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Tomasz A Timek - One of the best experts on this subject based on the ideXlab platform.

  • single dose del nido cardioplegia in minimally invasive Aortic Valve Surgery
    Seminars in Thoracic and Cardiovascular Surgery, 2017
    Co-Authors: Daniel Ziazadeh, Regina Mater, Ben Himelhoch, Andrew Borgman, Jessica Parker, Charles L Willekes, Tomasz A Timek
    Abstract:

    del Nido cardioplegia (DC) offers prolonged cardiac protection with single-dose administration and has been shown to be safe in adult CABG Surgery. We set out to evaluate the efficacy of cardiac protection and clinical outcomes of DC versus standard blood cardioplegia (BC) in minimally invasive Aortic Valve Surgery. From August 2011 to May 2016, 178 patients underwent minimally invasive Aortic Valve replacement (mini-AVR) with BC (n = 101) or DC (n = 77). Ministernotomy or right minithoracotomy was utilized for surgical access. Clinical patient characteristics and data were extracted from our local Society of Thoracic Surgeons (STS) database and the electronic medical record. Patients were propensity matched for age, gender, body mass index, Valve size and type, STS score, surgical access, preop creatinine, diabetes, and chronic obstructive pulmonary disease, yielding 63 well-matched pairs. There was no difference in patient age, preoperative creatinine, body mass index, diabetes, chronic obstructive pulmonary disease, or STS score between BC and DC before or after propensity matching. BC patients received both anterograde and retrograde cardioplegias in multiple doses, whereas DC was delivered almost entirely anterograde with 95% of the patients (73/77) receiving a single dose only. DC was associated with decreased cardiopulmonary bypass time (108 ± 24 vs 135 ± 43 minutes, P = 0.001) and Aortic cross-clamp time (80 ± 16 vs 102 ± 30 min, P = 0.001) and maximal glucose levels during cardiopulmonary bypass (165 ± 39 vs 202 ± 49 mg/dL, P = 0.001), whereas troponin T level did not differ between DC and BC (0.3 ± 0.29 vs 0.44 ± 1.7 ng/mL, P = 0.7). Preoperative ejection fraction did not change in either BC (64% ± 12% vs 61% ± 10%, P = 0.09) or DC (58% ± 14% vs 57% ± 14%, P = 0.4) after AVR. In minimally invasive AVR Surgery, DC provided equivalent myocardial protection and clinical outcomes to BC while simplifying cardioprotective regimen and reducing Aortic cross-clamp time. DC was associated with lower cardiopulmonary bypass glucose levels and demonstrated the feasibility of a single-dose administration.

  • withdrawn single dose del nido cardioplegia in minimally invasive Aortic Valve Surgery
    The Journal of Thoracic and Cardiovascular Surgery, 2017
    Co-Authors: Daniel Ziazadeh, Regina Mater, Ben Himelhoch, Andrew Borgman, Jessica Parker, Charles L Willekes, Tomasz A Timek
    Abstract:

    Abstract Background The del Nido cardioplegia (DC) procedure offers prolonged cardiac protection with single-dose administration and has proven safe in adult coronary artery bypass grafting (CABG) Surgery. We set out to evaluate the efficacy of cardiac protection and clinical outcomes of DC versus standard blood cardioplegia (BC) in minimally invasive Aortic Valve Surgery. Methods Between August 2011 and May 2016, 178 patients underwent minimally invasive Aortic Valve replacement (AVR) with BC (n = 101) or DC (n = 77). Mini-sternotomy or right mini-thoracotomy was performed to gain surgical access. Clinical patient characteristics and data were extracted from our local Society of Thoracic Surgeons (STS) database and the electronic medical record. Patients were propensity-matched for age, sex, body mass index (BMI), Valve size and type, STS score, surgical access, preoperative serum creatinine level, diabetes, and chronic obstructive pulmonary disease (COPD), yielding 63 well-matched pairs. Results There was no difference in patient age, preoperative serum creatinine, BMI, diabetes, COPD, or STS score between the BC and DC groups before or after propensity matching. BC patients received both anterograde and retrograde cardioplegia in multiple doses, whereas DC was delivered almost entirely anterograde, with 95% (73 of 77) of patients receiving a single dose only. DC was associated with decreased mean cardiopulmonary bypass (CPB) time (108 ± 24 vs 135 ± 43 minutes; P  = .001), mean Aortic cross-clamping time (80 ± 16 vs 102 ± 30 minutes; P  = .001), and mean maximal glucose level during CPB (165 ± 39 vs 202 ± 49 mg/dL; P  = .001), whereas mean troponin T level did not differ significantly between the DC and BC groups (0.3 ± 0.29 vs 0.44 ± 1.7 ng/mL; P  = .70). The mean preoperative ejection fraction did not change after AVR in either the BC group (64 ± 12% vs 61 ± 10%; P  = .09) or the DC group (58 ± 14% vs 57 ± 14%; P  = .40). Conclusions In minimally invasive AVR Surgery, DC provided equivalent myocardial protection and clinical outcomes as BC while simplifying the cardioprotective regimen and reducing Aortic cross-clamping time. DC was associated with lower CPB glucose levels and demonstrated the feasibility of single dose administration.

Charles L Willekes - One of the best experts on this subject based on the ideXlab platform.

  • single dose del nido cardioplegia in minimally invasive Aortic Valve Surgery
    Seminars in Thoracic and Cardiovascular Surgery, 2017
    Co-Authors: Daniel Ziazadeh, Regina Mater, Ben Himelhoch, Andrew Borgman, Jessica Parker, Charles L Willekes, Tomasz A Timek
    Abstract:

    del Nido cardioplegia (DC) offers prolonged cardiac protection with single-dose administration and has been shown to be safe in adult CABG Surgery. We set out to evaluate the efficacy of cardiac protection and clinical outcomes of DC versus standard blood cardioplegia (BC) in minimally invasive Aortic Valve Surgery. From August 2011 to May 2016, 178 patients underwent minimally invasive Aortic Valve replacement (mini-AVR) with BC (n = 101) or DC (n = 77). Ministernotomy or right minithoracotomy was utilized for surgical access. Clinical patient characteristics and data were extracted from our local Society of Thoracic Surgeons (STS) database and the electronic medical record. Patients were propensity matched for age, gender, body mass index, Valve size and type, STS score, surgical access, preop creatinine, diabetes, and chronic obstructive pulmonary disease, yielding 63 well-matched pairs. There was no difference in patient age, preoperative creatinine, body mass index, diabetes, chronic obstructive pulmonary disease, or STS score between BC and DC before or after propensity matching. BC patients received both anterograde and retrograde cardioplegias in multiple doses, whereas DC was delivered almost entirely anterograde with 95% of the patients (73/77) receiving a single dose only. DC was associated with decreased cardiopulmonary bypass time (108 ± 24 vs 135 ± 43 minutes, P = 0.001) and Aortic cross-clamp time (80 ± 16 vs 102 ± 30 min, P = 0.001) and maximal glucose levels during cardiopulmonary bypass (165 ± 39 vs 202 ± 49 mg/dL, P = 0.001), whereas troponin T level did not differ between DC and BC (0.3 ± 0.29 vs 0.44 ± 1.7 ng/mL, P = 0.7). Preoperative ejection fraction did not change in either BC (64% ± 12% vs 61% ± 10%, P = 0.09) or DC (58% ± 14% vs 57% ± 14%, P = 0.4) after AVR. In minimally invasive AVR Surgery, DC provided equivalent myocardial protection and clinical outcomes to BC while simplifying cardioprotective regimen and reducing Aortic cross-clamp time. DC was associated with lower cardiopulmonary bypass glucose levels and demonstrated the feasibility of a single-dose administration.

