Kayla N. Laraia, M. Sabatino, Lindsay E. Volk, K. Dewan, NaYoung K. Yang, Jin Yoo, Ankitha H. Dindigal, Mark J. Russo, L. Lee
Background and Aim of the Study. To investigate if mitral valve (MV) surgery quality differs by hospital volume in New Jersey (NJ). Methods. Using the NJ State Inpatient Database, patients ≥18 years undergoing MV repair or replacement from 2016–2019 were identified. Centers were considered high-volume if they performed more than 50 mitral operations annually. Baseline characteristics and outcomes (in-hospital mortality, seven-day readmission, hospital length of stay (LOS), and postoperative complications) were evaluated for the population and by center volume. Subanalysis by center volume within each procedure was conducted. Results. Among 2,560 mitral operations, MV replacement (92.3% (n = 2,362)) was performed more often than repair. High- (4) and low-volume (15) centers performed 1,180 (46.1%) and 1,380 (53.9%) mitral surgeries, respectively. Charlson Comorbidity Indices did not differ by center volume, including in subgroup analyses. Low-volume centers had higher rates of Hispanic patients, low-income patients, and readmission rates. High-volume centers had more transfers, urgent/emergent admissions, higher rates of in-hospital mortality, and longer LOS. Postoperative complications did not differ by volume. The MV replacement cohort reflected many of the differences seen in the total population, in addition to seeing higher rates of heart failure at high-volume centers and stroke at low-volume centers. Within MV repairs, significantly more Hispanic patients presented to low-volume centers and high-volume centers had longer LOS. Multivariable analysis indicated that hospital volume was not correlated to in-hospital mortality for the total population and within each procedure. Conclusions. MV replacement is performed more frequently than repair. Hospital volume is not correlated with MV surgical quality, and more representative quality measures are needed.
{"title":"Quality of Mitral Valve Surgery Does Not Differ by Hospital Volume in New Jersey","authors":"Kayla N. Laraia, M. Sabatino, Lindsay E. Volk, K. Dewan, NaYoung K. Yang, Jin Yoo, Ankitha H. Dindigal, Mark J. Russo, L. Lee","doi":"10.1155/2023/6983270","DOIUrl":"https://doi.org/10.1155/2023/6983270","url":null,"abstract":"Background and Aim of the Study. To investigate if mitral valve (MV) surgery quality differs by hospital volume in New Jersey (NJ). Methods. Using the NJ State Inpatient Database, patients ≥18 years undergoing MV repair or replacement from 2016–2019 were identified. Centers were considered high-volume if they performed more than 50 mitral operations annually. Baseline characteristics and outcomes (in-hospital mortality, seven-day readmission, hospital length of stay (LOS), and postoperative complications) were evaluated for the population and by center volume. Subanalysis by center volume within each procedure was conducted. Results. Among 2,560 mitral operations, MV replacement (92.3% (n = 2,362)) was performed more often than repair. High- (4) and low-volume (15) centers performed 1,180 (46.1%) and 1,380 (53.9%) mitral surgeries, respectively. Charlson Comorbidity Indices did not differ by center volume, including in subgroup analyses. Low-volume centers had higher rates of Hispanic patients, low-income patients, and readmission rates. High-volume centers had more transfers, urgent/emergent admissions, higher rates of in-hospital mortality, and longer LOS. Postoperative complications did not differ by volume. The MV replacement cohort reflected many of the differences seen in the total population, in addition to seeing higher rates of heart failure at high-volume centers and stroke at low-volume centers. Within MV repairs, significantly more Hispanic patients presented to low-volume centers and high-volume centers had longer LOS. Multivariable analysis indicated that hospital volume was not correlated to in-hospital mortality for the total population and within each procedure. Conclusions. MV replacement is performed more frequently than repair. Hospital volume is not correlated with MV surgical quality, and more representative quality measures are needed.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44832517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elnaz Shahmohamadi, A. Hadizadeh, Aryan Ayati, Amirhossein Tayebi, Seyed Hossein Ahmadi Tafti, K. Abbasi, Namvar Movahedi, J. Bagheri, S. Davoodi
Introduction. Tricuspid valve (TV) disease is substantially less common than mitral or aortic valve disease, and it is commonly missed due to the tolerability of stenosis or regurgitation. Adults seldom have primary tricuspid valve regurgitation, which is linked to rheumatic heart disease, infectious endocarditis, myxomatous valve disease, congenital heart disease, carcinoid syndrome, and/or infiltrative valvopathy. Materials and Methods. The authors examined the Valve Surgery Data Bank retrospectively to identify all patients who underwent TV replacement without concomitant surgeries between 2004 and 2014. In addition, the exclusion criteria suggested that all instances involving solitary valve repair were eliminated. Through visits or phone interviews, long-term follow-up was collected through the end of June 2022 in order to gather information on postoperative occurrences among the patients. The average follow-up time was 10.7 + 2.1 (5–15) years. Results. The overall survival rate was 90.9%. Survival rate was not significantly different between bioprostheses and mechanical ones (log rank p = 0.05 ). The incidence of endocarditis and valvar thrombosis in short-term was higher in the mechanical group than in the biological group, but the frequency of valve malfunction and redo surgery was higher in the replacement group. We found a higher incidence of valvular thrombosis, GI bleeding, and myocardial infarction rate in mechanical valve complications compared to the bioprosthetic group regarding late complications.
