78 results on '"Chu, Michael"'
Search Results
2. Contributors
- Author
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Agnihotri, Arvind K., primary, Ailawadi, Gorav, additional, Arsalan, Mani, additional, Bajwa, Gurjyot, additional, Baker, Craig J., additional, Bavaria, Joseph E., additional, Bonatti, Johannes, additional, Boodhwani, Munir, additional, Chan, Vincent, additional, Chu, Michael W.A., additional, Coselli, Joseph S., additional, Coyan, Garrett, additional, Dagenais, François, additional, Dahl, Jolian, additional, David, Tirone E., additional, DeNino, Walter F., additional, De Roock, Sophie, additional, Doty, John R., additional, Ehsan, Afshin, additional, El Khoury, Gebrine, additional, Elmistekway, Elsayed, additional, Fortier, Jacqueline H., additional, Ghanta, Ravi K., additional, Giambruno, Vincenzo, additional, Gillinov, A. Marc, additional, Glineur, David, additional, Goldstone, Andrew B., additional, Grau, Juan B., additional, Hang, Dustin, additional, Hasan, Faisal, additional, Hussain, Syed Tarique, additional, Ikonomidis, John S., additional, Javadikasgari, Hoda, additional, Kiaii, Bob, additional, Kim, Won-Keun, additional, Kron, Irving L., additional, Kumar, S. Ram, additional, Lamelas, Joseph, additional, LeMaire, Scott A., additional, Luc, Jessica G.Y., additional, Mangi, Abeel A., additional, Mesana, Thierry G., additional, Mick, Stephanie, additional, Mihaljevic, Tomislav, additional, Moncef, Hlal, additional, Niu, Zhaozhou, additional, Paulsen, Michael J., additional, Pettersson, Gӧsta B., additional, Preventza, Ourania, additional, Prud'Homme, Dominique, additional, Rao, Vivek, additional, Raza, Sajjad, additional, Ribeiro, Igo B., additional, Rodriguez, Maria Lorena, additional, Rubens, Fraser D., additional, Ruel, Marc, additional, Sabik, Joseph F., additional, Schaff, Hartzell V., additional, Sciortino, Christopher, additional, Seki, Hiroshi, additional, Sellke, Frank W., additional, Shemin, Richard Jay, additional, Sodha, Neel R., additional, Soltesz, Edward G., additional, Sridhar, Kumar, additional, Starnes, Vaughn A., additional, Sultan, Ibrahim, additional, Suri, Rakesh M., additional, Szeto, Wilson Y., additional, Taghavi, Sharven, additional, Teefy, Patrick, additional, Toeg, Hadi, additional, Une, Dai, additional, Vlahakes, Gus J., additional, Walther, Thomas, additional, Woo, Y. Joseph, additional, and Wright, Cameron D., additional
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- 2019
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3. Stream Computations Organized for Reconfigurable Execution
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DeHon, André, primary, Markovskiy, Yury, additional, Caspi, Eylon, additional, Chu, Michael, additional, Wawrzynek, John, additional, Huang, Randy, additional, Perissakis, Stylianos, additional, Pozzi, Laura, additional, and Yeh, Joseph, additional
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- 2008
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4. Relaxed Si1−xGex films with reduced dislocation densities grown by molecular beam epitaxy
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Tanner, Martin O., primary, Chu, Michael A., additional, Wang, Kang L., additional, Meshkinpour, Marjohn, additional, and Goorsky, Mark S., additional
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- 1996
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5. Overcoming the Disparity in Mitral Valve Repair: A Sex-based Analysis of Long-term Outcomes.
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Malik MI, Nedadur R, Fox S, Hage A, Hage F, Tzemos N, and Chu MWA
- Abstract
Background: Sex-disparities remain pervasive across most cardiovascular diseases and continue to demonstrate significantly worse early and late outcomes for women, especially after surgical repair. This study aims to investigate outcomes of mitral valve (MV) repair by sex and identify opportunities for improvement., Methods: A single-centre retrospective analysis of consecutive patients undergoing MV repair was conducted, from May 2008 - February 2023. In-hospital and long-term outcomes, including survival and symptomatic disease recurrence (sMR) were examined by sex. Adjusted outcome analysis was performed using inverse-probability treatment weighting (IPTW)., Results: In total, 490 patients underwent MV repair (Median age 65 years [IQR 57-73 years] sternotomy n=128 [26%], minimally-invasive n=362 [74%]), including 343 males and 147 females. Median follow-up time was 5.4 years, with an interquartile range of 3.1 to 8.4 years. IPTW-adjusted 30-day outcomes for female versus males, including death (1.4% vs 0.6%, p=0.59) and MACE (8.2% vs 7.6%, p=0.81), were not significantly different. Survival for females vs males after mitral valve repair was 94.9% vs 98.0% at 2 years, 91.4% vs 97.8% at 4 years and 87.2 % vs 88.7% at 8 years (HR 0.52 [0.19-1.44]). Both unadjusted and IPTW-adjusted Cox-regression hazard ratios for survival and freedom from sMR demonstrated no significant difference between sexes at long-term follow up., Conclusions: These contemporary results are encouraging and suggest that a critical "bridging of the gap" between sexes is possible with comprehensive efforts including earlier detection and awareness and improved surgical techniques, though other factors may be important to explore further., (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
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6. The Emerging and Important Role of Artificial Intelligence in Cardiac Surgery.
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Nedadur R, Bhatt N, Lui T, Chu MWA, McCarthy PM, and Kline A
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Artificial Intelligence (AI) has greatly affected our everyday lives and holds great promise to change the landscape of medicine. AI is particularly positioned to improve care for the increasingly complex patients undergoing cardiac surgery utilizing immense amount of data generated in the course of their care. When deployed, AI can be used to analyze this information at the patient's bedside more expediently and accurately, all while providing new insights. This review summarizes the current applications of AI in cardiac surgery, from the vantage point of a patient's journey. Applications of AI include pre-operative risk assessment, intraoperative planning, post-operative patient care and out-patient telemonitoring, encompassing the spectrum of cardiac surgical care. Offloading of administrative processes and enhanced experience with information gathering also represent a unique and underrepresented avenue for future utilization of AI. As clinicians, understanding the nomenclature and applications of AI is important to contextualize problems, to ensure problem-driven solutions and for clinical benefit. Precision medicine, and thus clinically relevant AI, remains dependent on data curation and warehousing to gather insights from large multicenter repositories while treating privacy with the utmost importance. AI tasks should not be siloed but rather holistically integrated into clinical workflow to retain context and relevance. As cardiac surgeons, AI allows us to look forward to a bright future of more efficient utilization of our clinical expertise toward high-level decision making and technical prowess., (Copyright © 2024 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
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- 2024
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7. Outcomes of Total Aortic Arch Replacement in a Canadian Nationwide Registry.
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Chen JF, Ouzounian M, Peterson M, Tatangelo M, Dagenais F, Hage A, Lindsay TF, Chu MWA, and Chung JCY
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- Humans, Female, Male, Canada epidemiology, Middle Aged, Postoperative Complications epidemiology, Blood Vessel Prosthesis Implantation methods, Aged, Elective Surgical Procedures methods, Elective Surgical Procedures statistics & numerical data, Propensity Score, Treatment Outcome, Aortic Aneurysm, Thoracic surgery, Retrospective Studies, Aorta, Thoracic surgery, Registries, Hospital Mortality trends
- Abstract
Background: Accurate benchmarking of outcomes after elective open total arch replacement is important for surgical decision making and for comparisons with emerging endovascular technologies., Methods: A multicentre registry of consecutive aortic arch procedures in 9 centres across Canada contained 250 elective total arch replacements from 2010 to 2021. A total of 728 patients undergoing elective hemiarch replacement over the same time period was used as a comparator group. Propensity score matching was used to construct 202 well matched pairs., Results: Patients undergoing total arch replacement were 63.2 ± 13.6 years old, and 34% were female. These patients were more likely to have connective tissue disorders compared with patients undergoing hemiarch replacement. When under hypothermic circulatory arrest, the total arch group uniformly used antegrade cerebral perfusion with median nadir temperature of 24°C (interquartile range [IQR] 21-25°C), and median duration 33 minutes (IQR 23-51 minutes). Before matching, in-hospital mortality and stroke rates were 5.2% and 10%, respectively, for the total arch group. After matching, the total arch group had in-hospital mortality similar to the hemiarch group (P = 0.58). Rates of stroke were also not statistically different (P = 0.11). The total arch group was more likely to experience delirium, prolonged intubation, increased intensive care unit length of stay, and transfusions., Conclusions: Elective total arch replacement is performed with good in-hospital mortality rates that are similar to rates after elective hemiarch repairs. However, total arch replacement was associated with significantly higher rates of other morbidities, including delirium and prolonged intubation., (Copyright © 2024 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
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- 2024
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8. Ambulatory facial feminization surgery: a comparative analysis of outcomes and complications.
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Nguyen N, Doan L, Jiang F, Chu MW, Liu YY, Francis SH, Kim H, and Lee JC
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- Humans, Female, Retrospective Studies, Adult, Male, Middle Aged, Face surgery, Treatment Outcome, Emergency Service, Hospital statistics & numerical data, Feminization, Sex Reassignment Surgery methods, Ambulatory Surgical Procedures adverse effects, Postoperative Complications epidemiology, Patient Readmission statistics & numerical data
- Abstract
Background: To date, there are no studies investigating the safety and outcomes of facial feminization surgery (FFS) as an outpatient procedure. This is the first study of its kind analyzing the outcomes of ambulatory FFS based on a comparison of complications, post-operative emergency department or urgent care (ED/UC) visits, and readmissions between patients who underwent FFS with admission versus same-day surgery., Methods: A retrospective analysis was conducted on all patients who underwent FFS in a single integrated healthcare system. Patient charts were reviewed for operative details, complications, post-operative ED/UC visits, readmission, and demographic factors. Major outcomes including complications, readmissions, and ED/UC visits were compared between groups with same-day discharge and post-operative hospital admission., Results: Of 242 patients included in the study, ED/UC visits were comparable between patients discharged same-day (18.2%) and patients admitted post-operatively (21.6%, p = 0.52). Logistic regression showed no significant difference in the composite outcomes of minor complications, major complications, and readmissions (15.6% for ambulatory versus 19.3% for admission, p = 0.46). Temporary nerve palsy, infection, and hematoma were the most common post-operative complications. However, covariates of a lower face procedure and operative time were shown to have significant differences in the composite complication outcome (p = 0.04 and p = 0.045, respectively)., Conclusion: Ambulatory FFS is a safe practice with no associated increase in adverse outcomes including complications, ED/UC visits, and readmission when compared to post-operative admission. Adoption of same-day FFS should be considered by high-volume gender health centers to potentially benefit from increased scheduling flexibility and efficiency, increased access to care, and lower healthcare costs., Competing Interests: Declaration of Competing Interest All authors have no conflict of interests or financial interests including products, devices, or drugs associated with this manuscript., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)
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- 2024
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9. Quality of Life 5 Years Following Transfemoral TAVR or SAVR in Intermediate Risk Patients.
