Journal: The Journal of Thoracic and Cardiovascular Surgery

Abbreviation

J Thorac Cardiovasc Surg

Publisher

Elsevier

Journal Volumes

ISSN

0022-5223
1097-685X

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2020 - 20247
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Publications 1 - 7 of 7
  • Percutaneous coronary intervention versus coronary artery surgery for left main disease according to lesion site: A meta-analysis
    Item type: Journal Article
    De Filippo, Ovidio; Di Franco, Antonino; Boretto, Paolo; et al. (2023)
    The Journal of Thoracic and Cardiovascular Surgery
    Background: Comparative data after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for unprotected left main coronary artery (ULMCA) disease according to lesion site (ostial/shaft vs distal) are scant. The aim of this meta-analysis was to investigate outcomes after PCI or CABG for ULMCA disease according to lesion site. Methods: Randomized controlled trials (RCTs) and adjusted observational studies that compared PCI versus CABG in patients with ULMCA disease and reported outcomes according to lesion site were systematically identified. Major adverse cardiovascular events (MACE; a composite of all-cause death, myocardial infarction, stroke, and repeat revascularization) and all-cause death were the co-primary end points. Individual components of MACE were secondary end points. Sensitivity analysis including RCTs only were performed for each outcome. Results: Nine studies (3 RCTs, 6 adjusted observational), encompassing 6296 patients (2274 and 4022 treated for ostial/shaft or distal ULMCA, respectively) were included. At the 5-year follow-up, there were no significant differences between CABG and PCI for MACE, death, or any other secondary outcome for ostial/shaft ULMCA lesions (MACE: hazard ratio [HR], 1.0 [95% confidence interval (CI), 0.79-1.27]; death: HR, 1.10 [95% CI, 0.84-1.46]). For distal ULMCA, PCI was associated with an increased risk of MACE (HR, 1.32; 95% CI, 1.10-1.58), death (HR, 1.56; 95% CI, 1.19-2.04), and revascularization (HR, 2.07; 95% CI, 1.5-2.84). The benefit of CABG for MACE and revascularization was confirmed in the analysis limited to RCTs, whereas the benefit for mortality was not. Conclusions: Among patients with distal ULMCA disease, CABG is associated with lower incidence of MACE and revascularization compared with PCI, whereas no differences in outcomes were observed for ostial/shaft ULMCA disease.
  • Intracavitary cisplatin-fibrin chemotherapy after surgery for malignant pleural mesothelioma: A phase I trial
    Item type: Journal Article
    Opitz, Isabelle; Lauk, Olivia; Meerang, Mayura; et al. (2020)
    The Journal of Thoracic and Cardiovascular Surgery
  • Blood trauma potential of the HeartWare Ventricular Assist Device in pediatric patient
    Item type: Journal Article
    Granegger, Marcus; Thamsen, Bente; Schlöglhofer, Thomas; et al. (2020)
    The Journal of Thoracic and Cardiovascular Surgery
  • A multicenter evaluation of external outflow graft obstruction with a fully magnetically levitated left ventricular assist device
    Item type: Journal Article
    Wert, Leonhard; Stewart, Garrick C.; Mehra, Mandeep R.; et al. (2024)
    The Journal of Thoracic and Cardiovascular Surgery
    Background: The HeartMate 3 (HM 3; Abbott) left ventricular assist device (LVAD) has improved hemocompatibility-related adverse outcomes. In sporadic cases, external compression of the outflow graft causing obstruction (eOGO) can result from substance accumulation between the outflow graft and its bend relief. We sought to evaluate the prevalence, course, and clinical implications of eOGO in an international study. Methods: A multicenter retrospective analysis of HM 3 LVADs implanted between November 2014 and April 2021 (n = 2108) was conducted across 17 cardiac centers in 8 countries. We defined eOGO as obstruction >25% in the cross-sectional area in imaging (percutaneous angiography, computed tomography, or intravascular ultrasound). The prevalence and annual incidence were calculated. Serious adverse events and outcomes (death, transplantation, or device exchange) were analyzed for eOGO cases. Results: Of 2108 patients, 62 were diagnosed