcomes after heart transplantation.
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Affiliation(s)
- Atsushi Kainuma
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Yuming Ning
- Center for Innovation and Outcomes Research, Columbia University, New York, New York, USA
| | - Paul A Kurlansky
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Amy S Wang
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Kelly Axom
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Maryjane Farr
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Gabriel Sayer
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Nir Uriel
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Yoshifumi Naka
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Koji Takeda
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
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22
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Shahian DM, Badhwar V, Kurlansky PA, Bowdish ME, Lobdell KW, Furnary AP, Thourani VH, Jacobs JP, Wyler von Ballmoos MC, Kim KM, Vassileva C, Antman MS, Grau-Sepulveda MV, O'Brien SM. The STS Participant-Level, Multi-Procedural Composite Measure for Adult Cardiac Surgery. Ann Thorac Surg 2021; 114:467-475. [PMID: 34370982 DOI: 10.1016/j.athoracsur.2021.06.084] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/25/2021] [Accepted: 06/28/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Composite performance measures for STS Adult Cardiac Surgery Database participants (typically hospital departments or practice groups) are currently available only for individual procedures. To assess overall participant performance, STS has developed a composite metric encompassing the most common adult cardiac procedures. METHODS Analyses included 1-year (July 1, 2018-June 30, 2019) and 3-year (July 1, 2016-June 30, 2019) time windows. Operations included isolated CABG, isolated AVR, isolated mitral valve repair (MVr) or replacement (MVR), AVR+CABG, MVr/MVR+CABG, AVR+MVr/MVR, and AVR+MVr/MVR+CABG. The composite was estimated using Bayesian hierarchical models with risk-adjusted mortality and morbidity endpoints. Star ratings were based on whether the 95% credible interval of a participant's score was entirely below (1-star), overlapped (2-star), or was above (3-star) the STS average composite score. RESULTS The North American procedural mix in the 3-year study cohort was 448,569 CABG, 72,067 AVR, 35,708 MVr, 29,953 MVR, 45,254 AVR+CABG, 12,247 MVr+CABG, 10,118 MVR+CABG, 3,743 AVR+MVr, 6,846 AVR+MVR, and 3,765 AVR+(MVr/MVR)+CABG. Mortality and morbidity weightings were similar for 1- and 3-year analyses (76% and 24%, [3-year]), as were composite score distributions (median 94.7%, IQR 93.6% to 95.6%, [3-year]). The 3-year timeframe was selected for operational use because of higher model reliability (0.81 [0.78 - 0.83]) and better outlier discrimination (26% 3-star, 16% 1-star). Risk-adjusted outcomes for 1-, 2-, and 3-star programs were 4.3%, 3.0%, and 1.8% mortality, and 18.4%, 13.4%, and 9.7% morbidity, respectively. CONCLUSIONS The STS participant-level, multi-procedural composite measure provides comprehensive, highly reliable, overall quality assessment of adult cardiac surgery practices.
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Affiliation(s)
- David M Shahian
- Division of Cardiac Surgery, Department of Surgery, and Center for Quality and Safety, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV
| | - Paul A Kurlansky
- College of Physicians and Surgeons, Columbia University, New York, NY
| | - Michael E Bowdish
- Departments of Surgery and Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
| | - Kevin W Lobdell
- Atrium Health, Cardiovascular and Thoracic Surgery, Charlotte, NC
| | | | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA
| | - Jeffrey P Jacobs
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL
| | | | - Karen M Kim
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI
| | | | | | | | - Sean M O'Brien
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
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23
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Shahian DM, Bowdish ME, Bloom JP, Wyler von Ballmoos MC, Edgerton JR, Antman MS, Kurlansky PA, Lobdell KW, Cleveland JC, Gaudino MFL, Paone G, Vassileva C, Thourani VH, Furnary AP, Badhwar V, Jacobs JP, O'Brien SM. The STS CABG composite measure: 2021 methodology update. Ann Thorac Surg 2021; 113:1954-1961. [PMID: 34280375 DOI: 10.1016/j.athoracsur.2021.06.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The original STS CABG composite measure uses a 1-year analytic cohort and 98% credible intervals (CrI) to classify better (3-star) or worse (1-star) than expected performance. As CABG volumes per STS participant (e.g., hospital or practice group) have decreased, it has become more challenging to classify performance categories using this approach, especially for lower volume programs, and alternative approaches have been explored. METHODS Among 990 STS Adult Cardiac Surgery Database participants, performance classifications for the CABG composite were studied using various analytic cohorts: single year (current approach, 2017); 3 years (2015-2017); last 450 cases within 3 years; most recent year (2017) plus additional cases to 450 total. We also compared 98% CrI with 95% CrI (used in other STS composite measures). RESULTS Using 3 years of data and 95% CrI's, 113 of 990 participants (11.4%) were classified 1-star and 198 (20%) 3-star. Compared with 1-year analytic cohorts and 98% CrI, the absolute and relative increases in the proportion of 3-star participants were 14 percentage points and 233% (n=198[20%] versus n=59[6%]). Corresponding changes for 1-star participants were 6.5 percentage points and 133% (n=113[11.4%] versus n=48[4.9%]). These changes were particularly notable among lower volume (<199 CABG/year) participants. Measure reliability with the 3-year, 95% CrI modification is 0.78. CONCLUSIONS Compared with current STS CABG composite methodology, a 3-year analytic cohort and 95% CrI increases the number and proportion of better or worse than expected outliers, especially among lower-volume ACSD participants. This revised methodology is also now consistent with other STS procedure composites.