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Kleiman NS, Van Mieghem NM, Reardon MJ, Gada H, Mumtaz M, Olsen PS, Heiser J, Merhi W, Chetcuti S, Deeb GM, Chawla A, Kiaii B, Teefy P, Chu MWA, Yakubov SJ, Windecker S, Althouse AD, and Baron SJ
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- Humans, Female, Male, Time Factors, Treatment Outcome, Aged, Aged, 80 and over, Risk Factors, Risk Assessment, Heart Valve Prosthesis Implantation instrumentation, Heart Valve Prosthesis Implantation adverse effects, Catheterization, Peripheral adverse effects, Punctures, Prosthesis Design, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis physiopathology, Quality of Life, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement instrumentation, Health Status, Aortic Valve surgery, Aortic Valve physiopathology, Aortic Valve diagnostic imaging, Recovery of Function, Severity of Illness Index, Heart Valve Prosthesis, Femoral Artery
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Background: Symptomatic patients with severe aortic stenosis (AS) at high risk for surgical aortic valve replacement (SAVR) sustain comparable improvements in health status over 5 years after transcatheter aortic valve replacement (TAVR) or SAVR. Whether a similar long-term benefit is observed among intermediate-risk AS patients is unknown., Objectives: The purpose of this study was to assess health status outcomes through 5 years in intermediate risk patients treated with a self-expanding TAVR prosthesis or SAVR using data from the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial., Methods: Intermediate-risk patients randomized to transfemoral TAVR or SAVR in the SURTAVI trial had disease-specific health status assessed at baseline, 30 days, and annually to 5 years using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Health status was compared between groups using fixed effects repeated measures modelling., Results: Of the 1,584 patients (TAVR, n = 805; SAVR, n = 779) included in the analysis, health status improved more rapidly after TAVR compared with SAVR. However, by 1 year, both groups experienced large health status benefits (mean change in KCCQ-Overall Summary Score (KCCQ-OS) from baseline: TAVR: 20.5 ± 22.4; SAVR: 20.5 ± 22.2). This benefit was sustained, albeit modestly attenuated, at 5 years (mean change in KCCQ-OS from baseline: TAVR: 15.4 ± 25.1; SAVR: 14.3 ± 24.2). There were no significant differences in health status between the cohorts at 1 year or beyond. Similar findings were observed in the KCCQ subscales, although a substantial attenuation of benefit was noted in the physical limitation subscale over time in both groups., Conclusions: In intermediate-risk AS patients, both transfemoral TAVR and SAVR resulted in comparable and durable health status benefits to 5 years. Further research is necessary to elucidate the mechanisms for the small decline in health status noted at 5 years compared with 1 year in both groups. (Safety and Efficacy Study of the Medtronic CoreValve® System in the Treatment of Severe, Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement [SURTAVI]; NCT01586910)., Competing Interests: Funding Support and Author Disclosures Medtronic funded the trial. Dr Kleiman is a consultant for Medtronic, Abbott, and Boston Scientific; and receives grant support from Medtronic. Dr Van Mieghem has received grant support from Abbott Vascular, Boston Scientific, Edwards Lifesciences, and Medtronic; and advisory fees from Abbott, Boston Scientific, Pulse Cath BV, and Medtronic. Dr Reardon has received institutional fees from Medtronic for consulting and providing educational services. Dr Gada serves as a consultant to Abbott Vascular, Bard, Inc., Boston Scientific, Edwards Lifesciences, and Medtronic. Dr Mumtaz serves as a consultant to and receives honoraria and research grants from Edwards Lifesciences, the Japanese Organization for Medical Device Development, Medtronic, Triflex, and Foldax. Dr Chetcuti has received personal fees from Medtronic; has received grants from Edwards Lifesciences, Boston Scientific, and Jena; and serves on advisory boards for Biotrace and Jena Valve. Dr Deeb has received grant support from Medtronic; and personal fees from Medtronic outside the submitted work. Dr Chawla is a proctor for Medtronic. Dr Kiaii is a consultant and speaker for Medtronic, Johnson & Johnson, and Abbott. Dr Chu has received speaker honoraria from Medtronic, Edwards Lifesciences, Terumo Aortic, and Artivion. Dr Yakubov has received grants from Boston Scientific and Medtronic. Dr Windecker has received institutional research, travel, or educational grants from Abbott, Abiomed, Amgen, AstraZeneca, Bayer, Braun, Biotronik, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Cardinal Health, CardioValve, Cordis Medical, Corflow Therapeutics, CSL Behring, Daiichi-Sankyo, Edwards Lifesciences, Farapulse Inc. Fumedica, Guerbet, Idorsia, Inari Medical, InfraRedx, Janssen-Cilag, Johnson & Johnson, Medalliance, Medicure, Medtronic, Merck Sharp & Dohme, Miracor Medical, Novartis, Novo Nordisk, Organon, OrPha Suisse, Pharming Tech. Pfizer, Polares, Regeneron, Sanofi, Servier, Sinomed, Terumo, Vifor, and V-Wave; has served as an advisory board member and/or member of the steering/executive group of trials funded by Abbott, Abiomed, Amgen, AstraZeneca, Bayer, Boston Scientific, Biotronik, Bristol Myers Squibb, Edwards Lifesciences, MedAlliance, Medtronic, Novartis, Polares, Recardio, Sinomed, Terumo, and V-Wave with payments to the institution; and is also member of the steering/executive committee group of several investigator-initiated trials that receive funding by industry without impact on his personal remuneration. Dr Althouse is a shareholder and employee of Medtronic plc. Dr Baron has received research support from Boston Scientific and Abiomed, consulting/advisory board fees from Medtronic, Biotronik, Shockwave, and Zoll Medical; and speaker honoraria from Zoll Medical, Edwards Lifesciences, Boston Scientific, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2024
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10. Association of Cerebral Oximetry With Brain Ischemic Lesions and Functional Outcomes in Arch Repair.
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Hibino M, Peterson MD, Tachibana R, Chu MWA, Bozinovski J, Dagenais F, Quan A, Papa FV, Dickson J, Teoh H, Alli A, Hare GMT, Smith EE, Verma S, and Mazer CD
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- Humans, Brain, Catheterization methods, Perfusion methods, Oximetry, Cerebrovascular Circulation
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Background: This exploratory analysis of the randomized controlled Aortic Surgery Cerebral Protection Evaluation CardioLink-3 trial sought to determine if cerebral oximetry desaturation during elective proximal arch repair is associated with detrimental postoperative neuroradiologic and neurofunctional outcomes., Methods: Cerebral oximetry and pre- and postoperative brain magnetic resonance imaging data from 101 participants were analyzed. Oximetry data from the trial allocation groups were compared; the relationships between cerebral oximetry indices and new ischemic cerebral lesions on magnetic resonance imaging and neurologic outcomes were also evaluated., Results: Total cerebral desaturation events (>20% decrease from baseline) on the left (median [interquartile range], 1 [1-3] vs 1.5 [0.5-3] with innominate and axillary cannulation; P = .80) were comparable to those on the right (1 [1-3] vs 1 [0-3]; P = .75) as were the total area under the curve of desaturation (left, P = .61; right, P = .84). Seventy patients had new ischemic lesions, among whom 36 had new severe lesions. Total desaturation events and area under the curve of desaturation were similar in patients with and without new ischemic lesions or severe lesions. The nadir regional cerebral saturation was lower on the left (49% [41-56]) than the right (53% [44-59]); left desaturation episodes were associated with lower postoperative cognitive test scores (P = .004)., Conclusions: The innominate and axillary cannulation techniques for elective proximal arch repair with unilateral antegrade cerebral perfusion were associated with similar occurrences of cerebral oximetry desaturation and neither were associated with new ischemic lesions., (Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2024
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11. The Aortic Team Model and Collaborative Decision Pathways for the Management of Complex Aortic Disease: Clinical Practice Update From the Canadian Cardiovascular Society/Canadian Society of Cardiac Surgeons/Canadian Society for Vascular Surgery/Canadian Association for Interventional Radiology.
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McClure RS, Lindsay TF, Keir M, Bayne JP, Berry RF, Chu MWA, Chung JC, Dagenais F, Ducas RA, Duncan A, Horne G, Klass D, Mongeon FP, Richer J, and Rommens KL
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- Humans, Radiology, Interventional, Canada, Aorta, Vascular Surgical Procedures, Aortic Diseases diagnosis, Aortic Diseases surgery, Specialties, Surgical, Surgeons
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Disease of the aortic arch, descending thoracic, or thoracoabdominal aorta necessitates dedicated expertise across medical, endovascular, and surgical specialties. Cardiologists, cardiac surgeons, vascular surgeons, interventional radiologists, and others have expertise and skills that aid in the management of patients with complex aortic disease. No specialty is uniformly expert in all aspects of required care. Because of this dispersion of expertise across specialties, an aortic team model approach to decision-making and treatment is advocated. A nonhierarchical partnership across specialties within an interdisciplinary aortic clinic ensures that all treatment options are considered and promotes shared decision-making between the patient and all aortic experts. Furthermore, regionalization of care for aortic disease of increased complexity assures that the breadth of treatment options is available and that favourable volume-outcome ratios for high-risk procedures are maintained. An awareness of best practice care pathways for patient referrals for preventative management, acute care scenarios, chronic care scenarios, and pregnancy might facilitate a more organized management schema for aortic disease across Canada and improve lifelong surveillance initiatives., (Copyright © 2023 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
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- 2023
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12. Obstructive Tricuspid Mass Resulting in Cardiac Cirrhosis.
