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Conduction Disturbances and Outcome After Surgical Aortic Valve Replacement in Patients With Bicuspid and Tricuspid Aortic Stenosis. 二尖瓣和三尖瓣主动脉瓣狭窄患者手术主动脉瓣置换术后的传导障碍和预后。
IF 37.8 3区 工程技术 Q2 ENERGY & FUELS Pub Date : 2024-10-23 DOI: 10.1161/circulationaha.124.070753
Johan O Wedin,Viktor Näslund,Sergey Rodin,Oscar E Simonson,Frank A Flachskampf,Stefan K James,Elisabeth Ståhle,Karl-Henrik Grinnemo
BACKGROUNDThis study aimed to compare the incidence and prognostic implications of new-onset conduction disturbances after surgical aortic valve replacement (SAVR) in patients with bicuspid aortic valve (BAV) aortic stenosis (AS) versus patients with tricuspid aortic valve (TAV) AS (ie, BAV-AS and TAV-AS, respectively). Additionally, the study included stratification of BAV patients according to subtype.METHODSIn this cohort study, the incidence of postoperative third-degree atrioventricular (AV) block with subsequent permanent pacemaker requirement and new-onset left bundle-branch block (LBBB) was investigated in 1147 consecutive patients without preoperative conduction disorder who underwent isolated SAVR (with or without ascending aortic surgery) between January 1, 2005, and December 31, 2022. The groups were stratified by aortic valve morphology (BAV, n=589; TAV, n=558). The outcomes of interests were new-onset third-degree AV block or new-onset LBBB during the index hospitalization. The impact of new-onset postoperative conduction disturbances on survival was investigated in BAV-AS and TAV-AS patients during a median follow-up of 8.2 years. BAV morphology was further categorized according to the Sievers and Schmidtke classification system (possible in 307 BAV-AS patients) to explore association between BAV subtypes and new-onset conduction disturbances after SAVR.RESULTSThe overall incidence of third-degree AV block and new-onset LBBB after SAVR was 4.5% and 7.8%, respectively. BAV-AS patients had a higher incidence of both new-onset third-degree AV block (6.5% versus 2.5%; P=0.001) and new-onset LBBB (9.7% versus 5.7%; P=0.013) compared with TAV-AS patients. New-onset LBBB was associated with an increased all-cause mortality during follow-up (adjusted hazard ratio, 1.60 [95% CI, 1.12-2.30]; P=0.011), whereas new-onset third-degree AV block was not associated with worse prognosis. Subgroup analysis of the BAV cohort revealed that BAV-AS patients with fusion of the right- and non-coronary cusps had the highest risk of new-onset third-degree AV block (adjusted odds ratio [aOR], 8.33 [95% CI, 3.31-20.97]; P<0.001, with TAV as reference group) and new-onset LBBB (aOR, 4.03 [95% CI, 1.84-8.82]; P<0.001, with TAV as reference group), whereas no significant association was observed for the other BAV subtypes.CONCLUSIONSNew-onset LBBB after SAVR is associated with increased all-cause mortality during follow-up, and is more frequent complication in BAV AS patients compared with TAV-AS patients. BAV-AS patients with fusion of the right- and non-coronary cusps have an increased risk for conduction disturbances after SAVR. This should be taken into consideration when managing these patients.