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Affiliation(s)
- David M Shahian
- Division of Cardiac Surgery, Department of Surgery, and Center for Quality and Safety, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
| | - Michael E Bowdish
- Departments of Surgery and Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
| | - Jordan P Bloom
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | | | | | - Paul A Kurlansky
- College of Physicians and Surgeons, Columbia University, New York, NY
| | - Kevin W Lobdell
- Atrium Health, Cardiovascular and Thoracic Surgery, Charlotte, NC
| | - Joseph C Cleveland
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, CO
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Gaetano Paone
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA
| | | | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA
| | | | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown WV
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL
| | - Sean M O'Brien
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
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24
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Kurlansky PA, O'Brien SM, Vassileva CM, Lobdell KW, Edwards FH, Jacobs JP, von Ballmoos MW, Paone G, Edgerton JR, Thourani VH, Furnary AP, Ferraris VA, Cleveland JC, Bowdish ME, Likosky DS, Badhwar V, Shahian DM. Failure to Rescue: A New Society of Thoracic Surgeons Quality Metric for Cardiac Surgery. Ann Thorac Surg 2021; 113:1935-1942. [PMID: 34242640 DOI: 10.1016/j.athoracsur.2021.06.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [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: 03/09/2021] [Revised: 05/19/2021] [Accepted: 06/01/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Failure to rescue (FTR) focuses on the ability to prevent death among patients who experience postoperative complications. The Society of Thoracic Surgeons (STS) Quality Measurement Task Force has developed a new, risk- adjusted FTR quality metric for adult cardiac surgery. METHODS The study population was taken from 1118 STS Adult Cardiac Surgery Database participants including patients who underwent isolated CABG, aortic valve replacement +/- CABG, or mitral valve repair/replacement, +/- CABG between January, 2015 and June, 2019. The FTR analysis was derived from patients who experienced ≥ 1 of the following complications: prolonged ventilation, stroke, reoperation, and renal failure. Data were randomly split into 70% training (n=89,059) and 30% validation samples (n=38,242),Risk variables included STS predicted risk of mortality, operative procedures, and intraoperative variables (cardiopulmonary bypass and cross-clamp times, unplanned procedures, need for circulatory support, and massive transfusion). RESULTS Overall mortality for the for patients undergoing any of the index operations during the study period was 2.6% (27,045/1,058,138), with mortality of 0.9% (8,316/930,837), 8.0% (7,618/94,918), 30.6% (8,247/26,934), 51.9%(2,661/5,123), and 62.3% (203/326) among patients suffering none, one, two, three or four complications. FTR risk model calibration was excellent, as were model discrimination (c-statistic 0.806) and the Brier score (0.102). Using 95% Bayesian credible intervals, 62 (5.6%) participants performed worse and 53 (4.7%) participants performed better than expected. CONCLUSIONS A new risk-adjusted FTR metric has been developed which complements existing STS performance measures. The metric specifically assesses institutional effectiveness of postoperative care, allowing hospitals to target quality improvement efforts.
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Affiliation(s)
- Paul A Kurlansky
- Columbia University, Department of Surgery, Division of Cardiac Surgery, New York, New York.
| | - Sean M O'Brien
- Duke Clinical Research Institute, Durham, North Carolina
| | | | | | - Fred H Edwards
- University of Florida College of Medicine, Department of Surgery, Jacksonville, Florida
| | - Jeffrey P Jacobs
- University of Florida, Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Gainesville, Florida
| | | | - Gaetano Paone
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Vinod H Thourani
- Piedmont Heart Institute and Piedmont Healthcare, Atlanta, Georgia
| | - Anthony P Furnary
- Providence Health Systems, Starr-Wood Cardiac Group, Anchorage, Alaska
| | | | - Joseph C Cleveland
- University of Colorado, Division of Cardiothoracic Surgery, Aurora, Colorado
| | - Michael E Bowdish
- University of Southern California, Department of Surgery, Los Angeles, California
| | - Donald S Likosky
- Michigan Medicine, Department of Cardiac Surgery, Health Services Research and Quality, Ann Arbor, Michigan
| | - Vinay Badhwar
- West Virginia University, Department of Cardiovascular and Thoracic Surgery, Morgantown, West Virginia
| | - David M Shahian
- Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
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25
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Jacobs JP, Shahian DM, Grau-Sepulveda M, O'Brien SM, Pruitt EY, Bloom JP, Edgerton JR, Kurlansky PA, Habib RH, Antman MS, Cleveland JC, Fernandez FG, Thourani VH, Badhwar V. Current Penetration, Completeness, and Representativeness of The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg 2021; 113:1461-1468. [PMID: 34153294 DOI: 10.1016/j.athoracsur.2021.04.107] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/14/2021] [Accepted: 04/27/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) is the largest cardiac surgical database in the world. Linked data from STS ACSD and the CMS Medicare database were used to determine contemporary completeness, penetration, and representativeness of STS ACSD. METHODS Using variables common to both STS and CMS databases, STS procedures were linked to CMS data for all CMS CABG discharges between 2000 and 2018, inclusive. For each CMS CABG hospitalization, it was determined whether a matching STS record existed. RESULTS Center-level penetration (number of CMS sites with at least one matched STS participant divided by total number of CMS CABG sites) increased from 45% in 2000 to 95% in 2018. In 2018, 949 of 1,004 CMS CABG sites (95%) were linked to an STS site. Patient-level penetration (number of CMS CABG hospitalizations at STS sites divided by total number of CMS CABG hospitalizations) increased from 51% in 2000 to 97% in 2018. In 2018, 68,584 of 70,818 CMS CABG hospitalizations (97%) occurred at an STS site. Completeness of case inclusion at STS sites (number of CMS CABG cases at STS sites linked to STS records divided by total number of CMS CABG cases at STS sites) increased from 88% in 2000 to 98% in 2018. In 2018, 66,673 of 68,108 CMS CABG hospitalizations at STS sites (98%) were linked to an STS record. CONCLUSIONS Linkage of STS and CMS databases demonstrates high and increasing penetration and completeness of STS ACSD. STS ACSD now includes 97% of CABG in USA.
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Affiliation(s)
- Jeffrey P Jacobs
- Congenital Heart Center, Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida.
| | - David M Shahian
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maria Grau-Sepulveda
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Sean M O'Brien
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Eric Y Pruitt
- Congenital Heart Center, Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Jordan P Bloom
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - James R Edgerton
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri; and Baylor Research Institute, Dallas, Texas
| | - Paul A Kurlansky
- Division of Cardiac Surgery, Columbia University, New York, New York
| | | | | | - Joseph C Cleveland
- Division of Cardiothoracic Surgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado
| | - Felix G Fernandez
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
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26
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Yamabe T, Zhao Y, Kurlansky PA, Nitta S, Borger MA, George I, Smith CR, Takayama H. Assessment of long-term outcomes: aortic valve reimplantation versus aortic valve and root replacement with biological valved conduit in aortic root aneurysm with tricuspid valve. Eur J Cardiothorac Surg 2021; 59:658-665. [PMID: 33230518 DOI: 10.1093/ejcts/ezaa389] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/18/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES We compared the long-term outcomes between aortic valve reimplantation [David V (DV)] and aortic valve and root replacement with biological valved conduit [Bentall-De Bono (BD)] for the patients with aortic root aneurysm with tricuspid valve. METHODS Among 876 patients who underwent aortic root replacement in our institution between 2005 and 2018, 371 patients who underwent DV (n = 199) or BD (n = 172) for aortic root aneurysm with tricuspid valve were retrospectively reviewed. Exclusion criteria included aortic stenosis, infective endocarditis, previous prosthetic aortic valve, bicuspid aortic valve, aortic dissection and mechanical Bentall procedure. Propensity score matching was performed based on the patient characteristics, matching 90 patients in each group. The primary end point was all-cause mortality. Secondary end points were reoperation for any cause and specifically for aortic valve-related cause. RESULTS After propensity score matching, DV and BD groups each had 1 in-hospital mortality (1.1%). Survival at 10 years was 95.3% [95% confidence interval (CI) 85.8-98.5] in DV and 98.6% (95% CI 90.8-99.8) in BD (P = 0.345). The cumulative incidences of reoperation at 10 years in DV versus BD were 3.9% (95% CI 0.7-11.8) vs 18.1% (95% CI 6.9-33.4) for any cause (P = 0.046) and 1.9% (95% CI 0.1-8.8) vs 15.9% (95% CI 5.5-31.4) for aortic valve-related causes (P = 0.032). The reasons for valve-related reoperation were aortic insufficiency (3/5 in DV vs 5/10 in BD), aortic stenosis (0/5 vs 2/10) and infective endocarditis (2/5 vs 3/10). CONCLUSIONS Both DV and BD procedures for patients with aortic root aneurysm with tricuspid valve resulted in excellent 10-year survival. All-cause and aortic valve-related reoperations were significantly less frequent with valve-sparing root replacement, suggesting an advantage of DV over biological BD.