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Malik MI, Abazid RM, De S, and Chu MWA
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- Humans, Liver Cirrhosis complications, Liver Cirrhosis diagnosis, Tricuspid Valve diagnostic imaging, Tricuspid Valve surgery, Liver Diseases, Tricuspid Valve Insufficiency diagnosis, Tricuspid Valve Insufficiency etiology
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- 2023
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13. Multimodal imaging of isolated tricuspid valve calcification causing severe tricuspid valve stenosis.
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Abazid RM, Malik MI, De S, and Chu MWA
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- Humans, Tricuspid Valve diagnostic imaging, Tricuspid Valve surgery, Predictive Value of Tests, Multimodal Imaging, Tricuspid Valve Stenosis diagnostic imaging, Tricuspid Valve Stenosis etiology, Tricuspid Valve Stenosis surgery, Calcinosis complications, Calcinosis diagnostic imaging, Calcinosis surgery
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Competing Interests: Declaration of competing interest No conflict of interest.
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- 2023
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14. Low-Dose vs Standard Warfarin After Mechanical Mitral Valve Replacement: A Randomized Trial.
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Chu MWA, Ruel M, Graeve A, Gerdisch MW, Damiano RJ Jr, Smith RL 2nd, Keeling WB, Wait MA, Hagberg RC, Quinn RD, Sethi GK, Floridia R, Barreiro CJ, Pruitt AL, Accola KD, Dagenais F, Markowitz AH, Ye J, Sekela ME, Tsuda RY, Duncan DA, Swistel DG, Harville LE 3rd, DeRose JJ, Lehr EJ, Alexander JH, and Puskas JD
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- Humans, Warfarin adverse effects, Anticoagulants adverse effects, Prospective Studies, Mitral Valve surgery, Hemorrhage etiology, Thromboembolism etiology, Thromboembolism prevention & control, Thrombosis etiology, Heart Valve Prosthesis Implantation adverse effects
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Background: Current guidelines recommend a target international normalized ratio (INR) range of 2.5 to 3.5 in patients with a mechanical mitral prosthesis. The Prospective Randomized On-X Anticoagulation Clinical Trial (PROACT) Mitral randomized controlled noninferiority trial assessed safety and efficacy of warfarin at doses lower than currently recommended in patients with an On-X (Artivion, Inc) mechanical mitral valve., Methods: After On-X mechanical mitral valve replacement, followed by at least 3 months of standard anticoagulation, 401 patients at 44 North American centers were randomized to low-dose warfarin (target INR, 2.0-2.5) or standard-dose warfarin (target INR, 2.5-3.5). All patients were prescribed aspirin, 81 mg daily, and encouraged to use home INR testing. The primary end point was the sum of the linearized rates of thromboembolism, valve thrombosis, and bleeding events. The design was based on an expected 7.3% event rate and 1.5% noninferiority margin., Results: Mean patient follow-up was 4.1 years. Mean INR was 2.47 and 2.92 (P <.001) in the low-dose and standard-dose warfarin groups, respectively. Primary end point rates were 11.9% per patient-year in the low-dose group and 12.0% per patient-year in the standard-dose group (difference, -0.07%; 95% CI, -3.40% to 3.26%). The CI >1.5%, thus noninferiority was not achieved. Rates (percentage per patient-year) of the individual components of the primary end point were 2.3% vs 2.5% for thromboembolism, 0.5% vs 0.5% for valve thrombosis, and 9.13% vs 9.04% for bleeding., Conclusions: Compared with standard-dose warfarin, low-dose warfarin did not achieve noninferiority for the composite primary end point. (PROACT Clinicaltrials.gov number, NCT00291525)., (Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2023
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15. Single Access for Transfemoral Transcatheter Aortic Valve Implantation With the Acurate neo/neo 2 Self-Expanding Valve.
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Bagur R, Chu MWA, Ordoñez S, Valdis M, Gelinas J, Chaumont G, Teefy PJ, and Diamantouros P
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- Humans, Aortic Valve diagnostic imaging, Aortic Valve surgery, Prosthesis Design, Treatment Outcome, Transcatheter Aortic Valve Replacement, Aortic Valve Stenosis surgery, Heart Valve Prosthesis
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- 2023
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16. The Critically Important Role of the Annuloplasty in Mitral Repair.
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Hage A and Chu MWA
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- Humans, Mitral Valve surgery, Tricuspid Valve, Treatment Outcome, Mitral Valve Annuloplasty, Mitral Valve Insufficiency surgery
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- 2022
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17. Cardiac Surgery for Atrial Septal Defect Repair: Normalization of Hyperpolarized Xenon-129 MRI RBC-to-Barrier Ratio.
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Matheson AM, Cunningham RSP, Parraga G, Chu MWA, and Blissett S
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- Humans, Magnetic Resonance Imaging, Xenon Isotopes, Cardiac Surgical Procedures, Heart Septal Defects, Atrial diagnostic imaging, Heart Septal Defects, Atrial surgery
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- 2022
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18. Imaging of Glycosaminoglycans in Ascending Aortic Aneurysms With Chemical Exchange Saturation Transfer MRI.
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Mortuza R, Ching-Johnson JA, Yin H, O'Neil C, Cronin AE, Randhawa VK, Nong Z, Hashi AA, Li AX, Bartha R, Chu MWA, and Pickering JG
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- Humans, Magnetic Resonance Imaging methods, Predictive Value of Tests, Aortic Aneurysm diagnostic imaging, Glycosaminoglycans
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- 2022
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19. Minimally Invasive Endoscopic Mitral Repair: How I Teach It.
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Hage A, Ghoneim A, and Chu MWA
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- Humans, Minimally Invasive Surgical Procedures, Treatment Outcome, Mitral Valve surgery, Mitral Valve Insufficiency surgery
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- 2022
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20. Aortic Arch Replacement: How I Teach It.
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Mazine A, Dhingra NK, Chu MWA, El-Hamamsy I, and Peterson MD
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- Aorta, Thoracic diagnostic imaging, Aorta, Thoracic surgery, Humans, Treatment Outcome, Vascular Surgical Procedures, Aortic Dissection surgery, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation
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- 2022
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21. WITHDRAWN: Low-Dose Versus Standard Warfarin After Mechanical Mitral Valve Replacement: A Randomized Controlled Trial.
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Chu MWA, Ruel M, Graeve A, Gerdisch MW, Damiano RJ Jr, Smith RL 2nd, Keeling WB, Wait MA, Hagberg RC, Quinn RD, Sethi GK, Floridia R, Barreiro CJ, Pruitt AL, Accola KD, Dagenais F, Markowitz AH, Ye J, Sekela ME, Tsuda RY, Duncan DA, Swistel DG, Harville LE 3rd, DeRose JJ, Lehr EJ, and Puskas JD
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This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal., (Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2022
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22. Development of Quality Indicators for the Management of Acute Type A Aortic Dissection.
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Hassan A, Ouzounian M, Dagenais F, El-Hamamsy I, Moon MC, Pozeg Z, McClure RS, Yamashita M, Peterson MD, MacArthur R, Appoo JJ, and Chu MWA
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- Acute Disease, Aorta, Thoracic surgery, Canada, Follow-Up Studies, Humans, Retrospective Studies, Aortic Dissection surgery, Aortic Aneurysm, Thoracic surgery, Cardiology, Disease Management, Quality Indicators, Health Care trends, Societies, Medical, Vascular Surgical Procedures standards
- Abstract
In an effort to further improve surgical outcomes in patients with acute type A aortic dissection (ATAD), the Canadian Thoracic Aortic Collaborative (CTAC), with the support of the Canadian Society of Cardiac Surgeons (CSCS), endeavoured to develop quality indicators (QIs) for the management of patients with ATAD. After 2 successive consultations with the CTAC membership, 11 QIs were selected and separated into 5 broad categories: preoperative (time from presentation to diagnosis, time from presentation to the operating room), intraoperative (use of hypothermic circulatory arrest and antegrade cerebral perfusion), 30-day outcomes (30-day rates of all-cause mortality, 30-day rates of new postoperative stroke), 1-year outcomes (1-year rates of follow-up imaging, 1-year rates of all-cause mortality, and 1-year rates of surgical reintervention), and institutional (institutional surgical volumes, individual surgical volumes, and presence of institutional aortic disease teams). The purpose of this article is to describe the process by which QIs for the management of ATAD were developed and the feasibility by which they may be collected using existing clinical and administrative data sources. Furthermore, we demonstrate how they may be used to evaluate success following surgery for repair of ATAD and ultimately improve clinical outcomes., (Crown Copyright © 2021. Published by Elsevier Inc. All rights reserved.)
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- 2021
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23. Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair: Mid-Term Outcomes From the CUTTING-EDGE International Registry.