背景本研究旨在比较双尖瓣主动脉瓣狭窄(BAV)患者与三尖瓣主动脉瓣狭窄(TAV)患者(即分别为 BAV-AS 和 TAV-AS)在主动脉瓣置换术(SAVR)后新发传导障碍的发生率和预后影响。在这项队列研究中,研究人员调查了 2005 年 1 月 1 日至 2022 年 12 月 31 日期间接受孤立 SAVR(无论是否进行升主动脉手术)的 1147 名连续患者术前无传导障碍,术后出现三度房室(AV)传导阻滞并随后需要永久起搏器和新发左束支传导阻滞(LBBB)的发生率。各组按主动脉瓣形态分层(BAV,589 人;TAV,558 人)。关注的结果是在指数住院期间新发的三度房室传导阻滞或新发的 LBBB。在中位随访 8.2 年期间,研究人员调查了 BAV-AS 和 TAV-AS 患者术后新发传导障碍对存活率的影响。结果SAVR术后三度房室传导阻滞和新发LBBB的总发生率分别为4.5%和7.8%。与TAV-AS患者相比,BAV-AS患者新发三度房室传导阻滞(6.5%对2.5%;P=0.001)和新发LBBB(9.7%对5.7%;P=0.013)的发生率更高。新发 LBBB 与随访期间全因死亡率增加有关(调整后危险比为 1.60 [95% CI, 1.12-2.30];P=0.011),而新发三度房室传导阻滞与预后恶化无关。BAV 队列的亚组分析显示,右心尖和非心尖融合的 BAV-AS 患者发生新发三度房室传导阻滞的风险最高(调整后比值比 [aOR],8.33 [95% CI,3.31-20.97];P<0.001,以 TAV 为参照组),新发 LBBB 的风险也最高(aOR,4.03 [95% CI,1.84-8.82];P<0.001,以 TAV 为参照组)。结论SAVR术后新发LBBB与随访期间全因死亡率增加有关,与TAV-AS患者相比,LBBB是BAV AS患者更常见的并发症。右心尖和非心尖融合的 BAV-AS 患者在 SAVR 术后出现传导障碍的风险更高。在管理这些患者时应考虑到这一点。
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引用次数: 0
Against Odds of Prolonged Warm Ischemia: Early Experience With DCD Heart Transplantation After 20-Minute No-Touch Period. 与长期温缺血的几率相反:20 分钟无接触期后 DCD 心脏移植的早期经验。
IF 35.5 3区 工程技术 Q2 ENERGY & FUELS Pub Date : 2024-10-22 Epub Date: 2024-10-21 DOI: 10.1161/CIRCULATIONAHA.124.071239
Gino Gerosa, Giovanni Battista Luciani, Nicola Pradegan, Vincenzo Tarzia, Tea Lena, Paolo Zanatta, Demetrio Pittarello, Francesco Onorati, Antonella Galeone, Leonardo Gottin, Massimo Boffini, Marinella Zanierato, Matteo Marro, Sofia Martin Suarez, Luca Botta, Paola Lilla Della Monica, Mariano Feccia, Guido Maria Olivieri, Amedeo Terzi, Alessandra Oliveti, Giuseppe Feltrin, Massimo Cardillo, Claudio Francesco Russo, Davide Pacini, Mauro Rinaldi
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引用次数: 0
Bleeding After Cardiovascular Surgery: A Continuing Problem. 心血管手术后出血:一个持续存在的问题
IF 35.5 3区 工程技术 Q2 ENERGY & FUELS Pub Date : 2024-10-22 Epub Date: 2024-10-21 DOI: 10.1161/CIRCULATIONAHA.124.071147
Frank W Sellke
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引用次数: 0
Introduction to the 2024 Cardiovascular Surgery-Themed Issue of Circulation. 介绍以心血管外科为主题的 2024 年《循环》期刊。
IF 35.5 3区 工程技术 Q2 ENERGY & FUELS Pub Date : 2024-10-22 Epub Date: 2024-10-21 DOI: 10.1161/CIRCULATIONAHA.124.072090
Marc Ruel, James de Lemos, Michael Fischbein, Joseph A Hill
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引用次数: 0
Progressive Understanding of Aortic Disease. 逐步了解主动脉疾病。
IF 35.5 3区 工程技术 Q2 ENERGY & FUELS Pub Date : 2024-10-22 Epub Date: 2024-10-21 DOI: 10.1161/CIRCULATIONAHA.124.070477
Tara M Mastracci, Stéphan Haulon
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引用次数: 0
Multicenter Study on Physician-Modified Endografts for Thoracoabdominal and Complex Abdominal Aortic Aneurysm Repair. 关于胸腹和复杂腹主动脉瘤修复的医生改良内移植物的多中心研究。
IF 35.5 3区 工程技术 Q2 ENERGY & FUELS Pub Date : 2024-10-22 Epub Date: 2024-07-11 DOI: 10.1161/CIRCULATIONAHA.123.068587
Nikolaos Tsilimparis, Ryan Gouveia E Melo, Emanuel R Tenorio, Salvatore Scali, Bernardo Mendes, Sukgu Han, Marc Schermerhorn, Donald J Adam, Mahmoud B Malas, Mark Farber, Tilo Kölbel, Benjamin Starnes, George Joseph, Daniela Branzan, Frederic Cochennec, Carlos Timaran, Luca Bertoglio, Enrico Cieri, Luís Mendes Pedro, Fabio Verzini, Adam W Beck, Jesse Chait, Alyssa Pyun, Gregory A Magee, Nicholas Swerdlow, Maciej Juszczak, Andrew Barleben, Rohini Patel, Vivian C Gomes, Giuseppe Panuccio, Matthew P Sweet, Sara L Zettervall, Jean-Pierre Becquemin, Jennifer Canonge, Jésus Porras-Colón, Marina Dias-Neto, Antonino Giordano, Gustavo S Oderich