{"title":"Evaluation of Risk Factors and Outcomes of Isolated Tricuspid Valve Replacement with a Conventional Surgical Approach: A Retrospective Cohort Study","authors":"Elnaz Shahmohamadi, A. Hadizadeh, Aryan Ayati, Amirhossein Tayebi, Seyed Hossein Ahmadi Tafti, K. Abbasi, Namvar Movahedi, J. Bagheri, S. Davoodi","doi":"10.1155/2023/5777125","DOIUrl":"https://doi.org/10.1155/2023/5777125","url":null,"abstract":"Introduction. Tricuspid valve (TV) disease is substantially less common than mitral or aortic valve disease, and it is commonly missed due to the tolerability of stenosis or regurgitation. Adults seldom have primary tricuspid valve regurgitation, which is linked to rheumatic heart disease, infectious endocarditis, myxomatous valve disease, congenital heart disease, carcinoid syndrome, and/or infiltrative valvopathy. Materials and Methods. The authors examined the Valve Surgery Data Bank retrospectively to identify all patients who underwent TV replacement without concomitant surgeries between 2004 and 2014. In addition, the exclusion criteria suggested that all instances involving solitary valve repair were eliminated. Through visits or phone interviews, long-term follow-up was collected through the end of June 2022 in order to gather information on postoperative occurrences among the patients. The average follow-up time was 10.7 + 2.1 (5–15) years. Results. The overall survival rate was 90.9%. Survival rate was not significantly different between bioprostheses and mechanical ones (log rank \u0000 \u0000 p\u0000 =\u0000 0.05\u0000 \u0000 ). The incidence of endocarditis and valvar thrombosis in short-term was higher in the mechanical group than in the biological group, but the frequency of valve malfunction and redo surgery was higher in the replacement group. We found a higher incidence of valvular thrombosis, GI bleeding, and myocardial infarction rate in mechanical valve complications compared to the bioprosthetic group regarding late complications.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46123686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chenyu Zhou, Jinlin Wu, E. Xie, L. Dai, Jian Song, R. Zhao, Shiqi Gao, J. Qiu, Cuntao Yu
Background and Aim of the Study. The effects of sex on the prognosis of patients with acute type A aortic dissection (ATAAD) have still remained controversial. This study aimed to explore the sex differences in outcomes of ATAAD patients undergoing surgery. Methods. Data of patients with ATAAD who were operated in our center from 2010 to 2018 were retrospectively collected. Data on pre-, intra-, and postoperative courses were analyzed. Propensity score weighting was performed to balance the baseline characteristics. Multivariable logistic regression was used to assess predictors of early mortality in overall female and male patients. Results. A total of 1448 patients were enrolled, including 352 (24.3%) female patients and 1096 (75.7%) male patients. Females were significantly older than males (56.0 vs. 47.8 years, P < 0.001 ). Dissection was less extensive (Fuwai Ct: 85.8% vs. 91.3%, P = 0.003 ) and malperfusion syndrome was less frequently diagnosed (Penn Ab: 19.3% vs. 29.7%, P < 0.001 ) in females. Males experienced more aortic root replacement (Bentall: 14.2% vs. 24.9%, P < 0.001 ) and total arch replacement combined with frozen elephant trunk (56.8% vs. 75.8%, P < 0.001 ) with the prolonged operation time (6.1 vs. 6.4 hours, P = 0.001 ). In contrast, early mortality was higher in females (9.4% vs. 6.1%, P = 0.036 ). No differences were found in long-term survival and reoperation rates. After propensity score weighting, sex suggested no influence on both early and long-term outcomes. Cardiopulmonary bypass time was an independent risk factor for early mortality in both overall and sex-related populations according to the multivariable logistic regression. Conclusions. In ATAAD, different presentations and surgical strategies were noted in male and female patients. However, there were no significant differences in early and long-term outcomes between sexes after propensity score weighting.