with eOGO at a median LVAD support duration of 953 (interquartile range, 600-1267) days. The prevalence of eOGO was 3.0% and the incidence at 1, 2, 3, 4, and 5 years of support was 0.6%, 2.8%, 4.0%, 5.2%, and 9.1%, respectively. Of 62 patients, 9 were observed, 27 underwent surgical revision, 15 underwent percutaneous stent implantation, 8 received a heart transplant, and 2 died before intervention. One patient underwent surgical revision and later stent implantation. The mortality with therapeutic intervention was 9/53 (17.0%). Conclusions: Although uncommon, HM 3 LVAD-supported patients might develop eOGO with an increasing incidence after 1 year of support. Although engineering efforts to reduce this complication are under way, clinicians must maintain a focus on early detection and remain vigilant.
  • Transatlantic editorial: The use of multiple arterial grafts for coronary revascularization in Europe and North America
    Item type: Other Journal Item
    Gaudino, Mario; Chikwe, Joanna; Falk, Volkmar; et al. (2020)
    The Journal of Thoracic and Cardiovascular Surgery
  • Experience with a standardized protocol to predict successful explantation of left ventricular assist devices
    Item type: Journal Article
    Hrytsyna, Yuriy; Kneissler, Simon; Kaufmann, Friedrich; et al. (2022)
    The Journal of Thoracic and Cardiovascular Surgery
    Objective: Patients with a continuous-flow left ventricular assist device may show recovery of myocardial function with unloading. Identifying candidates for and predicting clinical and hemodynamic stability after left ventricular assist device explantation remain challenging. Methods: Retrospective analysis of patients who underwent evaluation for left ventricular assist device explantation following a standardized protocol from January 2016 to March 2020. Patients who met screening criteria underwent echocardiography under “baseline,” “minimal net flow,” and “pump stop” conditions. If the protocol criteria were met, right heart catheterization with left ventricular assist device stoppage and occlusion of the outflow graft with a balloon catheter were performed. In patients with pulmonary capillary wedge pressure less than 16 mm Hg, explantation was performed under “pump stop” conditions. Results: A total of 544 patients were screened. Of these, 57 (10.5%) underwent a total of 73 echocardiography under “baseline” “minimal net flow” and “pump stop” conditions and 46 underwent left ventricular assist device stoppage and occlusion of the outflow graft with balloon catheter maneuvers. Complications during the procedure were rare. Ultimately, 21 patients (3.9%) underwent explantation. The left ventricular ejection fraction at baseline was 55.5% ± 6.5%. The mean pulmonary capillary wedge pressure was 8.1 ± 2.6 mm Hg and increased to 10.7 ± 2.9 mm Hg under left ventricular assist device stoppage and occlusion of the outflow graft with a balloon catheter. A nonischemic cause of cardiomyopathy was more likely to be found in patients who underwent explantation (20/21 patients [95%], P = .020). The survival 1 year after explantation was 95.2%, with 1 death occurring 222 days after left ventricular assist device explantation. At follow-up (median 24.9 months [interquartile range, 16.4-43.1 months]), patients were in New York Heart Association class 1 (61.9%), 2 (28.6%), and 3 (9.5%). Conclusions: Our 4-year experience with a standardized protocol for left ventricular assist device explantation showed a low rate of adverse events. If all criteria are met, explantation can be performed safely and with an excellent survival and functional class.
  • Noninferiority trials: What's clinically (ir)relevant?
    Item type: Journal Article
    Falk, Volkmar; Friede, Tim (2021)
    The Journal of Thoracic and Cardiovascular Surgery
    The debates in clinical cardiovascular science are increasingly dominated by the results of noninferiority trials. Although there is no doubt that these trials are fundamental to generate the evidence on which we make our clinical decisions, it is equally important that clinicians clearly understand the principles, benefits, and limitations of the underlying trial design and statistics.
Publications 1 - 7 of 7