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Kaneko T, Hirji S, Zaid S, Lange R, Kempfert J, Conradi L, Hagl C, Borger MA, Taramasso M, Nguyen TC, Ailawadi G, Shah AS, Smith RL, Anselmi A, Romano MA, Ben Ali W, Ramlawi B, Grubb KJ, Robinson NB, Pirelli L, Chu MWA, Andreas M, Obadia JF, Gennari M, Garatti A, Tchetche D, Nazif TM, Bapat VN, Modine T, Denti P, and Tang GHL
- Subjects
- Aged, Aged, 80 and over, Humans, Middle Aged, Mitral Valve diagnostic imaging, Mitral Valve surgery, Registries, Retrospective Studies, Treatment Outcome, Heart Valve Prosthesis Implantation adverse effects, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency surgery
- Abstract
Objectives: The aim of this study was to determine clinical and echocardiographic characteristics, mechanisms of failure, and outcomes of mitral valve (MV) surgery after transcatheter edge-to-edge repair (TEER)., Background: Although >100,000 mitral TEER procedures have been performed worldwide, longitudinal data on MV surgery after TEER are lacking., Methods: Data from the multicenter, international CUTTING-EDGE registry were retrospectively analyzed. Clinical and echocardiographic outcomes were evaluated. Median follow-up duration was 9.0 months (interquartile range [IQR]: 1.2-25.7 months) after MV surgery, and follow-up was 96.1% complete at 30 days and 81.1% complete at 1 year., Results: From July 2009 to July 2020, 332 patients across 34 centers underwent MV surgery after TEER. The mean age was 73.8 ± 10.1 years, median Society of Thoracic Surgeons risk for MV repair at initial TEER was 4.0 (IQR: 2.3-7.3), and primary/mixed and secondary mitral regurgitation were present in 59.0% and 38.5%, respectively. The median interval from TEER to surgery was 3.5 months (IQR: 0.5-11.9 months), with overall median Society of Thoracic Surgeons risk of 4.8% for MV replacement (IQR: 2.8%-8.4%). The primary indication for surgery was recurrent mitral regurgitation (33.5%), and MV replacement and concomitant tricuspid surgery were performed in 92.5% and 42.2% of patients, respectively. The 30-day and 1-year mortality rates were 16.6% and 31.3%, respectively. On Kaplan-Meier analysis, the actuarial estimates of mortality were 24.1% at 1 year and 31.7% at 3 years after MV surgery., Conclusions: In this first report of the CUTTING-EDGE registry, the mortality and morbidity risks of MV surgery after TEER were not negligible, and only <10% of patients underwent MV repair. These registry data provide valuable insights for further research to improve these outcomes., Competing Interests: Funding Support and Author Disclosures Dr Kaneko is a speaker for Edwards Lifesciences, Medtronic, Abbott, and Baylis Medical; and is a consultant for 4C Medical. Dr Lange is an advisory board member for and has received royalties and speaker honoraria from Medtronic; has received speaker honoraria from Abbott; and is a shareholder in Highlife. Dr Kempfert has served as a physician proctor for Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic. Dr Conradi is a physician proctor, consultant, and speaker for Edwards Lifesciences and Medtronic. Dr Hagl has received speaker honoraria from Edwards Lifesciences. Dr Borger has received speaker honoraria and/or consulting fees to his hospital from Edwards Lifesciences, Medtronic, Abbott, and CryoLife. Dr Taramasso has been a consultant for Abbott Vascular, Boston Scientific, Edwards Lifesciences, 4Tech, Mitraltech, Simulands, MTEx, Occlufit, CoreMedic, and Shenqi Medical. Dr Nguyen has received speaker honoraria from Edwards Lifesciences, CryoLife, and Abbott. Dr Ailawadi is a consultant for Abbott, Edwards Lifesciences, Medtronic, and AtriCure. Dr Smith has received grant support from Edwards Lifesciences; and has received speaker honoraria from Edwards Lifesciences, Abbott, and CryoLife. Dr Anselmi is a physician proctor and consultant for Abbott and Edwards Lifesciences. Dr Ben Ali has received research grants from Edwards Lifesciences and Medtronic. Dr Ramlawi is a consultant for Boston Scientific, Medtronic, LivaNova, and Atricure. Dr Grubb is a physician proctor for Medtronic, Edwards Lifesciences, and Boston Scientific; and has served as a consultant for Medtronic, Boston Scientific, Ancora, HLT, and BioVentrics. Dr Pirelli is a physician proctor for and has received speaker honoraria from Edwards Lifesciences; and is a consultant for Medtronic. Dr Chu has received speaker honoraria from Medtronic, Edwards Lifesciences, and Terumo Aortic. Dr Andreas is a physician proctor and consultant for and has received speaker honoraria from Edwards Lifesciences, Abbott, and Medtronic; and has received institutional research grants from Edwards Lifesciences, Abbott, Medtronic, and LSI Solutions. Dr Obadia is a consultant for Abbott, Carmat, Delacroix-Chevalier, Landanger, and Medtronic. Dr Gennari is a consultant for Medtronic. Dr Garatti is a physician proctor for Abbott. Dr Nazif has equity in Venus Medtech; and has received consulting fees or honoraria from Keystone Heart, Edwards Lifesciences, Medtronic, and Boston Scientific. Dr Bapat has served as a consultant for Medtronic, Edwards Lifesciences, 4C Medical, and Boston Scientific. Dr Modine is a physician proctor and consultant for Medtronic, Edwards Lifesciences, and Abbott. Dr Denti receives speaker honoraria from Abbott and Edwards Lifesciences; and is a consultant for InnovHeart. Dr Tang is a physician proctor for Medtronic; is a consultant for Medtronic, NeoChord, and Abbott; and is a physician advisory board member for Abbott and JenaValve. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2021
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24. Surgical Explantation After TAVR Failure: Mid-Term Outcomes From the EXPLANT-TAVR International Registry.
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Bapat VN, Zaid S, Fukuhara S, Saha S, Vitanova K, Kiefer P, Squiers JJ, Voisine P, Pirelli L, von Ballmoos MW, Chu MWA, Rodés-Cabau J, DiMaio JM, Borger MA, Lange R, Hagl C, Denti P, Modine T, Kaneko T, and Tang GHL
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- Aged, Aged, 80 and over, Aortic Valve diagnostic imaging, Aortic Valve surgery, Humans, Middle Aged, Registries, Retrospective Studies, Risk Factors, Treatment Outcome, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Heart Valve Prosthesis, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Objectives: The aim of this study was to evaluate clinical characteristics, mechanisms of failure, and outcomes of transcatheter aortic valve replacement (TAVR) explantation., Background: Surgical explantation following TAVR may be required for structural valve degeneration, paravalvular leak, infection, or other reasons. However, in-depth data on indications and outcomes are lacking., Methods: Data from a multicenter, international registry (EXPLANT-TAVR) of patients who underwent TAVR explantation were reviewed retrospectively. Explantations performed during the same admission as initial TAVR were excluded. Clinical and echocardiographic outcomes were evaluated. Median follow-up duration was 6.7 months (interquartile range [IQR]: 1.0-18.8 months) after TAVR explantation and was 97.7% complete at 30 days and 86.1% complete at 1 year., Results: From November 2009 to September 2020, 269 patients across 42 centers with a mean age of 72.7 ± 10.4 years underwent TAVR explantation. About one quarter (25.9%) were deemed low surgical risk at index TAVR, and median Society of Thoracic Surgeons risk at TAVR explantation was 5.6% (IQR: 3.2%-9.6%). The median time to explantation was 11.5 months (IQR: 4.0-32.4 months). Balloon-expandable and self-expanding or mechanically expandable valves accounted for 50.9% and 49.1%, respectively. Indications for explantation included endocarditis (43.1%), structural valve degeneration (20.1%), paravalvular leak (18.2%), and prosthesis-patient mismatch (10.8%). Redo TAVR was not feasible because of unfavorable anatomy in 26.8% of patients. Urgent or emergency cases were performed in 53.1% of patients, aortic root replacement in 13.4%, and 54.6% had concomitant cardiac procedures. Overall survival at last follow-up was 76.1%. In-hospital, 30-day, and 1-year mortality rates were 11.9%, 13.1%, and 28.5%, respectively, and stroke rates were 5.9%, 8.6%, and 18.7%, respectively., Conclusions: The EXPLANT-TAVR registry reveals that surgical risks associated with TAVR explantation are not negligible and should be taken into consideration in the lifetime management of aortic stenosis., Competing Interests: Funding Support and Author Disclosures Dr Bapat has served as a consultant for Medtronic, Edwards Lifesciences, 4C Medical, and Boston Scientific. Dr Fukuhara is a consultant for Terumo Aortic. Dr Pirelli is a physician proctor for and has received speaker honoraria from Edwards Lifesciences; and is a consultant for Medtronic. Dr Wyler von Ballmoos has served as a consultant for LivaNova, Medtronic, and Boston Scientific. Dr Chu has received speaker honoraria from Medtronic, Edwards Lifesciences, and Terumo Aortic. Dr Rodés-Cabau has received institutional research grants from and is a consultant for Edwards Lifesciences, Medtronic, and Boston Scientific. Dr Borger has reported that his hospital receives speaker honoraria and/or consulting fees on his behalf from Edwards Lifesciences, Medtronic, Abbott, and CryoLife. Dr Lange is a consultant for Medtronic. Dr Hagl has received speaker honoraria from Edwards Lifesciences. Dr Denti has received speaker honoraria from Abbott and Edwards Lifesciences; and is a consultant for InnovHeart. Dr Modine is a physician proctor and consultant for Medtronic, Edwards Lifesciences, and Abbott. Dr Kaneko is a speaker for Edwards Lifesciences, Medtronic, Abbott, and Baylis Medical; and is a consultant for 4C Medical. Dr Tang is a physician proctor for Medtronic; is a consultant for Medtronic, Abbott, and NeoChord; and is an advisory board member for Abbott and JenaValve. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2021
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25. First-in-Human Use of the Cook Hybrid Frozen Elephant Trunk Graft: The Canadian Experience.
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Chauvette V, Demers P, Lachapelle K, Chu MWA, and Dagenais F
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- Aged, Aortic Dissection surgery, Aortic Aneurysm, Thoracic surgery, Canada, Female, Freezing, Humans, Male, Middle Aged, Prospective Studies, Prosthesis Design, Treatment Outcome, Aorta, Thoracic surgery, Aortic Diseases surgery, Blood Vessel Prosthesis, Stents
- Abstract
Background: Advancements in technology have changed the treatment of aortic arch pathologies. Specifically, the introduction of the frozen elephant trunk technique has allowed one-stage treatment of pathologies that would have otherwise required a two-stage procedure. We present the early outcomes of a novel frozen elephant hybrid stent graft., Methods: Between August 2015 and July 2019, 39 patients (56% male; mean age 67 ± 11years) underwent an arch reconstruction with a novel hybrid stent graft in four different Canadian centers. The most common indication for surgery was arch aneurysm (31%) followed by acute dissection (28%). All patients were prospectively followed with clinical and imaging assessments., Results: The device was successfully implanted in all patients. There were 3 perioperative deaths (8%). Transient spinal cord injury occurred in 5 patients (13%); all had complete neurologic recovery before discharge. Seven patients had a perioperative stroke/transient ischemic attack; 3 of them initially presented with cerebral malperfusion caused by acute dissection. One patient died during the study follow-up. Survival at 30 days and at 1 and 3 years was 92% ± 5%, 89% ± 5%, and 89% ± 5%, respectively. At a median follow-up of 16 months, 3 patients required a reintervention to address a type I distal endoleak and 1 patient was treated for a type II endoleak. There was no arch anastomosis complications., Conclusions: The Cook hybrid stent graft device provides encouraging midterm results in a high-risk cohort. This novel graft is simple to deploy, may be customized to patients' anatomy in elective cases, eases arch reconstruction, and allows versatility in the choice of arch grafts., (Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
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26. Midterm Outcomes of the Dissected Aorta Repair Through Stent Implantation Trial.