Background: Physician modified endografts (PMEGs) have been widely used in the treatment of complex abdominal aortic aneurysm and thoracoabdominal aortic aneurysm, however, previous data are limited to small single center studies and robust data on safety and effectiveness of PMEGs are lacking. We aimed to perform an international multicenter study analyzing the outcomes of PMEGs in complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms.

Methods: An international multicenter single-arm cohort study was performed analyzing the outcomes of PMEGs in the treatment of elective, symptomatic, and ruptured complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms. Variables and outcomes were defined according to the Society for Vascular Surgery reporting standards. Device modification and procedure details were collected and analyzed. Efficacy outcomes included technical success and safety outcomes included major adverse events and 30-day mortality. Follow-up outcomes included reinterventions, endoleaks, target vessel patency rates and overall and aortic-related mortality. Multivariable analysis was performed aiming at identifying predictors of technical success, 30-day mortality, and major adverse events.

Results: Overall, 1274 patients were included in the study from 19 centers. Median age was 74 (IQR, 68-79), and 75.7% were men; 45.7% were complex abdominal aortic aneurysms, and 54.3% were thoracoabdominal aortic aneurysms; 65.5% patients presented electively, 24.6% were symptomatic, and 9.9% were ruptured. Most patients (83.1%) were submitted to a fenestrated repair, 3.6% to branched repair, and 13.4% to a combined fenestrated and branched repair. Most patients (85.8%) had ≥3 target vessels included. The overall technical success was 94% (94% in elective, 93.4% in symptomatic, and 95.1% in ruptured cases). Thirty-day mortality was 5.8% (4.1% in elective, 7.6% in symptomatic, and 12.7% in ruptured aneurysms). Major adverse events occurred in 25.2% of cases (23.1% in elective, 27.8% in symptomatic, and 30.3% in ruptured aneurysms). Median follow-up was 21 months (5.6-50.6). Freedom from reintervention was 73.8%, 61.8%, and 51.4% at 1, 3, and 5 years; primary target vessel patency was 96.9%, 93.6%, and 90.3%. Overall survival and freedom from aortic-related mortality was 82.4%/92.9%, 69.9%/91.6%, and 55.0%/89.1% at 1, 3, and 5 years.

Conclusions: PMEGs were a safe and effective treatment option for elective, symptomatic, and ruptured complex aortic aneurysms. Long-term data and future prospective studies are needed for more robust and detailed analysis.