  • withdrawn single dose del nido cardioplegia in minimally invasive Aortic Valve Surgery
    The Journal of Thoracic and Cardiovascular Surgery, 2017
    Co-Authors: Daniel Ziazadeh, Regina Mater, Ben Himelhoch, Andrew Borgman, Jessica Parker, Charles L Willekes, Tomasz A Timek
    Abstract:

    Abstract Background The del Nido cardioplegia (DC) procedure offers prolonged cardiac protection with single-dose administration and has proven safe in adult coronary artery bypass grafting (CABG) Surgery. We set out to evaluate the efficacy of cardiac protection and clinical outcomes of DC versus standard blood cardioplegia (BC) in minimally invasive Aortic Valve Surgery. Methods Between August 2011 and May 2016, 178 patients underwent minimally invasive Aortic Valve replacement (AVR) with BC (n = 101) or DC (n = 77). Mini-sternotomy or right mini-thoracotomy was performed to gain surgical access. Clinical patient characteristics and data were extracted from our local Society of Thoracic Surgeons (STS) database and the electronic medical record. Patients were propensity-matched for age, sex, body mass index (BMI), Valve size and type, STS score, surgical access, preoperative serum creatinine level, diabetes, and chronic obstructive pulmonary disease (COPD), yielding 63 well-matched pairs. Results There was no difference in patient age, preoperative serum creatinine, BMI, diabetes, COPD, or STS score between the BC and DC groups before or after propensity matching. BC patients received both anterograde and retrograde cardioplegia in multiple doses, whereas DC was delivered almost entirely anterograde, with 95% (73 of 77) of patients receiving a single dose only. DC was associated with decreased mean cardiopulmonary bypass (CPB) time (108 ± 24 vs 135 ± 43 minutes; P  = .001), mean Aortic cross-clamping time (80 ± 16 vs 102 ± 30 minutes; P  = .001), and mean maximal glucose level during CPB (165 ± 39 vs 202 ± 49 mg/dL; P  = .001), whereas mean troponin T level did not differ significantly between the DC and BC groups (0.3 ± 0.29 vs 0.44 ± 1.7 ng/mL; P  = .70). The mean preoperative ejection fraction did not change after AVR in either the BC group (64 ± 12% vs 61 ± 10%; P  = .09) or the DC group (58 ± 14% vs 57 ± 14%; P  = .40). Conclusions In minimally invasive AVR Surgery, DC provided equivalent myocardial protection and clinical outcomes as BC while simplifying the cardioprotective regimen and reducing Aortic cross-clamping time. DC was associated with lower CPB glucose levels and demonstrated the feasibility of single dose administration.

Marc A Gillinov - One of the best experts on this subject based on the ideXlab platform.

  • incidence and risk factors for permanent pacemaker implantation following mitral or Aortic Valve Surgery
    Journal of the American College of Cardiology, 2019
    Co-Authors: Gil Moskowitz, Marc A Gillinov, Kimberly N Hong, Gennaro Giustino, Gorav Ailawadi, Joseph J Derose, Alexander Iribarne, Alan J Moskowitz, Annetine C Gelijns, Natalia Egorova
    Abstract:

    Abstract Background Risk factors for post-operative conduction disturbances after cardiac Valve Surgery requiring a permanent pacemaker (PPM) are poorly characterized. Objectives The aim of this study was to investigate the timing and risk factors for PPM implantation after mitral or Aortic Valve Surgery. Methods All patients who underwent open Aortic or mitral Valve Surgery between January 1996 and December 2014 were reviewed using New York State’s mandatory hospital discharge database. Patients with prior cardiac Surgery or pre-existing PPM were excluded. The primary endpoint was PPM implantation within 1 year. Results Among 77,882 patients, 63.8% (n = 49,706) underwent Aortic Valve replacement (AVR), 18.9% (n = 14,686) underwent mitral Valve replacement (MVR), 10.5% (n = 8,219) underwent mitral Valve repair (MVr), 5.4% (n = 4,202) underwent AVR plus MVR, and 1.4% (n = 1,069) underwent AVR plus MVr. The 1-year PPM implantation rate was 4.5% after MVr, 6.6% after AVR, 9.3% after AVR plus MVr, 10.5% after MVR, and 13.3% after AVR plus MVR (p  Conclusions Conduction disturbances requiring PPM remain a common adverse event after Valve Surgery. Identifying patients at risk for PPM will help facilitate perioperative planning and inform clinical decision making regarding post-operative rhythm surveillance.