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Affiliation(s)
- Tsuyoshi Yamabe
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.,Department of Cardiovascular Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Yanling Zhao
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Paul A Kurlansky
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Suzuka Nitta
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Michael A Borger
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Isaac George
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Craig R Smith
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Hiroo Takayama
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
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27
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Yamabe T, Pearsall CA, Zhao Y, Kurlansky PA, Bethancourt CNR, Nitta S, George I, Smith CR, Takayama H. Incidence, Cause, and Outcome of Reinterventions after Aortic Root Replacement. Ann Thorac Surg 2021; 113:25-32. [PMID: 33705779 DOI: 10.1016/j.athoracsur.2021.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/01/2021] [Accepted: 03/01/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aims to comprehensively characterize the details of the aortic and aortic valve reinterventions after aortic root replacement (ARR). METHODS Between 2005 and 2019, 882 patients underwent ARR. The indication was for aneurysm in 666, aortic valve-related in 116, aortic dissection in 64, and infective endocarditis (IE) in 36. Valve-sparing root replacement was performed in 290 while Bio-Bentall was done in 528. Among them, 52 (5.9%) patients required reintervention. The incidence, cause, and time to reintervention, as well as outcomes after reintervention were investigated. Cause-Specific Cox hazard model was performed to identify predictors for reintervention after ARR. RESULTS The 10-year cumulative incidence of aortic and aortic valve reintervention after ARR was 10.3% [95%CI, 7.3%-14.0%]. Age per year decrease was the only independent predictor for reintervention [sHR, 0.97; 95%CI, 0.95-0.99]. The causes for 52 reinterventions were: 29 (55.8%) for aortic valve causes including aortic stenosis/insufficiency, and prosthetic valve dysfunction; 15 (28.9%) for IE; 7 (13.5%) for aortic-related causes including pseudoaneurysm, development of aneurysm, and residual dissection; and 1 (1.9%) for coronary button pseudoaneurysm. Median times to reintervention were 11.0 [IQR, 2.0-20.5] months for IE, 24.0 [IQR, 3.7-46.1] months for aortic-related causes, 77.0 [IQR, 28.4-97.6] months for aortic valve-related causes (p=.005). Overall in-hospital mortality after the reinterventions was 7.7% (4/52) with 20.0% with IE (3/15) . CONCLUSIONS Reintervention for IE occurs relatively early after ARR while aortic valve- and aortic-related reinterventions gradually increase over time. In-hospital mortality after the reintervention is low, unless it is for IE.
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Affiliation(s)
- Tsuyoshi Yamabe
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY; Department of Cardiovascular Surgery, Shonan-Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | | | - Yanling Zhao
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Paul A Kurlansky
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | | | - Suzuka Nitta
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Isaac George
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Craig R Smith
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Hiroo Takayama
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY.
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28
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Kainuma A, Ning Y, Kurlansky PA, Axsom K, Farr M, Sayer G, Uriel N, Lewis MJ, Rosenbaum MS, Kalfa D, LaPar DJ, Bacha EA, Takayama H, Naka Y, Takeda K. Cardiac transplantation in adult congenital heart disease with prior sternotomy. Clin Transplant 2021; 35:e14229. [PMID: 33476438 DOI: 10.1111/ctr.14229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Adult congenital heart disease (ACHD) patients who require orthotopic heart transplantation are surgically complex due to anatomical abnormalities and multiple prior surgeries. In this study, we investigated these patients' outcomes using our institutional database. METHODS ACHD patients who had prior intracardiac repair and subsequent heart transplant were included (2008-2018). Adult patients without ACHD were extracted as a control. A comparison of patients with functional single ventricular (SV) and biventricular (BV) hearts was performed. RESULTS There were 9 SV and 24 BV patients. The SV group had higher central venous pressure/pulmonary capillary wedge pressure (P = .028), hemoglobin concentration (P = .010), alkaline phosphatase (P = .022), and were more likely to have liver congestion (P = .006). Major complications included infection in 16 (48.5%), temporary dialysis in 12 (36.4%), and graft dysfunction requiring perioperative mechanical support in 7 (21.2%). Overall in-hospital mortality was 15.2%. Kaplan-Meier analysis showed a higher, but not statistically significant, survival after 10 years between the ACHD and control groups (ACHD 84.9% vs. control 67.5%, P = .429). There was no significant difference in 10-year survival between SV and BV groups (78% vs. 88%, P = .467). CONCLUSIONS Complex ACHD cardiac transplant recipients have a high incidence of early morbidities after transplantation. However, long-term outcomes were acceptable.
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Affiliation(s)
- Atsushi Kainuma
- Department of Cardiovascular Surgery, Columbia University Medical Center, New York, NY, USA
| | - Yuming Ning
- Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, NY, USA
| | - Paul A Kurlansky
- Department of Surgery CT, Columbia University Medical Center, New York, NY, USA
| | - Kelly Axsom
- Department of Medicine Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Maryjane Farr
- Department of Medicine Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Gabriel Sayer
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Nir Uriel
- Department of Medicine Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Matthew J Lewis
- Department of Medicine Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Marlon S Rosenbaum
- Department of Medicine Cardiology, Columbia University Medical Center, New York, NY, USA
| | - David Kalfa
- Pediatric Cardiac Surgery, Columbia University Medical Center, Morgan Stanley Children's Hospital, New York, NY, USA
| | - Damien J LaPar
- Department of Surgery CT, Columbia University Medical Center, New York, NY, USA
| | - Emile A Bacha
- Pediatric Cardiac Surgery, Columbia University Medical Center, Morgan Stanley Children's Hospital, New York, NY, USA
| | - Hiroo Takayama
- Department of Cardiovascular Surgery, Columbia University Medical Center, New York, NY, USA
| | - Yoshifumi Naka
- Department of Cardiovascular Surgery, Columbia University Medical Center, New York, NY, USA
| | - Koji Takeda
- Department of Cardiovascular Surgery, Columbia University Medical Center, New York, NY, USA
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29
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Singh SK, Bi A, Kurlansky PA, Argenziano M, Smith CR. A Cross-sectional Review of Cardiothoracic Surgery Department Chairs and Program Directors. J Surg Educ 2021; 78:665-671. [PMID: 32741689 DOI: 10.1016/j.jsurg.2020.07.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/04/2020] [Accepted: 07/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Departmental leadership, namely the chair and program director, are sought after positions among academic cardiothoracic surgeons. However, the path to achieving these positions remains unclear. This study sought to characterize the demographics, educational pathways, and career trajectories of current cardiothoracic academic leaders in the United States. METHODS A comprehensive list of ACGME accredited thoracic surgery residency and fellowship programs was obtained. Department chairs and program directors were identified for each program from May to June 2019. For each surgeon, demographic data, education, and training institutions were identified. Information was obtained primarily using institutional based websites. RESULTS A total of 72 department chairs or division chiefs and 77 program directors were identified. A minority of chairs and program directors were female (4.2%, 10.4%) or had PhD degrees (4.2%, 6.5%). A large number of surgeons trained in the North East region (35%), with Brigham and Women's hospital being the most common training institution (8%). Few chairs (31%) and program directors (39%) hold leadership positions at the institution at which they trained, however a larger proportion (52.8%, 58.4%) remain or return to the same region. Finally, 34.7% of chairs and 32.5% of program directors had some institutional exposure to where they currently practice, through medical school or training. CONCLUSION Cardiothoracic department chairs and program directors represent an important group of surgical leaders within our evolving field. As we better understand this group of surgeon-leaders, young trainees and junior faculty that aspire for leadership positions may have a clearer idea of the path to these positions.