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Bozso SJ, Nagendran J, Chu MWA, Kiaii B, El-Hamamsy I, Ouzounian M, Kempfert J, Starck C, and Moon MC
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- Aged, Aortic Dissection diagnosis, Aortic Aneurysm, Thoracic diagnosis, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Prosthesis Design, Time Factors, Tomography, X-Ray Computed, Treatment Outcome, Aortic Dissection surgery, Aorta, Thoracic surgery, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation methods, Stents
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Background: The intimal flap at the distal aortic anastomosis after standard aortic dissection repair creates distal anastomotic new entry, leading to false lumen (FL) pressurization and true lumen (TL) collapse and resulting in increased mortality, malperfusion, aortic growth, and reinterventions. The Ascyrus Medical Dissection Stent (AMDS; Ascyrus Medical, Boca Raton, FL) is a hybrid prosthesis that seals and depressurizes the FL at the distal anastomosis while expanding and pressurizing the TL., Methods: The Dissected Aorta Repair Through Stent Implantation trial is a prospective, nonrandomized, international type A dissection trial where patients with acute DeBakey I dissections were enrolled between March 2017 and January 2019. Forty-seven patients were enrolled (median age, 62.5; 67.4% men) with a median follow-up of 631 days., Results: All patients underwent emergent surgical repair with successful AMDS implantation. One patient was excluded because of use in iatrogenic dissection. Overall mortality at 30 days and 1 year was 13.0% (6/46) and 19.6% (9/46), whereas new strokes occurred in 6.5% (3/46). Over 95% of vessel malperfusions resolved because of AMDS-induced TL expansion, including 3 patients with preoperative paralysis. Positive remodeling of the aortic arch occurred in 100% of cases with complete obliteration or thrombosis of the FL in 74%. In the proximal descending thoracic aorta positive remodeling occurred in 77% and complete obliteration or FL thrombosis in 53% of cases., Conclusions: AMDS facilitates single-stage management of malperfusion and induces positive remodeling of the aortic arch through effective sealing of the distal anastomotic FL, depressurization of the FL with expansion, and pressurization of the TL. Importantly the use of AMDS is safe and reproducible., (Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2021
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27. Echocardiographic Method to Determine the Length of Neochordae Reconstruction for Mitral Repair.
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Makhdom F, Hage A, Manian U, Ginty O, Losenno KL, Kiaii B, and Chu MWA
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- Aged, Female, Humans, Male, Middle Aged, Mitral Valve diagnostic imaging, Chordae Tendineae surgery, Echocardiography, Transesophageal methods, Heart Valve Prosthesis Implantation methods, Mitral Valve surgery, Plastic Surgery Procedures methods
- Abstract
Background: We evaluated a novel formula using preoperative transesophageal echocardiographic measurements to determine neochordae length for repair of degenerative mitral regurgitation (MR)., Methods: The formula is based on measuring the distance from the adjacent papillary head to the intended coaptation zone of the flail/prolapsing leaflet segment and subtracting the redundant leaflet length. Between 2008 and 2017, 264 consecutive patients underwent mitral valve repair (82.2% endoscopic, minimally invasive approach and 17.8% sternotomy) with neochordae loop reconstruction (68.6% posterior, 6.4% anterior, and 25% bileaflet repair). Mean patient age was 63 ± 13.6 years, 73.5% were men, and mean left ventricular ejection fraction was 63.1% ± 6.7%., Results: Mitral valve repair was successful in 100% of patients, with no patient requiring conversion to replacement. Neochordae length measurement was accurate in 259 patients (98%), with 4 patients requiring conversion to resection and 1 patient requiring longer anterior leaflet neochordae. Median anterior and posterior neochordae lengths were 27 mm (range, 18-32) and 17 mm (range, 9-27), respectively. Intraoperative transesophageal echocardiography demonstrated no or trace residual MR in 254 patients and mild residual MR in 10 patients. In-hospital mortality occurred in 1 patient, and complications included respiratory failure (2.7%) and renal failure (1.8%). At the median follow-up of 12.6 months (interquartile range, 11.1), 98.9% of patients remained free from ≥2+ MR, whereas freedom from reoperation was 100%., Conclusions: Preoperative transesophageal echocardiographic measurements can accurately and reproducibly predict the required length of neochordae loop reconstruction for degenerative mitral valve repair with good results. Longer-term follow-up is necessary., (Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2021
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28. Valve-Sparing Root Replacement Versus Composite Valve Grafting in Aortic Root Dilation: A Meta-Analysis.
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Elbatarny M, Tam DY, Edelman JJ, Rocha RV, Chu MWA, Peterson MD, El-Hamamsy I, Appoo JJ, Friedrich JO, Boodhwani M, Yanagawa B, and Ouzounian M
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- Aortic Diseases etiology, Aortic Diseases pathology, Humans, Aortic Diseases surgery, Heart Valve Prosthesis Implantation
- Abstract
Background: Aortic valve-sparing operations theoretically have fewer stroke and bleeding complications but may increase late reoperation risk versus composite valve grafts., Methods: We meta-analyzed all studies comparing aortic valve-sparing (reimplantation and remodelling) and composite valve-grafting (bioprosthetic and mechanical) procedures. Early outcomes were all-cause mortality, reoperation for bleeding, myocardial infarction, and thromboembolism/stroke. Long-term outcomes included all-cause mortality, reintervention, bleeding, and thromboembolism/stroke. Studies exclusively investigating dissection or pediatric populations were excluded., Results: A total of 3794 patients who underwent composite valve grafting and 2424 who underwent aortic valve-sparing procedures were included from 9 adjusted and 17 unadjusted observational studies. Mean follow-up was 5.8 ± 3.0 years. Aortic valve sparing was not associated with any difference in early mortality, bleeding, myocardial infarction, or thromboembolic complications. Late mortality was significantly lower after valve sparing (incident risk ratio, 0.68; 95% confidence interval [CI], 0.54-0.87; P < .01). Late thromboembolism/stroke (incident rate ratio, 0.36; 95% CI, 0.22-0.60; P < .01) and bleeding (incident rate ratio, 0.21; 95% CI, 0.11-0.42; P < .01) risks were lower after valve sparing. Procedure type did not affect late reintervention., Conclusions: Aortic valve sparing appears to be safe and associated with reduced late mortality, thromboembolism/stroke, and bleeding compared with composite valve grafting. Late durability is equivalent. Aortic valve sparing should be considered in patients with favorable aortic valve morphology., (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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29. Minimally Invasive Hybrid Approach to High Risk Mitral Disease With Severe Mitral Annular Calcification.
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de Waard D, Alukayli M, Gelinas J, Iglesias I, Fujii S, Bagur R, and Chu MWA
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- Aged, Calcinosis diagnostic imaging, Echocardiography methods, Endoscopy methods, Female, Humans, Severity of Illness Index, Treatment Outcome, Heart Valve Prosthesis Implantation instrumentation, Heart Valve Prosthesis Implantation methods, Mitral Valve diagnostic imaging, Mitral Valve pathology, Mitral Valve surgery, Mitral Valve Stenosis diagnosis, Mitral Valve Stenosis etiology, Mitral Valve Stenosis physiopathology, Mitral Valve Stenosis surgery, Risk Adjustment methods, Surgery, Computer-Assisted methods
- Abstract
Severe circumferential mitral annular calcification (MAC) remains a significant challenge, complicating surgical treatment of mitral valve disease. Transcatheter treatment options are attractive; however, they remain fraught with risks of annular fixation, paravalvular leak, atrioventricular-groove disruption, and left-ventricular outflow tract obstruction. We describe a novel minimally invasive hybrid technique of transcatheter mitral valve replacement in a patient with severe circumferential MAC., (Copyright © 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
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- 2020
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30. Evolution of Tricuspid Regurgitation After Repair of Degenerative Mitral Regurgitation.
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Hage A, Hage F, Jones PM, Manian U, Tzemos N, and Chu MWA
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- Aged, Echocardiography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Mitral Valve Insufficiency diagnosis, Prognosis, Retrospective Studies, Severity of Illness Index, Time Factors, Treatment Outcome, Tricuspid Valve Insufficiency diagnosis, Tricuspid Valve Insufficiency surgery, Heart Valve Prosthesis Implantation adverse effects, Mitral Valve surgery, Mitral Valve Insufficiency surgery, Postoperative Complications, Tricuspid Valve Insufficiency etiology
- Abstract
Background: The fate of unrepaired tricuspid regurgitation (TR) after mitral valve repair for degenerative mitral regurgitation remains highly debated. The objective of this study was to examine the progress of unrepaired TR after mitral valve repair for degenerative mitral regurgitation, with a particular focus on comparing patients with moderate preoperative TR with those having none or mild preoperative TR., Methods: Between 2008 and 2018, 183 consecutive patients (mean age, 61 years [SD, 14]) with severe degenerative mitral regurgitation and less-than-severe TR underwent mitral valve repair alone without concomitant TR repair. They were prospectively followed for a median duration of 3.1 years (interquartile range, 1.6-5.5; maximal duration of 9.4 years)., Results: At baseline 146 patients (80%) had none or mild TR; 37 patients (20%) had moderate TR. At follow-up 51 patients (30%) had improved TR compared with 28 patients (17%) who had worse TR. At 3 years postoperatively echocardiographic data were available for 82 of 183 patients: 70 (85%) had none or mild TR, 11 (13%) had moderate TR, and 1 (1.2%) had moderate to severe TR. In an exploratory multivariable analysis with limited statistical power, patients with moderate preoperative TR (vs those with none or mild TR) had an association with higher mortality (hazard ratio, 2.8; 95% confidence interval, 0.81-9.4; P = .11)., Conclusions: After mitral valve repair but without concomitant tricuspid valve repair, a number of patients had progression in their TR. There was a signal of harm in patients having moderate preoperative TR in terms of mortality, but this finding is exploratory and requires investigation., (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2020
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31. Single-Stage Management of Dynamic Malperfusion Using a Novel Arch Remodeling Hybrid Graft.