背景:医生改良内植物(PMEGs)已被广泛用于复杂腹主动脉瘤和胸腹主动脉瘤的治疗,然而,以往的数据仅限于小型单中心研究,缺乏有关PMEGs安全性和有效性的可靠数据。我们旨在开展一项国际多中心研究,分析 PMEGs 在复杂腹主动脉瘤和胸腹主动脉瘤中的疗效:一项国际多中心单臂队列研究分析了PMEGs治疗择期、无症状和破裂的复杂腹主动脉瘤和胸腹主动脉瘤的疗效。变量和结果根据血管外科学会的报告标准进行定义。收集并分析了设备改造和手术细节。疗效结果包括技术成功率,安全性结果包括主要不良事件和30天死亡率。随访结果包括再介入、内膜渗漏、靶血管通畅率以及总死亡率和主动脉相关死亡率。进行了多变量分析,旨在确定技术成功率、30 天死亡率和主要不良事件的预测因素:共有来自19个中心的1274名患者参与了研究。中位年龄为 74 岁(IQR,68-79),75.7% 为男性;45.7% 为复杂性腹主动脉瘤,54.3% 为胸腹主动脉瘤;65.5% 的患者为择期手术,24.6% 为无症状,9.9% 为破裂。大多数患者(83.1%)接受了栅栏式修补术,3.6%接受了分支式修补术,13.4%接受了栅栏式和分支式联合修补术。大多数患者(85.8%)的目标血管≥3根。总体技术成功率为94%(94%为择期手术,93.4%为无症状手术,95.1%为破裂手术)。30天死亡率为5.8%(选择性4.1%,无症状7.6%,破裂动脉瘤12.7%)。25.2%的病例发生了重大不良事件(23.1%为选择性,27.8%为无症状,30.3%为动脉瘤破裂)。中位随访时间为 21 个月(5.6-50.6 个月)。1年、3年和5年内,无再介入的比例分别为73.8%、61.8%和51.4%;主要靶血管通畅率分别为96.9%、93.6%和90.3%。1年、3年和5年的总生存率和无主动脉相关死亡率分别为82.4%/92.9%、69.9%/91.6%和55.0%/89.1%:PMEG是治疗择期、无症状和破裂的复杂主动脉瘤的一种安全有效的方法。需要长期数据和未来的前瞻性研究来进行更可靠、更详细的分析。
{"title":"Multicenter Study on Physician-Modified Endografts for Thoracoabdominal and Complex Abdominal Aortic Aneurysm Repair.","authors":"Nikolaos Tsilimparis, Ryan Gouveia E Melo, Emanuel R Tenorio, Salvatore Scali, Bernardo Mendes, Sukgu Han, Marc Schermerhorn, Donald J Adam, Mahmoud B Malas, Mark Farber, Tilo Kölbel, Benjamin Starnes, George Joseph, Daniela Branzan, Frederic Cochennec, Carlos Timaran, Luca Bertoglio, Enrico Cieri, Luís Mendes Pedro, Fabio Verzini, Adam W Beck, Jesse Chait, Alyssa Pyun, Gregory A Magee, Nicholas Swerdlow, Maciej Juszczak, Andrew Barleben, Rohini Patel, Vivian C Gomes, Giuseppe Panuccio, Matthew P Sweet, Sara L Zettervall, Jean-Pierre Becquemin, Jennifer Canonge, Jésus Porras-Colón, Marina Dias-Neto, Antonino Giordano, Gustavo S Oderich","doi":"10.1161/CIRCULATIONAHA.123.068587","DOIUrl":"10.1161/CIRCULATIONAHA.123.068587","url":null,"abstract":"<p><strong>Background: </strong>Physician modified endografts (PMEGs) have been widely used in the treatment of complex abdominal aortic aneurysm and thoracoabdominal aortic aneurysm, however, previous data are limited to small single center studies and robust data on safety and effectiveness of PMEGs are lacking. We aimed to perform an international multicenter study analyzing the outcomes of PMEGs in complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms.</p><p><strong>Methods: </strong>An international multicenter single-arm cohort study was performed analyzing the outcomes of PMEGs in the treatment of elective, symptomatic, and ruptured complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms. Variables and outcomes were defined according to the Society for Vascular Surgery reporting standards. Device modification and procedure details were collected and analyzed. Efficacy outcomes included technical success and safety outcomes included major adverse events and 30-day mortality. Follow-up outcomes included reinterventions, endoleaks, target vessel patency rates and overall and aortic-related mortality. Multivariable analysis was performed aiming at identifying predictors of technical success, 30-day mortality, and major adverse events.</p><p><strong>Results: </strong>Overall, 1274 patients were included in the study from 19 centers. Median age was 74 (IQR, 68-79), and 75.7% were men; 45.7% were complex abdominal aortic aneurysms, and 54.3% were thoracoabdominal aortic aneurysms; 65.5% patients presented electively, 24.6% were symptomatic, and 9.9% were ruptured. Most patients (83.1%) were submitted to a fenestrated repair, 3.6% to branched repair, and 13.4% to a combined fenestrated and branched repair. Most patients (85.8%) had ≥3 target vessels included. The overall technical success was 94% (94% in elective, 93.4% in symptomatic, and 95.1% in ruptured cases). Thirty-day mortality was 5.8% (4.1% in elective, 7.6% in symptomatic, and 12.7% in ruptured aneurysms). Major adverse events occurred in 25.2% of cases (23.1% in elective, 27.8% in symptomatic, and 30.3% in ruptured aneurysms). Median follow-up was 21 months (5.6-50.6). Freedom from reintervention was 73.8%, 61.8%, and 51.4% at 1, 3, and 5 years; primary target vessel patency was 96.9%, 93.6%, and 90.3%. Overall survival and freedom from aortic-related mortality was 82.4%/92.9%, 69.9%/91.6%, and 55.0%/89.1% at 1, 3, and 5 years.</p><p><strong>Conclusions: </strong>PMEGs were a safe and effective treatment option for elective, symptomatic, and ruptured complex aortic aneurysms. Long-term data and future prospective studies are needed for more robust and detailed analysis.</p>","PeriodicalId":35,"journal":{"name":"Energy & Fuels","volume":" ","pages":"1327-1342"},"PeriodicalIF":35.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"工程技术","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Partial Heart Transplantation. 部分心脏移植
IF 35.5 3区 工程技术 Q2 ENERGY & FUELS Pub Date : 2024-10-22 Epub Date: 2024-10-21 DOI: 10.1161/CIRCULATIONAHA.124.071498
Taufiek K Rajab, Alekhya Mitta, Brian L Reemtsen
{"title":"Partial Heart Transplantation.","authors":"Taufiek K Rajab, Alekhya Mitta, Brian L Reemtsen","doi":"10.1161/CIRCULATIONAHA.124.071498","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.071498","url":null,"abstract":"","PeriodicalId":35,"journal":{"name":"Energy & Fuels","volume":"150 17","pages":"1313-1314"},"PeriodicalIF":35.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"工程技术","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Long-Term Outcomes After Septal Reduction Therapies in Obstructive Hypertrophic Cardiomyopathy: Insights From the SHARE Registry. 阻塞性肥厚型心肌病的室间隔缩窄疗法后的长期疗效:SHARE 登记的启示。
IF 35.5 3区 工程技术 Q2 ENERGY & FUELS Pub Date : 2024-10-22 Epub Date: 2024-10-02 DOI: 10.1161/CIRCULATIONAHA.124.069378
Niccolò Maurizi, Panagiotis Antiochos, Anjali Owens, Neal Lakdwala, Sara Saberi, Mark W Russell, Carlo Fumagalli, Ioannis Skalidis, Kimberly Y Lin, Ashwin S Nathan, Alejandro De Feria Alsina, Nosheen Reza, John C Stendahl, Dominic Abrams, Christopher Semsarian, Brian Clagget, Rachel Lampert, Matthew Wheeler, Victoria N Parikh, Euan Ashley, Michelle Michels, Joseph Rossano, Thomas D Ryan, Jodie Ingles, James Ware, Carolyn Y Ho, Adam S Helms, Sharlene M Day, Iacopo Olivotto