研究背景和目的。性别对急性A型主动脉夹层(ATAAD)患者预后的影响仍存在争议。本研究旨在探讨ATAAD患者手术预后的性别差异。方法。回顾性收集2010 - 2018年在我中心手术的ATAAD患者资料。分析术前、术中和术后病程的数据。倾向得分加权来平衡基线特征。多变量逻辑回归用于评估女性和男性患者早期死亡率的预测因素。结果。共纳入1448例患者，其中女性352例(24.3%)，男性1096例(75.7%)。女性明显大于男性(56.0岁比47.8岁，P < 0.001)。女性夹层较少(Fuwai Ct: 85.8% vs. 91.3%， P = 0.003)，灌注不良综合征的诊断较少(Penn Ab: 19.3% vs. 29.7%， P < 0.001)。随着手术时间的延长(6.1小时比6.4小时，P = 0.001)，男性主动脉根部置换术(Bentall: 14.2%比24.9%，P < 0.001)和全弓置换术联合冷冻象鼻(56.8%比75.8%，P < 0.001)的发生率更高。相比之下，女性的早期死亡率更高(9.4%比6.1%，P = 0.036)。两组的长期生存率和再手术率均无差异。在倾向评分加权后，性别对早期和长期结果都没有影响。根据多变量logistic回归，体外循环时间是整体人群和性别相关人群早期死亡的独立危险因素。结论。在ATAAD中，男性和女性患者的表现和手术策略不同。然而，在倾向得分加权后，两性之间的早期和长期结果没有显著差异。
{"title":"Female Sex Is Not an Independent Risk Factor for Poor Prognosis of Patients with Acute Type A Aortic Dissection Undergoing Surgery","authors":"Chenyu Zhou, Jinlin Wu, E. Xie, L. Dai, Jian Song, R. Zhao, Shiqi Gao, J. Qiu, Cuntao Yu","doi":"10.1155/2023/8889261","DOIUrl":"https://doi.org/10.1155/2023/8889261","url":null,"abstract":"Background and Aim of the Study. The effects of sex on the prognosis of patients with acute type A aortic dissection (ATAAD) have still remained controversial. This study aimed to explore the sex differences in outcomes of ATAAD patients undergoing surgery. Methods. Data of patients with ATAAD who were operated in our center from 2010 to 2018 were retrospectively collected. Data on pre-, intra-, and postoperative courses were analyzed. Propensity score weighting was performed to balance the baseline characteristics. Multivariable logistic regression was used to assess predictors of early mortality in overall female and male patients. Results. A total of 1448 patients were enrolled, including 352 (24.3%) female patients and 1096 (75.7%) male patients. Females were significantly older than males (56.0 vs. 47.8 years, \u0000 \u0000 P\u0000 <\u0000 0.001\u0000 \u0000 ). Dissection was less extensive (Fuwai Ct: 85.8% vs. 91.3%, \u0000 \u0000 P\u0000 =\u0000 0.003\u0000 \u0000 ) and malperfusion syndrome was less frequently diagnosed (Penn Ab: 19.3% vs. 29.7%, \u0000 \u0000 P\u0000 <\u0000 0.001\u0000 \u0000 ) in females. Males experienced more aortic root replacement (Bentall: 14.2% vs. 24.9%, \u0000 \u0000 P\u0000 <\u0000 0.001\u0000 \u0000 ) and total arch replacement combined with frozen elephant trunk (56.8% vs. 75.8%, \u0000 \u0000 P\u0000 <\u0000 0.001\u0000 \u0000 ) with the prolonged operation time (6.1 vs. 6.4 hours, \u0000 \u0000 P\u0000 =\u0000 0.001\u0000 \u0000 ). In contrast, early mortality was higher in females (9.4% vs. 6.1%, \u0000 \u0000 P\u0000 =\u0000 0.036\u0000 \u0000 ). No differences were found in long-term survival and reoperation rates. After propensity score weighting, sex suggested no influence on both early and long-term outcomes. Cardiopulmonary bypass time was an independent risk factor for early mortality in both overall and sex-related populations according to the multivariable logistic regression. Conclusions. In ATAAD, different presentations and surgical strategies were noted in male and female patients. However, there were no significant differences in early and long-term outcomes between sexes after propensity score weighting.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48824844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Arnaout, Yaman Nerabani, Hassan Alhaj Ali, Mohamad Zaher Shahrour, M. Fallaha, I. Arnaout, Ahmad Sajee, Mohamad Morjan, Hussein Al-Kanj
Background. In the Norwood procedure, a conduit is performed either from the subclavian artery to the pulmonary artery, Blalock–Taussig shunt (mBTs), or from the right ventricle to the pulmonary artery (RV-PA shunt). There are some concerns regarding the two shunts and which one is better according to morbidity and mortality in patients with hypoplastic left heart syndrome or its variants. Methods. We systematically searched PubMed, Web of Science, Scopus, Embase, and Cochrane Library databases from inception to 04/June/2021 to collect articles reporting a comparison of RV-PA shunt and mBTs. Results. Our meta-analysis showed that the mortality rate after 6 months, 1, 2, 3, 4, 5, and 6 years for the mBTS group was 16.3%, 28.6%, 34.8%, 42.4%, 44.6%, 45.1%, and 39.6%, respectively, and for the RV-PAS, 14.8%, 26.6%, 31%, 40.1%, 36.1%, 37.5%, and 34.0%, respectively. The mortality rate was significantly higher in the mBTs group at 1 and 2 years; otherwise, there is no significance differences. Overall complications rate was higher in the mBTs group than in the RV-PAs group (17.8% vs. 8.5%). In contrast, the rate of cardiac complications was higher in the RV-PAS group. Conclusions. The RV-PA shunt had lower mortality and overall complications rate than mBT shunt at the short-term outcome within the first two years, but at the long term, there was no difference between the two shunts. On the other hand, the mBT shunt had a lower incidence of cardiac complications at the early stage after the operations. However, some studies are poor due to the difficulties in conducting original research in this field. Therefore, we recommend conducting systematic reviews and original studies to compare these and other therapeutic procedures for these patients.