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Bozso SJ, Nagendran J, Chu MWA, Kiaii B, El-Hamamsy I, Ouzounian M, Kempfert J, Starck C, Shahriari A, and Moon MC
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Aortic Dissection diagnosis, Aortic Dissection physiopathology, Aortic Aneurysm, Thoracic diagnosis, Aortic Aneurysm, Thoracic physiopathology, Canada epidemiology, Female, Follow-Up Studies, Germany epidemiology, Humans, Male, Middle Aged, Postoperative Complications physiopathology, Postoperative Complications surgery, Prospective Studies, Prosthesis Design, Regional Blood Flow physiology, Reoperation, Tomography, X-Ray Computed, Treatment Outcome, Young Adult, Aortic Dissection surgery, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation adverse effects, Endovascular Procedures adverse effects, Postoperative Complications epidemiology, Stents adverse effects
- Abstract
Background: Organ malperfusion remains challenging, causing complications associated with acute DeBakey I dissections. We describe the results of malperfusion management after implantation of the Ascyrus Medical Dissection Stent (AMDS; Ascyrus Medical, Boca Raton, FL), an adjunct to current surgical aortic dissection repair., Methods: From March 2017 to January 2019, 47 consecutive patients (median age, 65 years; interquartile range, 15.8 years; 61.9% male) presented with acute DeBakey I aortic dissections and underwent emergent surgical aortic repair with AMDS implantation. Malperfusion was detected preoperatively in 55.3% (n = 26) of patients. Two patients were excluded from efficacy analysis due to lack of follow-up. Overall, 66 vessel malperfusions were identified, consisting of 1.5% (n = 1) coronary, 33.3% (n = 22) supraaortic, 21.2% (n = 14) visceral, 24.2% (n = 16) renal, and 15.1% (n = 10) extremities. Three patients (11.5%) had clinical evidence of paralysis at presentation., Results: All 26 device implants were successful. In the malperfusion cohort, 30-day mortality was 7.7% (n = 2). A new neurologic deficit identified postoperatively in patients without neurologic symptoms preoperatively occurred in 7.7% (n = 2). During the follow-up period, 95.5% (n = 63) of vessel malperfusions had resolved without an additional procedure, including 95.5% (n = 21) supraaortic, 92.9% (n = 13) visceral, 93.8% (n = 15) renal, and 100% (n = 10) extremity. All patients with paralysis at presentation had complete resolution., Conclusions: The AMDS provides an effective single-stage malperfusion management strategy. In this study, dynamic malperfusion involving supraaortic, visceral, spinal cord, and lower extremities were treated concurrently with the index standard-of-care operation without delay in life-saving care., (Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
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32. Effects of Proton Pump Inhibitors on FOLFOX and CapeOx Regimens in Colorectal Cancer.
- Author
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Wong GG, Ha V, Chu MP, Dersch-Mills D, Ghosh S, Chambers CR, and Sawyer MB
- Subjects
- Capecitabine administration & dosage, Colorectal Neoplasms pathology, Drug Therapy, Combination, Female, Fluorouracil administration & dosage, Follow-Up Studies, Humans, Leucovorin administration & dosage, Male, Middle Aged, Neoplasm Recurrence, Local pathology, Oxaliplatin administration & dosage, Prognosis, Retrospective Studies, Survival Rate, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Colorectal Neoplasms drug therapy, Drug Interactions, Neoplasm Recurrence, Local drug therapy, Proton Pump Inhibitors therapeutic use
- Abstract
Background: First-line adjuvant chemotherapy options for early-stage colorectal cancer (CRC) include CapeOx (capecitabine, intravenous oxaliplatin) and FOLFOX (intravenous 5-fluorouracil, leucovorin, oxaliplatin). Capecitabine is an oral prodrug analog of 5-fluorouracil, and recent studies have suggested that proton pump inhibitors (PPIs) may detrimentally affect capecitabine efficacy. Conversely, some literature suggests that PPIs may negatively affect CRC itself. To gain insight into the nature of PPIs' effect on capecitabine and CRC, we investigated their effects on effectiveness of CapeOx versus FOLFOX chemotherapy., Patients and Methods: We conducted a retrospective chart review of 389 patients with stage II-III CRC who received adjuvant CapeOx or FOLFOX from 2004 to 2013. Information regarding PPI receipt, chemotherapy, and patient outcomes from medical records was analyzed., Results: Three-year recurrence-free survival was significantly lower in CapeOx-treated PPI recipients than non-PPI recipients (69.5 vs. 82.6%; P = .029). Unadjusted analysis showed that CapeOx-treated PPI recipients were twice as likely to experience cancer recurrence or death as CapeOx-treated non-PPI recipients (hazard ratio = 2.03; 95% confidence interval, 1.06-3.88; P = .033). FOLFOX-treated PPI recipients had a non-statistically significant difference in 3-year recurrence-free survival versus non-PPI recipients (82.9 vs. 61.7%; P = .066) and a non-statistically significant difference in recurrence/death (hazard ratio = 0.51; 95% confidence interval, 0.25-1.06; P = .071). No significant differences were seen in overall survival between groups., Conclusion: Our results suggest PPIs negatively affected recurrence-free survival in CapeOx-treated CRC patients and yielded no significant effects among FOLFOX-treated patients, potentially implicating a pharmacokinetic interaction between PPIs and capecitabine. No overall survival effects were seen. Given PPIs' widespread use, further studies are required to corroborate our findings., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2019
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33. Early Clinical Outcomes of Hybrid Arch Frozen Elephant Trunk Repair With the Thoraflex Hybrid Graft.
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Chu MWA, Losenno KL, Dubois LA, Jones PM, Ouzounian M, Whitlock R, Dagenais F, Boodhwani M, Bhatnagar G, Poostizadeh A, Pozeg Z, Moon M, Kiaii B, and Peterson MD
- Subjects
- Aged, Aged, 80 and over, Aortic Dissection mortality, Aortic Aneurysm, Thoracic mortality, Cohort Studies, Female, Humans, Male, Middle Aged, Survival Rate, Time Factors, Treatment Outcome, Aortic Dissection surgery, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation, Endovascular Procedures, Stents
- Abstract
Background: Hybrid aortic arch surgery has evolved to include several technical variations, with most including an off-label use of a conventional thoracic endograft. We describe the early clinical outcomes of the Thoraflex Hybrid graft (Vascutek, Glasgow, Scotland) specifically designed for the treatment of complex arch and proximal descending aortic disease., Methods: Between January 2014 and April 2017, 40 consecutive patients (66 ± 14 years of age, 45% women) underwent hybrid aortic arch and frozen elephant trunk repair with the multibranched Thoraflex Hybrid graft at 9 Canadian centers. Surgical indications included transverse arch or proximal descending aortic aneurysm in 100%, acute dissection in 10%, chronic dissection in 43%, and acute aortic rupture in 1 patient. Antegrade cerebral perfusion and moderate hypothermia (24.3 ± 1.8°C) were employed in all cases., Results: All 40 device implants were successful. The 30-day or in-hospital mortality was 5%. Stroke and transient neurological deficits occurred in 5% and 3% of patients, respectively. Two (5%) patients experienced transient spinal cord ischemia-there were no instances of permanent paraplegia. Mean follow-up was 550 ± 328 days and late complications included type A aortic dissection in 1 patient, type B dissection in 2 patients, and further distal endografting in 2 patients. Survival at 30 days, 1 year, and 2 years was 95%, 95%, and 90%, respectively., Conclusions: Hybrid aortic arch and frozen elephant trunk repair with the Thoraflex Hybrid graft appears to be associated with good clinical outcomes, despite being early in the learning curve with this graft. Further investigation with this device is warranted to establish its role within the variations of hybrid arch repair., (Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
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34. Expanding Eligibility for the Ross Procedure: A Reasonable Proposition?
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Ghoneim A, Bouhout I, Losenno K, Poirier N, Cartier R, Demers P, Tousch M, Guo L, Chu MWA, and El-Hamamsy I
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- Adult, Bicuspid Aortic Valve Disease, Canada epidemiology, Female, Hospital Mortality, Humans, Length of Stay, Long Term Adverse Effects diagnosis, Long Term Adverse Effects epidemiology, Long Term Adverse Effects etiology, Male, Middle Aged, Outcome and Process Assessment, Health Care, Reproducibility of Results, Risk Assessment methods, Aortic Valve pathology, Aortic Valve physiopathology, Aortic Valve surgery, Cardiac Surgical Procedures adverse effects, Cardiac Surgical Procedures methods, Cardiac Surgical Procedures statistics & numerical data, Endocarditis complications, Endocarditis etiology, Heart Defects, Congenital complications, Heart Defects, Congenital mortality, Heart Defects, Congenital physiopathology, Heart Defects, Congenital surgery, Heart Valve Diseases complications, Heart Valve Diseases mortality, Heart Valve Diseases physiopathology, Heart Valve Diseases surgery, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation methods, Heart Valve Prosthesis Implantation statistics & numerical data, Postoperative Complications diagnosis, Postoperative Complications epidemiology, Postoperative Complications etiology, Pulmonary Valve transplantation
- Abstract
Background: Although the Ross procedure offers potential benefits in young adults, technical complexity represents a significant limitation. Therefore, the safety of expanding its use in more complex settings is uncertain. The aim of this study was to compare early outcomes of standard isolated Ross procedures vs expanding elgibility to higher-risk clinical settings., Methods: From 2011 to 2016, 261 patients (46 ± 12 years) underwent Ross procedures in 2 centres. Patients were divided into 2 groups: standard Ross (n = 166) and expanded eligibility Ross (n = 95). Inclusion criteria for the expanded eligibility group were previous cardiac surgery, acute aortic valve endocarditis, severely impaired left ventricular (LV) function and patients undergoing concomitant procedures. All data were prospectively collected and are 100% complete., Results: Hospital mortality was 0% in the standard group (0/166) vs 2% in the expanded eligibility group (2/95) (P = 0.13). Sixteen patients (10%) developed acute renal injury in the standard group vs 13 (14%) patients in the expanded eligibility group (P = 0.31). There were no postoperative myocardial infarctions, no neurological events, and no infectious complications. Median intensive care unit (ICU) stay in the standard group was 2 vs 3 days in the expanded eligibility group (P = 0.004), whereas median hospital stay was 6 vs 7 days, respectively (range: 3-19 days) (P < 0.001)., Conclusion: Aside from longer ICU and hospital lengths of stay after the Ross procedure in higher-risk clinical scenarios, perioperative mortality and morbidity is similar to standard Ross procedures. Expanding the use of the Ross operation in young adults is a safe alternative in centres of expertise., (Copyright © 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
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35. Response to "Letter to the editor: Predictors of internal mammary vessel diameter: A computed tomographic angiography-assisted anatomic analysis", Madada-Nyakauru, et al.