Background: Septal reduction therapy (SRT) provides substantial symptomatic improvement in patients with obstructive hypertrophic cardiomyopathy (HCM). However, long-term disease course after SRT and predictors of adverse outcomes have not been systematically examined.

Methods: Data from 13 high clinical volume HCM centers from the international SHARE (Sarcomeric Human Cardiomyopathy Registry) were analyzed. Patients were followed from the time of SRT until last follow-up or occurrence of heart failure (HF) composite outcome (cardiac transplantation, implantation of a left ventricular assist device, left ventricular ejection fraction <35%, development of New York Heart Association class III or IV symptoms), ventricular arrhythmias composite outcome (sudden cardiac death, resuscitated cardiac arrest, or appropriate implantable cardioverter defibrillator therapy), or HCM-related death. Cox proportional hazards models were used to identify predictors of outcome.

Results: Of the 10 225 patients in SHARE, 1832 (18%; 968 [53%] male) underwent SRT, including 455 (25%) with alcohol septal ablation and 1377 (75%) with septal myectomy. The periprocedural 30-day mortality rate was 0.4% (8 of 1832) and 1499 of 1565 (92%) had a maximal left ventricular outflow tract gradient <50 mm Hg at 1 year. After 6.8 years (range, 3.4-9.8 years; 12 565 person-years) from SRT, 77 (4%) experienced HCM-related death (0.6% per year), 236 (13%) a composite HF outcome (1.9% per year), and 87 (5%) a composite ventricular arrhythmia outcome (0.7% per year). Among adults, older age at SRT was associated with a higher incidence of HCM death (hazard ratio, 1.22 [95 CI, 1.1-1.3]; P<0.01) and the HF composite (hazard ratio, 1.14 [95 CI, 1.1-1.2] per 5-year increase; P<0.01) in a multivariable model. Female patients also had a higher risk of the HF composite after SRT (hazard ratio, 1.4 [95 CI, 1.1-1.8]; P<0.01). De novo atrial fibrillation occurred after SRT in 387 patients (21%). Among pediatric patients followed for a median of 13 years after SRT, 26 of 343 (16%) developed the HF composite outcome, despite 96% being free of recurrent left ventricular outflow tract obstruction.

Conclusions: Successful short- and long-term relief of outflow tract obstruction was observed in experienced multidisciplinary HCM centers. A subset of patients progressed to develop HF, but event-free survival at 10 years was 83% and ventricular arrhythmias were rare. Older age, female sex, and SRT during childhood were associated with a greater risk of developing HF.