背景。在Norwood手术中，从锁骨下动脉到肺动脉(blallock - taussig分流术，mBTs)或从右心室到肺动脉(RV-PA分流术)进行导管。根据左心发育不全综合征或其变体患者的发病率和死亡率，关于两种分流术以及哪一种分流术更好的问题存在一些担忧。方法。我们系统地检索了PubMed、Web of Science、Scopus、Embase和Cochrane Library数据库，从成立到2021年6月4日收集了报道RV-PA分流术和mbt比较的文章。结果。我们的荟萃分析显示，mBTS组在6个月、1、2、3、4、5和6年后的死亡率分别为16.3%、28.6%、34.8%、42.4%、44.6%、45.1%和39.6%，而RV-PAS组的死亡率分别为14.8%、26.6%、31%、40.1%、36.1%、37.5%和34.0%。mbt组在1年和2年时的死亡率显著高于对照组;否则，无显著性差异。mbt组的总并发症发生率高于RV-PAs组(17.8%比8.5%)。相反，RV-PAS组心脏并发症发生率较高。结论。RV-PA分流术在前两年的短期预后中死亡率和总并发症发生率低于mBT分流术，但在长期预后中，两种分流术之间没有差异。另一方面，mBT分流术术后早期心脏并发症发生率较低。然而，由于难以进行原创性研究，一些研究较差。因此，我们建议对这些患者进行系统评价和原始研究，以比较这些治疗方法和其他治疗方法。
{"title":"Mortality and Survival after Norwood Procedure Comparison between Shunt Type in Patients with Hypoplastic Left Heart Syndrome or Its Variants: A Systematic Review and Meta-Analysis Study","authors":"A. Arnaout, Yaman Nerabani, Hassan Alhaj Ali, Mohamad Zaher Shahrour, M. Fallaha, I. Arnaout, Ahmad Sajee, Mohamad Morjan, Hussein Al-Kanj","doi":"10.1155/2023/8534205","DOIUrl":"https://doi.org/10.1155/2023/8534205","url":null,"abstract":"Background. In the Norwood procedure, a conduit is performed either from the subclavian artery to the pulmonary artery, Blalock–Taussig shunt (mBTs), or from the right ventricle to the pulmonary artery (RV-PA shunt). There are some concerns regarding the two shunts and which one is better according to morbidity and mortality in patients with hypoplastic left heart syndrome or its variants. Methods. We systematically searched PubMed, Web of Science, Scopus, Embase, and Cochrane Library databases from inception to 04/June/2021 to collect articles reporting a comparison of RV-PA shunt and mBTs. Results. Our meta-analysis showed that the mortality rate after 6 months, 1, 2, 3, 4, 5, and 6 years for the mBTS group was 16.3%, 28.6%, 34.8%, 42.4%, 44.6%, 45.1%, and 39.6%, respectively, and for the RV-PAS, 14.8%, 26.6%, 31%, 40.1%, 36.1%, 37.5%, and 34.0%, respectively. The mortality rate was significantly higher in the mBTs group at 1 and 2 years; otherwise, there is no significance differences. Overall complications rate was higher in the mBTs group than in the RV-PAs group (17.8% vs. 8.5%). In contrast, the rate of cardiac complications was higher in the RV-PAS group. Conclusions. The RV-PA shunt had lower mortality and overall complications rate than mBT shunt at the short-term outcome within the first two years, but at the long term, there was no difference between the two shunts. On the other hand, the mBT shunt had a lower incidence of cardiac complications at the early stage after the operations. However, some studies are poor due to the difficulties in conducting original research in this field. Therefore, we recommend conducting systematic reviews and original studies to compare these and other therapeutic procedures for these patients.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42976913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective. The optimal cerebral protection strategy in acute type A aortic dissection (ATAAD) is still without a clear consensus. The purpose of this meta-analysis was to compare the outcome of different cerebral protection strategies on ATAAD patients. Materials and Methods. We conducted a systematic review including all studies concerning surgically managed ATAAD patients between 1.1.2010 and 28.2.2022 and reporting the use of cerebral protection strategies in three large databases (Pubmed, Cochrane library, and Scopus). The main outcome events were 30-day mortality and a postoperative stroke rate. The pooled event rates adjusted by age, gender, CPB duration, circulatory arrest duration, and total arch reconstruction rate were calculated. Results. Overall, 39 articles were included covering a total of 16, 876 ATAAD patients. The estimated adjusted pooled early mortality rate was 10.1% (95% confidence interval [CI] 9.1–11.3%) in the ACP group, 15.9% (13.3–18.9%) in the RCP group, and 11.6% (9.2–14.5%) in the HCA group. Compared to the RCP group, ACP and HCA demonstrated lower early mortality (RCP vs. ACP odds-ratio 1.66 [1.28–2.15], < 0.001; RCP vs. HCA odds-ratio 1.45 [1.02–2.07], = 0.039). The adjusted pooled stroke rate was 9.0% (8.3–9.8%) in the ACP group, 10.5% (9.3–11.7%) in the RCP group, and 9.1% (8.1–10.2%) in the HCA group. Conclusion. Early mortality might be more common in ATAAD patients treated with RCP compared to ACP and HCA. With regards to postoperative stroke, the results were inconclusive despite the trending inferiority of RCP compared to the other strategies.