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Affiliation(s)
- Sameer K Singh
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York.
| | - Andrew Bi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York
| | - Paul A Kurlansky
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York
| | - Michael Argenziano
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York
| | - Craig R Smith
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York
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Lazar AN, Nemeth SK, Kurlansky PA, Patel VI, Homma S, Morrissey NJ. Adoption and Usage of Video Telehealth in a Large, Academic Department of Surgery. Ann Surg Open 2021; 2:e040. [PMID: 37638243 PMCID: PMC10455297 DOI: 10.1097/as9.0000000000000040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/08/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives To understand the impact that video telehealth has on outpatient visit volume and reimbursement as a method of maintaining care. Background As the coronavirus disease 2019 (COVID-19) spread across the United States starting in 2020, it caused numerous areas of medicine and healthcare to reexamine how we provide care to patients across all disciplines. One method clinicians used to rapidly adapt to these transformed settings was video telehealth, which was previously rarely used. Methods This retrospective review examined outpatient volume and reimbursement data of a large, academic department of surgery. The study reviewed data during 2 time periods: pre-COVID-19 (February 1, 2020, to March 15, 2020) and COVID-19 (March 16, 2020, to April 30, 2020). Results During the period of February 1 to April 30, 13,193 outpatient visits were analyzed. The pre-COVID-19 group contained 9041 (68.5%) visits, whereas the COVID-19 group contained 4152 (31.4%) visits. All divisions noted a drop in visit volume from pre-COVID-19 compared with COVID-19. There was rapid adoption of video telehealth during COVID-19, which made up most patient visits during that time (61.3%). We also found that video telehealth led to significant reimbursements while also allowing patients in numerous states to receive care. Conclusions Previously, video telehealth was used by clinicians in a small portion of outpatient visits. However, safety concerns surrounding COVID-19 forced multiple changes to the way care is provided. Although outpatient volume at our center was less than that before the pandemic, video telehealth was rapidly adopted by providers and allowed for safe and effective outpatient care to patients in a high number of states while still being reimbursed at a high rate.
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Affiliation(s)
- Andrew N. Lazar
- From the Department of Surgery, Division of Vascular Surgery, Columbia University Medical Center, New York, NY
| | - Samantha K. Nemeth
- Department of Surgery, Center for Innovation and Outcome Research, Columbia University Medical Center, New York, NY
| | - Paul A. Kurlansky
- Department of Surgery, Center for Innovation and Outcome Research, Columbia University Medical Center, New York, NY
| | - Virendra I. Patel
- From the Department of Surgery, Division of Vascular Surgery, Columbia University Medical Center, New York, NY
| | - Shunichi Homma
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Nicholas J. Morrissey
- From the Department of Surgery, Division of Vascular Surgery, Columbia University Medical Center, New York, NY
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Nguyen SN, Yamabe T, Zhao Y, Kurlansky PA, George I, Smith CR, Takayama H. Bicuspid-Associated Aortic Root Aneurysm: Mid to Long-Term Outcomes of David V Versus the Bio-Bentall Procedure. Semin Thorac Cardiovasc Surg 2021; 33:933-943. [PMID: 33609674 DOI: 10.1053/j.semtcvs.2021.02.004] [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] [Received: 01/01/2021] [Accepted: 02/12/2021] [Indexed: 11/11/2022]
Abstract
David V valve-sparing root replacement (VSRR) and bio-Bentall (BB) are increasingly performed for aortic root aneurysms associated with a bicuspid aortic valve (BAV). However, durability remains a concern in both procedures. We compared the 10-year outcomes of VSRR vs BB for BAV-associated root aneurysms. A retrospective review identified 134 patients with a BAV-associated root aneurysm who underwent VSRR (n = 65) or BB (n = 69) from 2005 to 2019. Patients with aortic stenosis, endocarditis, previous aortic valve replacement, and emergent cases were excluded. Propensity-score matching was performed, resulting in 2 risk-adjusted groups (n = 40 per group). Median follow-up was 6.21 (1.43-8.28) years. The VSRR cohort was younger (46.0 years vs 56.0 years, P < 0.001) and had a lower incidence of at least moderate aortic insufficiency (AI) (78.5% vs 92.8%, P = 0.02). The incidence of Marfan syndrome, aortic root diameter, and ascending aortic diameter were similar. In-hospital mortality was 1.5% (n = 1) and 1.4% (n = 1) for VSRR and BB, respectively. There was no difference between VSRR and BB in 10-year survival (98.3% [95% confidence interval (CI): 88.6-99.8%] vs 96.2% [95% CI: 85.5-99.0%], P = 0.567) and aortic valve reintervention at 10 years (16.1% [95% CI: 6.3-29.8%] vs 12.9% [95% CI: 3.7-28.0%], P = 0.309). The most common reason for valve reintervention in both groups was AI. Survival and valve reintervention at 10 years were similar in the matched cohort. David V VSRR yields similar mid to long-term outcomes to BB for select patients with a BAV-associated aortic root aneurysm in regards to survival and reintervention rates. Further studies comparing longer term outcomes between root replacement techniques and native valve durability are needed.
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Affiliation(s)
- Stephanie N Nguyen
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Medical Center, New York, New York
| | - Tsuyoshi Yamabe
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Medical Center, New York, New York; Department of Cardiac Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Yanling Zhao
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Medical Center, New York, New York
| | - Paul A Kurlansky
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Medical Center, New York, New York
| | - Isaac George
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Medical Center, New York, New York
| | - Craig R Smith
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Medical Center, New York, New York
| | - Hiroo Takayama
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Medical Center, New York, New York.