- Author
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Cook JA, Tholpady SS, Momeni A, and Chu MW
- Subjects
- Angiography, Breast, Computed Tomography Angiography
- Published
- 2018
- Full Text
- View/download PDF
36. Hybrid Coronary Revascularization Versus On-Pump Coronary Artery Bypass Grafting.
- Author
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Giambruno V, Jones P, Khaliel F, Chu MW, Teefy P, Sridhar K, Cucchietti C, Barnfield R, and Kiaii B
- Subjects
- Aged, Cohort Studies, Female, Humans, Male, Middle Aged, Recovery of Function, Treatment Outcome, Cardiopulmonary Bypass, Coronary Artery Bypass, Coronary Artery Disease surgery, Percutaneous Coronary Intervention
- Abstract
Background: Hybrid coronary revascularization (HCR) is an evolving coronary revascularization strategy for the treatment of multivessel coronary artery disease. We provide a comparative analysis to conventional on-pump coronary artery bypass graft surgery (CABG) with long-term follow-up., Methods: We included all double on-pump CABG (n = 682) and HCR (147 robotic-assisted minimally invasive bypass grafts of the left internal thoracic artery to the left anterior descending coronary artery and percutaneous coronary intervention to one of the non-left anterior descending coronary artery vessels) performed in our institution between March 2004 and November 2015. We performed an adjusted analysis using inverse-probability weighting based on the propensity score of receiving either on-pump CABG or HCR., Results: In the adjusted analysis, there was no statistically significant difference in the incidence of reexploration for bleeding, perioperative myocardial infarction, stroke, need for hemodialysis, blood transfusion rate, prolonged mechanical ventilation, and intensive care unit length of stay. Hybrid coronary revascularization was associated with lower inhospital mortality (CABG 1.3%, HCR 0%, p = 0.008), and shorter mean (± SD) hospital length of stay (CABG 6.7 ± 4.7 days, HCR 4.5 ± 2.1 days, p < 0.001). After a median follow-up period of 70 months (range, 37 to 106) for the CABG group and 96 months (range, 53 to 114) for the HCR group, there was no significant difference in survival (CABG 92%, HCR 97%, p = 0.13) or freedom from any form of revascularization (CABG 93%, HCR 91%, p = 0.27). Hybrid coronary revascularization was superior in freedom from angina (CABG 70%, HCR 91%, p < 0.001)., Conclusions: For selected patients, HCR is associated with a faster postoperative recovery as well as similar short-term and long-term outcomes when compared with standard on-pump CABG., (Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
37. 3-Dimensional-Printed Model for Planning Transcatheter Mitral Valve Replacement.
- Author
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Bagur R, Cheung A, Chu MWA, and Kiaii B
- Subjects
- Aged, Echocardiography, Three-Dimensional, Echocardiography, Transesophageal, Heart Valve Prosthesis Implantation adverse effects, Hemodynamics, Humans, Male, Mitral Valve diagnostic imaging, Mitral Valve physiopathology, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency etiology, Mitral Valve Insufficiency physiopathology, Models, Anatomic, Models, Cardiovascular, Prosthesis Design, Recovery of Function, Treatment Outcome, Cardiac Catheterization instrumentation, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation, Mitral Valve surgery, Mitral Valve Insufficiency surgery, Printing, Three-Dimensional
- Published
- 2018
- Full Text
- View/download PDF
38. Aortic Arch Reconstructive Surgery With Conventional Techniques vs Frozen Elephant Trunk: A Systematic Review and Meta-Analysis.
- Author
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Hanif H, Dubois L, Ouzounian M, Peterson MD, El-Hamamsy I, Dagenais F, Hassan A, and Chu MWA
- Subjects
- Aortic Dissection diagnostic imaging, Aorta, Thoracic diagnostic imaging, Aorta, Thoracic surgery, Aortic Aneurysm, Thoracic diagnostic imaging, Blood Vessel Prosthesis, Female, Follow-Up Studies, Humans, Male, Prosthesis Design, Risk Assessment, Survival Rate, Time Factors, Treatment Outcome, Aortic Dissection surgery, Aortic Aneurysm, Thoracic mortality, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation methods, Hospital Mortality
- Abstract
Background: Frozen elephant trunk (FET) surgery offers a new alternative in the management of complex thoracic aortic aneurysms and dissections. We performed a systematic review and meta-analysis of comparator observational studies evaluating the efficacy of FET compared with conventional aortic arch surgery, primarily focusing on mortality and stroke as well as the secondary outcomes of spinal cord ischemia, major bleeding, and operative time., Methods: We searched MEDLINE, EMBASE, PubMed, and the Cochrane Library for trials and studies comparing the FET technique with conventional surgery in patients with aortic aneurysms or dissections, or both. The overall quality of evidence was low, as assessed by Grading of Recommendations, Assessment, Development, and Evaluation, based primarily on the risk of bias secondary to study design, plausible confounding, and imprecision., Results: Meta-analysis revealed a significant reduction in mortality (12 studies, 1803 patients: odds ratio [OR], 0.55; 95% CI, 0.39-0.78) and a nonsignificant reduction in stroke (12 studies, 1803 patients: OR, 0.78; 95% CI, 0.52-1.15) favouring FET; however, FET was associated with a significant increase in spinal cord ischemia (9 studies, 1476 patients: OR, 2.20; 95% CI, 1.10-4.37). No significant differences between groups were observed regarding major bleeding, cardiopulmonary bypass time, or cross-clamp time., Conclusions: Current evidence suggests that FET surgery is associated with lower mortality in patients with thoracic aneurysmal disease and dissections, without a significant increase in stroke, bleeding, or operative times. However, the risk of spinal cord ischemia is increased in patients who undergo FET. A well-powered randomized trial is needed to evaluate this evolving field., (Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
39. Hybrid Arch Frozen Elephant Trunk for Persistent Endoleak After Thoracic Endovascular Aortic Repair.
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Landau JH, Dubois LA, and Chu MWA
- Subjects
- Aged, Endoleak etiology, Humans, Male, Recurrence, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation adverse effects, Endoleak surgery, Endovascular Procedures adverse effects
- Abstract
Aneurysms of the distal aortic arch and proximal descending thoracic aorta remain challenging to treat. Whereas thoracic endovascular aortic repair (TEVAR) with arch debranching has provided a more minimally invasive option for patients with such aneurysms, recurrent type Ia endoleaks can be difficult or impossible to treat with further endovascular intervention. We report the successful use of a hybrid arch and frozen elephant trunk graft for the treatment of a patient with a recurrent type Ia endoleak after TEVAR and arch debranching., (Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
40. Atypical Chest Pain and a Blood Blister: More Than Meets the Eye.
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Gottschalk BH, Fujii S, Jones PM, and Chu MWA
- Subjects
- Aged, Chest Pain diagnosis, Chest Pain surgery, Coronary Aneurysm diagnosis, Coronary Aneurysm surgery, Coronary Angiography, Echocardiography, Humans, Male, Chest Pain etiology, Coronary Aneurysm complications, Percutaneous Coronary Intervention methods
- Published
- 2017
- Full Text
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41. The Use of Topical Hemostatic Agents in Cardiothoracic Surgery.
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Bracey A, Shander A, Aronson S, Boucher BA, Calcaterra D, Chu MWA, Culbertson R, Jabr K, Kehlet H, Lattouf O, Malaisrie SC, Mazer CD, Oberhoffer MM, Ozawa S, Price T, Rosengart T, Spiess BD, and Turchetti G
- Subjects
- Administration, Topical, Humans, Blood Loss, Surgical prevention & control, Cardiac Surgical Procedures, Hemostatic Techniques, Hemostatics administration & dosage
- Abstract
Topical hemostatic agents are used in conjunction with conventional procedures to reduce blood loss. They are often used in cardiothoracic surgery, which is particularly prone to bleeding risks. Variation in their use exists because detailed policy and practice guidelines reflecting the current medical evidence have not been developed to promote best surgical practice in this setting. To address this need, the Society for the Advancement of Blood Management convened an International Hemostatic Expert Panel. This article reviews the available literature and sets out evidence-based recommendations for the use of topical hemostatic agents in cardiothoracic surgery., (Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
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42. Black Aortic Valve: A Surprise Finding of What Clinical Relevance?
- Author
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Al-Amodi HA, Tweedie EJ, Iglesias I, and Chu MWA
- Subjects
- Adult, Aortic Valve surgery, Aortic Valve Stenosis etiology, Calcinosis complications, Cardiomyopathies complications, Echocardiography, Female, Humans, Aortic Valve diagnostic imaging, Aortic Valve Stenosis diagnosis, Calcinosis diagnosis, Cardiomyopathies diagnosis
- Published
- 2017
- Full Text
- View/download PDF
43. Ross, Hybrid Arch, and Frozen Elephant Trunk Reconstruction for Late Complications of Bicuspid Aortic Valve and Aortopathy.
- Author
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Valdis M, DeRose G, Guo L, and Chu MW
- Subjects
- Adult, Aortic Valve surgery, Bicuspid Aortic Valve Disease, Echocardiography methods, Female, Humans, Long Term Adverse Effects diagnosis, Long Term Adverse Effects physiopathology, Long Term Adverse Effects surgery, Plastic Surgery Procedures methods, Reoperation methods, Sternotomy methods, Tomography, X-Ray Computed methods, Treatment Outcome, Vascular Surgical Procedures methods, Aorta, Thoracic pathology, Aorta, Thoracic physiopathology, Aorta, Thoracic surgery, Aortic Diseases complications, Aortic Diseases surgery, Aortic Valve abnormalities, Heart Valve Diseases complications, Heart Valve Diseases surgery, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation methods, Sternotomy adverse effects
- Abstract
Young patients with bicuspid aortic valve disease and aortopathy remain a clinical challenge, with many requiring multiple corrective operations throughout their lifetimes. Innovative surgical approaches are often required to address complex aortic pathologic conditions but leave patients at risk for reintervention, lifelong anticoagulation, and suboptimal hemodynamics. We describe an active 44-year-old female triathlete with recurrent bicuspid aortic stenosis, a small aortic root, a hypoplastic aortic arch and complex distal arch, and a descending aortic aneurysm, who underwent a single-stage reconstruction with a combined Ross procedure, hybrid arch, and frozen elephant trunk reconstruction., (Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
44. Minimally Invasive En Bloc Resection of Massive Obstructive Atrial Tumour.
- Author
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Cote CL, Alkhamees N, Goldbach M, Bagur R, and Chu MW
- Subjects
- Echocardiography methods, Female, Humans, Middle Aged, Minimally Invasive Surgical Procedures methods, Mobility Limitation, Tomography, X-Ray Computed methods, Treatment Outcome, Tumor Burden, Cardiac Surgical Procedures methods, Heart Atria pathology, Heart Atria surgery, Heart Neoplasms complications, Heart Neoplasms pathology, Heart Neoplasms surgery, Multiple Sclerosis complications, Myxoma complications, Myxoma pathology, Myxoma surgery
- Abstract
Minimally invasive cardiac surgery techniques offer better cosmesis, quicker recovery, and shorter hospital stay when compared with sternotomy. Large cardiac tumours have been traditionally resected via sternotomy to provide adequate surgical exposure, complete surgical resection, and prevent tumour fragmentation. We describe a patient with advanced multiple sclerosis and wheelchair dependence with a massive obstructive left atrial tumour who underwent successful minimally invasive en bloc resection with an uncomplicated postoperative course., (Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
45. Transcaval Transcatheter Aortic Valve Replacement With the ACURATE-neo Aortic Bioprosthesis: First North American Experience.