目标。急性A型主动脉夹层(ATAAD)的最佳脑保护策略仍没有明确的共识。本荟萃分析的目的是比较不同脑保护策略对ATAAD患者的效果。材料与方法。我们对2010年1月1日至2022年2月28日期间所有手术治疗ATAAD患者的研究进行了系统回顾，并在三个大型数据库(Pubmed、Cochrane图书馆和Scopus)中报告了脑保护策略的使用情况。主要结局事件为30天死亡率和术后卒中发生率。计算按年龄、性别、CPB持续时间、循环停搏持续时间和总弓重建率调整的合并事件发生率。结果。总共纳入39篇文章，共16,876例ATAAD患者。校正后的合并早期死亡率在ACP组为10.1%(95%可信区间[CI] 9.1-11.3%)，在RCP组为15.9%(13.3-18.9%)，在HCA组为11.6%(9.2-14.5%)。与RCP组相比，ACP和HCA组的早期死亡率较低(RCP vs. ACP比值比1.66 [1.28-2.15]，p <0.001;RCP vs. HCA比值比1.45 [1.02-2.07]，p = 0.039)。ACP组调整合并脑卒中发生率为9.0% (8.3-9.8%)，RCP组为10.5% (9.3-11.7%)，HCA组为9.1%(8.1-10.2%)。结论。与ACP和HCA相比，RCP治疗的ATAAD患者早期死亡可能更常见。关于术后卒中，尽管RCP与其他策略相比有较低的趋势，但结果仍不确定。
{"title":"The Association of the Cerebral Protection Strategy with Early Mortality and Postoperative Stroke in Acute Type A Aortic Dissection: A Systematic Review and Meta-Analysis","authors":"Caius Mustonen, Mikko Uimonen","doi":"10.1155/2023/3975367","DOIUrl":"https://doi.org/10.1155/2023/3975367","url":null,"abstract":"Objective. The optimal cerebral protection strategy in acute type A aortic dissection (ATAAD) is still without a clear consensus. The purpose of this meta-analysis was to compare the outcome of different cerebral protection strategies on ATAAD patients. Materials and Methods. We conducted a systematic review including all studies concerning surgically managed ATAAD patients between 1.1.2010 and 28.2.2022 and reporting the use of cerebral protection strategies in three large databases (Pubmed, Cochrane library, and Scopus). The main outcome events were 30-day mortality and a postoperative stroke rate. The pooled event rates adjusted by age, gender, CPB duration, circulatory arrest duration, and total arch reconstruction rate were calculated. Results. Overall, 39 articles were included covering a total of 16, 876 ATAAD patients. The estimated adjusted pooled early mortality rate was 10.1% (95% confidence interval [CI] 9.1–11.3%) in the ACP group, 15.9% (13.3–18.9%) in the RCP group, and 11.6% (9.2–14.5%) in the HCA group. Compared to the RCP group, ACP and HCA demonstrated lower early mortality (RCP vs. ACP odds-ratio 1.66 [1.28–2.15], <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M1\"> <mi>p</mi> </math> < 0.001; RCP vs. HCA odds-ratio 1.45 [1.02–2.07], <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M2\"> <mi>p</mi> </math> = 0.039). The adjusted pooled stroke rate was 9.0% (8.3–9.8%) in the ACP group, 10.5% (9.3–11.7%) in the RCP group, and 9.1% (8.1–10.2%) in the HCA group. Conclusion. Early mortality might be more common in ATAAD patients treated with RCP compared to ACP and HCA. With regards to postoperative stroke, the results were inconclusive despite the trending inferiority of RCP compared to the other strategies.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135643222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Aim of the Study. To evaluate differences in left ventricular recovery after transapical transcatheter aortic valve implantation and conventional aortic valve replacement in patients with aortic regurgitation and reduced left ventricular ejection fraction. Methods. All patients with reduced left ventricular ejection fraction who underwent aortic valve surgery for AR at our institution between January 2015 and November 2021 were retrospectively reviewed. Generalized estimating equations were used to compare left ventricular recovery and remodeling outcomes between the patient groups. Results. A total of 87 cases were included in this study, 36 patients for TA-TAVI and 51 patients for C-AVR. Transapical transcatheter aortic valve implantation was associated with better and faster recovery of left ventricular ejection fraction and left ventricular end-diastolic dimension (adjusted β = 0.002, 95% CI: 0.000 to 0.003, and ; adjusted β = 0.330, 95% CI: 0.185 to 0.474, and , respectively) within the first 3 months postoperatively compared with left ventricular ejection fraction, with the same improvement in New York Heart Association function class (adjusted β = 0.381, 95% CI: −0.349 to 1.111, and ). Conclusions. This study highlights patients who underwent transapical transcatheter aortic valve implantation for aortic regurgitation with reduced left ventricular ejection fraction. However, future randomized controlled prospective clinical trials with longer follow-up durations are required.