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Yamabe T, Zhao Y, Kurlansky PA, Nitta S, Kelebeyev S, Bethancourt CNR, George I, Smith CR, Takayama H. Chronic kidney disease stage stratifies short- and long-term outcomes after aortic root replacement. Interact Cardiovasc Thorac Surg 2020; 32:573-581. [PMID: 33378536 DOI: 10.1093/icvts/ivaa320] [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: 06/12/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Chronic kidney disease (CKD) is prevalent in patients undergoing cardiovascular surgery, and it negatively impacts procedural outcomes; however, its influence on the outcomes of aortic surgery has not been well studied. This study aims to elucidate the importance of CKD on the outcomes of aortic root replacement (ARR). METHODS Patients who underwent ARR between 2005 and 2019 were retrospectively reviewed (n = 882). Patients were divided into 3 groups based on the Kidney Disease: Improving Global Outcomes criteria: Group 1 [estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m2, n = 421); Group 2 (eGFR = 30-59 ml/min/1.73 m2, n = 424); and Group 3 (eGFR < 30 ml/min/1.73 m2, n = 37). To reduce potential confounding, a propensity score matching was also performed between Group 1 and the combined group of Group 2 and Group 3. The primary end point was 10-year survival. Secondary end points were in-hospital mortality and perioperative morbidity. RESULTS Severe CKD patients presented with more advanced overall chronic and acute illnesses. Kaplan-Meier analysis showed a significant correlation between CKD stage and 10-year survival (log-rank P < 0.001). The number of events for Group 1 was 15, Group 2 was 49 and Group 3 was 11 in 10 years. Group 3 had significantly higher in-hospital mortality (13.5% vs 3.5% in Group 2 vs 0.7% in Group 1, P < 0.001) and stroke (8.1% vs 7.1% vs 1.2%, P < 0.001) as well as introduction to new dialysis (27.0% vs 5.4% vs 1.7%, P < 0.001). eGFR was shown to be an independent predictor of mortality (hazard ratio, 0.98; 95% confidence interval, 0.96-0.99). Comparison between propensity matched groups showed similar postoperative outcomes, and eGFR was still identified as a predictor of mortality (hazard ratio, 0.97; 95% confidence interval, 0.95-0.99). CONCLUSIONS Higher stage in CKD negatively impacts the long-term survival in patients who are undergoing ARR.
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Affiliation(s)
- Tsuyoshi Yamabe
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.,Department of Cardiovascular Surgery, Shonan-Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Yanling Zhao
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Paul A Kurlansky
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Suzuka Nitta
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Saveliy Kelebeyev
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Isaac George
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Craig R Smith
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Hiroo Takayama
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
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Yamabe T, Zhao Y, Sanchez J, Kelebeyev S, Bethancourt CNR, Mcmullen HL, Kurlansky PA, George I, Smith CR, Takayama H. Probability of Uneventful Recovery After Elective Aortic Root Replacement for Aortic Aneurysm. Ann Thorac Surg 2020; 110:1485-1493. [DOI: 10.1016/j.athoracsur.2020.02.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/03/2020] [Accepted: 02/27/2020] [Indexed: 01/01/2023]
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Badhwar V, Vemulapalli S, Mack MA, Gillinov AM, Chikwe J, Dearani JA, Grau-Sepulveda MV, Habib R, Rankin JS, Jacobs JP, McCarthy PM, Bloom JP, Kurlansky PA, Wyler von Ballmoos MC, Thourani VH, Edgerton JR, Vassileva CM, Gammie JS, Shahian DM. Volume-Outcome Association of Mitral Valve Surgery in the United States. JAMA Cardiol 2020; 5:1092-1101. [PMID: 32609292 DOI: 10.1001/jamacardio.2020.2221] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [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] [Indexed: 11/14/2022]
Abstract
Importance Early surgery for severe primary degenerative mitral regurgitation is recommended, provided optimal outcomes are achievable. Contemporary national data defining mitral valve surgery volume and outcomes are lacking. Objective To assess national 30-day and 1-year outcomes of mitral valve surgery and define the hospital- and surgeon-level volume-outcome association with mitral valve repair or replacement (MVRR) in patients with primary mitral regurgitation. Design, Setting, and Participants This multicenter cross-sectional observational study used the Society of Thoracic Surgeons Adult Cardiac Surgery Database to identify patients undergoing isolated MVRR for primary mitral regurgitation in the United States. Operative data were collected from July 1, 2011, to December 31, 2016, and analyzed from March 1 to July 1, 2019, with data linked to the Centers for Medicare and Medicaid Services. Main Outcomes and Measures The primary outcome was 30-day in-hospital operative mortality after isolated MVRR for primary mitral regurgitation. Secondary outcomes were 30-day composite mortality plus morbidity (any occurrence of bleeding, stroke, prolonged ventilation, renal failure, or deep wound infection), rate of successful mitral valve repair of primary mitral regurgitation (residual mitral regurgitation of mild [1+] or better), and 1-year mortality, reoperation, and rehospitalization for heart failure. Results A total of 55 311 patients, 1094 hospitals, and 2410 surgeons were identified. Increasing hospital and surgeon volumes were associated with lower risk-adjusted 30-day mortality, lower 30-day composite mortality plus morbidity, and higher rate of successful repair. The lowest vs highest hospital volume quartile had higher 1-year risk-adjusted mortality (hazard ratio [HR], 1.61, 95% CI, 1.31-1.98), but not mitral reoperation (odds ratio [OR], 1.51; 95% CI, 0.81-2.78) or hospitalization for heart failure (HR, 1.25; 95% CI, 0.96-1.64). The surgeon-level 1-year volume-outcome associations were similar for mortality (HR, 1.60; 95% CI, 1.32-1.94) but not significant for mitral reoperation (HR, 1.14; 95% CI, 0.60-2.18) or hospitalization for heart failure (HR, 1.17; 95% CI, 0.91-1.50). Conclusions and Relevance National hospital- and surgeon-level inverse volume-outcome associations were observed for 30-day and 1-year mortality after mitral valve surgery for primary mitral regurgitation. These findings may help to define access to experienced centers and surgeons for the management of primary mitral regurgitation.