背景:室间隔减容疗法(SRT)可显著改善梗阻性肥厚型心肌病(HCM)患者的症状。然而,SRT 后的长期病程和不良后果的预测因素尚未得到系统研究:方法:分析了来自 13 个临床量大的 HCM 中心的数据,这些中心来自国际 SHARE(肉瘤人类心肌病注册中心)。患者从接受 SRT 治疗开始随访,直至最后一次随访或出现心力衰竭(HF)综合结果(心脏移植、植入左室辅助装置、左室射血分数):在10 225名SHARE患者中,1832名(18%;968名[53%]男性)接受了SRT,其中455名(25%)接受了酒精室间隔消融术,1377名(75%)接受了室间隔肌肉切除术。围手术期 30 天的死亡率为 0.4%(1832 人中有 8 人),1565 人中有 1499 人(92%)的左室流出道梯度达到最大值:在经验丰富的多学科 HCM 中心,流出道阻塞得到了短期和长期的成功缓解。一部分患者发展为 HF,但 10 年的无事件生存率为 83%,室性心律失常很少发生。高龄、女性和儿童期接受 SRT 与罹患心房颤动的风险较高有关。
{"title":"Long-Term Outcomes After Septal Reduction Therapies in Obstructive Hypertrophic Cardiomyopathy: Insights From the SHARE Registry.","authors":"Niccolò Maurizi, Panagiotis Antiochos, Anjali Owens, Neal Lakdwala, Sara Saberi, Mark W Russell, Carlo Fumagalli, Ioannis Skalidis, Kimberly Y Lin, Ashwin S Nathan, Alejandro De Feria Alsina, Nosheen Reza, John C Stendahl, Dominic Abrams, Christopher Semsarian, Brian Clagget, Rachel Lampert, Matthew Wheeler, Victoria N Parikh, Euan Ashley, Michelle Michels, Joseph Rossano, Thomas D Ryan, Jodie Ingles, James Ware, Carolyn Y Ho, Adam S Helms, Sharlene M Day, Iacopo Olivotto","doi":"10.1161/CIRCULATIONAHA.124.069378","DOIUrl":"10.1161/CIRCULATIONAHA.124.069378","url":null,"abstract":"<p><strong>Background: </strong>Septal reduction therapy (SRT) provides substantial symptomatic improvement in patients with obstructive hypertrophic cardiomyopathy (HCM). However, long-term disease course after SRT and predictors of adverse outcomes have not been systematically examined.</p><p><strong>Methods: </strong>Data from 13 high clinical volume HCM centers from the international SHARE (Sarcomeric Human Cardiomyopathy Registry) were analyzed. Patients were followed from the time of SRT until last follow-up or occurrence of heart failure (HF) composite outcome (cardiac transplantation, implantation of a left ventricular assist device, left ventricular ejection fraction <35%, development of New York Heart Association class III or IV symptoms), ventricular arrhythmias composite outcome (sudden cardiac death, resuscitated cardiac arrest, or appropriate implantable cardioverter defibrillator therapy), or HCM-related death. Cox proportional hazards models were used to identify predictors of outcome.</p><p><strong>Results: </strong>Of the 10 225 patients in SHARE, 1832 (18%; 968 [53%] male) underwent SRT, including 455 (25%) with alcohol septal ablation and 1377 (75%) with septal myectomy. The periprocedural 30-day mortality rate was 0.4% (8 of 1832) and 1499 of 1565 (92%) had a maximal left ventricular outflow tract gradient <50 mm Hg at 1 year. After 6.8 years (range, 3.4-9.8 years; 12 565 person-years) from SRT, 77 (4%) experienced HCM-related death (0.6% per year), 236 (13%) a composite HF outcome (1.9% per year), and 87 (5%) a composite ventricular arrhythmia outcome (0.7% per year). Among adults, older age at SRT was associated with a higher incidence of HCM death (hazard ratio, 1.22 [95 CI, 1.1-1.3]; <i>P</i><0.01) and the HF composite (hazard ratio, 1.14 [95 CI, 1.1-1.2] per 5-year increase; <i>P</i><0.01) in a multivariable model. Female patients also had a higher risk of the HF composite after SRT (hazard ratio, 1.4 [95 CI, 1.1-1.8]; <i>P</i><0.01). De novo atrial fibrillation occurred after SRT in 387 patients (21%). Among pediatric patients followed for a median of 13 years after SRT, 26 of 343 (16%) developed the HF composite outcome, despite 96% being free of recurrent left ventricular outflow tract obstruction.</p><p><strong>Conclusions: </strong>Successful short- and long-term relief of outflow tract obstruction was observed in experienced multidisciplinary HCM centers. A subset of patients progressed to develop HF, but event-free survival at 10 years was 83% and ventricular arrhythmias were rare. Older age, female sex, and SRT during childhood were associated with a greater risk of developing HF.</p>","PeriodicalId":35,"journal":{"name":"Energy & Fuels","volume":" ","pages":"1377-1390"},"PeriodicalIF":35.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11493522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"工程技术","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evolution of Coronary Surgery. 冠状动脉外科的演变。
IF 35.5 3区 工程技术 Q2 ENERGY & FUELS Pub Date : 2024-10-22 Epub Date: 2024-10-21 DOI: 10.1161/CIRCULATIONAHA.124.070918
Bruce Lytle
{"title":"Evolution of Coronary Surgery.","authors":"Bruce Lytle","doi":"10.1161/CIRCULATIONAHA.124.070918","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.070918","url":null,"abstract":"","PeriodicalId":35,"journal":{"name":"Energy & Fuels","volume":"150 17","pages":"1311-1312"},"PeriodicalIF":35.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"工程技术","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Early and Late Aortic-Related Mortality and Rupture After Fenestrated-Branched Endovascular Aortic Repair of Thoracoabdominal Aortic Aneurysms: A Prospective Multicenter Cohort Study. 胸腹主动脉瘤瓣膜内血管主动脉修补术后与主动脉相关的早期和晚期死亡率及破裂:一项前瞻性多中心队列研究。
IF 35.5 3区 工程技术 Q2 ENERGY & FUELS Pub Date : 2024-10-22 Epub Date: 2024-07-11 DOI: 10.1161/CIRCULATIONAHA.123.068234
Gustavo S Oderich, Ying Huang, William S Harmsen, Emanuel R Tenorio, Andres Schanzer, Carlos H Timaran, Darren B Schneider, Bernardo C Mendes, Matthew J Eagleton, Mark A Farber, Warren J Gasper, Adam W Beck, Matthew P Sweet, W Anthony Lee