{"title":"Left Ventricular Recovery after Transapical Transcatheter Aortic Valve Implantation Compared with Conventional Aortic Valve Replacement in Patients with Aortic Regurgitation and Reduced Ejection Fraction","authors":"Zhiqin Lin, Zheng Xu, Xiaofu Dai, Liangwan Chen","doi":"10.1155/2023/3691715","DOIUrl":"https://doi.org/10.1155/2023/3691715","url":null,"abstract":"Background and Aim of the Study. To evaluate differences in left ventricular recovery after transapical transcatheter aortic valve implantation and conventional aortic valve replacement in patients with aortic regurgitation and reduced left ventricular ejection fraction. Methods. All patients with reduced left ventricular ejection fraction who underwent aortic valve surgery for AR at our institution between January 2015 and November 2021 were retrospectively reviewed. Generalized estimating equations were used to compare left ventricular recovery and remodeling outcomes between the patient groups. Results. A total of 87 cases were included in this study, 36 patients for TA-TAVI and 51 patients for C-AVR. Transapical transcatheter aortic valve implantation was associated with better and faster recovery of left ventricular ejection fraction and left ventricular end-diastolic dimension (adjusted β = 0.002, 95% CI: 0.000 to 0.003, and <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M1\"> <mi>p</mi> <mo>=</mo> <mn>0.046</mn> </math> ; adjusted β = 0.330, 95% CI: 0.185 to 0.474, and <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M2\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> , respectively) within the first 3 months postoperatively compared with left ventricular ejection fraction, with the same improvement in New York Heart Association function class (adjusted β = 0.381, 95% CI: −0.349 to 1.111, and <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M3\"> <mi>p</mi> <mo>=</mo> <mn>0.306</mn> </math> ). Conclusions. This study highlights patients who underwent transapical transcatheter aortic valve implantation for aortic regurgitation with reduced left ventricular ejection fraction. However, future randomized controlled prospective clinical trials with longer follow-up durations are required.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135831769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nudge theory has influenced the behaviour of millions of individuals across the world; however, the potential power of this approach has yet to be fully utilised in the field of inpatient cardiac surgery. The nudge theory also presents multiple nonalert choice architecture modifications that may be employed. Choice architecture is already influencing decisions made in hospitals every day, whether it has been deliberately designed to promote beneficial behaviours or not. Decision making for cardiac surgery inpatients is already subject to inherent choice architectures, which may be amenable to nudges. The types of choices to which nudges may be employed in the inpatient surgical setting are numerous and may be relevant to medical officers, nursing staff, allied health staff, and patients. Through the strategic development and robust evaluation of choice architecture modification, using the principles of the nudge theory, further optimisation of cardiac surgery inpatient management may be achieved.
{"title":"Nudge Theory Can Be Used to Optimise Cardiac Surgery Inpatient Management","authors":"Aashray K. Gupta, J. Kovoor, S. Bacchi","doi":"10.1155/2023/7291773","DOIUrl":"https://doi.org/10.1155/2023/7291773","url":null,"abstract":"Nudge theory has influenced the behaviour of millions of individuals across the world; however, the potential power of this approach has yet to be fully utilised in the field of inpatient cardiac surgery. The nudge theory also presents multiple nonalert choice architecture modifications that may be employed. Choice architecture is already influencing decisions made in hospitals every day, whether it has been deliberately designed to promote beneficial behaviours or not. Decision making for cardiac surgery inpatients is already subject to inherent choice architectures, which may be amenable to nudges. The types of choices to which nudges may be employed in the inpatient surgical setting are numerous and may be relevant to medical officers, nursing staff, allied health staff, and patients. Through the strategic development and robust evaluation of choice architecture modification, using the principles of the nudge theory, further optimisation of cardiac surgery inpatient management may be achieved.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44559394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Chen, Dongxu Wang, Yuanchen He, M. Fang, P. Hou, Yiming Tan, Yu Liu, Yan Jin, Liming Yu, Yong Zhang
Objectives. To investigate the potential role of extracellular cold-inducible RNA-binding protein (CIRP) in total aortic arch replacement under hypothermic circulatory arrest. Methods. The serum extracellular CIRP levels at five time points in 96 patients with Stanford A aortic dissection were detected. Overall change trend of CIRP levels at five time points was described, and the risk factors for 30-day mortality after surgery were analyzed. Results. The serum extracellular CIRP levels increased gradually after surgery, starting to rise significantly at approximately 12 h postoperatively, reaching or approaching a peak at approximately 24 h postoperatively, and ceasing to rise significantly after approximately 48 h postoperatively. Age, troponin-I, urodilatin, cooling time, cardiopulmonary bypass time, cross-clamp time, duration of surgery, and CIRP level at the end of surgery in the death group were significantly higher than those in the survival group. Multivariable analysis indicated that CIRP level at the end of surgery, age, urodilatin, and cross-clamp time were independent risk factors for postoperative 30-day mortality. Conclusion. Extracellular CIRP is closely related to the perioperative condition and prognosis of hypothermic circulatory arrest.