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Affiliation(s)
- Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown
| | - Sreekanth Vemulapalli
- Division of Cardiology, Duke University, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Michael A Mack
- Cardiovascular Service Line, Baylor Scott & White Health System, Dallas, Texas
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - J Scott Rankin
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown
| | | | | | - Jordan P Bloom
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Paul A Kurlansky
- Center for Outcomes Research, Columbia University, New York, New York
| | | | - Vinod H Thourani
- Department of Cardiac Surgery, Marcus Heart and Vascular Center, Piedmont Heart and Vascular Institute, Atlanta, Georgia
| | - James R Edgerton
- Cardiovascular Service Line, Baylor Scott & White Health System, Dallas, Texas
| | | | - James S Gammie
- Division of Cardiac Surgery, University of Maryland, Baltimore
| | - David M Shahian
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
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Ando M, Takayama H, Kurlansky PA, Han J, Garan AR, Topkara VK, Yuzefpolskaya M, Colombo PC, Farr M, Naka Y, Takeda K. Effect of Pulmonary Hypertension on Transplant Outcomes in Patients With Ventricular Assist Devices. Ann Thorac Surg 2020; 110:158-164. [DOI: 10.1016/j.athoracsur.2019.09.095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 09/07/2019] [Accepted: 09/27/2019] [Indexed: 01/05/2023]
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El-Hamamsy I, Brinster DR, DeRose JJ, Girardi LN, Hisamoto K, Imam MN, Itagaki S, Kurlansky PA, Lau C, Nemeth S, Williams M, Youdelman BA, Takayama H. The COVID-19 Pandemic and Acute Aortic Dissections in New York: A Matter of Public Health. J Am Coll Cardiol 2020; 76:227-229. [PMID: 32422182 PMCID: PMC7228708 DOI: 10.1016/j.jacc.2020.05.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/05/2020] [Accepted: 05/08/2020] [Indexed: 11/23/2022]
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Ando M, Takeda K, Kurlansky PA, Garan AR, Topkara VK, Yuzefpolskaya M, Colombo PC, Farr M, Naka Y, Takayama H. Association between recipient blood type and heart transplantation outcomes in the United States. J Heart Lung Transplant 2020; 39:363-370. [DOI: 10.1016/j.healun.2019.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 12/07/2019] [Accepted: 12/29/2019] [Indexed: 10/25/2022] Open
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Ogami T, Zimmermann E, Zhu R, Ning Y, Kurlansky PA, Takeda K, George I, Avgerinos D, Takayama H. LONG-TERM OUTCOME COMPARISON BETWEEN MECHANICAL AND BIOPROSTHETIC VALVE IN END-STAGE RENAL DISEASE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32744-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Broderick SR, Grau-Sepulveda M, Kosinski AS, Kurlansky PA, Shahian DM, Jacobs JP, Becker S, DeCamp MM, Seder CW, Grogan EL, Brown LM, Burfeind W, Magee M, Raymond DP, Puri V, Chang AC, Kozower BD. The Society of Thoracic Surgeons Composite Score Rating for Pulmonary Resection for Lung Cancer. Ann Thorac Surg 2020; 109:848-855. [DOI: 10.1016/j.athoracsur.2019.08.114] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 12/01/2022]
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Hannan EL, Samadashvili Z, Cozzens K, Chikwe J, Adams DH, Sundt TM, Girardi L, Smith CR, Lahey SJ, Gold JP, Wechsler A, Jordan D, Ashraf MH, Kurlansky PA. Out-of-Hospital 30-day Deaths After Cardiac Surgery Are Often Underreported. Ann Thorac Surg 2019; 110:183-188. [PMID: 31715155 DOI: 10.1016/j.athoracsur.2019.09.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/26/2019] [Accepted: 09/12/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Operative mortality (in-hospital during the index admission or within 30 days of the procedure after discharge) is commonly used as a quality of care measure for public reporting of cardiac surgery outcomes, but the ability to capture out-of-hospital deaths accurately remains undetermined. The objective of the study was to estimate the impact of incomplete reporting of out-of-hospital deaths on hospital risk-adjusted mortality and outlier status. METHODS New York State's 2014 to 2016 cardiac registry data were used to compare the capture of 30-day postprocedure deaths after discharge with and without the use of national and state-level vital statistics data for all 54,442 patients undergoing isolated coronary artery bypass graft, cardiac valve surgery, or both. Hospital risk-adjusted operative mortality rates and mortality outliers were compared based on statistical models that were developed with and without the use of vital statistics data. RESULTS Thirty-day deaths postprocedure after discharge ranged from 10% to 39% of all operative deaths among cardiac surgical procedures. More than 30% of these deaths were missing without vital statistics confirmation for 7 of the 10 cardiac procedures examined, and more than 40% were missing for 5 of the procedures examined. When vital statistics data were used to confirm 30-day postprocedure deaths after discharge, an additional high outlier for valve surgery was identified. CONCLUSIONS Operative mortality after cardiac surgery is often underreported owing to a considerable percentage of out-of-hospital cardiac surgery deaths that are missed by reporting centers. This can adversely affect the assessment of hospital risk-adjusted mortality in public reports.
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Affiliation(s)
- Edward L Hannan
- Cardiac Services Program, School of Public Health, University at Albany, State University of New York, Albany, New York.
| | - Zaza Samadashvili
- Cardiac Services Program, School of Public Health, University at Albany, State University of New York, Albany, New York
| | - Kimberly Cozzens
- Cardiac Services Program, School of Public Health, University at Albany, State University of New York, Albany, New York
| | - Joanna Chikwe
- Department of Cardiothoracic Surgery, Stony Brook School of Medicine, Stony Brook, New York
| | - David H Adams
- Department of Surgery, Mount Sinai Hospital, New York, New York
| | - Thoralf M Sundt
- Cardiac Surgical Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Leonard Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, New York, New York
| | - Craig R Smith
- Department of Surgery, Columbia-Presbyterian Medical Center, New York, New York
| | - Stephen J Lahey
- Division of Cardiothoracic Surgery, University of Connecticut, Storrs, Connecticut
| | - Jeffrey P Gold
- Chancellor's Office, University of Nebraska Medical Center, Omaha, Nebraska
| | - Andrew Wechsler
- Department of Cardiothoracic Surgery, Drexel University, Philadelphia, Pennsylvania
| | - Desmond Jordan
- Department of Surgery, Columbia-Presbyterian Medical Center, New York, New York
| | - Mohammed H Ashraf
- Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, New York
| | - Paul A Kurlansky
- Department of Surgery, Columbia-Presbyterian Medical Center, New York, New York
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Yamabe T, Eudailey KW, Jimenez OG, DeRoo S, Kurlansky PA, George I, Takayama H. Double mattress suture lines for valve‐sparing aortic root replacement. J Card Surg 2019; 34:1344-1346. [DOI: 10.1111/jocs.14241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tsuyoshi Yamabe
- Division of Thoracic and Cardiovascular Surgery, New York Presbyterian HospitalColumbia University Medical CenterNew York New York
- Department of Cardiovascular SurgeryShonan‐Kamakura General HospitalKamakura Kanagawa Japan
| | - Kyle W. Eudailey
