Prospective Evaluation of Neurocognition in Patients Following Transcatheter Aortic Valve Replacement.

Background: Data regarding change in neurocognitive function after transcatheter aortic valve replacement (TAVR) are conflicting. We sought to investigate the change in cognition up to 6 months post-TAVR in patients with mild cognitive impairment (MCI).

Methods: This is a prospective, observational, nonrandomized, cohort study of patients with MCI who underwent TAVR between February 2022 and June 2023 in a multicenter health care system.

Surgical ablation of preexisting atrial fibrillation during aortic valve replacement in Medicare beneficiaries.

Objectives: Guidelines recommend surgical ablation(SA) during isolated aortic valve replacement(AVR) in patients with preexisting atrial fibrillation(AF). Nevertheless, SA remains under-utilized during AVR, and the impact of SA on long-term outcomes is poorly quantified. We examined the association of SA with survival and the incidence of stroke or transient ischemic attack(TIA) in Medicare beneficiaries with AF undergoing AVR.

Long-term survival after multidisciplinary heart team-guided management of complex coronary artery disease.

Objective: Guidelines recommend a multidisciplinary heart team approach for managing complex coronary artery disease (CAD), yet its impact on clinical outcomes and adherence to recommendations is rarely reported.

Methods: Between June 2021 and August 2022, 210 high-risk patients with isolated, complex CAD were evaluated at our institution's weekly heart team conference for consideration of coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), hybrid PCI/CABG, or optimal medical therapy (OMT). Adherence to recommendations and clinical outcomes, including 30-day, 1-year, and 2-year mortality, were assessed.

Intracardiac versus transesophageal echocardiographic guidance for left atrial appendage occlusion: Design and rationale of the ICE-TEE trial.

Left atrial appendage occlusion (LAAO) has emerged as an alternative to long-term anticoagulation for stroke prevention in patients with non-valvular atrial fibrillation deemed high risk for bleeding. LAAO is performed via a transseptal approach with the placement of an occlusion device in the left atrial appendage (LAA) to seal it. Intraoperative imaging with echocardiography is needed to guide and complete the procedure.

Survival After Surgical Ablation of Atrial Fibrillation During Coronary Artery Bypass in Medicare Beneficiaries.

Background: Despite guideline recommendations, use of concomitant surgical ablation during isolated coronary artery bypass grafting (CABG) in patients with preexisting atrial fibrillation is low, with a poorly quantified impact on stroke and survival.

Methods: A retrospective review of Medicare data identified 87,699 beneficiaries with preexisting atrial fibrillation undergoing CABG, with or without concomitant surgical ablation, from 2008 to 2019. All-cause mortality and the incidence of stroke were evaluated as separate end points.

Surgeon proclivity for coronary endarterectomy during isolated coronary artery bypass grafting in Medicare beneficiaries†.

Objectives: Coronary endarterectomy (CE) is an adjunct to coronary artery bypass grafting (CABG) in patients with one or more diffusely diseased coronary arteries. Although associated with increased perioperative morbidity and mortality, it remains a therapeutic strategy to potentially improve late outcomes by facilitating the revascularization of an otherwise ungraftable target.

Methods: Medicare beneficiaries undergoing CABG from 2001 to 2019 were identified.

Surgeon Frequency of Aortic Root Enlargement and Long-Term Survival in Medicare Beneficiaries Undergoing Surgical Aortic Valve Replacement.

Aortic root enlargement (ARE) is a variably performed during surgical aortic valve replacement (SAVR) to minimize patient-prothesis mismatch (PPM), but its impact on survival remains under-evaluated. We retrospectively analyzed Medicare beneficiaries (1999-2019) undergoing isolated SAVR with or without non-Konno ARE. Procedural details were doubly-adjudicated by ICD and CPT codes.

Enhanced Survival With Surgical Ablation of Atrial Fibrillation During Mitral Valve Surgery.

Background: Surgical ablation (SA) at the time of isolated mitral valve surgery (MVS) is recommended in patients with preexisting atrial fibrillation (AF). However, SA remains infrequently utilized during MVS with a poorly quantified impact on stroke and survival.

Methods: Medicare claims (2008-2019) were queried to identify beneficiaries with preexisting AF undergoing MVS.

Coronary Artery Bypass Grafting With Mitral Annuloplasty or Replacement for Ischemic Mitral Regurgitation in Medicare Beneficiaries.

Background: Retrospective studies of patients with ischemic mitral regurgitation (iMR) undergoing coronary artery bypass grafting (CABG) with concomitant mitral valve surgery frequently report improved survival with mitral valve repair/annuloplasty (MVr) over replacement (MVR). However, the only randomized controlled trial found no survival difference.

Methods: Medicare claims data were queried to identify beneficiaries with iMR undergoing CABG/MVr or CABG/MVR.

Hospital Volume and Long-Term Survival Among Medicare Beneficiaries Undergoing Surgical Repair of Acute Type A Aortic Dissection.

Despite guideline recommendations, transfer rates to high-volume aortic centers (high-VACs) for acute type A aortic dissections (TAAD) remain suboptimal. This may be because the benefit of undergoing surgical repair of TAAD at high-VACs remains poorly quantified. Medicare beneficiaries undergoing surgical repair of TAAD from 1999-2019 were identified.

Improving Cardiogenic Shock Team Activation Through Nurse Education and Alert Implementation.

Background: Patients with cardiogenic shock have a 25% to 50% mortality rate despite the introduction of mechanical circulatory devices and coordinated medical treatment. The use of shock teams has improved outcomes for these patients.