  • incremental prognostic utility of left ventricular global longitudinal strain in asymptomatic patients with significant chronic Aortic regurgitation and preserved left ventricular ejection fraction
    Jacc-cardiovascular Imaging, 2018
    Co-Authors: Alaa Alashi, Marc A Gillinov, Lars G Svensson, Douglas R Johnston, Amgad Mentias, Amjad Abdallah, Ke Feng, Leonardo L Rodriguez, Zoran B Popovic, Brian P Griffin
    Abstract:

    Abstract Objectives This study sought to examine the prognostic utility of left ventricular (LV) global longitudinal strain (GLS) in asymptomatic patients with ≥III+ Aortic regurgitation (AR), an indexed LV end-systolic dimension of  Background Management of asymptomatic patients with severe chronic AR and preserved LVEF is challenging and is typically based on LV dimensions. Methods We studied 1,063 such patients (age 53 ± 16 years; 77% men) seen between 2003 and 2010 (excluding those with symptoms, obstructive coronary artery disease, acute AR/dissection, Aortic/mitral stenosis, more than moderate mitral regurgitation, and previous cardiac Surgery). Society of Thoracic Surgeons (STS) score was calculated. The primary endpoint was mortality. Average resting LV-GLS was measured offline on 2-, 3-, and 4-chamber views using Velocity Vector Imaging (Siemens, Malvern, Pennsylvania). Results Mean STS score, LVEF, LV-GLS, and right ventricular systolic pressure were 4.4 ± 5.0%, 57.0 ± 4.0%, −19.5 ± 0.2%, and 31.0 ± 9.0 mm Hg, respectively. In total, 671 patients (63%) underwent Aortic Valve Surgery at a median of 42 days after the initial evaluation. At 6.8 ± 3.0 years, 146 patients (14%) had died. On multivariable Cox survival analysis, LV-GLS (hazard ratio [HR]: 1.11), STS score (HR: 1.51), indexed LV end-systolic dimension (HR: 0.50), right ventricular systolic pressure (HR: 1.33), and Aortic Valve Surgery (HR: 0.35) were associated with longer term mortality (all p  Conclusions In asymptomatic patients with ≥III+ chronic AR and preserved LVEF, worsening LV-GLS was associated with longer term mortality, providing incremental prognostic value and improved reclassification.

  • prevalence of mitral Valve prolapse and congenital bicuspid Aortic Valves in black and white patients undergoing cardiac Valve operations
    American Journal of Cardiology, 2013
    Co-Authors: Gian M Novaro, Penny L Houghtaling, Marc A Gillinov, Eugene H Blackstone, Craig R Asher
    Abstract:

    The risk factors for Aortic and mitral Valve diseases that require surgical repair such as congenital bicuspid Aortic Valve (BAV) and mitral Valve prolapse include acquired clinical factors and genetic influences. Whether race affects the prevalence of certain valvular diseases has not been sufficiently investigated. Through the Cleveland Clinic's Cardiovascular Information Registry, we evaluated the data from 40,419 patients who had undergone Aortic Valve Surgery, mitral Valve Surgery, and/or coronary artery bypass grafting from 1993 to 2007. Of these patients, 38,366 were white and 2,053 were black. The prospective evaluation of valvular disease was coded, identifying the etiology and morphology by echocardiographic, surgical, and pathologic inspection. At baseline, compared to white patients, the black patients were younger, more often women, had a greater body mass index, and a greater prevalence of hypertension, diabetes, tobacco use, and renal disease. The prevalence of congenital BAV and mitral Valve prolapse was considerably lower in blacks than in whites (9% vs 25%, p