- Department of Cardiothoracic SurgeryPrinceton Baptist Medical Center/Brookwood Baptist Health SystemBirmingham Alabama
| | - Omar G. Jimenez
- Division of Thoracic and Cardiovascular Surgery, New York Presbyterian HospitalColumbia University Medical CenterNew York New York
| | - Scott DeRoo
- Division of Thoracic and Cardiovascular Surgery, New York Presbyterian HospitalColumbia University Medical CenterNew York New York
| | - Paul A. Kurlansky
- Division of Thoracic and Cardiovascular Surgery, New York Presbyterian HospitalColumbia University Medical CenterNew York New York
| | - Isaac George
- Division of Thoracic and Cardiovascular Surgery, New York Presbyterian HospitalColumbia University Medical CenterNew York New York
| | - Hiroo Takayama
- Division of Thoracic and Cardiovascular Surgery, New York Presbyterian HospitalColumbia University Medical CenterNew York New York
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Han J, Pinsino A, Sanchez J, Takayama H, Garan AR, Topkara VK, Naka Y, Demmer RT, Kurlansky PA, Colombo PC, Takeda K, Yuzefpolskaya M. Prognostic value of vasoactive-inotropic score following continuous flow left ventricular assist device implantation. J Heart Lung Transplant 2019; 38:930-938. [PMID: 31201088 PMCID: PMC9891263 DOI: 10.1016/j.healun.2019.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/06/2019] [Accepted: 05/17/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The purpose of this study is to evaluate the utility of vasoactive-inotropic score (VIS) in predicting outcomes after left ventricular assist device (LVAD) implantation and explore possible mechanisms of post-operative hemodynamic instability. METHODS Retrospective review was performed in 418 consecutive patients with LVAD implantation. VIS was calculated as dopamine + dobutamine + 10 × milrinone + 100 × epinephrine + 100 × norepinephrine (all μg/kg/min) + 10000 × vasopressin (U/kg/min) after initial stabilization in the operating room and upon arrival at the intensive care unit. The primary outcome was in-hospital mortality. The secondary outcomes were a composite of in-hospital mortality, delayed right ventricular assist device (RVAD) implantation, and continuous renal replacement therapy. The pre-operative biomarkers of inflammation, oxidative stress, endotoxemia and gut-derived metabolite trimethylamine-N-oxide (TMAO) were measured in a subset of 61 patients. RESULTS Median VIS was 20.0 (interquartile range 13.3-27.9). VIS was an independent predictor of in-hospital mortality (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.03-1.09, p < 0.001) and composite outcome (OR 1.03, 95% CI 1.01-1.06, p = 0.008). In-hospital mortality increased for each VIS quartile (0% vs 3.9% vs 7.6% vs 12.3%, p = 0.002). VIS was superior to other established LVAD risk models as a predictor of in-hospital mortality (area under the curve 0.73, 95% CI 0.64-0.82). The optimal cut-off point for VIS as a predictor of in-hospital mortality was 20. Pre-operative hemoglobin level was the only independent predictor of VIS ≥ 20 (p = 0.003). Patients with a high VIS were more likely to have elevated TMAO pre-operatively (53.6% vs 25.8%, p = 0.03). CONCLUSIONS A high post-operative VIS is associated with adverse in-hospital outcomes and is a better predictor of in-hospital mortality compared with existing LVAD risk models. Whether early hemodynamic stabilization using RVAD may benefit patients with a high VIS remains to be investigated.
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Affiliation(s)
- Jiho Han
- Department of Medicine, Stanford University Medical Center, Stanford, California
| | - Alberto Pinsino
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Joseph Sanchez
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - A Reshad Garan
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Paul A Kurlansky
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
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Kurlansky PA. Invited Commentary. Ann Thorac Surg 2019; 107:1735-1736. [PMID: 30721693 DOI: 10.1016/j.athoracsur.2018.12.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 12/22/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Paul A Kurlansky
- Department of Surgery, Columbia University, Black Bldg 210, 650 W 168th St, New York, NY 10032.
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Zhao Q, Wang L, Kurlansky PA, Schein J, Baser O, Berger JS. Cardiovascular outcomes among elderly patients with heart failure and coronary artery disease and without atrial fibrillation: a retrospective cohort study. BMC Cardiovasc Disord 2019; 19:19. [PMID: 30646855 PMCID: PMC6334438 DOI: 10.1186/s12872-018-0991-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/21/2018] [Indexed: 01/30/2023] Open
Abstract
Background Coronary artery disease accelerates heart failure progression, leading to poor prognosis and a substantial increase in morbidity and mortality. This study was aimed to assess the impact of coronary artery disease on all-cause mortality, myocardial infarction (MI), and ischemic stroke (IS) among hospitalized newly-diagnosed heart failure (HF) patients with left ventricular systolic dysfunction (LVSD). Methods This retrospective cohort study included Medicare patients (aged ≥65 years) with ≥1 inpatient heart failure claim (index date = discharge date) during 01JAN2007-31DEC2013. Patients were required to have continuous enrollment for ≥1-year pre-index date (baseline: 1-year pre-index period) without a prior heart failure claim (in the 1 year pre-index prior to the index hospital admission); follow-up ran from the index date to death, disenrollment from the health plan, or the end of the study period, whichever occurred first. HF with LVSD patients, identified with diagnosis codes of systolic dysfunction (excluding baseline atrial fibrillation), were stratified based on prevalent coronary artery disease at baseline into coronary artery disease and non-coronary artery disease cohorts. Main outcomes were occurrence of major adverse cardiovascular events including all-cause mortality, myocardial infarction, and ischemic stroke. Propensity score matching (PSM) was used to balance patient characteristics. Kaplan-Meier curves of ACM and cumulative incidence distribution of MI/IS were presented. Results Of 22,230 HF with LVSD patients, 15,827 (71.2%) had coronary artery disease and were overall more likely to be younger (79.8 vs 80.9 years), male (49.6% vs. 35.6%), white (86.2% vs 81.4%), with more prevalent comorbidities including hypertension (80.7% vs 74.3%), hyperlipidemia (67.7% vs 46.7%), and diabetes (46.3% vs 35.8%) (all p < 0.0001). After propensity score matching, cohorts included 5792 patients each. The coronary artery disease cohort had significantly higher cumulative incidence of myocardial infarction and ischemic stroke at the end of 7-year follow-up vs non-coronary artery disease (myocardial infarction = 50.0% vs 18.0%; ischemic stroke = 23.3% vs 18.7%; all p < 0.0001). Follow-up all-cause mortality rates were similar between the two cohorts. Conclusions HF with LVSD patients with coronary artery disease had significantly higher incidence of ischemic stroke and myocardial infarction, but similar all-cause mortality compared to those without coronary artery disease. Electronic supplementary material The online version of this article (10.1186/s12872-018-0991-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Qi Zhao
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Li Wang
- STATinMED Research, Plano, TX, USA.
| | | | - Jeff Schein
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA.