- Author
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Bagur R, Teefy PJ, Kiaii B, Goela A, Greenbaum A, and Chu MWA
- Subjects
- Aortic Valve, Aortic Valve Stenosis, Heart Valve Prosthesis, Prosthesis Design, Treatment Outcome, United States, Bioprosthesis, Transcatheter Aortic Valve Replacement
- Published
- 2016
- Full Text
- View/download PDF
46. Predictors of internal mammary vessel diameter: A computed tomographic angiography-assisted anatomic analysis.
- Author
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Cook JA, Tholpady SS, Momeni A, and Chu MW
- Subjects
- Adult, Anthropometry methods, Female, Humans, Models, Anatomic, Breast blood supply, Computed Tomography Angiography methods, Free Tissue Flaps blood supply, Mammaplasty methods, Mammary Arteries anatomy & histology, Mammary Arteries diagnostic imaging, Mammary Arteries physiology
- Abstract
The internal mammary vessels are the most common recipient vessels in free flap breast reconstruction. The literature on internal mammary vascular anatomy is limited by small sample sizes, cadaveric studies, or intraoperative changes. The purpose of this study is to analyze internal mammary anatomy using computed tomographic angiography. A retrospective review of 110 consecutive computed tomographic angiography studies of female patients was performed. Measurements of vessel caliber, distance of internal mammary vessels to sternum, location of internal mammary vein bifurcation, intercostal space height, and chest width were analyzed. Patient demographics and comorbidities were reviewed. The right internal mammary artery and vein were larger than the left in all intercostal spaces (p = 0.02 and p < 0.001, respectively). A significant correlation was found between both skeletal chest width and body mass index with internal mammary vessel caliber at the third intercostal space (p ≤ 0.02). The internal mammary vein bifurcated at the third intercostal space bilaterally, 4.3 and 1.2 mm caudal to the third rib on the right and left sides, respectively. The third intercostal space was <1.5 cm in 25% of patients. Understanding the anatomy, bifurcation, and caliber of internal mammary vessels can aid preoperative planning of autologous, free flap breast reconstruction. On average, the internal mammary vein bifurcates at the third intercostal space; patients with larger chest widths and body mass index had larger caliber internal mammary vessels, and 25% of patients had third intercostal space <1.5 cm and, thus, may not be suitable candidates for rib-sparing techniques., (Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
47. Minimally Invasive Periareolar Approach to Unroofed Coronary Sinus Atrial Septal Defect Repair.
- Author
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Bozso SJ, Grant A, Iglesias I, and Chu MWA
- Subjects
- Female, Follow-Up Studies, Heart Septal Defects, Atrial diagnostic imaging, Humans, Middle Aged, Minimally Invasive Surgical Procedures methods, Risk Assessment, Treatment Outcome, Wound Healing physiology, Coronary Sinus surgery, Echocardiography, Transesophageal methods, Endoscopy methods, Heart Septal Defects, Atrial surgery, Nipples surgery
- Abstract
Less invasive techniques are commonly used to treat patients with anatomically suitable secundum atrial septal defects; however, repair of more complex atrial septal defects are still performed through sternotomy. Cosmetically appealing periareolar incisions have been used in breast reconstructive surgery and may provide an esthetically superior alternative to the anterolateral minithoracotomy incision used in minimally invasive cardiac surgery. We describe a patient with an unroofed coronary sinus atrial septal defect who underwent successful minimally invasive, endoscopic repair of this defect with autologous pericardial baffle reconstruction of the coronary sinus roof and closure of the interatrial communication through a periareolar approach., (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
48. Concomitant Administration of Proton Pump Inhibitors and Capecitabine is Associated With Increased Recurrence Risk in Early Stage Colorectal Cancer Patients.
- Author
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Sun J, Ilich AI, Kim CA, Chu MP, Wong GG, Ghosh S, Danilak M, Mulder KE, Spratlin JL, Chambers CR, and Sawyer MB
- Subjects
- Adult, Aged, Colorectal Neoplasms mortality, Disease-Free Survival, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Proportional Hazards Models, Retrospective Studies, Antineoplastic Agents therapeutic use, Capecitabine therapeutic use, Colorectal Neoplasms drug therapy, Neoplasm Recurrence, Local epidemiology, Neoplasm Recurrence, Local mortality, Proton Pump Inhibitors adverse effects
- Abstract
Background: Capecitabine is used to treat colorectal (CRC) cancer. TRIO-013, a study examining capecitabine/oxaliplatin ± lapatinib in metastatic gastro-esophageal cancer did not show increases in overall survival (OS) with lapatinib. An analysis showed concurrent proton pump inhibitor (PPI) usage negatively impacted recurrence-free survival (RFS). We retrospectively studied PPI effects on capecitabine efficacy in early stage CRC and how capecitabine adjustments impacted RFS., Methods: Early stage CRC patients taking monotherapy capecitabine treated from 2008 to 2012 were reviewed for demographics, medications, toxicities, and patient outcomes., Results: Of 298 identified patients, 25.8% (n = 77) received concurrent PPIs. Five-year RFS was 74% versus 83% (hazard ratio [HR], 1.89; 95% confidence interval [CI], 1.07-3.35; P = .03) in PPI versus non-PPI patients respectively. OS was 81% versus 78%, respectively (HR, 1.13; 95% CI, 0.60-2.14; P = .7). After accounting for gender, stage, age, and performance status, PPI patients tended toward decreased RFS (HR, 1.65; 95% CI, 0.93-2.94; P = .09). Capecitabine dose modifications affected outcomes. Five-year RFS was 84% in the control group, 100% in the treatment-delay group (P = .99), 67% in the dose reduction group (HR, 2.46; 95% CI, 1.23-4.93; P = .01), and 64% in the discontinuation group (HR, 2.27; 95% CI, 0.93-5.53; P = .07). Five-year OS was significantly less in the discontinuation group than control group (59% vs. 82%; HR, 3.27; 95% CI, 1.44-7.45; P = .005)., Conclusions: PPIs appear to impact RFS; this may be due to PPIs preventing capecitabine tablet dissolution and absorption. Patients with dose reductions or who stopped treatment had worse outcomes than patients who continued with treatment at starting doses., (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
49. First North American Experience With the Engager Self-Expanding Transcatheter Aortic Valve: Insights From the London Health Sciences Centre Heart Team.
- Author
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Bagur R, Kiaii B, Teefy PJ, Diamantouros P, Lavi R, Harle C, Cassese M, and Chu MW
- Subjects
- Aged, 80 and over, Female, Humans, London, Male, North America, Prosthesis Design, Aortic Valve surgery, Aortic Valve Stenosis surgery, Bioprosthesis, Cardiology, Heart Valve Prosthesis, Transcatheter Aortic Valve Replacement methods
- Abstract
The Engager aortic bioprosthesis consists of bovine pericardial leaflets mounted on a self-expandable frame with unique anatomic orientation capabilities to engage the aortic valve cusps. We report the initial North American transcatheter aortic valve implantation (TAVI) experience with the Engager device. Transapical TAVI was performed in 4 patients (mean age 80 ± 6 years, Society of Thoracic Surgeons score 5 ± 1%). The valve was anatomically oriented and successfully implanted in all patients. There were no conversions to open operation or major procedure-related adverse events. Pacemaker implantation was necessary in 1 patient. None of the patients showed paravalvular leak. The Engager device for TAVI provides anatomic orientation and anchoring that prevents coronary obstruction and paravalvular leak., (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
50. Canadian Cardiovascular Society/Canadian Society of Cardiac Surgeons/Canadian Society for Vascular Surgery Joint Position Statement on Open and Endovascular Surgery for Thoracic Aortic Disease.
- Author
-
Appoo JJ, Bozinovski J, Chu MW, El-Hamamsy I, Forbes TL, Moon M, Ouzounian M, Peterson MD, Tittley J, and Boodhwani M
- Subjects
- Advisory Committees, Aorta, Thoracic surgery, Canada, Endovascular Procedures methods, Humans, Societies, Medical, Vascular Surgical Procedures methods, Aortic Diseases surgery, Cardiovascular Diseases surgery, Cardiovascular Surgical Procedures methods
- Abstract
In 2014, the Canadian Cardiovascular Society (CCS) published a position statement on the management of thoracic aortic disease addressing size thresholds for surgery, imaging modalities, medical therapy, and genetics. It did not address issues related to surgical intervention. This joint Position Statement on behalf of the CCS, Canadian Society of Cardiac Surgeons, and the Canadian Society for Vascular Surgery provides recommendations about thoracic aortic disease interventions, including: aortic valve repair, perfusion strategies for arch repair, extended arch hybrid reconstruction for acute type A dissection, endovascular management of arch and descending aortic aneurysms, and type B dissection. The position statement is constructed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and has been approved by the primary panel, an international secondary panel, and the CCS Guidelines Committee. Advent of endovascular technology has improved aortic surgery safety and extended the indications of minimally invasive thoracic aortic surgery. The combination of safer open surgery with endovascular treatment has improved patient outcomes in this rapidly evolving subspecialty field of cardiovascular surgery., (Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
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