  • outcomes of less invasive j incision approach to Aortic Valve Surgery
    The Journal of Thoracic and Cardiovascular Surgery, 2012
    Co-Authors: Douglas R Johnston, Marc A Gillinov, Eugene H Blackstone, Jeevanantham Rajeswaran, Tomislav Mihaljevic, Fernando A Atik, Edward R Nowicki, Joseph F Sabik, Bruce W Lytle, Lars G Svensson
    Abstract:

    Objective Less invasive approaches to Aortic Valve Surgery are increasingly used; however, few studies have investigated their impact on outcome. We sought to compare clinical outcomes after these approaches with full sternotomy using propensity-matching methods. Methods From January 1995 to January 2004, a total of 2689 patients underwent isolated Aortic Valve Surgery, 1193 via upper J-hemisternotomy and 1496 via full sternotomy. Because of important differences in patient characteristics between these groups, a propensity score based on 42 variables was used to obtain 832 well-matched patient pairs (70% of possible cases). Results In-hospital mortality was identical for propensity-matched patients, 0.96% (8 in each). Occurrences of stroke ( P > .9), renal failure ( P  = .8), and myocardial infarction ( P  = .7) were similar. However, 24-hour mediastinal drainage was a third less after less invasive Surgery (median, 250 vs 350 mL; P .0001), and fewer patients received transfusions (24% vs 34%; P .0001). More patients undergoing less invasive Surgery were extubated in the operating room (12% vs 1.6%; P .0001), postoperative forced 1-second expiratory volume was higher ( P  = .009), and fewer had respiratory failure ( P  = .01). Early after operation, pain scores were lower ( P .0001) after less-invasive Surgery and postoperative length of stay shorter ( P  0001). Conclusions Within that portion of the spectrum of isolated Aortic Valve Surgery where propensity matching was possible, minimally invasive Aortic Valve Surgery had not only cosmetic advantages, but blood product use, respiratory, pain, and resource utilization advantages over full sternotomy, and no apparent detriments. Less invasive Aortic Valve Surgery should be considered for most Aortic Valve operations.

  • bicuspid Aortic Valve Surgery with proactive ascending aorta repair
    The Journal of Thoracic and Cardiovascular Surgery, 2011
    Co-Authors: Lars G Svensson, Marc A Gillinov, Eugene H Blackstone, Kyung Hwan Kim, Jeevanantham Rajeswaran, Tomislav Mihaljevic, Brian P Griffin, Richard A Grimm, William J Stewart, Donald Hammer
    Abstract:

    Objectives Bicuspid Aortic Valves are associated with Aortic catastrophes, particularly dissection. We examined whether proactive repair of associated dilatation would reduce risk of subsequent Aortic dissection or reoperation and whether more aggressive resection is needed in patients undergoing bicuspid Aortic Valve Surgery alone. Methods From January 1993 to June 2003, 1989 patients (of our total experience of 4316) underwent bicuspid Aortic Valve Surgery. Long-term outcomes of 1810 were analyzed according to Aortic size and whether bicuspid Aortic Valve Surgery was performed alone or with Aortic repair. Results In-hospital 30-day survival was similar (98.8% Valve alone vs 98.9% with Aortic repair), with no penalty incurred for concomitant Aortic repair. Bicuspid Aortic Valve–alone patients had worse late survival (75% vs 85% at 10 years, P  = .0001), but in the matched cohort survival was nearly identical (85% vs 86%; P  = .7). With this strategy, freedom from late Aortic events was high in both groups (99% Valve alone vs 97% with Aortic repair at 10 years; P [log-rank] = .06) and similar in the matched cohort (95% vs 97%; P  = .2). Approximately 95% of patients undergoing Valve-alone Surgery had Aortic diameters smaller than 4.6 cm or cross-sectional area/height ratios less than 9.4 cm 2 /m; 80% undergoing Valve Surgery plus Aortic repair had diameters larger than 4.1 cm or ratios greater than 7.3 cm 2 /m. Only 0.2% of events occurred at an Aortic diameter size of less than 4.5 cm. Conclusions Aortic size larger than 4.5 cm or Aortic cross-sectional area/height ratio greater than 8 to 10 should be considered triggers for concurrent Aortic repair, because there is no added risk, and late survival is better; however, more aggressive resection is unwarranted.