| | - Onur Baser
- The University of Michigan, Ann Arbor, MI, USA
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Ando M, Takeda K, Kurlansky PA, Han J, Garan AR, Topkara VK, Yuzefpolskaya M, Colombo PC, Farr M, Naka Y, Takayama H. Impact of Sharing O Heart With Non-O Recipients: Simulation in the United Network for Organ Sharing Registry. Ann Thorac Surg 2018; 106:1356-1363. [DOI: 10.1016/j.athoracsur.2018.06.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/13/2018] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
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Fukuhara S, Takeda K, Kurlansky PA, Naka Y, Takayama H. Extracorporeal membrane oxygenation as a direct bridge to heart transplantation in adults. J Thorac Cardiovasc Surg 2018; 155:1607-1618.e6. [DOI: 10.1016/j.jtcvs.2017.10.152] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 10/01/2017] [Accepted: 10/30/2017] [Indexed: 11/26/2022]
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Han J, Mauro CM, Kurlansky PA, Fukuhara S, Yuzefpolskaya M, Topkara VK, Garan AR, Colombo PC, Takayama H, Naka Y, Takeda K. Impact of Obesity on Readmission in Patients With Left Ventricular Assist Devices. Ann Thorac Surg 2018; 105:1192-1198. [DOI: 10.1016/j.athoracsur.2017.10.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 09/04/2017] [Accepted: 10/16/2017] [Indexed: 11/16/2022]
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Schwann TA, Habib RH, Wallace A, Shahian DM, O’Brien S, Jacobs JP, Puskas JD, Kurlansky PA, Engoren MC, Tranbaugh RF, Bonnell MR. Operative Outcomes of Multiple-Arterial Versus Single-Arterial Coronary Bypass Grafting. Ann Thorac Surg 2018; 105:1109-1119. [DOI: 10.1016/j.athoracsur.2017.10.058] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 09/02/2017] [Accepted: 10/23/2017] [Indexed: 11/16/2022]
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Yu SN, Han J, Takeda K, Ginns JN, Kurlansky PA, Garan AR, Yuzefpolskaya M, Topkara VK, Colombo PC, Naka Y, Takayama H. Role of computed tomography angiography for HeartMate II left ventricular assist device thrombosis. Int J Artif Organs 2018; 41:325-332. [PMID: 29562790 DOI: 10.1177/0391398818762354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Device thrombosis is one of the most devastating complications of HeartMate II left ventricular assist devices. The purpose of this study is to assess the anatomical properties that the inflow and outflow computed tomography angiography provides in assessing for left ventricular assist device thrombosis, as well as their impact on clinical management and postoperative outcomes. METHODS Between April 2010 and December 2016, 22 patients who received a HeartMate II left ventricular assist device implantation were readmitted for suspected device thrombosis and underwent a computed tomography angiography for workup. Left ventricular assist device-associated anatomy was assessed, including outflow abnormality on computed tomography angiography (contrast filling defect), inflow abnormalities on computed tomography angiography (space at inflow, M-I angle), and inflow abnormalities on chest X-ray (inflow angulation, pump pocket depth). RESULTS Computed tomography angiography revealed an outflow filling defect in three patients (14%) resulting in change in surgical approach from subcostal pump exchange to resternotomy pump and outflow graft exchange. Inflow graft malpositioning was identified in four patients, with the inflow abutting the left ventricular wall and obstructing the cannula opening. On computed tomography angiography assessment, mean space at inflow was 5.3 ± 1.6 mL and M-I angle was 35.6° ± 6.6°. Chest X-ray evaluation revealed mean inflow angle and pump pocket depth of 75.7° ± 13.4° and 110.2 ± 26.6 mm, respectively. CONCLUSION Computed tomography angiography provides a noninvasive assessment of the outflow graft and inflow cannulas in left ventricular assist device patients. Findings on computed tomography angiography reveal possible mechanical etiologies of thrombosis and may be useful for determining the surgical management of device thrombosis patients.
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Affiliation(s)
- Sarah N Yu
- 1 Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Jiho Han
- 1 Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Koji Takeda
- 1 Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Jonathan N Ginns
- 2 Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Paul A Kurlansky
- 1 Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Arthur R Garan
- 2 Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Melana Yuzefpolskaya
- 2 Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Veli K Topkara
- 2 Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Paolo C Colombo
- 2 Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Yoshifumi Naka
- 1 Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Hiroo Takayama
- 1 Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
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O'Brien SM, Feng L, He X, Xian Y, Jacobs JP, Badhwar V, Kurlansky PA, Furnary AP, Cleveland JC, Lobdell KW, Vassileva C, Wyler von Ballmoos MC, Thourani VH, Rankin JS, Edgerton JR, D'Agostino RS, Desai ND, Edwards FH, Shahian DM. The Society of Thoracic Surgeons 2018 Adult Cardiac Surgery Risk Models: Part 2-Statistical Methods and Results. Ann Thorac Surg 2018; 105:1419-1428. [PMID: 29577924 DOI: 10.1016/j.athoracsur.2018.03.003] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [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: 02/24/2018] [Accepted: 03/09/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The Society of Thoracic Surgeons (STS) uses statistical models to create risk-adjusted performance metrics for Adult Cardiac Surgery Database (ACSD) participants. Because of temporal changes in patient characteristics and outcomes, evolution of surgical practice, and additional risk factors available in recent ACSD versions, completely new risk models have been developed. METHODS Using July 2011 to June 2014 ACSD data, risk models were developed for operative mortality, stroke, renal failure, prolonged ventilation, mediastinitis/deep sternal wound infection, reoperation, major morbidity or mortality composite, prolonged postoperative length of stay, and short postoperative length of stay among patients who underwent isolated coronary artery bypass grafting surgery (n = 439,092), aortic or mitral valve surgery (n = 150,150), or combined valve plus coronary artery bypass grafting surgery (n = 81,588). Separate models were developed for each procedure and endpoint except mediastinitis/deep sternal wound infection, which was analyzed in a combined model because of its infrequency. A surgeon panel selected predictors by assessing model performance and clinical face validity of full and progressively more parsimonious models. The ACSD data (July 2014 to December 2016) were used to assess model calibration and to compare discrimination with previous STS risk models. RESULTS Calibration in the validation sample was excellent for all models except mediastinitis/deep sternal wound infection, which slightly underestimated risk and will be recalibrated in feedback reports. The c-indices of new models exceeded those of the last published STS models for all populations and endpoints except stroke in valve patients. CONCLUSIONS New STS ACSD risk models have generally excellent calibration and discrimination and are well suited for risk adjustment of STS performance metrics.
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Affiliation(s)
- Sean M O'Brien
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Liqi Feng
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Xia He
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Ying Xian
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Jeffrey P Jacobs
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiovascular Surgery, Johns Hopkins All Children's Heart Institute, St. Petersburg, Florida
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Paul A Kurlansky
- Division of Cardiac Surgery, Columbia University, New York, New York
| | | | - Joseph C Cleveland
- Division of Cardiothoracic Surgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado
| | - Kevin W Lobdell
- Atrium Health, Cardiovascular and Thoracic Surgery, Charlotte, North Carolina
| | - Christina Vassileva
- Division of Cardiac Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Vinod H Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| | - J Scott Rankin
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | | | - Richard S D'Agostino
- Division of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Nimesh D Desai
- Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fred H Edwards
- Department of Surgery, University of Florida, Gainesville, Florida
| | - David M Shahian
- Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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