Background: Fenestrated-branched endovascular aortic repair (FB-EVAR) has been used as a minimally invasive alternative to open surgical repair to treat patients with thoracoabdominal aortic aneurysms (TAAAs). The aim of this study was to evaluate aortic-related mortality (ARM) and aortic aneurysm rupture after FB-EVAR of TAAAs.

Methods: Patients enrolled in 8 prospective, nonrandomized, physician-sponsored investigational device exemption studies between 2005 and 2020 who underwent elective FB-EVAR of asymptomatic intact TAAAs were analyzed. Primary end points were ARM, defined as any early mortality (30 days or in hospital) or late mortality from aortic rupture, dissection, organ or limb malperfusion attributable to aortic disease, complications of reinterventions, or aortic rupture. Secondary end points were early major adverse events, TAAA life-altering events (defined as death, permanent spinal cord injury, permanent dialysis, or stroke), all-cause mortality, and secondary interventions.

Results: A total of 1109 patients were analyzed; 589 (53.1%) had extent I-III and 520 (46.9%) had extent IV TAAAs. Median age was 73.4 years (interquartile range, 68.1-78.3 years); 368 (33.2%) were women. Early mortality was 2.7% (n=30); congestive heart failure was associated with early mortality (odds ratio, 3.30 [95% CI, 1.22-8.02]; P=0.01). Incidence of early aortic rupture was 0.4% (n=4). Incidence of early major adverse events and TAAA life-altering events was 20.4% (n=226) and 7.7% (n=85), respectively. There were 30 late ARMs; 5-year cumulative incidence was 3.8% (95% CI, 2.6%-5.4%); older age and extent I-III TAAAs were independently associated with late ARM (each P<0.05). Fourteen late aortic ruptures occurred; 5-year cumulative incidence was 2.7% (95% CI, 1.2%-4.3%); extent I-III TAAAs were associated with late aortic rupture (hazard ratio, 5.85 [95% CI, 1.31-26.2]; P=0.02). Five-year all-cause mortality was 45.7% (95% CI, 41.7%-49.4%). Five-year cumulative incidence of secondary intervention was 40.3% (95% CI, 35.8%-44.5%).

Conclusions: ARM and aortic rupture are uncommon after elective FB-EVAR of asymptomatic intact TAAAs. Half of the ARMs occurred early, and most of the late deaths were not aortic related. Late all-cause mortality rate and the need for secondary interventions were 46% and 40%, respectively, 5 years after FB-EVAR.

Registration: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02089607, NCT02050113, NCT02266719, NCT02323581, NCT00583817, NCT01654133, NCT00483249, NCT02043691, and NCT01874197.