Daniel Ziazadeh - One of the best experts on this subject based on the ideXlab platform.

  • single dose del nido cardioplegia in minimally invasive Aortic Valve Surgery
    Seminars in Thoracic and Cardiovascular Surgery, 2017
    Co-Authors: Daniel Ziazadeh, Regina Mater, Ben Himelhoch, Andrew Borgman, Jessica Parker, Charles L Willekes, Tomasz A Timek
    Abstract:

    del Nido cardioplegia (DC) offers prolonged cardiac protection with single-dose administration and has been shown to be safe in adult CABG Surgery. We set out to evaluate the efficacy of cardiac protection and clinical outcomes of DC versus standard blood cardioplegia (BC) in minimally invasive Aortic Valve Surgery. From August 2011 to May 2016, 178 patients underwent minimally invasive Aortic Valve replacement (mini-AVR) with BC (n = 101) or DC (n = 77). Ministernotomy or right minithoracotomy was utilized for surgical access. Clinical patient characteristics and data were extracted from our local Society of Thoracic Surgeons (STS) database and the electronic medical record. Patients were propensity matched for age, gender, body mass index, Valve size and type, STS score, surgical access, preop creatinine, diabetes, and chronic obstructive pulmonary disease, yielding 63 well-matched pairs. There was no difference in patient age, preoperative creatinine, body mass index, diabetes, chronic obstructive pulmonary disease, or STS score between BC and DC before or after propensity matching. BC patients received both anterograde and retrograde cardioplegias in multiple doses, whereas DC was delivered almost entirely anterograde with 95% of the patients (73/77) receiving a single dose only. DC was associated with decreased cardiopulmonary bypass time (108 ± 24 vs 135 ± 43 minutes, P = 0.001) and Aortic cross-clamp time (80 ± 16 vs 102 ± 30 min, P = 0.001) and maximal glucose levels during cardiopulmonary bypass (165 ± 39 vs 202 ± 49 mg/dL, P = 0.001), whereas troponin T level did not differ between DC and BC (0.3 ± 0.29 vs 0.44 ± 1.7 ng/mL, P = 0.7). Preoperative ejection fraction did not change in either BC (64% ± 12% vs 61% ± 10%, P = 0.09) or DC (58% ± 14% vs 57% ± 14%, P = 0.4) after AVR. In minimally invasive AVR Surgery, DC provided equivalent myocardial protection and clinical outcomes to BC while simplifying cardioprotective regimen and reducing Aortic cross-clamp time. DC was associated with lower cardiopulmonary bypass glucose levels and demonstrated the feasibility of a single-dose administration.

  • withdrawn single dose del nido cardioplegia in minimally invasive Aortic Valve Surgery
    The Journal of Thoracic and Cardiovascular Surgery, 2017
    Co-Authors: Daniel Ziazadeh, Regina Mater, Ben Himelhoch, Andrew Borgman, Jessica Parker, Charles L Willekes, Tomasz A Timek
    Abstract:

    Abstract Background The del Nido cardioplegia (DC) procedure offers prolonged cardiac protection with single-dose administration and has proven safe in adult coronary artery bypass grafting (CABG) Surgery. We set out to evaluate the efficacy of cardiac protection and clinical outcomes of DC versus standard blood cardioplegia (BC) in minimally invasive Aortic Valve Surgery. Methods Between August 2011 and May 2016, 178 patients underwent minimally invasive Aortic Valve replacement (AVR) with BC (n = 101) or DC (n = 77). Mini-sternotomy or right mini-thoracotomy was performed to gain surgical access. Clinical patient characteristics and data were extracted from our local Society of Thoracic Surgeons (STS) database and the electronic medical record. Patients were propensity-matched for age, sex, body mass index (BMI), Valve size and type, STS score, surgical access, preoperative serum creatinine level, diabetes, and chronic obstructive pulmonary disease (COPD), yielding 63 well-matched pairs. Results There was no difference in patient age, preoperative serum creatinine, BMI, diabetes, COPD, or STS score between the BC and DC groups before or after propensity matching. BC patients received both anterograde and retrograde cardioplegia in multiple doses, whereas DC was delivered almost entirely anterograde, with 95% (73 of 77) of patients receiving a single dose only. DC was associated with decreased mean cardiopulmonary bypass (CPB) time (108 ± 24 vs 135 ± 43 minutes; P  = .001), mean Aortic cross-clamping time (80 ± 16 vs 102 ± 30 minutes; P  = .001), and mean maximal glucose level during CPB (165 ± 39 vs 202 ± 49 mg/dL; P  = .001), whereas mean troponin T level did not differ significantly between the DC and BC groups (0.3 ± 0.29 vs 0.44 ± 1.7 ng/mL; P  = .70). The mean preoperative ejection fraction did not change after AVR in either the BC group (64 ± 12% vs 61 ± 10%; P  = .09) or the DC group (58 ± 14% vs 57 ± 14%; P  = .40). Conclusions In minimally invasive AVR Surgery, DC provided equivalent myocardial protection and clinical outcomes as BC while simplifying the cardioprotective regimen and reducing Aortic cross-clamping time. DC was associated with lower CPB glucose levels and demonstrated the feasibility of single dose administration.

Lars G Svensson - One of the best experts on this subject based on the ideXlab platform.

  • incremental prognostic utility of left ventricular global longitudinal strain in asymptomatic patients with significant chronic Aortic regurgitation and preserved left ventricular ejection fraction
    Jacc-cardiovascular Imaging, 2018
    Co-Authors: Alaa Alashi, Marc A Gillinov, Lars G Svensson, Douglas R Johnston, Amgad Mentias, Amjad Abdallah, Ke Feng, Leonardo L Rodriguez, Zoran B Popovic, Brian P Griffin
    Abstract:

    Abstract Objectives This study sought to examine the prognostic utility of left ventricular (LV) global longitudinal strain (GLS) in asymptomatic patients with ≥III+ Aortic regurgitation (AR), an indexed LV end-systolic dimension of  Background Management of asymptomatic patients with severe chronic AR and preserved LVEF is challenging and is typically based on LV dimensions. Methods We studied 1,063 such patients (age 53 ± 16 years; 77% men) seen between 2003 and 2010 (excluding those with symptoms, obstructive coronary artery disease, acute AR/dissection, Aortic/mitral stenosis, more than moderate mitral regurgitation, and previous cardiac Surgery). Society of Thoracic Surgeons (STS) score was calculated. The primary endpoint was mortality. Average resting LV-GLS was measured offline on 2-, 3-, and 4-chamber views using Velocity Vector Imaging (Siemens, Malvern, Pennsylvania). Results Mean STS score, LVEF, LV-GLS, and right ventricular systolic pressure were 4.4 ± 5.0%, 57.0 ± 4.0%, −19.5 ± 0.2%, and 31.0 ± 9.0 mm Hg, respectively. In total, 671 patients (63%) underwent Aortic Valve Surgery at a median of 42 days after the initial evaluation. At 6.8 ± 3.0 years, 146 patients (14%) had died. On multivariable Cox survival analysis, LV-GLS (hazard ratio [HR]: 1.11), STS score (HR: 1.51), indexed LV end-systolic dimension (HR: 0.50), right ventricular systolic pressure (HR: 1.33), and Aortic Valve Surgery (HR: 0.35) were associated with longer term mortality (all p  Conclusions In asymptomatic patients with ≥III+ chronic AR and preserved LVEF, worsening LV-GLS was associated with longer term mortality, providing incremental prognostic value and improved reclassification.