{"title":"Potential Role of Extracellular CIRP in Total Aortic Arch Replacement under Hypothermic Circulatory Arrest","authors":"K. Chen, Dongxu Wang, Yuanchen He, M. Fang, P. Hou, Yiming Tan, Yu Liu, Yan Jin, Liming Yu, Yong Zhang","doi":"10.1155/2023/6178343","DOIUrl":"https://doi.org/10.1155/2023/6178343","url":null,"abstract":"Objectives. To investigate the potential role of extracellular cold-inducible RNA-binding protein (CIRP) in total aortic arch replacement under hypothermic circulatory arrest. Methods. The serum extracellular CIRP levels at five time points in 96 patients with Stanford A aortic dissection were detected. Overall change trend of CIRP levels at five time points was described, and the risk factors for 30-day mortality after surgery were analyzed. Results. The serum extracellular CIRP levels increased gradually after surgery, starting to rise significantly at approximately 12 h postoperatively, reaching or approaching a peak at approximately 24 h postoperatively, and ceasing to rise significantly after approximately 48 h postoperatively. Age, troponin-I, urodilatin, cooling time, cardiopulmonary bypass time, cross-clamp time, duration of surgery, and CIRP level at the end of surgery in the death group were significantly higher than those in the survival group. Multivariable analysis indicated that CIRP level at the end of surgery, age, urodilatin, and cross-clamp time were independent risk factors for postoperative 30-day mortality. Conclusion. Extracellular CIRP is closely related to the perioperative condition and prognosis of hypothermic circulatory arrest.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41568122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives. The tricuspid anterior leaflet is considered important in most repair techniques for Ebstein anomaly (EA). We aim to assess the anterior leaflet morphology using novel metrics and investigate the association of the morphology with recurrent moderately severe or greater tricuspid regurgitation (TR). Methods. Seventy-four paediatric patients with EA undergoing cone reconstruction (CR) between 2010 and 2021 were included. Anterior leaflet mobility (ALM) and anterior leaflet length (ALL) were remeasured on preoperative 2D echocardiography. The prediction accuracies of ALM and ALL-I (ALL indexed to body surface area) for recurrent TR were evaluated using receiver operating characteristic (ROC) curve analyses. Results. The median age of patients was 3.3 years (interquartile range, 1.9–7.1 years). Both ALM and ALL-I correlated with the Carpentier type and GOSH score. Nine patients (12.2%) developed recurrent TR during the one-year follow-up. By univariable logistic regression analyses, ALM (odds ratio [OR], 0.89; 95% CI [confidence interval], 0.82–0.96; p = 0.003) and ALL-I (OR, 1.39; 95% CI, 1.08–1.78; p = 0.011) were risk factors for recurrent TR. ROC curve analyses showed that ALM (AUC = 0.81) and ALL-I (AUC = 0.77) had better predictive performance for recurrent TR compared with the GOSH score (AUC = 0.68), the Carpentier type (AUC = 0.67), and preoperative TR severity (AUC = 0.58), and the combinations of ALM and ALL-I (AUC = 0.87) improved the predictive performance compared with ALM or ALL-I alone. Conclusions. ALM and ALL-I can help optimize evaluation in the anterior leaflet morphology and predict recurrent TR after CR in pediatric EA.