Local Problem: A cardiovascular hospital with a multidisciplinary shock team had inconsistency and delays in recognition and diagnosis of patients with cardiogenic shock.

Hospital and surgeon surgical valvar volume and survival after multivalve cardiac surgery in Medicare beneficiaries.

Objective: Long-term outcomes after multivalve cardiac surgery remain underevaluated.

Methods: Medicare administrative claims from 2008 to 2019 identified beneficiaries undergoing multivalve surgery. Operative characteristics were doubly adjudicated using International Classification of Diseases and Current Procedural Technology codes.

Transcatheter Valve-in-Valve Replacement With Balloon- Versus Self-Expanding Valves in Patients With Degenerated Stentless Aortic Bioprosthesis.

Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has been associated with favorable outcomes in patients with degenerated stentless bioprosthesis. However, whether the outcomes after ViV TAVR for failed stentless bioprosthesis differ between balloon-expandable valves (BEVs) and self-expanding valves (SEVs) remains unknown. Therefore, we retrospectively analyzed 59 consecutive patients who underwent ViV TAVR for failed stentless bioprsothesis with BEVs (n = 42) versus SEVs (n = 17) in a single-health care system between 2013 and 2022.

Midterm durability of valve-sparing root replacement in bicuspid and tricuspid aortic valves.

Background: Among patients with bicuspid aortic valves (BAV) who are potential candidates for valve-sparing root replacement (VSRR), the long-term durability of this technique is not well understood. This study aimed to compare the clinical and echocardiographic outcomes of VSRR in those with BAV and tricuspid aortic valve (TAV) morphology.

Methods: This was a retrospective analysis of patients who underwent VSRR between 2007 and 2021 at a single center.

Causes and Clinical Outcomes of Patients Who Failed Screening for Transcatheter Tricuspid Valve Interventions.

Transcatheter tricuspid valve intervention (TTVI) has recently emerged as a promising alternative to surgery for tricuspid regurgitation (TR). However, a significant proportion of patients fail screening for TTVI, and little is known about their characteristics and natural history. This study sought to investigate causes of screen failure and outcomes of patients declined for TTVI.

Tricuspid regurgitation burden following transcatheter aortic valve replacement requiring early pacemaker implantation.

Background: Conduction abnormality requiring the implantation of a permanent pacemaker (PPM) is a well-known and clinically important complication of transcatheter aortic valve replacement (TAVR). However, PPM implantation may result in lead-associated tricuspid valve regurgitation (TR). This study sought to determine the incidence and progression of TR following PPM implantation after TAVR.

Distal Versus Proximal Radial Artery Access for Cardiac Catheterization: 30-Day Outcomes of the DIPRA Study.

Background Proximal radial artery (pRA) access for cardiac catheterization is safe but can jeopardize subsequent use of the artery because of occlusion. Distal radial artery (dRA) access in the anatomical snuffbox preserves the radial artery, but safety and potential detrimental effects on hand function are unknown. Methods and Results In the DIPRA (Distal Versus Proximal Radial Artery Access for Cardiac Catheterization and Intervention) study, a single-center trial, 300 patients were randomized 1:1 to cardiac catheterization through dRA or pRA.

Outcomes of the Ross procedure in patients older versus younger than 50 years old.

Objectives: The Ross procedure is traditionally considered for young adult patients with aortic valve disease. This study compares long-term outcomes of patients undergoing the Ross procedure who are ≥50 and <50-years old.

Methods: Data were collected from 225 patients undergoing Ross procedure at a single centre from 1994 to 2019.

Race, neighborhood disadvantage, and survival of Medicare beneficiaries after aortic valve replacement and concomitant coronary artery bypass grafting.

Background: Race, neighborhood disadvantage, and the interaction between these 2 social determinants of health remain poorly understood with regards to survival after aortic valve replacement with concomitant coronary artery bypass grafting (AVR+CABG).

Methods: Weighted Kaplan-Meier survival analyses and Cox proportional hazards modeling were used to evaluate the association between race, neighborhood disadvantage, and long-term survival in 205,408 Medicare beneficiaries undergoing AVR+CABG from 1999 to 2015. Neighborhood disadvantage was measured using the Area Deprivation Index, a broadly validated ranking of socioeconomic contextual disadvantage.

Vein Graft Use and Long-Term Survival Following Coronary Bypass Grafting.

Background: Although placement of at least 1 arterial graft during coronary artery bypass grafting (CABG) has a proven survival benefit, it is unknown what degree of revascularization with saphenous vein grafting (SVG) is associated with improved survival.

Objectives: The authors sought to determine whether undergoing surgery performed by a surgeon who is liberal with vein graft utilization is associated with improved survival in patients undergoing single arterial graft CABG (SAG-CABG).

Methods: This was a retrospective, observational study of SAG-CABG performed in Medicare beneficiaries from 2001 to 2015.

Contemporary Outcomes of Isolated Tricuspid Valve Surgery.

Introduction: Isolated tricuspid valve (TV) surgery is uncommonly performed and has historically been associated with excessive operative mortality. We previously reported improved short-term outcomes at our center. Understanding contemporary outcomes of isolated TV surgery beyond the perioperative period is essential to properly benchmark outcomes of newer transcatheter interventions.

Impact of improving severity of secondary mitral regurgitation on survival.

Aims: Secondary mitral regurgitation (SMR) is frequent in patients with heart failure with reduced ejection fraction (HFrEF) and portends detrimental prognosis. Despite interventions addressing the mitral valve (MV) have been proven effective to improve survival, an important knowledge gap exists regarding the role of medical therapy (MT) in this context. Thus, we aimed at investigating the role of MT optimization in patients with SMR and HFrEF.