  • outcomes of less invasive j incision approach to Aortic Valve Surgery
    The Journal of Thoracic and Cardiovascular Surgery, 2012
    Co-Authors: Douglas R Johnston, Marc A Gillinov, Eugene H Blackstone, Jeevanantham Rajeswaran, Tomislav Mihaljevic, Fernando A Atik, Edward R Nowicki, Joseph F Sabik, Bruce W Lytle, Lars G Svensson
    Abstract:

    Objective Less invasive approaches to Aortic Valve Surgery are increasingly used; however, few studies have investigated their impact on outcome. We sought to compare clinical outcomes after these approaches with full sternotomy using propensity-matching methods. Methods From January 1995 to January 2004, a total of 2689 patients underwent isolated Aortic Valve Surgery, 1193 via upper J-hemisternotomy and 1496 via full sternotomy. Because of important differences in patient characteristics between these groups, a propensity score based on 42 variables was used to obtain 832 well-matched patient pairs (70% of possible cases). Results In-hospital mortality was identical for propensity-matched patients, 0.96% (8 in each). Occurrences of stroke ( P > .9), renal failure ( P  = .8), and myocardial infarction ( P  = .7) were similar. However, 24-hour mediastinal drainage was a third less after less invasive Surgery (median, 250 vs 350 mL; P .0001), and fewer patients received transfusions (24% vs 34%; P .0001). More patients undergoing less invasive Surgery were extubated in the operating room (12% vs 1.6%; P .0001), postoperative forced 1-second expiratory volume was higher ( P  = .009), and fewer had respiratory failure ( P  = .01). Early after operation, pain scores were lower ( P .0001) after less-invasive Surgery and postoperative length of stay shorter ( P  0001). Conclusions Within that portion of the spectrum of isolated Aortic Valve Surgery where propensity matching was possible, minimally invasive Aortic Valve Surgery had not only cosmetic advantages, but blood product use, respiratory, pain, and resource utilization advantages over full sternotomy, and no apparent detriments. Less invasive Aortic Valve Surgery should be considered for most Aortic Valve operations.

  • bicuspid Aortic Valve Surgery with proactive ascending aorta repair
    The Journal of Thoracic and Cardiovascular Surgery, 2011
    Co-Authors: Lars G Svensson, Marc A Gillinov, Eugene H Blackstone, Kyung Hwan Kim, Jeevanantham Rajeswaran, Tomislav Mihaljevic, Brian P Griffin, Richard A Grimm, William J Stewart, Donald Hammer
    Abstract:

    Objectives Bicuspid Aortic Valves are associated with Aortic catastrophes, particularly dissection. We examined whether proactive repair of associated dilatation would reduce risk of subsequent Aortic dissection or reoperation and whether more aggressive resection is needed in patients undergoing bicuspid Aortic Valve Surgery alone. Methods From January 1993 to June 2003, 1989 patients (of our total experience of 4316) underwent bicuspid Aortic Valve Surgery. Long-term outcomes of 1810 were analyzed according to Aortic size and whether bicuspid Aortic Valve Surgery was performed alone or with Aortic repair. Results In-hospital 30-day survival was similar (98.8% Valve alone vs 98.9% with Aortic repair), with no penalty incurred for concomitant Aortic repair. Bicuspid Aortic Valve–alone patients had worse late survival (75% vs 85% at 10 years, P  = .0001), but in the matched cohort survival was nearly identical (85% vs 86%; P  = .7). With this strategy, freedom from late Aortic events was high in both groups (99% Valve alone vs 97% with Aortic repair at 10 years; P [log-rank] = .06) and similar in the matched cohort (95% vs 97%; P  = .2). Approximately 95% of patients undergoing Valve-alone Surgery had Aortic diameters smaller than 4.6 cm or cross-sectional area/height ratios less than 9.4 cm 2 /m; 80% undergoing Valve Surgery plus Aortic repair had diameters larger than 4.1 cm or ratios greater than 7.3 cm 2 /m. Only 0.2% of events occurred at an Aortic diameter size of less than 4.5 cm. Conclusions Aortic size larger than 4.5 cm or Aortic cross-sectional area/height ratio greater than 8 to 10 should be considered triggers for concurrent Aortic repair, because there is no added risk, and late survival is better; however, more aggressive resection is unwarranted.