{"title":"Novel Echocardiographic Metrics Predict Tricuspid Insufficiency in Pediatric Ebstein Anomaly","authors":"Wei Liu, Chen Wen, Shentu Jin, Yuqi Zhang, Zhongqun Zhu, Lijun Chen, Huiwen Chen","doi":"10.1155/2023/7796087","DOIUrl":"https://doi.org/10.1155/2023/7796087","url":null,"abstract":"Objectives. The tricuspid anterior leaflet is considered important in most repair techniques for Ebstein anomaly (EA). We aim to assess the anterior leaflet morphology using novel metrics and investigate the association of the morphology with recurrent moderately severe or greater tricuspid regurgitation (TR). Methods. Seventy-four paediatric patients with EA undergoing cone reconstruction (CR) between 2010 and 2021 were included. Anterior leaflet mobility (ALM) and anterior leaflet length (ALL) were remeasured on preoperative 2D echocardiography. The prediction accuracies of ALM and ALL-I (ALL indexed to body surface area) for recurrent TR were evaluated using receiver operating characteristic (ROC) curve analyses. Results. The median age of patients was 3.3 years (interquartile range, 1.9–7.1 years). Both ALM and ALL-I correlated with the Carpentier type and GOSH score. Nine patients (12.2%) developed recurrent TR during the one-year follow-up. By univariable logistic regression analyses, ALM (odds ratio [OR], 0.89; 95% CI [confidence interval], 0.82–0.96; \u0000 \u0000 p\u0000 \u0000 = 0.003) and ALL-I (OR, 1.39; 95% CI, 1.08–1.78; \u0000 \u0000 p\u0000 \u0000 = 0.011) were risk factors for recurrent TR. ROC curve analyses showed that ALM (AUC = 0.81) and ALL-I (AUC = 0.77) had better predictive performance for recurrent TR compared with the GOSH score (AUC = 0.68), the Carpentier type (AUC = 0.67), and preoperative TR severity (AUC = 0.58), and the combinations of ALM and ALL-I (AUC = 0.87) improved the predictive performance compared with ALM or ALL-I alone. Conclusions. ALM and ALL-I can help optimize evaluation in the anterior leaflet morphology and predict recurrent TR after CR in pediatric EA.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49452918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Curry Sherard, Savannah Skidmore, K. Shorbaji, B. Welch, K. Bhandari, A. Kilic
Objectives. Heart transplantation (HT) is a definitive therapy for refractory heart failure, making it the gold-standard treatment for recipients with end-stage disease. Heart allocation policy (HAP) in the United States was changed on October 18th, 2018. The aim of this study was to assess the effect of the new policy on racial disparities in heart transplantation (HT) outcomes. Methods. The United Network for Organ Sharing (UNOS) registry was used to identify adult recipients undergoing isolated HT between 2010 and 2021. Recipients were stratified into pre-HAP (January 2010 to September 2018) vs. post-HAP (October 2018 to September 2021). Recipient race was classified as White, Black, Hispanic, or other. The primary outcome was post-HT mortality. Cox proportional hazard models were used for risk-adjustment in evaluating the independent effect of race on post-HT mortality. Results. A total of 27,403 recipients underwent HT in 143 centers during study period. The proportion of non-Whites undergoing HT increased in the post-HAP era: (pre-HAP: White 66.0%, Black 21.2%, Hispanic 8.2%, Other 4.6% versus post-HAP: White 62.5%, Black 23.2%, Hispanic 9.5%, Other 4.8%; p < 0.001 ). In risk-adjusted analysis, Black recipients were at higher risk of post-HT mortality in the pre-HAP era (HR 1.31, 95% CI 1.22–1.41; p < 0.001 ) but not in the post-HAP era (HR 1.12, 95% CI 0.03–1.34; p = 0.222 ) compared to White recipients. Other non-White recipients had comparable risk-adjusted post-HT mortality rates compared to White recipients both in the pre-HAP and post-HAP eras. Conclusions. Under the new heart allocation system, a higher percentage of recipients are non-White. In addition, racial disparities in HT outcomes have improved with Black recipients no longer having an increased risk-adjusted mortality following HT.
{"title":"Improvement in Racial Disparities in Heart Transplantation following the Heart Allocation Policy Change","authors":"Curry Sherard, Savannah Skidmore, K. Shorbaji, B. Welch, K. Bhandari, A. Kilic","doi":"10.1155/2023/5061721","DOIUrl":"https://doi.org/10.1155/2023/5061721","url":null,"abstract":"Objectives. Heart transplantation (HT) is a definitive therapy for refractory heart failure, making it the gold-standard treatment for recipients with end-stage disease. Heart allocation policy (HAP) in the United States was changed on October 18th, 2018. The aim of this study was to assess the effect of the new policy on racial disparities in heart transplantation (HT) outcomes. Methods. The United Network for Organ Sharing (UNOS) registry was used to identify adult recipients undergoing isolated HT between 2010 and 2021. Recipients were stratified into pre-HAP (January 2010 to September 2018) vs. post-HAP (October 2018 to September 2021). Recipient race was classified as White, Black, Hispanic, or other. The primary outcome was post-HT mortality. Cox proportional hazard models were used for risk-adjustment in evaluating the independent effect of race on post-HT mortality. Results. A total of 27,403 recipients underwent HT in 143 centers during study period. The proportion of non-Whites undergoing HT increased in the post-HAP era: (pre-HAP: White 66.0%, Black 21.2%, Hispanic 8.2%, Other 4.6% versus post-HAP: White 62.5%, Black 23.2%, Hispanic 9.5%, Other 4.8%; \u0000 \u0000 p\u0000 <\u0000 0.001\u0000 \u0000 ). In risk-adjusted analysis, Black recipients were at higher risk of post-HT mortality in the pre-HAP era (HR 1.31, 95% CI 1.22–1.41; \u0000 \u0000 p\u0000 <\u0000 0.001\u0000 \u0000 ) but not in the post-HAP era (HR 1.12, 95% CI 0.03–1.34; \u0000 \u0000 p\u0000 =\u0000 0.222\u0000 \u0000 ) compared to White recipients. Other non-White recipients had comparable risk-adjusted post-HT mortality rates compared to White recipients both in the pre-HAP and post-HAP eras. Conclusions. Under the new heart allocation system, a higher percentage of recipients are non-White. In addition, racial disparities in HT outcomes have improved with Black recipients no longer having an increased risk-adjusted mortality following HT.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48837199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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