背景:开孔-分支主动脉内膜修复术(FB-EVAR)已被用作胸腹主动脉瘤(TAAA)患者开放手术修复术的微创替代治疗方法。本研究旨在评估主动脉相关死亡率(ARM)和TAAA FB-EVAR术后主动脉瘤破裂的情况:方法: 对 2005 年至 2020 年间 8 项前瞻性、非随机、由医生发起的研究性设备豁免研究的入组患者进行了分析,这些患者均接受了无症状完整 TAAAs 的选择性 FB-EVAR。主要终点为主动脉瘤,定义为主动脉破裂、夹层、主动脉疾病引起的器官或肢体灌注不良、再介入并发症或主动脉破裂导致的任何早期死亡率(30 天或住院)或晚期死亡率。次要终点为早期主要不良事件、TAAA生命改变事件(定义为死亡、永久性脊髓损伤、永久性透析或中风)、全因死亡率和二次干预:共分析了1109名患者,其中589人(53.1%)为I-III度TAAA,520人(46.9%)为IV度TAAA。中位年龄为 73.4 岁(四分位数间距为 68.1-78.3 岁);368 人(33.2%)为女性。早期死亡率为 2.7%(30 人);充血性心力衰竭与早期死亡率相关(几率比为 3.30 [95% CI, 1.22-8.02];P=0.01)。早期主动脉破裂发生率为 0.4%(4 例)。早期主要不良事件和TAAA生命改变事件的发生率分别为20.4%(226人)和7.7%(85人)。有30例晚期ARM;5年累计发生率为3.8%(95% CI,2.6%-5.4%);年龄较大和I-III度TAAA与晚期ARM独立相关(PP均=0.02)。五年全因死亡率为45.7%(95% CI,41.7%-49.4%)。五年内二次干预的累计发生率为40.3%(95% CI,35.8%-44.5%):结论:对无症状的完整TAAA进行择期FB-EVAR术后发生ARM和主动脉破裂的情况并不常见。一半的ARM发生在早期,大多数晚期死亡与主动脉无关。FB-EVAR术后5年,晚期全因死亡率和需要二次干预的比例分别为46%和40%:URL:https://www.clinicaltrials.gov;唯一标识符:NCT02089607、NCT02050113、NCT02266719、NCT02323581、NCT00583817、NCT01654133、NCT00483249、NCT02043691和NCT01874197。
{"title":"Early and Late Aortic-Related Mortality and Rupture After Fenestrated-Branched Endovascular Aortic Repair of Thoracoabdominal Aortic Aneurysms: A Prospective Multicenter Cohort Study.","authors":"Gustavo S Oderich, Ying Huang, William S Harmsen, Emanuel R Tenorio, Andres Schanzer, Carlos H Timaran, Darren B Schneider, Bernardo C Mendes, Matthew J Eagleton, Mark A Farber, Warren J Gasper, Adam W Beck, Matthew P Sweet, W Anthony Lee","doi":"10.1161/CIRCULATIONAHA.123.068234","DOIUrl":"10.1161/CIRCULATIONAHA.123.068234","url":null,"abstract":"<p><strong>Background: </strong>Fenestrated-branched endovascular aortic repair (FB-EVAR) has been used as a minimally invasive alternative to open surgical repair to treat patients with thoracoabdominal aortic aneurysms (TAAAs). The aim of this study was to evaluate aortic-related mortality (ARM) and aortic aneurysm rupture after FB-EVAR of TAAAs.</p><p><strong>Methods: </strong>Patients enrolled in 8 prospective, nonrandomized, physician-sponsored investigational device exemption studies between 2005 and 2020 who underwent elective FB-EVAR of asymptomatic intact TAAAs were analyzed. Primary end points were ARM, defined as any early mortality (30 days or in hospital) or late mortality from aortic rupture, dissection, organ or limb malperfusion attributable to aortic disease, complications of reinterventions, or aortic rupture. Secondary end points were early major adverse events, TAAA life-altering events (defined as death, permanent spinal cord injury, permanent dialysis, or stroke), all-cause mortality, and secondary interventions.</p><p><strong>Results: </strong>A total of 1109 patients were analyzed; 589 (53.1%) had extent I-III and 520 (46.9%) had extent IV TAAAs. Median age was 73.4 years (interquartile range, 68.1-78.3 years); 368 (33.2%) were women. Early mortality was 2.7% (n=30); congestive heart failure was associated with early mortality (odds ratio, 3.30 [95% CI, 1.22-8.02]; <i>P</i>=0.01). Incidence of early aortic rupture was 0.4% (n=4). Incidence of early major adverse events and TAAA life-altering events was 20.4% (n=226) and 7.7% (n=85), respectively. There were 30 late ARMs; 5-year cumulative incidence was 3.8% (95% CI, 2.6%-5.4%); older age and extent I-III TAAAs were independently associated with late ARM (each <i>P</i><0.05). Fourteen late aortic ruptures occurred; 5-year cumulative incidence was 2.7% (95% CI, 1.2%-4.3%); extent I-III TAAAs were associated with late aortic rupture (hazard ratio, 5.85 [95% CI, 1.31-26.2]; <i>P</i>=0.02). Five-year all-cause mortality was 45.7% (95% CI, 41.7%-49.4%). Five-year cumulative incidence of secondary intervention was 40.3% (95% CI, 35.8%-44.5%).</p><p><strong>Conclusions: </strong>ARM and aortic rupture are uncommon after elective FB-EVAR of asymptomatic intact TAAAs. Half of the ARMs occurred early, and most of the late deaths were not aortic related. Late all-cause mortality rate and the need for secondary interventions were 46% and 40%, respectively, 5 years after FB-EVAR.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02089607, NCT02050113, NCT02266719, NCT02323581, NCT00583817, NCT01654133, NCT00483249, NCT02043691, and NCT01874197.</p>","PeriodicalId":35,"journal":{"name":"Energy & Fuels","volume":" ","pages":"1343-1353"},"PeriodicalIF":35.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"工程技术","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Energy & Fuels
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